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not hitherto been given. Some children who would formerly have been turned away are now being given service.

A new use to which some of the Children's Bureau's crippled children's funds earmarked for mental retardation are being put is in the area of cytogenetic or laboratory services. Project grants have been approved which establish such programs as extensions of clinical services at hospitals or medical schools. Projects include chromosome analysis and diagnosis of various medical conditions which may be genetic and result in mental retardation. On the basis of these analyses, counseling may also be given to parents seeking advice on genetic questions. As of November 1965, 14 such projects had been approved.

An important use of the expanded funds available for mentally retarded crippled children is in providing services for institutionalized children; for example, orthopedic services not hitherto available to these children.

Another use to which these funds are being put is the development of special clinical programs for multiple-handicapped children. Eight such clinics were being financed by Children's Bureau funds as of the end of November 1965. C. Child welfare services

The Division of Social Services administers child welfare services funds authorized in title V of the Social Security Act for the purpose of cooperating with State public welfare agencies in establishing, extending, and strengthening child welfare services. These funds are allocated to States on a formula basis. The objective of the child welfare services program is to assure that each child receives the care, protection, and services that are necessary to enable him to realize his full potential. Child welfare services which can benefit the mentally retarded include parent counseling, homemaker services, day-care services, foster family care, small group care, services to unmarried mothers, protective services, and certain institutional preadmission and aftercare services.

Historically, after the passage of the Social Security Act, some child welfare services were provided for retarded children on a scattered basis. In 1957, a specialist in mental retardation was employed on the central office staff. Subsequently, special efforts have been made to encourage States to reach out and improve child welfare services to mentally retarded children and their families. Today, all State public welfare programs provide some social services for mentally retarded children. By conservative estimates of the Children's Bureau, 37,200 mentally retarded children receive services from public child welfare agencies. Over 5,500 are served by voluntary agencies.

Following are typical examples of State efforts to extend and improve services to the mentally retarded:

A Southeastern State has developed a special mental retardation unit which provides a range of public child welfare services in two counties. The effectiveness of this unit is demonstrated by the results obtained in its work with a group of families who previously had been advised by other sources to institutionalize their retarded child. With support from the unit's social worker, the unit's help in using other community resources such as day care, and help from the public health nurse in management of the retarded child, 60 percent of the parents were able to keep their family intact. Similar achievements are noted in other States which provide family counseling.

A single county in a Western State reports that it is providing foster family care for 100 mentally retarded children. Some children who must be cared for outside their own homes can profit from close interpersonal relationships and respond to the stimulation of family life. Short-term foster care at intervals or during periods of crisis may enable a family to provide adequately for a re tarded child at home for the most part. For other retarded children, foster family care permits long-term benefits of family life and community living Foster family care would be the plan of choice for many children who have been placed inappropriately in large residential facilities. In fact, some States are giving attention to the "exchange" of children between institutional and child welfare services programs to assure more appropriate services for particular children.

Several State public welfare agencies are developing day care services for the mentally retarded. Day care programs offer both constructive experiences for some retarded children and necessary relief for their parents. This kind of relief is often the key factor in retention of the child in his own home.

Two communities recently initiated programs of homemaker services which have demonstrated the value of this service specifically in families with mentally retarded children. Through this service, an overburdened mother can be re

lieved of the constant and full responsibility for the day-to-day care of her retarded child. Frequently, she acquires new skills which help her in better home management and in her special problems with child care.

Child welfare services also may have preventive aspects in relation to mental retardation. For example, day care or foster care for children from certain deprived homes may be preventive services.

Homemaker service may be preventive in nature when brought into play with some expectant mothers who need relief from the physical demands of caring for other children. Protective services can reduce child abuse as a cause of mental retardation. Services to unmarried expectant mothers can assure utilization of proper prenatal services.

Child welfare workers also are in a key position with regard to casefinding, assistance with obtaining proper diagnosis, and providing continuity of planning and services consistent with the individual retarded child's needs.

On the other hand, numbers of retarded children and their families need and could profit from child welfare services not now available. Professionally skilled staff, new programs, and extension of those in existence are needed. Many States, however, have been unable to finance these special programs because of other pressing priorities which are also consistent with implementing the 1962 public welfare amendments on use of State and Federal child welfare service funds.

D. Services under public assistance programs

The Bureau of Family Services administers the public assistance titles of the Social Security Act. Under these laws, the Bureau is responsible for the five federally aided programs of public assistance: old-age assistance, medical assistance, for the aged, aid to families with dependent children, aid to the blind, and aid to the permanently and totally disabled. Beginning January 1, 1966, the Bureau is also responsible for administering title XIX of Public Law 89-97 "Social Security Amendments of 1965," which authorizes grants to States for improved medical assistance programs.

Each State initiates and develops its own public assistance programs within the conditions of the Social Security Act; these conditions assure certain minimum standards. The freedom to determine the scope and content of their programs results in considerable variation between States in the level of assistance, itself, as well as in the extent of other services.

Information as to the number of retarded individuals receiving public assistance is limited, except for two programs.

During 1965, about 95,000 retarded adults received assistance through the program of aid to the permanently and totally disabled; in addition, about 5,000 adults, who were both blind and retarded, were assisted. Estimates of the number of retarded among the other 7 million recipients of public assistance vary from 200,000 to 500,000.

While State programs of medical care and social services to the retarded vary, there is little question that the recent emphasis on the importance of social services has resulted in increased awareness of the needs of retarded recipients and greater attention to meeting them. For instance, the 1962 public welfare amendments require that all State agencies study each child receiving assistance and develop an individual plan of services for him.

This requirement is an important means of early identification of the retarded child and insures at least minimum attention to his special needs.

Most States are able to provide broader service than this minimum, however. Under the 1962 public welfare amendments, 75 percent Federal matching is available for a wide range of services of particular value to the retarded. These include parental counseling, consultation on legal, social, educational, medical, psychiatric, or psychological problems. States can also provide specialized help to improve, restore, or maintain clients' capacities for personal and social functioning, such as homemaker services, family care for adults, group and volunteer services, social rehabilitation units, etc.

In addition, States can elect to provide a comprehensive program of services to the retarded. In four States-Kansas, Minnesota, Oklahoma, and Wisconsinthe mental retardation program is the responsibility of the State department of public welfare. In many States it is responsible for licensing and standardsetting for the institutional and group care programs which serve the retarded. Almost all States are involved to some degree in providing services and supervision to retarded adults leaving institutional care; some States have become con

cerned about the overdependence on nursing home care and are actively developing alternative living arrangements in communities.

The implications of Public Law 89-97, for the development of a comprehensive program of medical and social services for the retarded, are enormous. Under title XIX, States will be required to develop a broad, liberal, and comprehensive program of medical assistance to all people who need it by 1975. States are not required to submit plans under title XIX but those that do not by January 1, 1970, will not be able to receive Federal participation in payments for medical

care.

III. RESEARCH

The Children's Bureau has on its professional staff a specialist in environmental aspects of mental retardation, who reviews research and other activities in this area. The clearinghouse is currently revising its 1960 publication, “Research Relating to Mentally Retarded Children," a listing of on-going investigations in the United States. Also, the clearinghouse has recently entered into an exchange arrangement with a similar clearinghouse operated in the National Institute of Mental Health, as well as the Australian Mental Health Exchange (Canberra). The Howard project, operating out of Howard University, deals with children who are from culturally deprived backgrounds and thus exhibit poor mental functioning and borderline retardation. The research component of the Howard project is under the direction of the branch, and a summary report on the first year is now in preparation.

Under section 1115 of the Social Security Act, the Bureau of Family Services has funds to support experimental and demonstration projects. The purpose of these grants is to encourage States and localities to explore and experiment with fresh and original methods of promoting the objectives of the public assistance titles of the Social Security Act, i.e., to strength family life and to offer constructive help to individuals and families in their efforts to achieve selfsupport and self-care. New or improved programs for the retarded can be developed through this method. Four model projects related to mental retardation have been distributed to State agencies to stimulate their interest in this area.

IV. PROFESSIONAL PREPARATION

A. Training for health services

Training activities for health services in the field of mental retardation. assisted by Children's Bureau funds, have encompassed many approaches: Grants for fellowships; support of and participation in institutes, conferences, and other short-term training sessions; consultation on course curriculums; arrangements for clinical experience in mental retardation clinics; and distribution of information materials to professional workers. Also, because informational materials are an important training tool for professional workers, the Bureau has operated an exchange of educational materials as a service to mental retardation clinics. Since November 1961, through this exchange, approximately 275 different items have been distributed to each of the mental retardation clinics in the country, including clinics not supported by Children's Bureau funds. Special publications have been developed for professional personnel, these have been much in demand. Proceedings of institutes have spread the knowledge provided by the institutes well beyond those actually in attendance.

The following points up the wide range of disciplines involved in training activities and illustrates the variety of training approaches. During fiscal year 1965 the Children's Bureau funded 27 pediatric fellowships in mental retardation. In nursing, assistance was given to several university schools of nursing to incorporate training on mental retardation into the maternal and child health curriculum. Assistance was also provided for short-term, intensive educational programs in mental retardation for practicing staff nurses. Training of dentists to work with mentally retarded children was stimulated, as was the training of nutritionists, occupational therapists, physical therapists, and speech and hearing specialists. In the 1964-65 academic year, it is estimated that 44 graduate social work students from 15 schools of social work derived all or part of their caseloads from mental retardation clinics. Two new fields in which grants for training were made in fiscal year 1965 were in clinical psychology and in cytogenetics and biochemistry.

The 1965 amendments to the Social Security Act made additional provision for grants for training purposes to be administered by the Children's Bureau. The amendments authorize appropriations for grants "for training professional personnel for health and related care of crippled children, particularly mentally retarded children and children with multiple handicaps." The amounts authorized for this purpose are $5 million for fiscal year 1967, $10 million for fiscal year 1968, and $17.5 million for each fiscal year thereafter. The new grants are to be made to public or other nonprofit institutions of higher learning, and will be a major source of support of personnel who will staff the university affiliated centers for diagnosis and treatment of the mentally retarded, which are now being constructed.

B. Training for child welfare services

The Social Security Act, as amended, provides for grants to public or other nonprofit institutions of higher learning for special projects for training personnel in the field of child welfare, including traineeships to students. Training for child welfare services for mentally retarded children is included in this program.

States also are urged to use Children's Bureau child welfare services funds for tuition and maintenance grants for child welfare staff educational leave. All States have structures for a staff development program including orientation, inservice training, and educational leave. These programs contribute to the overall increase of child welfare staff which is better able to serve the mentally retarded.

V. INCOME MAINTENANCE

Income maintenance is a basic function of the Federal-State public assistance programs of the Bureau of Family Services. These programs assist children who are deprived of parental support or care, the needy and medically indigent aged and the needy blind and disabled, by providing financial aid to assure the necessities of life, essential medical care, and social services.

The cost of such assistance to retarded individuals is not known since retardation, itself, is an eligibility factor in only one program; the Federal share of the cost of assistance to retarded recipients of aid to the permanently and totally disabled was about $40 million in fiscal year 1966.

Program aids

VI. OTHER

The Children's Bureau has assisted in the production and circulation of films on mental retardation and has also operated an exchange of educational materials as a service to the mental retardation clinics. Since November of 1961, through this exchange, more than 300 items have been distributed to each of the mental retardation clinics in the country. Special publications have been developed which have been in great demand. In addition, pertinent articles appearing in various professional journals have been reprinted and distributed.

SURPLUS PROPERTY PROGRAM

The Division of Surplus Property Utilization, within the Office of Field Administration, carries out the responsibilities of the Department under the Federal Property and Admnistrative Services Act of 1949, which makes available for health and educational purposes surplus Federal real and personal properties. The properties which become available under this program are those that have been determined by the General Services Administration as no longer having any further Federal utilization.

Surplus personal properties are screened to determine those types which may be needed and usable by eligible institutions throughout the country in conducting health and educational programs. Properties determined to have utilization for these purposes are allocated by the Department of Health, Education, and Welfare for transfer to State agencies for surplus property which have been established in all States. It is the function of these State agencies to secure the properties, warehouse them, and make them available to eligible donees for health and educational uses. The only cost to the eligible donees are the handling and service charges which are assessed by the State agencies.

In the case of real properties which have been determined to be surplus to Federal needs, notices of their availability are sent to potential eligible applicants either by the State agencies or the regional representative for surplus prop

erty, located in each of our nine regional offices. Real properties available for removal from their site for relocation are conveyed by agreement of sale with restrictions as to the use of the facilities which run for a period of 5 years. These properties are conveyed with a 95-percent public benefit allowance discount from their fair market value. Land or land and buildings, together with other improvements, are conveyed by deed which contain restrictions as to use for a period of 20 years. These properties are conveyed with public benefit discount allowances ranging from 40 to 100 percent of fair market value. The only other costs to eligible transferees are out-of-pocket Federal costs; i.e., appraisals, surveys, etc.

Schools for the mentally retarded are eligible to acquire surplus real and personal property. In the case of personal property, such a school must be operated primarily to provide specialized instruction to students of limited mental capacity. It must be tax supported or nonprofit and exempt from taxation under section 501(c)(3) of the Internal Revenue Code of 1954. It must operate on a full-time basis with a staff of qualified instructors for the equivalent of a mininum school year prescribed for public school instruction of the mentally retarded. It must also demonstrate that the facility meets the health and safety standards of the local governmental body. In the case of the real property, the applicant must be a State or political subdivision thereof, or instrumentality, a taxsupported educational or public health institution, or a nonprofit educational or public health institution that has been held to be exempt from taxation under section 501 (c) (3) of the Internal Revenue Code of 1954. Its proposed program of use must be for a fundamentally educational or public health purpose; i.e., devoted to academic, vocational or professional instruction, or organized and operated to promote and protect the public health.

Types of personal property available would range anywhere from a nail to an electronic computer. Many items of surplus personal property have never been used before. Real properties would consist of all types of buildings which are removable, land with or without structures, and other improvements such as utility lines, sewer and water systems, etc.

Detailed information as to eligibility of organizations for both surplus real and personal properties, as well as additional information in connection with the surplus property utilization program, may be obtained from pamphlets listed in the bibliography included in this publication.

The following are examples of real properties conveyed under the program for use in aiding the mentally retarded. Frequently, these facilities are put to a joint use, namely, for the training of the mentally retarded as well as the physically handicapped. Other conveyances have been made for hospital use where, as a part of the total program, portions of the facility are used for the treatment and training of the mentally retarded.

The State of Missouri passed legislation authorizing the State department of education to establish and operate State schools for mentally retarded in any county or in a district comprised of two or more counties. One of the first of these schools has been established on the 4.95 acres of land and nine buildings were conveyed for this purpose at the surplus O'Reilly General Hospital, Springfield, Mo. The facility is a day school for a maximum enrollment of 90 children.

The State of Florida has undertaken the establishment of a system of Sunland Training Centers throughout the State for the training of its mentally retarded children. Present plans call for 10 of these centers having capacity of approximately 1,000 resident students each. One of these centers, serving the northwest section of the State, has been established at Mariana, Fla., on 372.67 acres of land and 65 buildings, formerly the Graham Air Force Station through our surplus property utilization program. Most of the personal property for the operation of this facility was conveyed with the real estate.

Texas, Louisiana, and Kansas also have programs for the mentally retarded, using Federal surplus real property. The Department conveyed 34.39 acres of land and 47 buildings, formerly the Lufkin Air Force Base, Lufkin, Tex., to the Texas State Hospital and special schools for a resident unit to accommodate between 1.000 and 1,500 retarded children. Louisiana received 537 acres with modest improvements at the Belle Chasse Navy Ammunition Depot, New Orleans as a site for a State unit, serving this area for day treatment and resident training and care of mentally retarded. The State of Kansas has renovated the Winters Veterans' Administration Hospital, also an intact transfer, comprising 225 acres and 194 buildings for the treatment and care of some 300400 mentally retarded children.

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