1966 enacted appropriation_-_ Summary of changes Transferred to "Operating expenses, Public Buildings Services," 1966 total estimated obligations__. 1967 estimate obligations-- Total change--- Increases: Mandatory: Carry 1966 jobs in 1967. Program increase: Health services for children (15 positions)_ $4,840,000 -14, 800 4,825, 200 5, 331,000 +505, 800 414, 800 125,000 Total increase___. 539, 800 Decreases: Nonrecurring equipment costs and transportation of household effects for new staff in 1966___. -34,000 Total net change requested... +505,800 EXPLANATION OF CHANGES Fifteen new positions, eight professional and seven clerical, are requested to assist in the implementation of two new programs: project grants for health care and services for school and preschool children and grants for training for professional personnel for care of crippled children, especially mentally retarded children and children with multiple handicaps. Staff in a number of spe cialized fields, including pediatrics, dentistry, nursing, and hospital administration are requested to perform this work. The legal authority of the Children's Bureau for serving the children of the United States is contained in the basic act of April 9, 1912, creating the Bureau (42 U.S.C., ch. 6) and in title V of the Social Security Act under delegations by the Secretary of the Department of Health, Education, and Welfare and the Commissioner of Welfare (42 U.S.C., ch. 7, subch. V). Under the basic act of 1912, the Bureau is charged with investigating and reporting "upon all matters pertaining to the welfare of children and child life among all classes of our people." The Bureau studies many types of conditions affecting the lives of children, compiles data and makes recommendations to improve practices in child health and child welfare programs, and helps establish standards for the care of children. Under title V of the Social Security Act, as amended, the Bureau administers grants for eight programs: (1) maternal and child health services; (2) services for crippled children; (3) child welfare services; (4) research, training, or demonstration projects in child welfare; (5) special project grants for maternity and infant care; (6) special project grants for health of school and preschool children; (7) training of professional personnel for the care of crippled children particularly mentally retarded children and children with multiple handicaps (authorized to become effective in 1967); and (8) research projects relating to maternal and child health and crippled children's services. The amount authorized for maternal and child health services, services for crippled children and child welfare services in 1967 is $50 million each. The 1967 authorization for special project grants for maternity and infant care is $30 million. The two programs authorized by the Social Security Amendments of 1965, special project grants for health of school and preschool children and training of professional personnel for the care of crippled children are authorized at $35 million and $5 million respectively for 1967. In administering these grants the Bureau works with State and local health and welfare departments, crippled children's agencies, institutions of higher learning including schools of social work, medical schools and teaching hospitals, and agencies and organizations engaged in child health and welfare research. The Bureau in carrying out its other functions works with voluntary child health and wefare agencies and with professional and civic organizations. It maintains a continuing close working relationship with the National Committee on Children and Youth, with the Council of National Organizations, the membership of which is made up of national voluntary agencies concerned with children and youth, and with State committees on children and youth. The Bureau provides the secretariat for the Interdepartmental Committee on Children and Youth which is made up of 11 Federal departments and independent agencies with representatives from 38 operating units of these departments and agencies whose programs affect children and youth. The Bureau cooperates with other nations in the furtherance of health and welfare activities for mothers and children. It make plans for long-term and short-term trainees and observers from other countries who come to the United States through the United Nations, World Health Organization, the Agency for International Development, or independently. Upon request, the Bureau assists in the recruiting of maternal and child health and child welfare personnel for service abroad. PROGRAM EMPHASIS FOR 1966 AND 1967 The passage of the 1965 Amendments to the Social Security Act greatly increased the responsibility and the workload of the Bureau. A supplemental appropriation for 1966 provided funds to finance: (1) the increased authorizations for maternal and child health services and services for crippled children; (2) the newly authorized program of special project grants for health of school and preschool children and (3) the first-year costs necessary to begin implementing the new amendments. In 1966 and 1967, the Children's Bureau will continue to give priority to programs for mentally retarded children. In these years special attention will be given to initiating the new program for training personnel for services for crippled children, particularly mentally retarded children and children with multiple handicaps. It will be necessary for the Children's Bureau to provide the States and local communities with information about the new programs authorized by the 1965 amendments, to develop guides and standards which will govern project approval and expenditure of grant funds under these new programs, and to develop policies and procedures. In addition to the new programs, the amendments added two requirements for the on-going maternal and child health and crippled children's programs: (1) that a State must make a satisfactory showing that it is extending the provision of services, and (2) must provide for payment of reasonable cost of in-patient hospital services provided under the State plan. In their ongoing activities in both 1966 and 1967, the divisions will continue to give special attention to services for children who have congenital heart disease, or who have speech and hearing impairments; and to the development of homemaker service, day-care services, and foster care for children who must be cared for away from their own family; and to services for delinquent youth. In 1965 it was necessary to reduce by 15 the number of positions authorized. This was necessary primarily to absorb within-grade salary advancements made over the past several years and part of 1965 pay act costs for which funds were not appropriated. This reduction will bring the number of positions more in line with the man-years that can be finaned with available funds. Within the Children's Bureau the Division of Health Services has responsibility for administering five grant programs for health services for mothers and children and for other activities of the Bureau related to the improvement and extension of health services for mothers and children. The grant programs include: maternal and child health services; services for crippled children; special project grants for maternity and infant care; special project grants for comprehensive health care and services for school age and preschool children; and grants for training of professional personnel for care of crippled children, particularly mentally retarded children and children with multiple handicaps. The purposes of these grant programs are: to extend and improve services to promote the health of mothers and children; to locate crippled children and provide medical, surgical, and other care for them; to provide necessary health care to prospective mothers who have or are likely to have conditions associated with childbearing which increase the hazards to the health of the mothers and their infants; and to provide health care to prematurely born infants and other infants at risk, all with the objective of helping reduce the incidence of mental retardation; to provide comprehensive health care and services for children of school and preschool age, particularly in areas with concentrations of lowincome families; and to help reduce the shortage of professional personnel to serve mentally retarded children and children with multiple handicaps by strengthening the programs of university centers for clinical services and training in the field of mental retardation. Activities of 1965 Major emphasis in 1965 was on the implementation of the Maternal and Child Health and Mental Retardation Planning Amendments of 1963 including expansion of the on-going maternal and child health and crippled children's programs and development of the new program of project grants for maternity and infant care. By the end of 1965 a total of 25 maternity and infant care projects had been approved with obligations totaling $14.2 million. Standards and guides needed to establish and maintain the quality of care required by high risk maternity and infant patients were developed with the help of technical advisory groups, and medical, nursing, social work and administrative consultation was provided to project applicants. Because of the successful outcome of the nationwide trial of the Guthrie screening test for phenylketonuria the Children's Bureau has actively encouraged States to set up programs for blood screening of newborn infants. As of March 1965 more than 2,600 hospitals were collecting blood for the screening of newborns. A number of States enacted laws with regard to the screening test with the objective of preventing mental retardation caused by phenylketonuria. Bureau staff provided consultation on screening programs and legislation. In the field of speech and hearing, the Bureau took initiative in 1965 in bringing together a group of consultants to develop guidelines for calibration of audiometers. In this same area, the Bureau published a pamphlet in 1965 entitled "Choosing a Hearing Aid." Guidelines for occupational therapy programs for mentally retarded children were developed in cooperation with educators and practicing therapists, and the first national conference of occupational therapists to focus exclusively on programs for children was held. Activities in 1966 and 1967 During 1966 and 1967 the major emphasis will be on implementation of the 1965 Social Security Amendments which provide for expansion of existing health programs and initiation of two new programs: Project grants for health care and services for school and preschool children effective in 1966 and grants for training for professional personnel for the care of crippled children effective in 1967. Under the new 5-year grant program for health care and services for school and preschool age children, grants may be made to a variety of agencies, including State and local health agencies, State crippled children's agencies, schools of medicine and teaching hospitals affiliated with schools of medicine. The legislation establishes a new relationship with medical schools and teaching hospitals since for the first time they are eligible for grants to provide health care and services for children. The legislation authorizes a program of comprehensive health care which includes screening, diagnosis, preventive health services, treatment, correction of defects, and aftercare, both medical and dental, for children of low-income families. Dental care is a major need of low-income families and its inclusion is a statutory requirement. The National Health Survey has reported that 59.5 percent of children aged 5 to 14 years in families with incomes of less than $2,000 had never been to a dentist compared with 9.7 percent of children in families with incomes of $7,000 and over. In the under $2,000 income per year group, 31.8 percent of the dental visits were for extractions compared with 4.8 percent for this purpose in the higher income group. A program of preventive dental health services and dental care is an essential component of comprehensive child health services. The new legislation also requires expansion of the existing maternal and child health and crippled children's programs in 1966 and 1967. Effective July 1, 1967, States must demonstrate that they are extending services with a view toward making them available to children in all parts of the State by July 1, 1975. Staff from the Bureau must be available to work with the State and local health departments, crippled children's agencies, schools of medicine, and teaching hospitals on the development of the new programs, and to facilitate the extension of the maternal and child health and crippled children's programs to all parts of the State, particularly to urban areas. The regional staff together with central office staff will provide consultation to communities in developing screening programs for vision, hearing, and other physical defects, and for providing for preventive health services, diagnosis, and treatment services; for facilitating the coordination of such services with the public schools and with other services of health and welfare departments; for initiating a new program of dental care for children in low-income families; and for organizing health services for preschool children to prevent disease, correct defects early where possible, and help such children to get ready for school. In 1967 the new program of project grants to institutions of higher learning will be initiated for training of professional personnel for the care of crippled children, especially mentally retarded children and children with multiple handicaps. Included in the amendments, also, is a requirement that the payment for inpatient hospital care be on the basis of reasonable cost of providing such care. Program standards, policies, and guides will be required in many areas to promote the orderly and rapid development of the new and expanded programs. Assistance must be provided to States and localities in planning and carrying out the new programs. Staff in a number of specialized fields, including pediatrics, dentistry, speech and hearing, school health nursing, and medical social work are required to perform this work. Fifteen positions are requested in 1967 to help meet the needs imposed by the new legislation. These are in addition to 35 positions included in a 1966 supple mental which provided funds for the first year's implementation of the 1965 amendments. A list of the new positions requested in 1967 appears at the end of the "Salaries and expenses" justification. B. Estimate 1967, $1,739,268-Increase $353,623 The estimate continues the 111 positions and related expenses for the Division of Health Services and provides an increase of 15 positions and $353,623 as follows: First year cost of 15 new positions to assist in the implementation Nonrecurring costs for new 1966 positions--- Total increase requested_ TABLE 2.-State and local social services for children 1966 estimate 1967 estimate $125,000 245, 599 -16, 976 353, 623 Increase or decrease The Division of Social Services is responsible for the Bureau's activities related to the development, extension and strengthening of social services in the child welfare field. This includes (1) administration of grants-in-aid to State public welfare agencies for child welfare services under title V, part 3 of the Social Security Act as amended, (2) administration of grants to institutions of higher learning for training in the field of child welfare, (3) development of program standards and guides for the use of State and local agencies and groups and national organizations in developing child welfare programs, and (4) consultation to, and cooperative work with national, State and local agencies, public and voluntary, and citizen groups on social services in the child welfare field. All professional staff of the Division share in these responsibilities. Responsibility for administration of grants-in-aid for public child welfare services is carried primarily by the Central Office staff and by nine regional child welfare representatives. Responsibility for administration of the training grants is carried by Central Office staff. A staff of specialists in the Central Office covers such areas as foster care of children, adoption, social services to children in their own homes, day care, and homemaker services, services to unmarried mothers, services to mentally retarded children, licensing of child care facilities, and training and staff development. A foster care consultant in each regional office works with State welfare departments and voluntary agencies on the expansion and improvement of foster care facilities for those children who must be cared for outside their own homes. Program emphasis for 1966 and 1967 During 1966 and 1967 major emphasis will be placed on (1) social services to mentally retarded children; (2) services to neglected, abused, and exploited children; (3) day-care services; and (4) training. There will also be continued emphasis on cooperative work and program coordination with the Bureau of Family Services in such areas as (1) staff development and staff utilization in State agencies; (2) homemaker services in welfare programs; (3) day-care services; and (4) foster-care services. With the nationwide interest at Federal, State, and local levels, in provision of special services for the deprived child, requests for consultation are increasing, |