This community program is under the direction of the Greater Kansas City Mental Health Foundation which was created in 1950 as a nonprofit corporation acting on a regional basis to coordinate and improve psychiatric facilities and services on inpatient and outpatient clinical levels, the training of psychiatric personnel, research, and mental health education. A grant of $350,000 from the Kansas City Association of Trusts and Foundations has assisted in financing the work of the mental health foundation.

A psychiatric receiving center with a capacity of 80 beds, with administrative offices and substantial outpatient facilities, has been constructed to house the major part of the foundation program for Kansas City, Mo. Funds for its construction were made available by a bond issue of $600,000 voted by the citizens of Kansas City, Mo., and an equal amount made available by the United States Public Health Service through the Hill-Burton Hospital Construction Act. This receiving center, which operates as a division of the Kansas City General Hospitals was formally dedicated on October 16, 1953, by Secretary Oveta Culp Hobby of the Department of Health, Education, and Welfare. It will admit patients in April 1954. The services of this institution will be available to patients who can profit by short-term therapy. If, at the expiration of a 90-day period of observation, it appears that the illness will be of long duration, transfer to a State institution for custodial care will be arranged.

By contractual agreement between the city of Kansas City, Mo., and the Greater Kansas City Mental Health Foundation, the foundation will be responsible for professional services. All physicians, nurses, social workers, psychologists, and occupational therapists will be employees of the foundation which has a psychiatrist as its director. The city will reimburse the foundation quarterly for the services of these professional personnel. All service and maintenance personnel will be the responsibility of the city.

The treatment program in the psychiatric receiving center will be under the direction of the clinical director of psychiatry at the City General Hospital who was employed 2 years ago to develop the program in the rather limited facilities then available. During the fiscal year 1952-53, this psychiatric unit admitted 387 patients to the hospital, of whom 275 (or more than 70 percent) were returned to their homes in the community during the year. The average length of stay in the psychiatric unit was 35 days.

A department of child psychiatry became a major part of the foundation's program when the child guidance clinic, formerly a Community Chest agency, agreed to suspend as an independent organization and to continue the services of the clinic as an integral part of the work of the Greater Kansas City Mental Health Foundation. It also will be located in the psychiatric receiving center.

Two important programs in the children's field have been started by the mental health foundation in the past 2 years which will help develop the earliest possible treatment for disturbed children. First, a child research council was financed jointly by the foundation and the Board of Education of Kansas City, Mo. This council has been at work since September 1952 exploring the problems of disturbed children in the classroom, studying the range and interests of the school system in this field, conducting programs of inservice training for school personnel, and giving intensive study to referral cases. The professional staff consists of a psychiatrist, clinical psychologist, pediatrician, and a psychiatrie social worker.

The second program in the children's field has been the establishment of a clinical unit at Children's Mercy Hospital in Kansas City, Mo., in conjunction with the department of pediatrics at the University of Kansas Medical Center. This unit, consisting of a psychiatrist, psychologist, and a psychiatrie social worker, is primarily concerned with the psychosomatic problems of the hospitalized children and with the training of medical students in pediatric psychiatry. The facilities of the receiving center will be used for the training of profes sional personnel. The Mental Health Foundation is collaborating with the department of psychiatry of the University of Kansas School of Medicine, within a framework known as the Associated Psychiatric Faculties of Greater Kansas City, whose purpose it is to provide lectures and continuing seminars for residents in psychiatry who are in training in the city. Social-work students from the University of Kansas School of Social Work will receive field-work training in the departments of child and adult psychiatry.

Within the last month, the residency program in psychiatry at General Hospital has been approved for 3 years of training by the council of medical education and hospitals of the American Medical Association and the American Board

of Psychiatry and Neurology. This means that advanced students in a specialized field of medicine may now take their training with full accreditation under the new Associated Psychiatric Faculties maintained jointly by the University of Kansas Medical Center and the Mental Health Foundation.

Thus, community, State, and Federal cooperation has succeeded in providing a first-class training and research program in mental health to replace the primitive or nonexistent resources of a few years ago.

Now, I would like to give you one more example of the importance of Federal and State contributions to a community program in the field of rehabilitation. Kansas City is now undertaking a research project designed to find out the costs and benefits of a comprehensive program of rehabilitation of the handicapped. This project will make available reliable information on the number of handicapped and disabled in a metropolitan area and on the cost of marshaling existing community resources to restore these people to lives of greater usefulness.

This project will be carried out in four stages. In the first, there will be interviews with each household in a random and representative sample of about 14,000 households drawn from the 4 counties which make up the metropolitan area of Kansas City. All persons, irrespective of age, sex, or race are included if they fall within the representative sample.

In the second stage, the persons found through the household survey to be in need of rehabilitation will be offered the opportunity of appearing before an evaluation team composed of a physician, a social worker, a psychologist, a physical therapist, an occupational therapist, a vocational rehabilitation counselor, and an employment-placement specialist. The team will determine the extent of disability and the suitabiliy for entering treatment or training.

In the third stage, the handicapped found able to benefit from rehabilitation services will be given the opportunity to receive the treatment needed. The necessary services will be available through the cooperation of local agencies, organizations, and professional groups, together with the Federal-State programs of Vocational rehabilitation and crippled children's service.

Treatment will be given to people of all ages: people of working age who can be restored to employment; housewives who can be restored to management of their households; children who can be given a chance for education and vocational guidance so that they will be able to take their place as productive citizens when they become adults; and older people and others who can be helped to take care of themselves so that there may be savings in the use of nursing services and hospital beds.

In the fourth stage, there will be a followup of the cases found so that the effects of rehabilitation can be measured. Interviews with the persons who received treatment will be obtained one year after completion of their rehabilitation. Interviews with the handicapped in a control group who have not yet received rehabilitation will be obtained 1 year after the initial contact. Information will be obtained about the level and range of activities which these people can perform and on such economic items as employment status, earnings, and taxes paid.

Information on the community expenditures for maintenance and medical care for handicapped persons before and after therapy will be obtained from public and private agencies. In addition, records will be kept of the costs of the rehabilitation provided. Thus, the community may learn what it costs to restore handicapped people to as much economic and social usefulness as is possible, and may compare this with the costs of supporting such people if they remain in their disabled condition.

This study is being undertaken because of the nationwide interest in plans for restoring handicapped people to lives of greater usefulness. It is needed because no one knows today with any accuracy how many disabled and handicapped people there are, how many become disabled annually, nor what it would cost to rehabilitate those who could benefit by modern treatment. As long as the size of this problem is unknown, no community can make precise plans to meet it. The findings of this study should prove useful, therefore, to all other communities interested in planning rehabilitation programs for their handicapped citizens.

This study was planned and will be conducted by a Kansas City research agency, Community Studies, Inc., which was created in 1949 as a nonprofit corporation to carry out research in the fields of health, education, and welfare. It will be financed in part by this local organization; it has widespread and enthusiastic community support. Yet the project cannot be carried through to

successful completion without the assistance of Federal-State programs in rehabilitation and public health.

Research grants from the Public Health Service are helping to finance the household survey. The evaluation examinations will be supplied from existing community resources, but the local teams of experts will have the benefit of instruction, at the beginning, from a demonstration team which will be furnished by the Office of Vocational Rehabilitation. The treatment stage will be financed in large part by the Federal-State programs for vocational rehabilitation and crippled children in the two States of Kansas and Missouri. Payments for services to persons who are not eligible for these programs will be met by the individuals themselves, to the extent possible, and by local health organizations. Thus, the financing and the carrying out of this useful project furnish a vivid example of the value of community, State, and Federal cooperation.

You will note from this description of the programs being carried out in Kansas City that vocational rehabilitation, the Public Health Service, and the crippled children's program have played very important roles. This demonstrates that even in a community as rehabilitation conscious and as active as ours, we cannot succeed in meeting all our goals for the disabled without the financial support and the stimulation from the Federal-State programs. If the rehabilitation institute is to expand to serve a greater area and the increasing numbers of people referred by Vocational Rehabilitation, and if the proposed rehabilitation project is to succeed and be of worth to the entire Nation, adequate funds are essential to provide facilities and services for diagnosis, treatment, and rehabilitation.

While I have used the situation in my own area as the basis for my presentation, we can be sure that the demand and the need for rehabilitation services are as great everywhere. The need for diagnostic centers, hospitals for the chronically ill, sheltered workshops, and rehabilitation centers is tremendous, and can be met only through Federal and State action as is proposed in S. 2758. Assistance in the establishment or expansion of nonprofit community rehabili tation centers and sheltered workshops is not possible under existing laws; yet such centers are essential to the total rehabilitation program. The provisions in S. 2759 which would permit the States to use Federal funds for the establishment, initial equipment, and expansion of community rehabilitation centers and sheltered workshops will be of the greatest value to communities which are trying to meet the needs of their disabled citizens.

Highly qualified personnel from many fields are necessary to carry on these programs. One of the big difficulties we face is the lack of trained people to meet the demand. Therefore, that part of the proposed vocational rehabilitation bill which will provide assistance in recruiting and training these scientific and technical people is, I believe, a most essential element in any comprehensive program.

Huge sums have been expended for the conservation of our natural resources, and rightly so, but when we compare the expenditures for such conservation with the current expenditures for rehabilitation services to conserve human resources, we find the latter pitifully inadequate. Now is the time to find sufficient funds to cary the rehabilitation program forward with the same vigor we have used in meeting other challenging problems. We should consider funds used for rehabilitation as an investment. The costs of rehabilitating a man are nonrecurring; they are not a drain on our tax funds year after year as are dependency payments which keep people from starving, but do not allow them the opportunity to become self-supporting citizens.

In order to show you the return from this investment, and to show how rehabilitation can change people's lives, I would like to tell of a few persons who have been served by our rehabilitation institute, and who are now successfully caring for themselves.

The first is a 40-year-old man who once was desperately despondent and helpless because of the loss of both legs above the knee. Vocational Rehabilitation purchased artificial limbs for him and sent him to our institute where he was trained in their use. He was sent to a local trade school and now is employed in a tailoring shop reweaving torn fabrics. He walks the short distance to work and climbs short flights of stairs with his new legs. At the time he was sent to us, he was a recipient of public relief, but he is now able to support himself and to contribute through taxes to his community.

A middle-aged woman was brought to the institute in an ambulance. She had to be carried into the building because the removal of a spinal tumor had

left her without the use of her hands and lower extremities. With the help of occupational therapy, she was soon signing her own name and writing again. Today, as a result of her work in physical therapy, she is walking unaided. She has now returned to a healthy, normal activity in her own home.

A 17-year-old boy was sent to us from a farm community by Vocational Rehabilitation. This boy who had polio when he was 11 had returned to his farm home after hospitalization at the Children's Mercy Hospital. From that time until he was sent to us, he had no treatments or schooling. He was practically bedfast, for though he had braces, he was barely able to use them. He had no outside interests or activities and had become very morose.

His program at our institute included work in physical therapy where he was taught how to get in and out of chairs, how to walk and go up and down stairs. This freed him from bondage. He was given a complete psychological evaluation and both personal and vocational counseling. In occupational therapy, he was given an opportunity to try his skills. On the basis of these tests and training, he was placed in a school to learn shoe repairing. His first employment as a shoe repairman was so successful that he has been able to start his own shop. He is now not only supporting himself, but is assisting in the care of his parents.

We

These are but three of the many persons whom our institute has served. have also helped housewives to return to their homes and take over their duties; small children to enter school. We have helped others to overcome serious speech difficulties. Still others have been helped to make personal and vocational adjustments through our psychological services. Some have had their first work experience in our curative workshop, and have earned their first wages there. Some have been trained in the activities of daily living so that they can care for themselves and thus have freed another member of the family to enter the labor market.

These enriched lives and the reduced cost of their cost are the dividends on our investment in rehabilitation.

It has been, indeed, a very great pleasure to meet with this committee, and I regard it as a privilege to have been allowed to present this description of how an extremely worthwhile community program in health and rehabilitation has been stimulated and supported by the Federal-State programs.

The proposed bills S. 2758 and S. 2759 would permit existing programs to develop as they should to meet the growing needs. They would also permit the establishment of new facilities and services so greatly needed. I hope, therefore, that my statement will help you to consider these bills favorably.

Mrs. SHEPHERD. I would like to talk with you all and emphasize certain things, because I am perhaps in a little bit different position from some of the others that appeared before you. I am down on the community level where rehabilitation is being carried out, and perhaps you may gain some insight of our problems and needs.

I want to say first it is a real pleasure to have this opportunity to appear before you because the matters you are considering are of such worth and value to so many people and of a very real concern on

my part.

For 5 years I was a rehabilitation counselor in the Federal-State program of vocational rehabilitation in Missouri, and for the past 7 years I have been the director of a nonprofit community rehabilitation center, the Rehabilitation Institute in Kansas City. I think those years of experience have given me a bit of knowledge about the needs and benefits that come from this, because I have served in both a public and private rehabilitation agency. I also think I have seen how essential the interaction between the two is to accomplish the rehabilitation goals for the disabled.

If I may, and since you brought up Mr. Cookingham's statement, I would like to show you all-that is my good old Missouri "you all"just how a sustained rehabilitation effort gets underway and just how the various agencies work together to the benefit of the handicapped

individual; and how necessary all of the integral parts are-community interest and support, sufficient and proper rehabilitation facilities, and a strong Federal-State program of vocational rehabilitation and public health.

It takes all of us to do this job. Without the legislation and some of the things that are represented in the bills before you, whatever we do down on our level is not going to solve the problem.

In my written statement you have a detailed description of three projects taking place in Kansas City. First is the development of the Rehabilitation Institute, which I will talk to you about a little bit more later on.

Second is the development of a coordinated community program for prevention, treatment, and rehabilitation in the field of mental health. This included the creation of three private funds through the Mental Health Organization designed to coordinate and improve psychiatric facilities for treatment and for training of psychiatric personnel; for research and for mental health education.

With a grant from the United States Public Health Service through the Hill-Burton Act an 80-bed hospital or psychiatric receiving center has been constructed and will go into service with our first patients this coming week.

Thus you have an example of community and Federal-State cooperation which has succeeded in providing a first-class treatment, training, and research program in mental health to replace the primitive or nonexistent resources in our community before this happened. Third, right now in Kansas City there is something happening that will be of interest and we hope of help to the entire Nation, that is, the Greater Kansas City survey and demonstration rehabilitation project. This was launched March 24, when Surgeon General Scheele came out to Kansas City and spoke to a group there. We had an overflow crowd. When you get that when rehabilitation is on the title it shows a real interest. There were over 400 persons, professional and lay leaders of our area. When I am speaking of Kansas City I am not thinking of the confines of Kansas City, Mo., alone. You remember, we sit on the State line. This project covers a 4county area-2 in Missouri and 2 in Kansas-because that is the metropolitan area of Kansas City.

The purpose of this project is to find out the number of disabled persons in a metropolitan area. You have heard it said many times to you before that we believe we have as many people that are disabled. A community cannot attack their problem until they know realistically the size of that problem. We hope to find out the number of disabled persons in our metropolitan area, and then we hope to find out the costs and the benefits of a comprehensive program of rehabilitation to restore these disabled persons to useful lives.

The survey is being financed in the most part by a grant from the United States Public Health Service, because as you can see the results of the survey may well be of importance to the entire Nation. They felt it was well worth putting public funds into it.

The rehabilitation phase of this project will of necessity have to be carried out primarily through Federal-State funds of vocational rehabilitation and the Crippled Children's Service, with community organizations and facilities assisting in every way possible.