KINDS OF SERVICES

The National Society for Crippled Children and Adults has a responsibility to serve persons 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 to 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 personnel 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 need that exists for this type of service and also because of their proved effectiveLess in rendering maximum service in the most efficient manner.

THE PROBLEM

The extent of the problem of permanent physical handicap is unknown. Estimates have been made, however, on the basis of careful studies. The most reliable available estimates of these composite studies, as compiled by the national society are as follows:

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 treatment center which offers physical therapy, occupational therapy, speech therapy, 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 needed 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 equivalent 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 handicapped-the physical, occupational, and speech therapists, special teachers, social 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 are 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 needed. To meet this need, a total of 8,000 must be trained (allowing for a 7 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 httle more than 600 per year caunot begin to meet present needs, much less the expanding future requirements.

It is generally accepted that employability and social acceptability are the two major aims of treatment and education of the handicapped. To achieve these goals, careful attention to vocational and personal guidance needs is essential. We need to stress abilities rather than disabilities, and assets rather than liabilities, if skills are to be developed which are the basis of econoraie independence. A note of warning must be given to those who would set crippled persons off by themselves. This is a world peopled by the nonhandicapied, and a crippled person does not learn best to live in it by associating only with those like himself. Our ol jective should be to provide the optimal degree of service with a minimum degree of separation from family, home, and parents, 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 great deal of evidence that investment of funds in the rehabilitation of the crippled produces social and economic returns of great value. Speaking from a purely business point of view, it is sound business practice to invest money in programs for the disabled. In the field of vocational rehabilitation it has been adequately demonstrated that, where disabled persons may be made fit for employment through rehabilitation and become tax producers rather than tax consumers, it would seem poor economy to deny them these services. It is estimated that for every dollar spent by the Federal Government on rehabilitation of disabled adults the average disable man or woman will pay $10 in Federal income taxes. This is the dollars-and cents Justification of a vocational rehabilitation program. We are confident that funds invested in expansion of this program to support the voluntary elects being made throughout the Nation will result in just as dramatic a dollars-andcents return for the original investment.

The National Society for Crippled Children and Adults believes the problem of crippling in general to be a tremendous one requiring all the energies of public and private agencies to meet. Additional funds and increased numbers of trained personnel are critically needed to provide and staff the services and facilities which will bring to the crippled of our country all of the techniques of rehabilitation of which we now have knowledge. Similarly, there is an urgent need for vastly increased research efforts in fields where we already have reason to believe heartening results can be realized and in fields not yet explored

While Federal, State, and local tax-supported services for the disabled have been constantly growing, the voluntary agencies are making a steadily increas ing contribution in this field. Extending and supplementing the public fene tions, the voluntary agencies are taking care not to duplicate these functions and offer resources from which tax-supported agencies may purchase care In addition, the flexibility of the private agency allows it to enter new fields, demonstrate new techniques, and to exercise important leadership in bringing to public attention the needs of the handicapped.

There is a real need for preserving the values of voluntary effort. In the United States, the voluntary health movement has taken a permanent and important place in the Nation's health program. Our public health structure has been compared to an equilateral triangle, one side of the triangle is the volum tary health agency, the second side is the governmental, tax supported health agency, and the base is the medical profession. Each side is of equal importance, for without the support of the public and the enthusiasm of the volunteer, the medical profession would be working alone in a population that is apathetic and uniformed a situation that does exist in many parts of the world Many local communities, faced with staggering costs of new construction and funds for maintenance and personnel, have delayed their plans or reduced their specifications to a minimum. With assistance in capital costs of construction, these limited programs can be expanded, and new programs can be established which will be truly effective in meeting the needs of the crippled. Around the nucleus of the smaller centers which have been established, a rehabilitation program truly national in scope and broad in range of services offered can be built A problem universally faced by voluntary agencies is finding ways and mens to serve those who need treatment but cannot pay for it. The dual challenge of financing and equipping an expensive physical plant, and at the same time providing services and securing community support for those unable to pay is one which can be more easily faced with support which can be given with the passage of 8. 2759. Also, there are age groups to be served, and persons with disabilities who do not come within the range of eligibility for vocational rehabilitation. These are the infants and young children, the housewives

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.

The value There are other benefits of rehabilitation besides the economic. of rehabilitation 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 critical, 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 services to make possible the development of this potentiality to its maximum. It is not so much a question of educating communities to accept rehabilitation services, but rather a problem of meeting the demand for services, which the average citizen is now coming 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 awareness 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 psychologist, 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 which challenges us to unite our forces toward achievement of a common goal. Only by this pooling of resources, working together under the unparalleled medical 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 any pay, and we have approximately 350,000 volunteers, of which 50,000 serve as board members in the local communities.

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

ization.

門

The national society, which was organized in 1919, has as its major emphasis the development of care and treatment facilities and direct services for the crippled and the handicapped and disabled.

We have a three-point program: We have education of the public for the understanding and acceptance of people who are crippled or 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 employers on the value and contribution of handicapped and crippled workers, and we have an educational program for the volunteers.

We do have a beginning research program, because we accept the fact that all knowledge stems and all progress comes from research; but since we were chartered in 1919 as a direct service organization, as the result of a very serious tragedy of more than 60 children being hurt in a community in the Midwest, and there were no resources for care, for rehabilitation for these children, we have abided by our charter and have proceeded on that basis.

Today we have 874 facilities in this country. There are many different types of facilities, but they could all be pretty well classified, the major number of them, as services that give rehabilitation.

You might be interested to know that we serve children and adults. We serve from birth to death, having no age range or no limitations, We have no limitations as to financial ability to pay, although we do hope those who can assist us will do so upon the advice of our medical committees in the communities and our national medical advisers and allied advisers.

Our program is guided by counselors from the American Medical Association and IS specialty organizations.

In these programs for direct care and treatment, about which I would like to talk for a minute and I would like to say here probably the particular reason I am addressing you for this organization is that I have completed program consultation and study in the 48 States and 2 of the Territories, and from this experience we know that there is no State or no Territory that has the rehabilitation services and facili ties that it needs to rehabilitate its people--for 1951 and 1952 we were able to rehabilitate a number of people, working with many community service agencies. We offer our services through many com 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 comprehensive.

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 suc cessfully. We do feel, however, that even some of our simple beginning centers, where there is a therapist, working under a medical advisory committee, that many of those centers have real potential to become community services to serve the community better. I would like to refer to some of these centers that you may know of. I refer to the Gompers Center in Phoenix, Ariz., for example, where we hope

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 us. 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 affiliated 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.