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Miss SHOVER. Well, there is no school. There are several schools which have departments, such as departments of social work and psychology, that are attempting to give the presentation of this new concept of rehabilitation, but I know of no particular school that has a completed course, a teamwork course in rehabilitation.

That is in process, for example, in the medical profession. There have been grants recently made by one of the national agencies, the National Foundation for Infantile Paralysis, to seven medical schools to develop the concept in the medical-training programs of rehabilitation. In other areas, and in specific colleges and universities, you will find--for instance, the University of California at Los Angeles, under Dr. Warren now, has a new program for the rehabilitation center developing out there, and I am sure they will have the concept of rehabilitation permeating through all the special schools that serve the rehabilitation field.

Rehabilitation encompasses many things, as you have found out, from medical care on through employment. It is the most comprehensive type of thing I think we have in the whole health and welfare type of field.

Senator GOLDWATER. The schools are beginning to recognize the need for training in this field, and do you feel, as we go along, year to year, that proper money should be appropriated according to the facilities that are available and according to the teachers that are available, and so forth, that this program is a progressive one and as facilities become available more money will become available ?

Miss Suover. There should be funds available to assist training schools and centers to give the courses they are prepared to give.

There have not been funds available in many instances for a college or university to develop certain programs. Private agencies at the present time are underwriting certain therapy courses in university departments in order to keep them in operation. I think specifically of one at Northwestern University in physical therapy, for example, and if there were funds available I feel quite sure some of the colleges and universities would be receptive to exploring the possibilities of developing more teaching programs: but colleges and universities have budget problems I need not mention that at this present time, and serious ones, many of them.

Senator GOLDWATER. This is a problem that has been in existence for a long, long time; this problem of training didn't just occur this year. id it!

Miss SHover. No; but I think we would have to say that rehabilitation has been something the importance of which many people have realized for many years, but have not always done something about.

You might say, "ihy all this interest?" now.
Well

, maybe World War II brought it about. I don't know, but maybe it is a late appreciation that human beings are still very important to us and can make a tremendous contribution, whether they have a crippling condition or not.

I think we have just in the past decade began to realize the true value and the great reservoir of worth in our handicapped persons, the millions that we have.

Senator GOLDWATER. I think you realize this is the first time that a rehabilitation bill has included any funds for training and that these funds, after this inception, will be based upon both the supply and the demand, supply of education and the demand for trained people.

Niiss SHOVER. I think we must face the fact if we expect the agencies, the Veterans Administration, for example, to rehabilitate and care for more people than they ever have before; this places a great burden on professional personnel for the rehabilitation of the soldier bors and disabled civilians. And, if you request us to take off these relief rolls as many as possible, then we must have, both the public and the private agencies, the tools with which to do the job; and there are three tools--the persons who do it, the buildings in which we do it, and the funds with which to operate.

You say this is the first time. I think it is significant for this is the first time that we, as a network in one of the largest voluntary organizations in this field, have spoken in favor of this, because we think it is so important.

Senator GOLDWATER. Miss Shover, I used the word "will" in connection with rehabilitation. I meant to say the Rehabilitation Act has never contained funds for the training before.

Miss SHOVER. I realize that, but I think that is unfortunate.

Senator GOLDWATER. I think it is very unfortunate, too, and I am very happy this year that has been caught and that this oversight has been corrected. There is now money available for training and we are dedicated now to a furtherance of the training program.

Do you have anything further to say?
Do you have anything further?

Senator LEUMAN. Yes. I just want to ask: Have you any information as to the cost of training an expert therapist ?

Miss SHOVER. An expert therapist?

I have no figures that have been scientifically arrived at by statisticians, but I have heard the physical-therapy consultants say that the cost will run all the way, for i year of training from around $1.200 to $1,500, depending on where they go, Mr. Lehman, depending on whether they go to a private school or to a public university. You see, there is the difference in tuition and fees and there is the difference in living costs.

We do not have the exact figures on the therapy field as the medical association has, for example, on the training of doctors, which, as I said, is $2.500 per year.

We do know that there is a vast number of young men and women, and I say men and women because we certainly want to get more men into the field of rehabilitation-who would go to school if there were scholarship funds available.

We know that through our experience and our own scholarship fund. We have trained more than a thousand people in rehabilitation the last 4 years, and we know it is only just a wee, tiny thing, becanse we cannot staff anywhere near our own centers. We need 2,500 therapists in our own centers in the next 3 years.

Senator LEHMAN. Mr. Power testified that in the vocational training of the physically handicapped, the actual vocational training is of far greater importance than the medical evaluation or even the medical treatment, which, of course, is necessary, too. But stress was laid on the fact that the vocational training factor is the greatest in

making a person self-supporting and again a useful and gainfully occupied member of society. Would you subscribe to that?

Miss SHOVER. Mr. Lehman, I do not believe that any one member of a rehabilitation team is more important than the other. I believe that all the members of the rehabilitation team are equally important, and they all have an important role to play, beginning with the case finding, often with the public health nurse who finds the person back in the home, on through the medical care specialist, because until we have the condition taken care of medically, then we are not building on a very sound basis any kind of a vocational or any type of rehabilitation program.

So, if you will permit me, it is our experience, through the past 15 or 18 years, and from working on the rehabilitation team myself for almost 2 decades, all are equally important. We strive very hard to bring into rehabilitation the whole teamwork approach.

There is no particular captain of this team. Maybe some people might think it would be the doctor; but if he does it, he does it so adroitly that every one of us on the team feels equally important to the life of that patient and the rehabilitation. So, I would say all are tremendously important, neither one to the exclusion or to the disadvantage of the other.

Senator LEHMAN. You know, Miss Shover, I was very much impressed by the moving sentences that you included in your statement. After discussing the economic situation and the costs of rehabilitation you say:

There are other benefits of rehabilitation besides the economic. The value of rehabilitation to these persons in terms of personal development and persanal freedom is immeasurable. No one can pace 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 hardicapped individuals for self care and employment creates a beneficial effect on the morale of the individual's entire family, his community, and society as & whole. I fully agree with that statement. It is very well expressed. But those are the things that have to be done by therapists and not by doctors. And unless you have a sufficient number of trained therapists, people will not be taught how to lift a spoon or walk across a room, and I think those things are so important. I have seen them in the institutions of my own State.

I want to see this thing speeded up: Miss Shover. If I may say so, I think the service to a person who first learns or first experiences that the father of the family is injured is sometimes as valuable as any service we can give them. That may be given by a doctor. That understanding that all of the world does not close because something happens to disable an individual is something that must be taught psychologically. After all, it is the spirit and the point of view. Living with a handicapped person is maybe not easy, but it is certainly possible.

Senator Hill. I am sorry I missed your testimony and I assure you I will read it with much interest and with much benefit, I am sure.

Senator GOLDWATER. I want to thank you, Miss Shover, for the very excellent testimony you have given. Your prepared testimony will be made a part of the record. You have been a very valuable witness, and thank you for coming.

The next witness will be Mrs. Vivian Shepherd, executive director, Kansas City Rehabilitation Institute.

Mrs. Shepherd, I would like to call the attention of the committee to the fact that the rehabilitation institute is a nonprofit private organization which started as late as 1947.

STATEMENT OF MRS. VIVIAN SHEPHERD, EXECUTIVE DIRECTOR,

KANSAS CITY REHABILITATION INSTITUTE

Mrs. SHEPHERD. That is right.

Senator GOLDWATER. I have heard through a mutual friend, Jír. Cookingham, of the tremendous strides you have made in this. In fact, on his last visit to Phoenix he mentioned the desirability of our cities following Kansas City's pattern, and our present city manager, who is Ray Wilson, who also used to be in Kansas City, concurred. So I think possibly the capital city of Arizona will shortly follow your own example.

You can proceed in any way you care to. If you want to read from notes or read your prepared text, you may.

Mrs. SIEPHERD. I will not read my prepared text. You have a copy.

Senator GOLDWATER. It will be made a part of the record. (The prepared statement of Mrs. Shepherd is as follows:)

STATEMENT BY MRS. VIVIAN SHEPHERD, EXECUTIVE DIRECTOR, THE REHABILITATION

INSTITUTE, KANSAS ('ity, MO. Mr. Chairman and members of the committee, I am very pleased to appear before you today as the representative of the Rehabilitation Institute of Kansas City, Mo., in support of the President's recommendations on vocational rehabilitation and other phases of his health program as expressed in Senate bills, 2738 and 2739.

I am especially pleased that S. 2759 does not contain the restrictive measures for financing the program included in the appropriation bill passed in the spring of 1973 which provided the funds for vocational rehabilitation. Ilowever, if this bill does not rescind that particular language, such action should be taken. This restriction will seriously cripple the rehabilitation program instead of permitting it to move forward in a positive manner. In the State of Missouri alone, it would mean a loss of more than $120,000, and hence several hundred people would not be given the opportunity for rehabilitation and would remain recipietis of public assistance instead of becoming tax producers. Since there is already a very large lacklog of persons in Missouri who need these services and who cannot be serveil because of the lack of sufficient funds, this reduction would mean an irretrievable loss to our people.

Although others are presenting to you the national situation, I would like to reemphasize the need for an adequate national program of rehabilitation. The rapid increase in the numbers of people in our population who need rehabilitation is mainly due to two developments: (1) Advances in medical science save the lives of many people who otherwise would die, but many of these people remain disabled, (2) the incidence of disabling conditions increases with age, and the number and proportion of older people in our population becomes greater each year.

Many of these disabled people are, of necessity, on welfare roles. Nearly $100 million in public assistance was paid nationally in 1972 to meet the barest needs of 845.00 men, women, and children who were ilisabled themselves, or who were the dependent children of disabled breadwinners.

Although the total number of people who are disabled is not known with any accuracy, it is estimatid to be around 2 million. And many thousands more become seriously disabled each year. The funds currently allocated to the Federal-State program of vocational rehabilitation are harilly enough to begin to meet the rehabilitation needs of these people.

The legislation proposed in these bills is not only vitally important now, but also, for the future development of our country. We are posing a teriflic problem for our young people unless we take the necessary steps to relieve them of some of the growing burden of disability. For instance, the young man with a growing family will be faced with the possibility of not being able to educate bis own children because he has to support an increasing number of the aged, the chronically ill, and the seriously disabled, both in his own family and in the community. Expanded programs are needed on the Federal level, the State level, and in local communities to meet this problem.

More can now be done to overcome the handicapping effects of disability than was erer possible before. Many thousands of these persons can be rehabilitate if all of us organize our resources to provide the best possible services and techniques. The expanded hospital construction and vocational rehabilitation programs which these proposed bills would make possible is an essential step in realizing these ains,

Community action in the fields of health and rehabilitation which will materially spread the base of support can be immensely stimulateri by Federal and State programs in these fields. I would like to illustrate the effect of such programs by describing our experiences in Kansas City.

First, I would like to tell you how the vocational rehabilitation program helped us develop a community rehabilitation center. In 186, professional workers in vocational rehabilitation and other allied programs, greatly concerned about the inadequacy of local facilities to meet the needs of the disalled met with community leaders and explored possible solutions to meet these needs.

As a result of the plans which developed out of these meetings, tłie Rebabilitation Institute was incorporated in 1947 as a nonprofit orzanization for handicapped persons disabled by disease and accident. The institute provides physical, occupational, and work theraps ; psychological services, speech therapy, prevocational tryouts, and some job placement of the disabled, so that they may become, to the fullest extent, independent and useful members of the community.

The institute is staffed by qualified personnel in each of the various departments and, in addition, trained volunteer aides are provided by a number of local women's groups.

Patients at the institute hare ranged in age from a 15-month-old baby stricken with polio to an 82-year-old man with a bad fracture of the hip. Patients are referred by private physicians, hospitals, clinics, vocational rehabilitation, the Veterans' Administration, workmen's compensation, crippled children's service, insurance companies, and welfare agen(ies. Feos from the Federal-State programs are an important part of the financing of the institute. Besides fees, funds are provided through gists and grants from organizations and foundations, and the Community Chest.

The demand for the services of the Rehabilitation Institute has grown rapidly. In the first full year (1918), the institute had 4,427 patient visits from 141 [ersons. The operating budget for that year was $24.010. Last year (1953), there were approximately 20.000 patient visits from 745 persons. A budget of $6,003 was required to serve these persons with a greatly expanded program. In Ebruary and Varch of this year (1974), the institute has received 176 new patients which is more than the total patient load of its first year of operation ; these new patients in addition to the aiready active load of 200 patients.

The existence of the institute is the result of careful planning, a great deal of hard work, and a community desire to serve its disabled citizens. When we secured the building which we now occupy, it was found that extensive remodeling was necessary to make the space usable for our purpose. It was amazing to see how the community rallied to meet this need. Organized labor, contractors, manufacturers, business, industry, civic organizations, and individuals donated time, labor, materials, and equipment with the result that we now have a very well-equipped center acquired at a minimum cost. This would have been impossible without the fine cooperation displayed by these many diverse groups.

It would, also, have been impossible without the Federal-State vocational rehabilitation program which influenced the formation of the institute, and stimulated its growth through referral of cases and payments for services Tendered.

Next, I would like to tell you how the Hill-Burton Hospital Survey and Construction Act helped us develop a coordinated community program for prevention, treatment and rehabilitation in the field of mental health.

46293-54pt. 2-12

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