The estimated additional number needed annually includes 20 prosthetists, 40 orthotists, and 120 technicians.

Manpower needs for trained shopworkers and prosthetic-orthotic technicians are also expected to continue to exceed the supply. It is anticipated that the graduates of the associate in arts programs will fill the needs for positions in both research and clinical facilities. It is also expected that other junior colleges will become interested in similar programs.

Proposed 1967 program.—In 1967, $787,000 is requested, an increase of $94,000 over 1966. Components of this request are : $718,000 to continue 9 teaching grants made in previous years and $69,000 for 23 traineeships, the same number as in 1966.

(d) Speech pathology-audiology

The purpose of training grants in this field is to increase the number of speech and hearing specialists qualified to diagnose and treat adults with communicative disorders.

Teaching grants are made to assist university training centers to expand their programs and modify their curriculums to provide more extensive training for work with adults. Prior to the initiation of the VRA training grants program, the majority of the programs traditionally prepared students to work with children in the public school system. A significant number of graduate training programs have modified their curriculums to include extensive training in the area of adult rehabilitation. Traineeship grants are made to training centers so that students may gain experience with adults and so that experienced clinicians may secure advanced training to prepare for university teaching positions.

Accomplishments.—Significant progress is being made in the effort to alleviate the shortages of qualified personnel to diagnose and treat individuals with communicative disorders, but shortages continue to exist. Since VRA began to support graduate training in this field in 1958, the number of universities with teaching grants has grown from 7 to 61 in fiscal year 1965, and the number of traineeships from 23 to 615 in fiscal year 1965. Approximately 1,000 VRA trainees have completed their graduate study in this field and of this number over 900 (90 percent) are employed in rehabilitation settings which provide services to adults with communicative disorders. In the 1964-65 academic year, 1,500 were enrolled for full-time study at the master's or doctoral levels, 615 of whom received VRA traineeships.

The number of speech pathologists and audiologists who have met the requirements for the certificate of clinical competence, as established by the profession, has increased in the past few years. They now total over 6,000 as compared with less than 1,100 in 1958. Improvements in the graduate curriculums account in large measure for this increase.

At the present time it is estimated that less than 400 trained persons are providing services in postlaryngectomy or esophageal speech to the laryngectomee. More persons are being trained in this area through short-term training programs.

A very conservative estimate of the number of trained persons providing language and speech training to the aphastic on a full-time basis would be 250. In additional there are a number of speech clinicians, some with limited training, providing minimal services. Some of these clinicians may provide services to one or two aphasic patients each year.

It is important that every speech clinician receive specialized training in working with both the laryngectomee and the aphasic. Such competence is most important to every clinician working in a large rehabilitation center, in a small community hospital, in private practice, or in any of the agencies serving disabled people.

Needs. Precise figures on the number of speech pathologists and audiologists now employed are lacking. The membership of the American Speech & Hearing Association is now over 13,000, and there are perhaps an additional 5,000 persons working in the field who are not members. It is estimated that about 20,000 clinicians are required to provide the necessary services to the approximately 8 million persons in the United States who have defective speech or hearing serious enough to handicap them in their social relationships and vocational adjustment. Approximately 800 students are completing their studies at the master's or doctoral level each year. This number represents about half of those needed to reach the goal of 20,000 trained clinicians in practice and 1,500 graduates a year.

Of the approximately 6,000 clinicians who have received the certificate of clinical competence, only 850 have certification in audiology and about 100 have certification in both speech and audiology. At the same time, many of the clinicians now in practice lack competence in dealing with specialized problems, such as work with the laryngectomized patient, the adult aphasic, or those with profound hearing loss. There is need for the continued training of these individuals who are presently providing only limited or inferior services.

Every rehabilitation environment should have at least one speech clinician who possesses special competence in working with the aphasic. This would mean that some 400 to 500 speech clinicians with special competence in aphasia should complete their training each year. In addition, training should be provided to the clinicians presently in practice.

Proposed 1967 program. In 1967 funds amounting to $3,267,000 are requested for support of 61 teaching grants and 678 traineeships, an increase of $131,000 over 1966. Components of this request are $1,006,000 to continue support of 61 teaching grants and $2,261,000 for 678 traineeships, the 1966 level.

(e) Occupational therapy

Accomplishments. The major goals of grants in this field are: (1) to assist schools in their efforts to make the curriculum an effective and dynamic professional educational program; (2) to encourage a greater number of students to prepare for the field; (3) to foster the establishment of new schools in medical centers where such a training program is needed to round out the training of medical and related professional groups; (4) to increase the number of occupational therapists who are qualified for teaching, research, clinical work or other leadership positions; (5) to increase the supply of occupational therapy assistants for service in nursing homes and senior citizens' centers; and (6) to encourage experiments to improve utilization of occupational therapy manpower. Since 1955 about 1,960 students have received VRA financial assistance in completing training in occupational therapy. The number of traineeships has increased from 52 in 1955 to 357 in 1965.

In 1965, 18 of the 32 approved schools of occupational therapy (58 percent) received teaching grants to help them expand their facilities, increase the rehabilitation content in the curriculum and strengthen the integration of theoretical and clinical course work. The findings of a recently completed curriculum study, conducted by the American Occupational Therapy Association, lends significant importance to VRA support of teaching grants in the approved schools. In line with the objective to help meet manpower shortages and improve utilization of professional personnel, training courses have continued to develop for preparation of certified occupational therapy assistants.

During 1965, 165 assistants were enrolled in a total of 14 training programs. VRA grants helped to support five of these programs, located in junior colleges, and in hospitals for the mentally ill and chronically ill, nursing homes, and senior citizens' centers.

Needs. The shortages of registered occupational therapists and certified assistants are particularly acute and have an adverse effect upon the development of comprehensive rehabilitation programs in rehabilitation centers, hospitals, and institutions for the mentally ill. The total estimated need is for about 12,000 therapists. The available supply is about 6,800, with approximately 4,000 new therapists needed each year.

The total enrollment of the 32 approved schools of occupational therapy is now about 2,800; the number of graduates is about 500 a year.

Proposed 1967 program.-In 1967, $1,019,000 is requested for support of 26 teaching grants and 458 traineeships, an increase of $38,000 over the 1966 level. Components of the request are $361,000 to continue support of 26 teaching grants and $658,000 for support of 458 traineeships, the same number as in 1966. (f) Physical therapy

The shortages of physical therapy personnel at the clinical and academic levels are a major concern of the field of rehabilitation. The purpose of training grants in physical therapy is to increase the number of physical therapists qualified to provide rehabilitation care and treatment to ill and disabled persons and to prepare graduate physical therapists for teaching, research, and leadership positions.

Accomplishments.-The major aims for training grants in the field of physical therapy are (1) to strengthen or expand the teaching programs in approved schools of physical therapy on the undergraduate and graduate level; (2) to 60-627-66-pt. 243

assist in the planning phase of new schools of physical therapy which are developing in geographical areas where such training has not been available; (3) to provide undergraduate traineeships for the purpose of increasing enrollment in physical therapy schools; (4) to provide graduate traineeships to prepare a corps of graduate physical therapists for teaching and research positions; (5) to assist universities to develop new graduate curriculums or improve those in existence: (6) to assist in the improvement of teaching methods and materials that will add depth and scope to the learning experience of students.

The impact of Vocational Rehabilitation Administration support in the field of physical therapy since 1962 can be measured by several factors. Enrollment in the schools of physical therapy at the junior, senior, and certificate level in 1965 increased by 10 percent over 1964. Enrollment at the master's and doctoral levels increased by 8 percent over 1964. From 1958 to date, 113 physical therapists who received a VRA traineeship have completed or are enrolled in graduate programs preparing for teaching, research, and administrative positions. Several of the graduate students who have received the doctoral degree in anatomy, physiology, or educational psychology are now teaching courses in their specialty to both physical therapy students and medical students.

Needs. It is estimated that there are over 12,000 physical therapists practicing in the United States. The American Physical Therapy Association reports that they carry in any given month requests for recruitment for approximately 500 physical therapists, and this figure does not include the number on placement registers of State chapters of the American Physical Therapy Association. It is further reported that in 1965, 703 juniors and 957 senior and certificate students were enrolled in approved schools of physical therapy, or a total of 1,660. About 1,000 graduate each year.

Proposed 1967 program.—In 1967, $1,165,000 is requested for 33 teaching grants and 418 traineeships, an increase of $52,000 over 1966. Components in this request are $396,000 to continue support of 33 previously initiated teaching grants and $769,000 for 418 traineeships, the same as in 1966.

(g) Social work

Accomplishments.-Grants to schools of social work have had as their objectives (1) the incorporation of material on disability, chronic illness and rehabilitation into the core curriculum for all students, and (2) the preparation of selected social workers for participation as social workers on the rehabilitation team.

In 1965, teaching grants were made to 41 of the 59 accredited schools of social work, primarily to enable them to employ field instructors for students in supervised fieldwork units in rehabilitation settings. Grants for traineeships included tuition and stipends for 312 students in 44 of the accredited schools of social work. Support for these students raises to 1,849 the number of traineeships awarded between 1955 and 1965.

Support for faculty institutes in undergraduate education in the social services continued and a grant was also made to the Western Interstate Commission on Higher Education to conduct an institute in this area. The institute included participants from about 80 colleges and universities in the 13 Western States included in the commission and was designed to increase and strengthen undergraduate programs in the social services. Undergraduate programs in the social services have a threefold purpose: (1) they are a source for urgently needed manpower to perform the many tasks requiring less than full professional training; (2) they offer sound preparation for graduate study in the helping professions; and (3) they provide a knowledge base for future community participation and leadership by the students enrolled in them.

Needs. The social work manpower crisis of today is not only more serious but is different, in many respects, from the manpower problems of the past. The implications for social work service in the antipoverty program, the emphasis on rehabilitation, and new opportunities in public and private programs for community planning and action have combined to increase the demands for social work personnel. New manpower studies now in process indicate that needs previously noted, 15,000 recruits annually of whom 20 percent, or 3.000, are needed in the field of health and rehabilitation, are far below the real needs of the new and ever-changing situations in our present society.

The 59 accredited schools of social work can presently enroll only about 8.000 students and graduate about 3,300 each year. Expansion of facilities for training is imperative and one way of achieving this is through increasing the number of field placements available by the employment of well-qualified fleld

instructors and the establishment of training units in rehabilitation settings serving the mentally and physically disabled including correctional institutions.

Vacancies presently exist for social workers in many State vocational rehabilitation agencies and in agencies closely allied with the State agencies. If the problem of the shortage of social workers in these settings is to be alleviated, more students must be attracted to the field and financial support made available to them for training specifically related to rehabilitation.

Proposed 1967 Program.-In 1967, $1,894,000 is requested, an increase of $100,000 over 1966. Components in the request are $804,000 to continue support of 41 teaching grants and $1,090,000 for 381 traineeships, the same number as in 1966.

(h) Rehabilitation of the Blind

The need for personnel trained to assist blind persons to develop skills of orientation to their surroundings and mobility, as well as attitudes that are necessary to live and move about independently in their environment, continues to increase. The two graduate programs for the training of such instructors were continued in 1965 and have graduated 106 students between 1961 and August 1965. The success of the graduates had confirmed the need and resulted in increased demand by both public and private agencies for personnel skilled in teaching orientation and mobility. Those already graduated are being moved into administrative and supervisory positions and there is, therefore, a need for instructors at the undergraduate level.

The one program for the training of home teachers was continued with an enrollment of nine students who will graduate in January 1966. Like the orientation and mobility instructors, every graduate has several offers of employment and in 1967 it is planned that at least one more program for the training of home teachers can be established.

Included are:

Other programs were continued with very satisfactory results. a program of instruction of rehabilitation counselors in the principles and techniques of placing blind persons in competitive occupations which annually trains about 50 employed counselors; a summer course to improve the knowledge and teaching skills of industrial arts instructors in schools for the blind which annually enrolls about 20 persons; and a teaching project for on-going professional education of personnel working with the blind which includes support for the annual "Blindness" and a library catalog of publications pertaining to the blind.

A course for instructors of home economics similar to that for industrial arts instructors is being planned to meet another obvious need.

Proposed 1967 program.—In 1967, $452,000 is requested for 8 teaching grants and 54 traineeships. Components in this request are $319,000 to continue support of 8 teaching grants initiated before 1967 and $133,000 for 54 traineeships, the same number as in 1966.

(i) Rehabilitation of the deaf

Trained personnel to meet the needs of people who are deaf are in short supply. Special skills are required to work with this group of handicapped persons. It is important for the trained worker to have some understanding of the psychological, social, and communicative problems of these individuals. The skill of manual communication is most important to the worker serving a deaf person whose verbal communication ability is limited or completely lacking. Teaching grants are made to prepare speech pathologists, audiologists, social workers, rehabilitation counselors, psychologists, physicians, and others to work with this specialized group. Traineeship support is important to help prepare a limited number of individuals to work with the deaf.

Accomplishments.-Until recent years, academic programs to prepare personnel for rehabilitation of deaf persons did not exist in the United States except those of preparation of teachers of deaf children. In fiscal year 1961, VRA began support of a specialized training program at the master's degree level which was designed to prepare a small number of persons now working with the deaf for leadership positions in rehabilitation of the deaf. The curriculum drew upon a number of disciplines and is composed of both classroom instruction and actual field experience in varied settings serving deaf persons. In 1963, three programs were developed to provide orientation of professional personnel to work with the deaf, through training courses of 4 to 6 weeks' duration. These courses were primarily geared to meet the needs of rehabilitation counselors, social workers, psychologists, and other rehabilitation personnel. In 1964, an interdisciplinary

program was developed to provide greater breadth and depth in the understanding of the problems of deaf persons. The students in this program are individuals from the fields of speech pathology, audiology, social work, or rehabilitation counseling. All of these programs are comparatively new and their full effectivness will not be realized until the students have returned to their work environments to try the new skills and knowledge gained.

Needs. Relatively few professional workers are now equipped with enough knowledge about problems of deaf persons or with skill in communicating with totally deaf persons. State vocational rehabilitation agencies need more counselors with adequate preparation for serving deaf persons. Less than onehalf of the agencies have even one counselor with special competence in serving deaf persons. Only six State agencies have more than one such specialized counselor.

Although some university training programs in rehabilitation counseling offer limited field work experience in rehabilitation of the deaf, most of them are faced with inability to locate satisfactory facilities for student clinical practice. Counselors with knowledge of the problems of the deaf are needed in residential schools for the deaf, in public employment services, in rehabilitation facilities, in vocational schools, and in mental hospitals and schools. Skilled audiologists are needed in the schools for the deaf to assist in determining the level of residual hearing and its possible contribution to independent living and employment. Proposed 1967 program.—In 1967. $551,000 is requested for 8 teaching grants and 81 traineeships, an increase of $32,000 over 1966. Components of the request are $243,000 for continuation of 8 teaching grants and $308,000 for 81 traineeships, the 1966 level.

(j) Rehabilitation of the Mentally Retarded

Accomplishments.-The special training centers in mental retardation, established in 1964 at four universities, Columbia, North Carolina, Texas, and Wisconsin, constitute the major bases for numerous intensive training courses throughout the year. They are staffed with full-time faculty members with competence in various aspects of retardation.

For preparation of personnel to work with the mentally retarded, grants were made in 1965 to 23 colleges and universities for field instructional units in institutions and agencies serving mental retardates. These units had a total of 178 trainees. Incorporation of knowledge about mental retardation into the basic curriculums of schools of social work, departments of speech pathology and rehabilitation counselor training programs has proved to be the best single way of bringing the problems of retardates to all the students, as well as to produce some with a special interest in the field.

One additional program is providing doctoral and postdoctoral training in rehabilitation of the mentally retarded for psychology and rehabilitation counseling interns.

Needs. In all professional fields the shortage of personnel qualified to provide rehabilitation services to the mentally retarded is very great. Disciplines, other than those previously mentioned, which should offer specialized training in serving persons with retardation are recreation, physical therapy and occupational therapy. Some of the increase is requested for the development of programs in those fields.

The 1967 proposed program.-In 1967, $1,580.000 is requested, an increase of $114,000 over 1966. A total of $872,000 will be required to continue support of the 31 projects for which teaching grants were made in 1966 and $708,000 will be required for 221 traineeships, the same level as in 1966.

(k) Rehabilitation Facilities Administration

Accomplishments.-In 1965, training grants were made to two educational institutions, the University of San Francisco and the University of Wisconsin, to conduct a 9-month training program for workshop administrators. In the first year of operation, these 2 programs enrolled a total of 16 students, all of whom completed the course satisfactorily and are now available for return to their positions or for seeking better ones. In 1966 the anticipated enrollment is 29 under the basic budget approved by the House and Senate.

In addition, these training centers conducted a number of short-term courses for workship administrators, floor supervisors and other workshop personnel which reached about 200 persons in 1965.