The $1,200,000 requested will be used primarily for two purposes, to support and expand the areas currently given priority in the program; namely, mental retardation, maternity, and newborn care, and handicapping conditions, and to add several new areas for research of pressing concern as described below. 1. Support of current priority areas

(a) Mental retardation

The four projects for testing newborn infants for PKU, a condition which if undetected and so untreated causes mental retardation, have been well launched and the data are beginning to come in. First returns from Israel and Poland show a higher incidence than had been expected. These studies together with the U.S. program for PKU testing have generated much interest in many other countries. Children's Bureau staff and Dr. Guthrie, the originator of the test who acts as consultant, carry on an extensive interchange of information with scientists from a number of countries. Several European countries are developing testing programs with their own funds along the lines suggested and are cooperating in supplying the Children's Bureau with results of their testing programs. Dr. Guthrie and investigators from some of the Children's Bureau supported projects attended the International Congress of Pediatrics in Tokyo in November 1965 on Public Law 480 funds, and presented papers and met informally to discuss problems and results. In June 1966 a conference on PKU, funded under this program, will be held in Yugoslavia to which prominent scientists in the United States and in Europe will be invited.

In 1967, currencies in Burma, Tunisia, and Ceylon will be used to extend the PKU program, so well launched in four countries, to these new geographic areas, thus extending the coverage into North Africa and southeast Asia.

The multiple screening test for several inborn errors of metabolism, being developed by Dr. Guthrie, will be ready for trial in 1966-67 and will be incorporated into established PKU programs. The United States has already helped the countries develop the laboratory facilities for these projects and has brought the staff to the United States for training. With very little additional outlay the investment made can yield substantial additional information.

The Polish mental retardation project to identify types of defects found in institutionalized children is progressing well. In 1966 two investigators will come to the United States to observe methods of diagnosis and care and the proj ect will expand to provide for a study of the effect of remedial services for physical handicaps on the potential for useful living of severely retarded children.

New proposals have been made to the Children's Bureau for useful projects in providing services for mentally retarded children in Israel, Yugoslavia, India. and Poland. These and other ideas suggested by Children's Bureau staff from experience with Children's Bureau programs are awaiting development pending availability of funds.

For example, in a Children's Bureau project in the United States it was found that a consultant team was more effective in improving services for retarded children when working with and through existing agencies such as well-baby clinics than in maintaining a stationary diagnostic clinic. This concept needs

further elaboration which can be done at less expense using foreign currencies abroad than dollars in the United States.

(b) Maternity and newborn care

A new domestic grants program administered by the Children's Bureau was authorized in 1963 for maternity care and infant care to attempt to minimize the damage to the infants of women with complications of pregnancy. New ways to provide adequate care are being sought. Studies of some of the complications of pregnancy, such as prematurity, goiter, Rh incompatibility, are contemplated in settings where large numbers of cases can be observed which have not been modified by treatment.

This material includes the ethnic origin, socioeconomic status, and pregnancy history of the women in the original study. Using this as background material the infants will be followed to study the effect of these factors on infant mortality and morbidity and to establish methods of identifying the characteristics of high risk groups in the population. Such information would be useful to the Children's Bureau in its maternal and infant care program.

With funds requested in this appropriation, a series of studies on birth weight is planned in India, Pakistan, Israel, Tunisia, and Yugoslavia which would add to our basic knowledge about the incidence of prematurity and perhaps throw some light on its cause.

In addition, studies will be made of postnatal care for women with complications of pregnancy in Egypt and Yugoslavia.

(c) Services for handicapped children

No studies in this series have been completed, but progress has been excellent in both Poland and Israel in studies of hearing. New ideas generated by the ongoing studies will be implemented in 1966 and 1967.

A study on the relation between goiter and hearing defects was started in Israel in a very modest way in 1965 and will be expanded in 1967.

In order to increase the range of the studies of spina bifida (a defect of the spine), one of which will be supported in Poland with funds from the 1966 budget, additional studies of methods of care for children with this condition, using somewhat different techniques, will be undertaken in Yugoslavia and Israel in 1967.

2. New program areas

(a) Methodology of providing services

Ways of using well-baby clinics (maternal and child health clinics) will be studied in Yugoslavia and Israel. These involve the use of the clinic as the source of information on various methods of child care and a determination of training needed by the public health nurse to make her efficient in screening for mental retardation, congenital defects, nutritional deficiencies, and inadequate maternal care in early infancy.

(b) Growth and development

One of the current controversies in the United States concerns the effect of malnutrition on mental development. Though much is known about the result of malnutrition on physical growth, only a few studies have been done of the possible damage to mental growth and these have not been definitive. In the countries where malnutrition is common and where its effects could be followed, unfortunately there are no norms or standard of growth for comparative purposes. Birth weight studies and studies of normal growth and development in the early years are contemplated in several countries to provide a basis for determining the effect of food and other environmental factors on the child's progress.

(c) Interchange of experts

One of the purposes of the International Health Research Act of 1960 was to provide for the interchange of experts between the United States and the participating countries. During 1967 additional emphasis will be placed on this phase, using nongovernment U.S. experts to visit Children's Bureau-supported projects and in return bringing specialists from the other countries to observe U.S. child health research. No dollars are involved, the cost being borne out of foreign currencies which are paid to American airlines.

Emphasis has increasingly been focused on subjects and methods being explored in different countries. Such cross-national studies not only provide new knowledge which can be used to strengthen and evaluate welfare programs in the country and in the United States but also serve as a basis for comparative studies. Findings which reveal the needs and aspirations of people can, moreover, help the United States carry out more effectively our role of leadership in international organizations, foreign aid, and training of personnel.

New funds requested will make possible more broad-scale research activities and an increased number of demonstration projects. The funds will be used to support neighborhood centered programs for older people; services for rehabilitation of dependent families; new community demonstration projects in prevention and treatment of juvenile delinquency. Experimental programs in family planning and treatment of alcoholism provide new areas for cooperation in research and demonstration.

In some countries, e.g., India, encouragement will be given to establishment of one or more social welfare research centers. Such centers could conduct a long range research program specializing on such critical problem as: effective social services required to meet displacements caused by rapid industrialization and urbanization; the effectiveness of community development in meeting problems of disadvantaged people with few material resources; or innovations and experimentation in use of less than fully trained professional social work per

sonnel.

1. Current priority areas

(a) Aging

Cross-national studies in Israel and Poland (as well as the United States, United Kingdom, and Denmark) reveal that older people are most concerned with some similar problems. Some life patterns, however, seem to be unique or more marked in specific settings. Extension of similar studies to more countries with still different social structures will further clarify the nature of some of the problems of the aged and provide a more scientific basis for planning of community services.

The needs of older people, particularly in urban communities, present new demands on community social, health and recreational services. New funds will make possible complementary studies and demonstration of services which will provide information basic for planning new and expanded services for the aging in the United States.

Increased avenues of communication in this field are illustrated in the opportunities opened up in relation to the study of the aging in Poland during the course of which an outstanding U.S. sociologist has provided consultation in Poland and arranged for exchange of experience and comparison of problems among social scientists in Denmark and Israel and the Polish principal investigator for whom plans are now being made to meet with scholars in the United States. Use of Public Law 480 funds will be encouraged for researchers to travel to the International Congress on Gerontology in Vienna where findings of these cross-national studies will be presented for analysis by international scientists.

(b) Families including chronically dependent and migrant

Chronic dependency and difficulties in adjustment to new situations are widespread social problems. Two projects in Israel, one completed and the other in process, have identified factors related to the use or failure to use available social services. U.S. research and family service specialists will meet with overseas experts and in a workshop in Israel to consider these findings and formulate alternative modes of helping socially deprived families. New funds will be used to finance experimental methods of providing services.

Proposals for demonstrations of public social services in small communities and of group services for practical work training of potential wage earners have also been received from Israel and from the United Arab Republic.

(c) Juvenile delinquency

International exchange in this field is well established and provides an excellent basis for cooperation with scientists in Poland, India, United Arab Republic, Yugoslavia, as well as Israel.

The director of an action-research project with delinquent street-corner groups reports on the familiar phenomena of disorganized poverty area or the "slumin transition" in Tel Aviv as well as in New York where he had worked with young delinquents for 8 years. Some behavior and attitudes of the youngsters show a remarkable resemblance. There are marked differences, however, in the degree of severity of the delinquent activities. Among the Tel Aviv "thieves' groups" robberies that involve the use of violence are the exception, rather than the rule and brawling, while not unusual, is neither as frequent nor as brutal as some outbreaks witnessed in New York. Findings from this study and a delinquency project in the United Arab Republic point to the desirability of followup projects. Proposals are already under consideration for similar projects in other cities in Israel, United Arab Republic, and India. Experimental programs useful in combating spread of delinquency among juveniles are being initiated.

A cross-national study of juvenile delinquency has been introduced in 1966 in four countries and will be extended to new countries as new funds become available. This study will provide for the first time valuable comparable data on the work of the courts and effectiveness of services in juvenile delinquency. This investigation will make a modest start toward answering the knotty questions of differences among delinquents, delinquencies, treatment methods, and results. Additional funds will facilitate increasing the number and amount of grant awards on the basis of logical requirements of a project instead of having to tailor the proposal stringently to limited funds.

(d) Child care

In the United States and internationally there is continuing debate regarding the best methods of providing care for children outside their own homes. A welfare administration-supported study in Israel has developed and is now testing criteria to determine what type of facilitiy will best promote the development of individual children. Results from this and other studies in the United States and abroad will be used as a basis for developing new approaches to providing services.

The emphasis on group care of children in some of the countries in contrast to current practice in the United States will make it easier and less costly to collect data overseas. This would vastly enhance a Children's Bureau program developed at the Yale study center to study characteristics and problems of infants and young children being given different types of care, to develop and evaluate approaches to providing services which will support the development of the children, and to develop a training program for child care workers. 2. New areas

(a) Alcoholism

A survey on alcoholism undertaken by the Welfare Administration, Division of Research, indicates a serious gap of information on alcoholism and problem drinking as it relates to low-income status, disordered family life, child abuse and neglect, and chronic economic dependecy. Other countries such as Poland. Yugoslavia, as well as the United States, are concerned with the problem of alcoholism associated with absenteeism from work, chronic dependency and family breakdown. Through a coordinated plan of study on causes and effective

therapy in several countries, the Welfare Administration would hope to uncover and develop new knowledge on alcoholism. The results would be tested in the United States in programs of social treatment and rehabilitation. Additional foreign currency will permit comparable experiments abroad.

(b) Family planning

Family planning has become an international concern as countries undertake to establish programs to control population growth in relation to economic development. Social agencies with an overall goal to promote the well-being and improve the functioning of families have a special concern because of the relationship between size of family and economic dependency. Evaluation of experi mental programs in the United Arab Republic and India, will be shared internationally.

Social welfare agencies aware of family attitudes and values are in a partic ularly good position to take leadership in developing and staffing positive programs. The role of social welfare in this planning needs to be clearly identified and welfare approaches built into programs.