if a proper program of rehabilitation is instituted, these workers will, during their working years, pay back in Federal income taxes $10 for every $1 the Federal Government invested in them. I cannot overemphasize the importance of training of personnel for a well-rounded rehabilitation program. Certainly $1 million for training people to work with the cerebral palsied is necessary. It is difficult to arrive at figures for the support of productive re search. However, we suggest that $5 million should be invested in much-needed research in the field of rehabilitation of the cerebral palsied. This was the amount that was determined as applicable in the case of research in rehabilitation of persons afflicted with poliomyelitis. Cerebral palsy is as common a cause of disability and far more complex. Senator GOLDWATER. May I interrupt? Dr. BROOKS. Yes. Senator GOLDWATER. How much is spent annually in research in this field? Dr. BROOKS. In the whole field of rehabilitation? Senator GOLDWATER. No, just in cerebral palsy; not rehabilitation. but to determine its causes and cure. Dr. BROOKS. I will have to answer that with a paragraph instead of a sentence. Early in the testimony I pointed out that cerebral palsy was not so much a thing as it was a reflection of something that happens to the brain. Therefore there is a great deal of research which must go on in cerebral palsy, and it is tied in with our own research program. The United Cerebral Palsy, for example, concentrates somewhat with our emphasis being research of the brain, which is a better understanding of the nature of the brain, and how it works, what its reactions are, and whether it repairs itself or not, and so on. Another whole area of research which does not have the term "cerebral palsy" in it has to do with prevention. You sometimes go rather far afield there. You may be familiar with the Rh factor business, which has to do with blood and the sensitivity of a mother to the incompatibility of blood of the fetus. Actually, that research, which was never supported by anyone recently interested in cerebral palsy, has probably paid off by giving a means of preventing a small segment, which is one of the effects of the blood incompatibility, which has an effect on the brain. By preventing incompatibility you prevent this from occurring, and so prevent cerebral palsy. So now United Cerebral Palsy is supporting currently activities in this field, and so on. I will not go on at great length. In terms of money which is earmarked for cerebral palsy our own research program has now gotten up to the level of half a million dollars a year. That is money spent by one voluntary organization, which is the major one interested in cerebral palsy. Other agencies and foundations contribute to research which has a bearing on cerebral palsy, and I would hestiate to give an estimate of it. A very important part of the Federal Government program is the American Institute of Neurological diseases and blindness. A very high percentage of the work being done at that institute in Bethesda, and which is being supported by their extramural grant program, has a direct bearing on cerebral palsy. So I cannot give you a figure. Senator GOLDWATER. Thank you very much. Dr. BROOKS. We at United Cerebral Palsy know first-hand that the cerebral palsied can be rehabilitated, provided they are placed under the supervision of trained personnel. One of our affiliates, United Cerebral Palsy of New York City, has, with limited facilities and only 1 person in charge of the program, placed 56 cerebral palsied persons in paying jobs in about a year and a half. That interesting record I have here, and I would like to submit it, and if possible, have it made a part of the record. Senator GOLDWATER. It will be received and made a part of the record. (The document entitled "Vocational Placement of the Cerebra! Palsied" is as follows:) [Printed and distributed by United Cerebral Palsy of New York City, Inc.] VOCATIONAL PLACEMENT OF THE CEREBRAL PALSIED A brief experience in dealing with the vocational problems of 200 cerebral palsied adults, by Linn W. Curtis PREFACE The report which you are about to read demonstrates how a combination of courage, great vision, professional skill, and the determination of clients can yield heretofore undemonstrated results. The courage and vision came from the conviction of the board of directors of United Cerebral Palsy of New York City, Inc., that every cerebral palsied person should be helped to achieve his or her greatest potential. To this end they created a guidance and placement service conducted by a qualified person with an excellent record of experience in the field. Hidden drives and interests were uncovered in the clients who applied to Mr. UNITED CEREBRAL PALSY OF NEW YORK CITY, INC., MORRIS KLAPPER, Executive Director. SUMMARY OF FOLLOWUP STUDY OF GUIDANCE AND PLACEMENT ACTIVITY FROM JULY 1951 THROUGH APRIL 1953 Submitted by Linn W. Curtis, Supervisor, Vocational Guidance and Placement Social workers, doctors, therapists, and laymen will all agree that persons afflicted with cerebral palsy are probably the most seriously handicapped people with whom they come in contact. There are, of course, a few cerebral palsied 46293-54-pt. 2—17 persons whose involvements are slight, but the great majority of persons having this disability are very extensively disabled and therefore present large problems to those who try to assist them. Of the applicants coming to guidance and placement agencies, the cerebral palsied are at the end of the list of those to be considered for jobs. This may be because of the enormous task involved in selecting suitable employment for these people and getting them ready to fill those jobs. Too frequently, neither staff nor time is available to spend on the countless hours absolutely demanded to give the personal counseling, the careful vocational guidance the close attention necessary to prepare these people to go into gainful occupations. They cannot devote the time necessary to finding the jobs that are suitable for the cerebral palsied nor have they the time to do the visiting, talking, and educating of businessmen that alone can open the doors of employment to these heavily afflicted people. Recognizing that the problems of adult cerebral palsied people were a most important part of its responsibility, United Cerebral Palsy of New York City, nc, decided 2 years ago to start a program of vocational guidance and placement for the many persons who, they knew, needed such service. This program was a departure from the basic philosophy of the organization, which is to strengthen and support the various other facilities in the community for cerebral palsy and to encourage the inauguration of needed services by supplying supplemental funds for such undertakings. Since no group or organization in the cornmunity, however, had made this their prime concern and since there seemed no prospect that this was to be done, a pilot program, designed to prove, first of all, that the cerebral palsied could be placed, and second, to work out techniques for accomplishing this purpose was initiated. Guidance and placement for the cerebral palsied only was the aim of the new program. Almost as soon as the program was started in July 1951, a constant flow of men and women with cerebral palsy in varying degrees, from mild cases to ones whose conditions were so severe that they must be classified as homebound, have come to us. Every one of the total of 202 who have applied in these 2 years, had an acute vocational problem. Many had not the slightest idea of what they were capable of doing; others had completely unrealistic ideas about what they could do; and there was another group which was simply not employable in a strictly competitive situation. Of course, there were those who were qualified for jobs within their capacities, but who needed help in getting to see the right people with an interpretation of their disability being made for them. Each man or woman, boy or girl, who has applied for help has been approached as an individual, for while cerebral palsy is common to all of them, each one is as distinctive an individual as is the able-bodied person. Each has his abilities and bis shortcomings ; each has difficulties that arise out of his social environment and not from his disability alone; each has the same drives and urges as do all of us: each must be thought of as distinct in order that effective job counseling and guidance may result. Through the painstaking work that has been put into each case, many interesting and revealing things have come to light. In far too many instances, so many, in fact, that it might be said to be common to almost all, the parents of these applicants have not had the vaguest notion of how to prepare their children to deal with the real world. In their anxieties, their guilt about their afflicted children, they have so overprotected them as to cripple them emotionally, psychologically, and, above all, vocationally. The cerebral palsied, even when they are fully grown and presumably adult, are so overdependent upon their parents that it has become almost the first order of business to try to break down this checkmating attitude. Such things as a parent accompanying a 25-year old capable man to an interview has not been infrequent. These people, because of having been so sheltered that they have not been allowed to make their own mistakes through which a child learns, do not know how to conduct themselves with others They do not know how to respond to questions put to them; they are ill at ease and often terrified in the presence of strangers; they do not know how to dress or groom themselves properly. They have never heard that it is essential to be on time for an interview, so they may be several minutes, hours, or even days late for an appointment. Above all, they cannot make decisions but must refer to their parents before committing themselves in any way. These and the deeper emotional problems of which they are mere symptoms frequently constitute far greater vocational handicaps than does the cerebral palsy condition itself. The picture, however, is far from being entirely black, dark as it may appear at times, for one of the most heartening things that has been learned from this program is that, given sufficient time and the requisite skill for dealing with the cerebral palsied, some of the most emotionally and psychologically dependent persons are still able to break through the barriers which have hemmed them in during all their lives. They have been found strong enough in an amazing number of instances, to begin to plan independently and realistically and even to get along independently without the constant stifling influence of too much parental supervision. To accomplish even a degree of self-sufficiency and then to direct that power toward productive goals ending in employment, demands all the skills and techniques known to counselors, and necessitates often the refinement of old ones and the devising of new ones. No other group of physically impaired persons presents such a wide variety of problems. With one client everything must be spelled out in minute detail, and directions must be given in a most positive, almost authoritarian, manner. "When you go in for an interview, do exactly this, and this, and this." No other method can be helpful to one who has relied on directions all his life. With another client, such an approach is all wrong; such a person responds only to the so-called nondirective method. He can be guided only through suggestions, never through directions. Just as each applicant is an individual, so the method of dealing with him must be highly individualized. There are no set patterns of procedure with the cerebral palsied. In almost every case, the counseling of a cerebral palsied victim takes much longer than does that for any other handicapped person. Only the most careful and gradual procedure can be used, for fear and deep insecurity-the two most powerful obstacles to be overcome-can only be conquered through the most careful and gradual processes. Confidence in the counselor must first be achieved. Then, and only then, can self-confidence be induced to grow in the applicant. This obviously cannot be accomplished in 2 or 3 meetings, but often takes a long, long time. In the cases of the 56 job placements made to date, it took an average of 7.09 intensive months to achieve the result. In some instances, to be sure, it actually took that long to find a job that was suitable for the applicant, but in most cases it also took that long to prepare the individual to apply for that job. Since so many of the most serious problems of the cerebral palsied arise from the lack of knowledge on the part of the families-fathers, mothers, sisters, and brothers-in how to deal with their afflicted relatives, it is very frequently necessary to bring these members of the family into the counseling sessions at one time or another. The person who is being counseled cannot make the essential changes in his point of view or his behavior, unless the people around him, who have been largely responsible for his failures, understand what must be done in order to lead the cerebral palsied one to a satisfactory adjustment to life as a useful, productive member of society. Often the greatest difficulties occur in trying to create an awareness on the part of the family members of the complicated situations which arise from having had to live constantly in the presence of a major disabling condition. In addition to such vital things as the proper understanding by families of the problems peculiar to the individual with cerebral palsy, we have had to deal with many of the practical matters of the daily routines which the nonhandicapped, for the most part, handle as a matter of course, Sometimes, it has been necessary to find suitable living quarters for a client. One young man, whose home environment became completely untenable, after the death of his mother, had to be completely relocated. This involved court action to remove the young man from the domination of a parent who was unfit to care for his son and finding a home where he could begin to build a decent existence. We worked with this particular case for almost a year from the time of the initial interview until the boy was satisfactorily settled in a foster home, which has proved to be exactly right for him, and to get him set up in a training program. Then there are cases where the client must be relocated so that he can get to his work without such great effort as to prevent him from doing that particular job. Other transportation problems must also be solved. Realizing very early in this program that one of the most effective means for inducing applicants to face work responsibilities and jobs in a realistic manner would be to expose them to people who were experts in the various work areas, we started a series of meetings for a group of young adults at which many kinds of occupations were presented. Men from such diversified fields as advertising. the paper-pulp industry, department stores, social work, physio and occupational therapy, medicine, electronics, and others, interpreted their fields and then gave the group an opportunity to discuss how they might relate to that field. Some found types of work which interested them and which could be within the realm of their capacities. These meetings also provided an opportunity for social contacts which are so greatly needed by all people and especially by those who have been confined to their narrow environments. Throughout the 2 years in which this program has been underway, there have been many times when the facilities of other agencies offering various therapies and services have been used to advantage. Invaluable cooperation has been given by the following: Beth Israel Hospital Brooklyn Bureau of Social Service Division of Vocational Rehabilitation Federation of the Handicapped Goodwill Industries Hospital for Special Surgery Institute for the Crippled and Disabled Institute of Physical Medicine and Rehabilitation of NYU-Bellevue Just-One-Break Men's League in Aid of Crippled Children New York State Employment Service Vocational Advisory Service We have found a great need, however, for psychotherapy. Not only do many cerebral palsied sufferers need psychiatric treatment; the parents and other relatives who live close to these people need it too. Unfortunately, as almost everyone knows, the facilities for such treatment are so limited that it has been necessary to work through many difficult problems without the benefit of this help. With some of the deeper problems under control, attention can be finally turned to the practical work of guidance in matters of proper grooming for an interview and the correct approach to an employer. Far too many clients have never before encountered any kind of a work situation. Many are literally like babes in the woods. They must be told how things are done and what to expect when they go to apply for a job, and they must be coached, so that they will not defeat themselves at the very outset. No amount of counseling and preparation would be truly effective if, in the crucial test of actually applying for a job, an individual should be forced to suffer the humiliation of rejection because he did not know how to deal with an employment interview, The success of the procedures, old and new, which have been used in this pilot program of vocational counseling and placement for the cerebral palsied, must, in the last analysis, rest upon the evidence of its usefulness in bringing the clients to a state of employability and then actually placing them in gainful occupations. It is extremely gratifying to report the results, and by way of measuring these results more accurately, some figures on the placement of the abled bodied or those with other types of handicaps are revealing. For instance, a large, free employment agency in New York City handling the general run of applicants who, for the most part, are not handicapped had an active caseload of 22,900 in 1952. During that year they placed 5,581 of these people or slightly less than one-quarter of the total. United Cerebral Palsy of New York City. Inc., is glad to report that, after the comparatively short period of 22 months, one-fourth of the total number of cerebral palsied people who have applied to us for help have been placed in a wide variety of jobs. We believe this is unprecedented. (The total includes 39 who were found to be beyond the reach of this program because of such various reasons as being homebound, mentally retarded, so deeply disturbed that only professional psychiatric care could help them, physically unemployable, hospitalized, and so on.) One might expect to find that all of these people, because of their handicaps, would be working at unskilled jobs, but this is not at all true. Of the 54 (out of the 202 applicants) who were put to work, only 11 are in unskilled jobs. Thirtyfour, the greatest number, are in semiskilled jobs, and 11 are doing skilled work The span of occupations is very wide ranging all the way from the simple job of messenger to the work of electronics research analyst, |