Financial condition at beginning of treatment.-This family was completely supported through ADC public welfare funds, and received all medical care through public welfare.

Treatment process.-This family received long-term, intensive casework service centering chiefly upon the mother. The mother and the daughter took part in all group activities at Huntington, including the mother's group the afterschool girl's group, family suppers, family life education and family camp. This was a cooperative case with the visiting teacher and the Syracuse Dispensary.

Present state of family. The mother's schizophrenic symptoms are in remission. She is able to relate well and warmly to her peers and has become somewhat of a leader in her group at Huntington and in her neighborhood. She functions adequately in the care of her home and her daughter and is beginning to deal realistically with this problem.

Financial condition at present.-This family is still supported through ADC public welfare funds. They receive $109 per month plus medical expenses when needed.

Tax dollars saved the community through Huntington Junior League project.It is probable that the treatment process at Huntington in which this family has participated had prevented a mental breakdown on the part of the mother and has enabled the daughter as well as the mother to stay out of institutions.

The cost to the community for 1 year's care in a mental institution for the mother figured on a minimum charge of $3.70 per day is $1,350.

The cost to the community for 1 year's care in a State institution for the daughter's care figured on a minimum charge of $2.50 per day is $912. Total cost__

Cost to the community for 1 year on present basis---.

Total community tax dollars saved___.

CASE NO. 10, NOVEMBER 1959

Referral. Onondaga County mental health clinic.
Treatment started.-October 1958.

$2,263

1, 308

955

State of family at beginning of treatment.-This family, consisting of a mother, age 50, two children, girl 12 and a boy 8, lives in a small two-bedroom unit in Pioneer Homes. This woman was presenting symptoms centering chiefly around somatization of her anxieties concerning her own self-esteem and her environmental pressures. The children were identifying with her and presenting certain hysterical, somatic symptoms which were impairing their functioning in school and at home. There had been repeated stays in the hospital for various ailments and the family was a constant disturbance to the clinic.

Financial condition at the beginning of treatment. This family was on total ADC relief and because of their emotional state, particularly that of the mother, were getting considerable time and attention from the Medical Department of Public Welfare.

Treatment process.-This family received intensive individual casework as well as group work. The family attended summer camp and took part in family suppers.

Present state of family. The family now functions more efficiently. The mother looks upon her physical ailments with more realism and had not needed so much medical attention. She is, however, receiving dental care. The mother and children at the beginning of treatments stood on the edge of groups but at this time are able to participate wholly in a group situation. This family is now ready to be dropped from individual casework service and continue on in group work treatment only.

Financial condition at present.-This family continues to be on total ADC relief but the incidence of need for medical care have been reduced.

Tax dollars saved the community through Huntington-Junior League project.— The care at Syracuse hospitals for this family has been cut considerably. The cost to the community for this type patient is approximately $19 per day.

If left to her own devices, this mother might have had to be committed to an institution-the cost to our community for 1 year's stay would be $1,350.50. The care of her two children would have been placed in the hands of foster homes at a yearly cost of $3,120.

Total community tax dollars saved, $4,470.50.

Senator KERR. Marvin E. Larson.

Senator CARLSON. Mr. Marvin E. Larson appears here for the American Public Welfare Association. He is the director of the Kansas State Social Welfare and has been for many years, has rendered outstanding service there and I was going to suggest that I be permitted to ask him a question or two.

Senator KERR. Go right at it.

Senator CARLSON. I have to leave at 11:20.
Senator KERR. Go right ahead.

Senator CARLSON. He has a very fine statement and I don't want to break in.

Mr. Larson, in view of your experience out in the field and I can assure you, Mr. Chairman, he is doing a good job because I don't receive complaints, and having served as a Governor of a State and you have, too, I know you appreciate the type of service he renders or any of these directors, I would like to ask, Mr. Larson, in view of the fact we have these new proposals from the Secretary of Health, Education, and Welfare and we have before us a bill passed by the House of Representatives, if you as a State director have given any consideration to its possible effect or probable effect on the future of the welfare programs in Kansas.

STATEMENT OF MARVIN E. LARSON, DIRECTOR, KANSAS STATE DEPARTMENT OF SOCIAL WELFARE, REPRESENTING THE AMERICAN PUBLIC WELFARE ASSOCIATION

Mr. LARSON. Yes; I certainly have, Senator Carlson.

One of the things that I have done as a State director is to reproduce all of the State letters sent out to the various States by Secretary Ribicoff and reproduce also a summary of the bill that we are hearing, sending it to all of the county directors in 105 counties of the State, and the 105 boards of social welfare.

As you know, our boards of social welfare are elected public officials. Then we have held workshops on this material, calling in all of the counties, and in addition we have held meetings on this material in five of our eight regional meetings.

One of the things that has impressed me, since we have a good deal of change in welfare, has been the almost universal acceptance by the people actually in the field of this new legislation. County boards of commissioners always have some-that's some of them have some question about welfare. But in the main, they have accepted this as a very constructive approach, and I think that perhaps Kansas has made the widest local distribution of the new Federal requirements in public welfare of any State, and I think I can confidently say that it has good public acceptance in our State.

Senator CARLSON. Well, Mr. Larson, is it your feeling that while it may be well received, will it in any way be burdensome on the people in Kansas as taxpayers?

Mr. LARSON. No. As a matter of fact, the bill as it now stands would improve the financial situation in Kansas. It would permit an expansion of our program, an improvement in our program without requiring any additional burdensome great taxes.

Senator CARLSON. At least without great expense to the State?

Mr. LARSON. That is right.

Senator KERR. You mean you would get more Federal money with the same amount of State matching?

Mr. LARSON. Yes, that is just exactly the situation.

Senator KERR. That puts it in language that the Senator from Oklahoma can understand. [Laughter.]

Mr. LARSON. I think the Senator from Oklahoma

Senator KERR. That wouldn't be especially burdensome to you? Mr. LARSON. No, that wouldn't be especially burdensome to us. We would, of course, try to expand our program and not just utilize the funds to reduce State taxes. We would endeavor to expand the program and to make utilization of the new Federal financing.

Senator CARLSON. Mr. Chairman, I can state, based on knowledge that Kansas has been one State that when we did receive Federal contribution, in addition to what we have had in the past, that we have secured approval of legislation in our own State and to get these payments out for the benefit of these people, so I have been very proud of our State in that regard.

Another question I would like to ask if the chairman would permit, and that is in regard to the new programs which Congress has approved in the past which have placed additional burdens on the State board of social welfare particularly when it comes to training of unemployed, and in other fields.

What is the situation in our State as far as needs for staff are concerned?

Do you need additional staff?

Mr. LARSON. I think the weakest part of the Kansas program is in the fact that we have many untrained people. We have 505 county welfare employees. These are county directors, case supervisors, and social workers, or, as we call them, social workers.

Only 297 of these have college degrees; 83 percent of our staff are women. The average age is 50. With a new retirement program, we have about 50 people coming up each year who will be subject to retirement. This means we have a really tragic shortage of staff. This is something that the new board of social welfare is working on through our finance council in the development of specifications requiring college degrees and requiring better training and also in the setting of better compensation.

The fact remains we are going to need a good big expansion in our educational leave program and in our training program. Here we run into something it is difficult to translate to State budget committees and State legislatures, the need for this kind of a program, because the training of people by a State is something that exists only in public welfare.

As a matter of fact, this is the only program where Kansas spends money for the training of public employees. But we have a real serious need for a big expansion in this area.

Senator CARLSON. Mr. Chairman, yesterday the Secretary stated that this bill makes it possible for the Federal Government to participate for the first time under the Social Security Act in payments for work performed on a work or training project and in his discussion and interrogation there were some questions that I asked him,

he stated that Kansas was one of 27 States that had this work type or training type of program.

May I inquire what type of work does the person engage in?

How do you set up these work program arrangements? Who sets them up?

Mr. LARSON. Well, this in Kansas is a matter of county option. A county may set up a work project subject to, one, they have to at least pay the going wage rate for similar employment.

They have to provide enough time off so that the person can seek regular employment. It has to be designed so that it doesn't compete with regular employment. It has to be designed so that the unit of government setting it up is doing work not otherwise budgeted for, so that you are not using this to replace the normal competitive labor market.

We do not have at the present time anything in the way of a worktraining program, Senator Carlson. But we do have different kinds of work projects on park work, some road work, some street work, and that sort of thing. This involves the person who is unable to get a job, but who is physically and mentally capable if he could find a job, to work, and we consider working one of the privileges that a good society provides to its people.

Senator CARLSON. Do these people work for the State, or county, or city, or for private individuals?

Who do they work for?

Mr. LARSON. No, they work for governmental units. It might be for the county itself.

For instance in Shawnee County, one of the projects-Shawnee County suffers a statutory levy situation so you get to various areas of county work that they don't have budget for.

Then they utilize these people to do that work.

For instance the improvement of Lake Shawnee, for one thing. Sometimes they are contracted out to the city government and then the city uses them in areas where the statutory limitation does not permit them to employ people regularly.

Senator CARLSON. Mr. Chairman, I appreciate your kindness in letting me ask these questions before he proceeds with his statement. Senator KERR. Fine.

All right, Mr. Larson.

Mr. LARSON. Well, I should say first that I represent the American Public Welfare Association and the American Public Welfare Association is an organization that represents in its membership State and local departments of public welfare, plus a great many individual memberships.

This is a democratic organization in the sense that it permits participation by all of its members in the development of its policies and the development of its programs.

We hold a biennial roundtable at which the leaders in the public. welfare field gather and we hold regional meetings. We have developed a series of Federal legislative objectives, and I have a formal statement which I am filing here, and attached to this are the legislative objectives of the American Public Welfare Association.

In the matter of making a statement here, to save time, I want to endorse on behalf of the American Public Welfare Association wholeheartedly the testimony of the previous witness.

Senator KERR. Let me say that the statement and exhibit will be made a part of the record at the end of your testimony.

Mr. LARSON. One of the things that comes up in connection with 107 and that has come up in connection with some of the requirements for service, and so on, is that we were invading States' rights.

On behalf of the American Public Welfare Association and on behalf of the State of Kansas, I would like to mention that this bill really improves the authority of the States.

Senator KERR. Are you talking about section 107 or 108?

Mr. LARSON. Well, I am not to 107 yet, but what I want now to bring out is the improvement in the authority and the financial assistance given to States by the bill.

No. 1, that provides for the extension of authority to include children of unemployed under title IV.

Senator KERR. You mean that it makes permanent the provision that was passed on a temporary basis?

Mr. LARSON. Yes; that is right. That is right. But this is still a State option, you see.

Senator KERR. All right.

Mr. LARSON. It provides for additional payment for the second parent in the home, a real improvement in the ADC program. This provides for increased matching of title, I, X, and XIV, to which the Senator has already adverted.

It extends the authority for limited foster care under title IV.
Senator KERR. Now, in what way does it do that?

Mr. LARSON. It provides for Federal participation for a child placed in foster care who has been on ADC and where foster care placement is by a welfare department.

Senator KERR. Whether it is in a foster home or an institution? Mr. LARSON. Yes.

Senator KERR. And you favor that?

Mr. LARSON. Yes.

Senator KERR. All right.

Mr. LARSON. Then it, well, you anticipated me, it extends foster care authority to include institutional as well as family care. It liberalizes the State's authority to comply with the so-called Flemming ruling in connection with suitable home provisions.

It gives authority to provide community work and training programs, which Senator Carlson just brought up.

It provides for demonstration projects outside of plan requirements and is an exception to the uniformity requirements of the bill. And it provides for an option to combine categories 1, 10, and 14, to combine in sort of a casserole category old-age assistance, aid to disabled, and aid to the blind.

Then it broadens the definition of child welfare services and then it provides for additional funds to help finance day care programs. So really this, rather than tightening the authority of the States, expands the authority of the States.