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3. Technical assistance to States and communities for juvenile delinquency programs.

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41 Transferred to "Operating expenses. Public Buildings Services," General Services Administration (76 Stat. 728)..

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1 Selected resources as of June 30 are as follows: Unpaid undelivered orders, 1964, $136,000; 1965, $133,000; 1966. $100,000; 1967, $105,000.

Mr. FOGARTY. The committee will now come to order and we will take up the request for the Children's Bureau.

Mrs. Oettinger, you may proceed.

GRANTS FOR MATERNAL AND CHILD WELFARE

Mrs. OETTINGER. May I first speak to grants for maternal and child welfare?

The 1967 estimate of $228,900,000 represents an increase of $41,900,000 over the $187 million appropriated for the fiscal year 1966. The $5 million increase requested for maternal and child health services and a comparable increase requested for services for crippled children will help States in their efforts to extend these essential health services to mothers and children in additional parts of the State as the 1965 Amendments to the Social Security Act, which authorized the increases, require. The increases will also help to meet the constantly increasing costs of providing services. The overall $100 million requested for these basic health services, together with State and local funds provided under the programs will make it possible for approximately 2 million infants to attend well baby clinics, 400,000 mothers to receive prenatal care and 500,000 children to receive care under the crippled children's program. It is expected that $8.5 million of the amount requested for the two programs will be earmarked for services for mentally retarded children.

MEDICAL AND HOSPITAL CARE FOR PROSPECTIVE MOTHERS

The Congress, in 1963, authorized project grants to provide medical and hospital care for prospective mothers who have or are likely to have conditions associated with childbearing which increase the hazards to the health of mothers or their babies. Goals of these projects include concentrated efforts to reduce the incidence of mental retardation caused by prematurity and complications of pregnancy among low-income groups, to increase the number and accessibility of prenatal clinics and to provide good quality hospital care for the mothers and their babies. Babies in poor families have a much better chance for a healthy start in life because of this new program through which many receive quality care in nurseries located in teaching hospitals. More than 50,000 mothers in low-income families have been admitted to these maternity care programs aimed at reducing prematurity, mental retardation, and birth defects. The budget contemplates the continuation of this program at the level of the full authorization, $30 million a year.

COMPREHENSIVE HEALTH CARE SERVICES FOR CHILDREN AND YOUTH

In 1965, the Congress again demonstrated its interest in child health by authorizing another 5-year program of special project grants, this one to provide comprehensive health services for children and youth. This program places emphasis on the early identification of children of low-income families who should receive continuing health supervision and medical care; on removing barriers to medical care and on assurance that our advancing medical knowledge leaves

no groups of children behind. Children acquainted with medical care only in emergencies will now have the benefit of early case finding and preventive health services. Nine applications have been received and other cities, State and medical schools and teaching hospitals have reported that plans are already being developed to bring high quality medical care to children who would otherwise go through acute illness with little or no care and spend their school years handicapped by remediable defects. The $35 million requested for these projects represents an increase of $20 million over the 1966 appropriation.

TRAINING PROGRAM

The purpose of the new training authorization in the 1965 amendments is to increase the availability of funds to support training for personnel to work with crippled children, particularly mentally retarded children and children with multiple handicaps. The university-affiliated centers being built in accordance with Public Law 88-164, will offer a complete range of specialized services for the diagnosis, treatment, education, training and care of mentally retarded children, including those with physical handicaps. Training under this authorization will be provided in these centers for professional personnel such as physicians, psychologists, nurses, dentists, and medical social workers. Four million dollars to initiate this new program is requested for 1967.

CHILD WELFARE SERVICES

The $46 million requested for child welfare services, an increase of $6 million, together with State and local funds will make it possible for States to extend and strengthen their child welfare programs by reaching more children in need and increasing quality and scope of child welfare services. Child welfare programs provide a wide range of preventive, protective and ameliorative services to children and their parents, including casework services to neglected, abused, and abandoned children; services to unmarried mothers and their babies; day-care services; homemaker services; foster care in family homes or institutions; and adoption services. In 1965 the number of children served by public child welfare agencies rose to 531,200, an increase of 9 percent.

RESEARCH PROGRAMS

The remaining increase of $1.9 million will finance expanded research programs related to the provision of maternal and child health services, crippled children's services, and child welfare services, and training programs in the field of child welfare. Schools of public health are conducting research on a regional basis which will aid in program evaluation. Medical schools and teaching hospitals are studying such subjects as the use of the teaching hospital for family and adolescent medical care, and the significance of variations of infant mortality within a State. Studies of the physically abused child have helped stimulate mandatory reporting laws in 47 States and the Virgin Islands. The project on physical facilities of children's residential

institutions has become a source of information for public and private agencies constructing new facilities. The estimated 762 traineeships and 158 teaching grants requested in fiscal year 1967 will help meet the very serious shortage of trained child welfare personnel.

Mr. FOGARTY. Proceed with your statement on salaries and expenses.

SALARIES AND EXPENSES

Mrs. OETTINGER. The 1967 estimate for salaries and expenses represents an increase of $506,000 over the estimate for 1966 to provide annualization of new positions authorized in 1966 and 15 additional positions.

Fundamental changes in society which contribute to our rapidly growing health and social problems and which have their inevitable impact on our children include the movement of large numbers of people of different income classes from rural areas to cities and from cities to suburbs; the erosion of the tax base in many of our large cities; the evergrowing numbers of children in the congested areas of our central cities; the crowding of hospitals and clinics; the waiting lists of applicants for help from public and voluntary social agencies. There are many expressions of these problems-family breakdown, large numbers of families headed by women, child neglect and abuse, juvenile delinquency, births out of wedlock, infants born into poverty too frequently handicapped from birth. Infant mortality rates are also an expression of these problems-they are now greatest in the big city slums and the most depressed rural areas. It is toward lessening the impact of forces such as these upon the lives of children that the programs of the Bureau are directed.

The Bureau's 1967 budget request provides for continuing emphasis on fact finding and reporting, and on technical assistance to States and communities relating to their problems of delinquency prevention, control and treatment. It also provides for consultation and guidance to State agencies administering the maternal and child welfare provisions of the Social Security Act, and staff for administering research grant programs in child health and welfare and training grant programs to prepare persons to work in the field of child welfare.

In the administration of all its programs the Bureau will continue its leadership in developing and expanding programs for mentally retarded children and in making the full range of Bureau services available on behalf of these children.

The request includes 15 new positions to help implement the two new grant programs authorized by the 1965 social security amendments. The new legislation authorizes a new program of comprehensive health care, both medical and dental, for children of low-income families to provide screening, diagnosis, preventive health services, treatment, correction of defects and aftercare. It also authorizes grants for the training of professional personnel for the care of crippled children. Finally, it requires expansion of existing maternal and child health and crippled children's programs in order to make services provided by these programs available to children in all parts of the State by 1975 and to allow payment for inpatient hospital care on the basis of reasonable cost.

Bureau staff must be readily available to State and local health departments, crippled children's agencies, medical schools, and teaching hospitals to assist in the development of new comprehensive programs of preventive health services and medical care for children and to facilitate the extension of the maternal and child health and crippled children's programs to children in all parts of the State, and particularly to urban areas. Staff will provide consultation to communities on screening programs for vision, hearing, and other physical defects. They will also assist in developing preventive health services and diagnostic and treatment services and in facilitating the coordination of such services with the public schools and with other services of health and welfare departments. This staff will also provide assistance in initiating new programs of dental care for children in lowincome families and in organizing community health services for preschool children to prevent disease, correct defects early where possible, and help such children get ready for school.

GRANTS TO STATES FOR MATERNAL AND CHILD WELFARE

Mr. FOGARTY. The appropriation for 1966 is $187 million. The request for 1967 is $228,900,000, an increase of $41,900,000.

For the first two items in the activities schedule, "Maternal and child health services" and "Crippled children's services," you are asking for $5 million increases to bring the total up to the full authoriza

tion.

AUTHORIZATION FOR CHILD WELFARE SERVICES

For the next one-and this has been so, I think, over the yearsthe request for child welfare services is $4 million short of the full authorization. Why?

This is a pattern that has been going on for a long time.

Mrs. OETTINGER. In this particular instance, I think where the earmarking for day-care services is discontinued, we have the comparability with the maternal and child health and crippled children's services losing out.

Mr. FOGARTY. What do you mean by that? I don't quite follow

you.

Mrs. OETTINGER. You will recall there were special funds earmarked for day care and this now has been discontinued as a result of the 1965 amendments and we did not make up for the loss of the amount of money that we had hoped in the last supplemental request would bring us to the maximum level of authorization for child welfare services.

Mr. FOGARTY. Are you happy about this being $4 million short of the authorization?

Mrs. OETTINGER. The day care has now become part of the General Child Welfare Services and it is so designated.

Mr. FOGARTY. Do you mean you couldn't use the $4 million if you had it?

Mrs. OETTINGER. There are always things we could use it for as you know, Mr. Fogarty.

Mr. FOGARTY. Why don't you tell me about it?

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