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KINDS OF SERVICES

The National Society for Crippled Children and Adults has a responsibility to serve persous suffering from any type of crippling condition within the scope of its program, and for whom no other agency provides needed care and treatment. Therefore, in order to carry out this responsibility, the society strives 10 establish services and facilities which can and do meet the needs of persons with various kinds of disabilities. It is not only undesirable but economically infeasible, particularly in view of the extreme shortage of qualified professional persoanel to develop separate treatment facilities for each of the different types of crippling diseases.

Rehabilitation centers are examples of facilities which give comprehensive Services to crippled persons suffering from various types of crippling conditions. Much of the national society's recent activity has been devoted to the extension and development of community rehabilitation centers, both because of the great Lietud that exists for this type of service and also because of their proved effectiveDess in rendering maximum service in the most efficient manner.

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THE PROBLEM

The extent of the problem of permanent physical handicap is unknown. Esti

The most wates bave been made, however, on the basis of careful studies. Teliable available estimates of these composite studies, as compiled by the national society are as follows: 50.000 children and adults with cerebral palsy 400,000 major amputees 1,300.000 severe arthritics 1,000.00w bemiplegies 10.000 with muscular dystrophy 20.00 with multiple sclerosis 6,02.0080 children and adults with significant speech defects 80,000) crippled from poliomyelitis alid others

COSTS

Costs of medical care and treatment vary, depending upon the extent of the care received. Some examples will serve to illustrate how costly treatment for the crippled actually is. Average month cost at an outpatient cerebral palsy tnatment center which offers physical therapy, occupational therapy, speech theraps, and psychological and social services may vary from $350 to $750 per child.

PERSONNEL SHORTAGE

The total funds which we have available are inadequate to perform the job at hand. The great need for additional trained personnel to perform these Deeded services has also made our task a difficult one. A survey of professional personnel employed by the Easter seal societies made in May 1953, is illustrative of the acute personnel shortage. The survey showed that these units of the national society employ 1,310 professional workers, but have vacancies equivdiet to almost 1 out of 5 members of the professional force. The societies, when asked to estimate their professional personnel needs in 5 years, anticipated almost a doubling of present professional personnel. The greatest expansion is expected to be among those professional groups who directly serve the handiall-the physical, occupational, and speech therapists, special teachers, Borial workers, and psychologists. In the Nation as a whole, this picture of present shortages and rapidly expanding additional needs for professional workers trained to work with the crippled is equally true. For example, there ate at present, an estimated 5,000 registered physical therapists practicing, and there are 2,500 vacancies. Within 5 years, an additional 5,000 will be heeled. To meet this need, a total of 8,000 must be trained (allowing for a ? percent attrition rate), requiring an annual average of 1,600 graduates. Instead, in 1953 there were an estimated 624 graduates in physical therapy. In the field of occupational therapy, there are about 3,600 registered therapists Practicing and vacancies for 3,000 more. The current graduation rate of a lite more than 600 per year cannot begin to meet present needs, much less the expanding future requirements.

OENTS HEALTH RECOMMENDATIONS

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PRESIDENT S HEALTH RECOMMENDATIONS

solist. The importance of early rebabilitation in physical

ha established. The longer a disability goes untreated, om bilees for success, the deeper are the emotional scars, - **¢ are chances for education and vocational adjustment.

dren, and continuity of care are of primary importance. : 1) cost carry responsibilities of homemaking and rearing

Dther problem. These are included in the groups to szety for Crippled Children has been devoting its elforts

for additional services is so urgent. its of rehabilitation besides the economic. The value Dane persons in terms of personal development and personal carote No one can place a value on ability to lift a spoon to fuis miss a roolll, and these are the things that rehabilitamet wisaluled persons. The increased ability of handicapped di cod employment creates a beneficial effect on the morale ...'n family, his community, and society as a whole. ** stitices in rehabilitation has been given by the national

The Deed for expansion of its facilities is urgent and "Ty of physical plants and equipment, and for adding

breased publie awareness of the potentiality which dis..ltful citizenship, economic productivity, and happy rad, y increasing the demand for sei vices to make possible

s potentiality to its maximum. It is not so much a quesmunities to accept rehabilitation services, but rather a e cuand for services, which the average citizen is now wapital. A combination of factors is responsible for this.

It is generally accepted that employability and social acceptability ar- the two major ains of treatment and education of the handicapped. To achiele these goals, careful attention to vocational and personal guidance needs is a sentinl. We need to stress abilities rather than disabilities, and assets rather than liabilities, if skills are to be developed which are the basis of economie independence. A note of warning must be given to those who would set cripped persons or by themselves. This is a world peopled by the nonhandicaji+d, and a crippled person does not learn best to live in it by associating only with thuse like himself. Our oljective should be to provide the optimal dekrip of service with a minimum degree of separation from family, home, and parent and minimum deprivation of opportunities to participate in the activities of other types of crippled persons as well as those of the nonhandicapped.

We have a creat deal of evidence that investment of funds in the rebabilita. tion of the crippled produces social and economie returns of great vaine. Speaking from a purely business point of view, it is sond business practice to invest money in programs for the disabled. In the field of vocational re habilitation it has been adequately demonstrated that, where disabled *P*r$ may be marie fit for employment through reubilitation and become tax prom lucers rather thin tax consumers, it would seem poor pennomy to deny them these services. It is estimated that for every dollar pent by the Fmeral Goro ernment on rehabilitation of disabled adults the average disabili man of woman will pay $10 in Federal income taxes. This is the dollars and a tots Justination of a vocational rehabilitation program. We are confident that funds invested in expansion of this program to support the voluntary pferts being made throughout the Nation will result in just as dramatic a dollare and cents return for the original inseminent,

The National Society for (rippled Children and adults belieses the problem of crippling in general to be a tremendous one retiring all the energie of public and private agencies to meet. Additional funds and increase mere of traved prsonnel are critically needed to provide and staff the west *-* and facilities which will bring to the cripplest of our counire all of the technines of rehabilitation of which we now have knowledge. Similarly, there is an urant necil for vastly increased research efforts in fields where we already have reano to boljese heartening results enn be realized and in teles tot per explised

While Federal, state, and local ta upported services for the disabled hive been constantly urowing, the voluntary sencies are making a steadily increas ing contribution in this field. Extending and supplementing the public fres tions, the voluntary agencies are taking care not to duplicate these functions and offer resonrepe from which tax-supported akencing may purchase care addition, the flexibility of the private agency allows it to enter new fields, demolistrate new techniques, and to overcine important leader-bip in bringing to publie aniontion the neeels of the handicapped.

There is a real need for preseriing the values of voluntary effort. In the I'nited States, the voluntary health movement has taken a permanent and fiportant place in the Nation's health program. Our public health strukture has

en comprred to an equilateral triangle, one side of the triangle is the voluntary healih agency, the second side is the governmental, t: supported hraith o geney, and the base is the medical profesion. Each side is of equal importance, for without the support of the public and the enthusiasm of the volume iter. the medical profession would be working alone in a population that is a puthetic and uniformed a situation that does enjst in many parts of the world

Many local communities, faced with starkering couts of new construction and funnits for maintenance and personnel, have delaved their plans or reduced their mpire intentions to a minimum. With assistance in capital costs of construction, tipse limited programe can be expandel, and new programs can be established which will be truly effective in meeting the needs of the crimpiled. Around the nucleus of the smaller centers which have been pastablished, a rehabilitattoo program truly national in scope and broad in range of services offered can be built. A prohlom universally faced by voluntary agencies is finding ways and meins to serve those who need treatment hiut cannot pay for it. The dual challenge of financing and equipping an expensive physical plant, and at the kame time providing services and securing community support for thosa unabie to pir in one which can be more easlly faced with support which can be riven with the passage of 8. 270.9. Also, there are age groups to be served, and this wins with disabilities who do not come within the range of eligibility for somet final rehabillitation. These are the infants and young children, the housewives

dwar Veterans, efforts to meet the tragic consequences sat toll, new knowledge for families of children born Ipi, public education programs of public and voluntary

bet stimuli have brought new hope and a keener aware*** ad future prospects in the lives of the disabled.

apimant role played by voluntary, nonprofit agencies in hin, services, we believe President Eisenhower has taken Tyrd in unitiuz private and public effort in a common cause.

47 agency whose strength lies in the local communities * In le provided to reach the individuals in need of wypy p'eiges its support to increased programs of care, ";to keep pace with developments which we believe will *the passage of S. 2759.

** field of health and welfare, none so much as rehabilitait to get the job done. It takes combined efforts of the - xtor, the therapist, the social workers, the psycholovitional counselor, the employer, to accomplish rehabilita

19,6 the community, voluntary and governmental groups, otsd fast amount of work to be done, a stupendous task

as feite our forces toward achievement of a common goal. sources, working together under the unparalleled bondable to us, can we reach the goal of which will mean 1. who need it the maximum service they need and can

1 an. Javne Shover, and I am the associate director of As for Crippled Children and Adults, which is a volwelfare organization operating in 48 States and

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ning for 33 years and we have over 1,300 organpemand in the Territories advising and governing 19. a beard of voluntary citizens who serve without

approximately 350,0wW) volunteers, of which members in the local communities. afa re have best been termed as a grassroots organ

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and mothers, the elderly. The importance of early rehabilitation in physical disability has long been established. The longer a disability goes untreated, the less favorable are chances for success, the deeper are the emotional scars, the more complicated are chances for education and vocational adjustment. Services to young children, and continuity of care are of primary importance. Disabled mothers, who must carry responsibilities of homemaking and rearing a family present still another problem. These are included in the groups to whom the National Society for Crippled Children has been devoting its efforts and for whom the need for additional services is so urgent.

There are other benefits of rehabilitation besides the economic. The value of rebabilitation to these persons in terms of personal development and personal freedom is immeasurable. No one can place a value on ability to lift a spoon to feed oneself, or to walk across a room, and these are the things that rehabilitation has meant to many disabled persons. The increased ability of handicapped individuals for self-care and employment creates a beneficial effect on the morale of the individual's entire family, his community, and society as a whole.

Leadership in direct services in rehabilitation has been given by the national society for many years. The need for expansion of its facilities is urgent and (Titical, both for expansion of physical plants and equipment, and for adding to services and staff. Increased public awareness of the potentiality which disabled persons have for useful citizenship, economic productivity, and happy adjusted social life is daily increasing the demand for sei vices to make possible the development of this potentiality to its maximum. It is not so much a ques0:00 of educating communities to accept rehabilitation services, but rather a problem of meeting the demand for services, which the average citizen is now crming to recognize as vital. A combination of factors is responsible for this. Rehabilitation of disabled war veterans, efforts to meet the tragic consequences of the increasing accident toll, new knowledge for families of children born with physical disabilities, public education programs of public and voluntary agencies—these and other stimuli have brought new hope and a keener awareDes of present needs and future prospects in the lives of the disabled.

In recognizing the important role played by voluntary, nonprofit agencies in developing rehabilitation services, we believe President Eisenhower has taken a significant step forward in uniting private and public effort in a common cause.

Speaking as a voluntary agency whose strength lies in the local communities where direct services must be provided to reach the individuals in need of them, the national society pledges its support to increased programs of care, treatment and education to keep pace with developments which we believe will be made possible through the passage of S. 2759. Of all programs in the field of health and welfare, none so much as rehabilitation depends on teamwork to get the job done. It takes combined efforts of the professional team: the doctor, the therapist, the social workers, the psycholokist

, the teacher, the vocational counselor, the employer, to accomplish rehabilitation. The cooperation of the community, voluntary and governmental groups, is essential. There is a vast amount of work to be done, a stupendous task whichballenges us to unite our forces toward achievement of a common goal. Only by this pooling of resources, working together under the unparalleled melical leadership available to us, can we reach the goal of which will mean making available to all who need it the maximum service they need and can utilize, Miss Shover. I am Jayne Shover, and I am the associate director of the National Society for Crippled Children and Adults, which is a voluntary health and welfare organization operating in 48 States and the 4 territories of the country.

We have been operating for 33 years and we have over 1,300 organized units in the States and in the Territories advising and governing the national society as a board of voluntary citizens who serve without ey pay, and we have approximately 350,000 volunteers, of which 30,000 serve as board members in the local communities.

I think perhaps we have best been termed as a grassroots organ

ization.

y We can take adults in addition to the childi the present time we have a small section of agencies and the medical societies look to 'ls.

mieran look to some additional assistance from our
... stocational rehabilitation.

where the societies for crippled children believe,
msuccessfully, as a team with the public agencies.

is in support of both the bills, S. 2758 and S. 2759,
we work very well with both the Public Health

The national society, which was organized in 1919, has as its major emphasis the development of care and treatment facilities and direct service for the crippled and the handicapped and disabled. for the understanding and acceptance of people who are crippled

obaved three point program: We have education of the public wherselop this further. This will not be possior handicapped; we have a program for training professional personnel, to which I should like to address some remarks a little later to you: we have a program for the training of the parents of children who are handicapped and crippled, particularly those who are crippled; and we have a new program for the emplovers on the value

nal Rehabilitation Service. and contribution of handicapped and crippled workers, and we have an educational program for the volunteers.

: of these services we may have many obstacles. We do have a beginning research program, because we accept the

Eo the lack of community interest. We are able fact that all knowledge stems and all progress comes from reparh;

z odatirely through our boards and through the but since we were chartered in 1919 as a direct service organization, as

... uity

. Our problems come where we have a the result of a very serious tragedy of more than 60 children being Erli a shortage of trained therapists, for example. hurt in a community in the Midwest, and there were no resources for - marams and in those that we assist–because we care, for rehabilitation for these children, we have abide by our ** pul program treatment centers and rehabilitation charter and have proceedel on that hasis

m. ibition to the 181 centers that we have—we have Today we have 574 facilities in this country. There are many dif- surtages in the field of personnel. For example, ferent types of facilities, but they could all be pretty well classified, * su physical therapists. We need additional the major number of them, as services that give rehabilitation.

We know that we are very short on vocational
You might be interested to know that we nerve children and adults. lowk somewhat to our vocational rehabilitation
We prve from birth to death, having no are range or no limitations.
We have no limitations as to financial ability to pay, although we address

ailes some remarks here to the point that we do hope those who can a-sint us will do so upon the advice of our ?im encompasses medical care straight through medical committees in the communities and our national medical

ver coun:eling, and employment or placement and advisers and allied advisers. Our program is guided by counselors from the American Metical

1any one suspect of rehabilitation is more imporAsociation and 15 specialty organizations.

inther, we see the medical care forming a basis, In these programs for direct care and treatment, about which I

to alleviate and eliminate the handicap. From would like to talk for a minute and I would like to say here probably

with the other associated health services, because the particular reason I am adı trening you for this organization is that

mt nl care and the basic services we cannot build I have completed program consultation and study in the th States and

bir rehabilitation, but the medical side is not the 2 of the Territories, and from this experience we know that there 15

: of reliabilitation. We recognize this and so state it. no State or no Territory that has the rehabilitation services and facili

ar that our units are located, some of them, in ties that it needs to rehabilitate its people--for 1951 and 1972 we were able to rehabilitate a number of people, working with many com

wme of them in medical schools

, and we hope

- Suur rehabilitation centers near or affiliated with munity service agencies. We offer our services through many com:

sa fie the reason that more personnel for rehabilitation munity groups, such as the American Legion, the Rotary. Kiwanis, the various men's and women's service groups and clubs. More recently we have had a campaign to bring college women from Panhellenic groups in the community for the benefit of these people.

In the communities we have some centers that are almost compra hensive.

I would say we have no one center that offers all of the services that we would like to have for everybody to rehabilitate them snecessfully. We do feel, however, that even some of our simple begin; ning centers, where there is a therapist, working under a medical udvisory committee, that many of those centers have real potential to become community services to serve the community better. I would like to refer to come of the centers that vou may know of. I refer

Pirds, the counseling fields, the employment fields, to the Gompers (enter in Phoenix, Ariz., for example, where we hope

the Senators here mentioned the problem of per

Mi like to say it takes a little while to mobilize the Ar and the training programs; it takes several years

't steps of establishing physical therapy training **; training departments

, hospitals which are recepave an interest in adding to their teaching programs *sion. It is not a question of whether or not $1

as we can adequately and conservatively spend 3.!. We can get our groundwork laid and our forces *** train more people in all of these fields, including

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to expand the program so we can take adults in addition to the children's program. At the present time we have a small section of adults, but the public agencies and the medical societies look to !is. with the community, to develop this further. This will not be possible. however, unless we can look to some additional assistance from our public agencies such as vocational rehabilitation.

I would like to say here the societies for crippled children believe, and have worked very successfully, as a team with the public agencies.

Since I am testifying in support of both the bills, S. 2758 and S. 2759, I would like to say we work very well with both the Public Health Service and the Vocational Rehabilitation Service. In the development of these services we may have many obstacles. But one of them is not the lack of community interest. We are able to mobilize rather effectively through our boards and through the citizens in the community. Our problems come where we have a shortage of personnel, a shortage of trained therapists, for example.

In the society's programs and in those that we assist–because we assist almost a hundred program treatment centers and rehabilitation units and services in addition to the 181 centers that we have, we have experienced critical shortages in the field of personnel. For example, we need now more than 80 physical therapists. We need additional speech therapists. We know that we are very short on vocational counselors, but we will look somewhat to our vocational rehabilitation service to provide these.

Perhaps I should address' some remarks here to the point that we believe that rehabilitation encompasses medical care straight through to vocational training, counseling, and employment or placement and followup.

We do not see that any one aspect of rehabilitation is more important than the other; rather, we see the medical care forming a basis, doing all that it can to alleviate and eliminate the handicap. From that basis we build with the other associated health services, because without good medical care and the basic services we cannot build A sound program for rehabilitation; but the medical side is not the complete program of rehabilitation. We recognize this and so state it.

I would like to say that our units are located, some of them, in community buildings; some of them in medical schools, and we hope to locate more of our rehabilitation centers near or afliliated with medical schools, for the reason that more personnel for rehabilitation can be trained.

I think one of the Senators here mentioned the problem of personnel, and I would like to say it takes a little while to mobilize the community's efforts and the training programs; it takes several years to work through the steps of establishing physical therapy training schools

, psychology training departments, hospitals which are receptive to and which have an interest in adding to their teaching programs courses in rehabilitation. It is not a question of whether or not $1 million is as much as we can adequately and conservatively spend the next year until we can get our groundwork laid and our forces mobilized

so we can train more people in all of these fields, including the psychological fields, the counseling fields, the employment fields, as well as the other fields.

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