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ACTIVITY II. TRAINING

The 1967 request for teaching grants, traineeships and research fellowships in rehabilitation amounts to $29,800,000, an increase of $5 million over 1966. Of the $29,800,000 requested, $26,834,000 is needed to continue at the same level training programs initiated in previous years; $2,966,000 is for initiation of new teaching programs, expansion of established teaching programs, and an increase in the number of traineeships.

This requested increase will make possible an orderly expansion of the training programs engaged in preparing the manpower for expanding rehabilitation programs in State vocational rehabilitation agencies, sheltered workshops and other community rehabilitation agencies. The increase of training, service and research in heart disease, cancer, and stroke programs will place new de mands for trained personnel upon educational institutions. Enactment of the 1965 vocational rehabilitation amendments also increases the demand for personnel, especially for rehabilitation counselors and sheltered workshop managers and floor supervisors. The recently enacted social security amendment which provides for the provisions of vocational rehabilitation services to disabled beneficiaries will also greatly increase the need for additional medical and paramedical personnel. Trends in the public vocational rehabilitation agencies to serve severely disabled persons, such as the alcoholic, the narcotic addict, the public offender and the recovering mental patient accentuate the demand for trained personnel. The passage of medicare, too, will mean an increased demand for rehabilitation personnel in hospitals and nursing homes. Failure to expand existing training programs and to initiate new ones will mean very serious delays in alleviating personnel shortages.

Legislative authority

SECTION A. GENERAL

Statutory authority for support of training activities is provided in sections 4(a) (1) and 7(a) (3) of the Vocational Rehabilitation Act of 1954, as amended. Activities under section 4 are financed by grants and those under section 7 through funds made available under contract.

Types of support

Training activities are financed in the following ways:

(1) Teaching grants.-These are grants made to educational institutions to employ faculty or otherwise expand or improve their instructional resources or to produce teaching materials;

(2) Traineeship grants.-These are grants to educational institutions for stipends for living expenses and tuition awarded to students selected by the grantees;

(3) State in-service training grants.-These are grants to State vocational rehabilitation agencies for the conduct of staff development programs for their own personnel;

(4) Contracts.-These are arrangements with educational institutions and agencies for the conduct of short-term training programs on technical matters pertaining to vocational rehabilitation; and

(5) Research fellowships.-These are funds awarded directly by the Vocational Rehabilitation Administration to individuals for independent research in rehabilitation or advanced training in research methods.

Program objectives

The long-range goal of the training program is to produce personnel in sufficient numbers and of sufficient quality to staff the rehabilitation programs of the Nation, both governmental and voluntary.

Current fields of support

SECTION B. LONG-TERM TRAINING

Grants are now being made in the fields of rehabilitation counseling, medicine, prosthetic-orthotic education, speech pathology and audiology, occupational therapy, physical therapy, psychology, rehabliation of the deaf, rehabilitation of the blind, rehabilitation of the mentally ill and retarded, rehabilitation facilities administration, nursing, social work, recreation for the ill and disabled, sociology, dentistry, and for interdisciplinary training in rehabilitation.

Fiscal year 1967 request

In 1967, the amount requested to support the basic or advanced professional training conducted on an academic or calendar year basis is $26,573,000. The sum of $11,486,000 is requested to finance 479 teaching grants and $15,087,000 is requested for 5,173 traineeships covering stipends and tuition. The increase over 1966 amounts to $4,799,000.

Components of the 1967 request are: (a) $10,648,000 to continue support of 444 teaching grants at the 1966 level; (b) $13,160,000 to continue the 4,520 traineeships supported in 1966; (c) $838,000 for 35 new teaching grants; and (d) $1,927,000 for 653 additional traineeships.

The proposed new teaching grants are chiefly in the fields of rehabilitation counseling, medicine, and rehabilitation facilities administration where shortages of trained personnel still delay program expansion and improvement.

Training in selected professional fields

(a) Rehabilitation counseling

Accomplishments.-Since 1954, colleges and universities have been receiving teaching grants and awarding traineeships to students planning for a career in rehabilitation counseling. Graduates of these programs find employment in State and community vocational rehabilitation programs.

Between 1955 and 1965 an estimated total of 2,442 rehabilitation counselors graduated from these programs who received a VRA traineeship for all or part of their training. It is estimated that an additional 350 students completed the course without VRA financial assistance, so that about 2,792 individuals may be considered to have been graduated from VRA-supported training programs in rehabilitation counseling.

Qualitatively, additional progress may be reported. The training programs are working more closely in their cooperative relationships with the State rehabilitation agencies. Arrangements are frequently being made, especially by new programs, which facilitate the formal training of counselors employed by the State agency; these often allow the counselor to continue at his job for part of the year while going to school during the remainder.

Special attention is being paid to the development of effective field instructional units and supervision. New methods of teaching are continuously being introduced and special attention is being paid to the problems of teaching certain specialized areas, such as job placement techniques. Several universities are planning to introduce courses on rehabilitation at the undergraduate level, in part as a means of interesting students in the field at the most appropriate point.

The training programs in psychiatric rehabilitation for rehabilitation counselors employed in State agencies are well established at this time. By the end of fiscal year 1965, 69 counselors had completed their training; the first trainees entered in 1963. Three university departments of psychiatry currently provide this 6 months' period of training in cooperation with psychiatric hospitals which offer comprehensive care and rehabilitation.

Needs No precise estimates can be made at this time concerning manpower needs in rehabilitation counseling because of a number of unpredictable factors. These include: (1) the rapidly envolving nature of the duties and responsibilities of the rehabilitation counselors; (2) the speed with which nonprofessional duties can be assigned to aid, assistant or clerical personnel; (3) the creation of trainee positions under State merit systems; (4) upward revisions of salary scales of State vocational rehabilitation agencies to meet competitive situations; (5) the development of educational programs in rehabilitation at the undergraduate level; and (6) the initiation of a variety of work-study programs for rehabilitation counselors.

Projections for State vocational rehabilitation agencies alone indicate there will be 8,500 counseling positions in 1970, almost triple the 3,259 in 1965. In addition, rehabilitation centers, sheltered workshops, work adjustment centers and other community rehabilitation agencies are expected to need rehabilitation counselors, as will rehabilitation research projects and colleges and universities for their rehabilitation counselor training program.

Proposed 1967 program.—In 1967, a total of $6,994,000 is requested for support of training rehabilitation counselors, an increase of $2,434,000 over 1966.

Components of the request are (a) $1,428,000 to continue 56 teaching grants at the 1966 level; (b) $3,464,000 for support of the 1966 level of traineeships; (c) $560,000 for 30 new teaching grants; and (d) $1,542,000 for 557 additional traineeships.

(b) Medicine

Major objectives of training grants in the field of medicine are (1) to give all medical students an understanding of rehabilitation philosophy and methods so that concepts of total health care may be incorporated in their future practice of medicine; (2) to stimulate interested medical students in future specialization in physcial medicine and rehabilitation; (3) to increase the supply of physiatrists by support of residency training, in physical medicine and rehabilitation; (4) to offer physicians in other medical specialties closely related to chronic illness and disability opportunities to secure training in rehabilitation medicine; and (5) to provide physicians now in practice with orientation or refresher courses in rehabilitation techniques in the major disability categories.

Accomplishments.-In 1965, 66 of the 91 schools of medicine and osteopathy received teaching grants to assist them in strengthening the curriculum in the area of rehabilitation. In 1966 two additional schools are expected to receive a grant for this purpose.

With respect to stimulating an interest in future specialization in physical medicine and rehabilitation, the device of traineeships for undergraduate students in their vacation periods has proved a most useful one. In 1965, traineeships were awarded to 338 undergraduate students for a 2- or 3-months' clinical or research experience in rehabilitaiton; approximately the same number will be awarded in 1966. Leaders in education in physical medicine and rehabilitation believe such traineeships will serve to increase the future supply of physiatrists.

In 1965, 159 physicians receiving VRA traineeships were enrolled in residency training programs in physical medicine and rehabilitation on a full-time basis. An additional six were enrolled in academic career programs of 1 or 2 years' duration. These advanced programs are designed to give physicians research and administrative experience that will fit them for academic careers as heads of departments or senior research-teaching in rehabilitation medicine.

In addition, 11 residents in related medical specialties (such as reconstructive hand surgery, neurology, internal medicine and orthopedic surgery) received VRA traineeships for full-time work in 1965. Still another 43 received VRA traineeships for part-time residency training in physical medicine and rehabilitation that could be credited toward the certification requirements of the American Medical Specialty Board in their own specialty. A slight increase is expected in 1966.

Needs. Although qualified physicians are generally in short supply, the shortage of specialists in physical medicine and rehabilitation is especially acute. In August 1965 the number of physicians with certification in physical medicine and rehabilitation was about 575. An additional 300 physiatrists could be used immediately in hospitals, medical schools and rehabilitation centers. Estimates of total need vary from 1,000 to 3,000.

About 385 residencies have been approved by the American Board of Physical Medicine and Rehabilitation in about 40 teaching hospitals. The percentage of residencies that are unfilled is much higher than in the older and better established medical specialties-about 50 percent. About 100 physicians annually complete the requirements for admission to the Board's examination and about 50 take the examination each year.

Orientation of all undergraduate students to rehabilitation philosophy and practice continues to be essential for the future practice of medicine in a society increasingly concerned with care of the chronically ill and disabled and specific teaching programs should be established in all of the schools of medicine and osteopathic medicine.

Academic career programs need to be developed in additional university centers, so that promising physicians who are interested in an academic career in physical medicine and rehabilitation can secure a breadth of training that will enhance their preparation for positions of leadership. At least 20 should be enrolled for the 1- or 2-year training program in 1967.

Proposed 1967 program.—In 1967, 112 teaching grants are planned, the same as in 1966. Of the total teaching grants, 72 will be for instruction of undergraduates, 35 will be for instruction at postgraduate levels (residency), and five will be for academic career programs. The estimated cost will be $2,530,000. The requested amount for traineeships totals $2,494,000. It would make possible the awarding of 254 traineeships for residency training in rehabilitation medicine, 300 traineeships for undergraduate medical students and 20 academic career traineeships.

(c) Prosthetics-orthotics

The specialized field of prosthetics and orthotics is constantly changing and responding to new research developments in the techniques and methods of fabricating artificial limbs, braces, and other assistive devices. VRA's training program in prosthetic-orthotic education has been the major means by which these research findings have been interpreted and disseminated to rehabilitation personnel.

Accomplishments.-VRA training grants at three major universities have made possible the employment of full-time faculty members to conduct a series of training courses for prosthetists, orthotists, physicians, surgeons, occupational therapists, physical therapists, rehabilitation counselors, and other related personnel who render services to orthopedically handicapped individuals. In addition, specialized training programs at the undergraduate, associate in arts, and technical level have been developed for prosthetists and orthotist-trainees so that such training will prepare them to function more effectively as recognized members of amputee clinic teams in rehabilitation centers, medical schools, and hospitals throughout the country.

Bachelor of science undergraduate curriculum.-At New York University continued progress has been made in conducting the 4-year program leading to a bachelor of science degree. New York University graduated in June 1965 the first students with a bachelor's degree in prosthetic-orthotic education. This curriculum was developed to help meet the needs of professionally trained personnel competent to provide leadership in clinical, research, and the teaching aspects of prosthetic-orthotic education. In the 1964-65 academic year 12 students were enrolled, and in 1965–66, 24 were to be enrolled. The first two graduates of this program are already employed, one in the teaching program at New York University, and the second one as regional manager in one of the largest prosthetic-orthotic facilities in the country.

Associate in arts degree.-The new associate in arts degree programs at Cerritos College, Norwalk, Calif., and Chicago City Junior College, have been developed in 1965 and are offering a 2-year course, combining didactic instruction with clinical practice.

It is anticipated that there will be 60 students in the two curriculum in the academic year of 1965-66.

Technical education.-At the technician level, training programs for high school graduates at Rancho Los Amigos, the Institute for the Crippled & Disabled, and Woodrow Wilson Rehabilitation Center have continued to prepare personnel for bench jobs in the fabrication of artificial limbs and braces. A total of 25 students were enrolled in 1965.

UCOPE.-The University Council on Orthotic-Prosthetic Education (UCOPE), established in 1962, has continued to function effectively in coordination of the three major university programs. Composed of the medical and educational directors, this group has been able to achieve a more uniform approach in curriculum offerings, teaching materials, and methodology, as well as evaluation procedures for the courses. Liaison representatives of the Veterans' Administration, American Orthotics & Prosthetics Association, American Board for Certification, and the National Academy of Sciences meet with the UCOPE members to coordinate the total prosthetic-orthotic education programs.

National Academy of Sciences.-Supported jointly by the Vocational Rehabili tation Administration and the Veterans' Administration, the Committee on Prosthetic-Orthotic Education (CPOE) of the National Academy of Sciences has continued to develop an extensive informational program, has fostered the development of new amputee clinics, and has prepared brochures, films, and slides for use in schools of medicine, physical therapy, and occupational therapy. In addition, CPOE has conducted an extensive amputee survey and is in the process of reviewing the policies and practices of State vocational rehabilitation agencies in connection with the purchase of prosthetic-orthotic appliances. Needs. The estimated number of prosthetists and orthotists now in practice is 4.200. Of this number about one-fourth are certified as competent by the American Board for Certification in Orthotics & Prosthetics. Approximately 60 are shopowners while the others are employed in prosthetic facilities, hospitals, and rehabilitation centers.

An estimated 400 to 500 could be placed immediately in shops and hospitals, according to the American Orthotics & Prosthetics Association. Especially acute is the need for personnel in entry occupations at the technician level.

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