Treatment process.-This family received long-term, intensive casework service centering chiefly upon the mother. The mother and the daughter took part in all group activities at Huntington, including the mother's group, the afterschool girl's group, family suppers, family life education and family camp. This was a cooperative case with the visiting teacher and the Syracuse Dispensary. Present state of family.-The mother's schizophrenic symptoms are in remission. She is able to relate well and warmly to her peers and has become somewhat of a leader in her group at Huntington and in her neighborhood. She functions adequately in the care of her home and her daughter and is beginning to deal realistically with this problem. Financial condition at present. This family is still supported through ADC public welfare funds. They receive $109 per month plus medical expenses when needed. Tax dollars saved the community through Huntington Junior League project. It is probable that the treatment process at Huntington in which this family has participated had prevented a mental breakdown on the part of the mother and has enabled the daughter as well as the mother to stay out of institutions. The cost to the community for 1 year's care in a mental institution for the mother figured on a minimum charge of $3.70 per day is‒‒‒‒‒‒‒‒ The cost to the community for 1 year's care in a State institution for the daughter's care figured on a minimum charge of $2.50 per day is____ Total cost__. Cost to the community for 1 year on present basis_ Total community tax dollar saved__. Case No. 10, November 1959 Referral.-Onondaga County Mental Health Clinic. $1,350 912 2,263 1,308 955 State of family at beginning of treatment.-This family consisting of a mother, age 50, two children, a girl 12 and a boy 8, live in a small two-bedroom unit in Pioneer Homes. This woman was presenting symptoms centering chiefly around somatization of her anxieties concerning her own self-esteem and her environmental pressures. The children were identifying with her and presenting certain hysterical, somatic symptoms which were impairing their functioning in school and at home. There had been repeated stays in the hospital for various ailments and the family were a constant disturbance to the clinic. Financial condition at the beginning of treatment.-This family was on total ADC relief and because of their emotional state, particularly that of the mother, were getting considerable time and attention from the medical department of public welfare. Treatment process.-This family received intensive individual casework as well as group work. The family attended summer camp and took part in family suppers. Present state of family. The family now functions more efficiently. The mother looks upon her physical ailments with more realism and had not needed so much medical attention. She is, however, receiving dental care. The mother and children at the beginning of treatments stood on the edge of groups but at this time are able to participate wholly in a group situation. This family is now ready to be dropped from individual casework service and continue on in group work treatment only. Financial condition at present.-This family continues to be on total ADC relief but the incidence of need for medical care have been reduced. Tax dollar saved the community through Huntington-Junior League project.— The care at Syracuse hospitals for this family has been cut considerably. The cost to the community for this type patient is approximately $19 per day. If left to her own devices this mother might have had to be committed to an institution-the cost to our community for 1 year's stay would be__ The care of her two children would have been placed in the hands of foster homes at a yearly cost of.... Total community tax dollar saved__ $1,350. 50 3, 120.00 4, 470, 50 The CHAIRMAN. Does that conclude your statement, Miss Colborn? Miss COLBORN. Yes, sir. The CHAIRMAN. Are there any questions? Miss Colborn, we always appreciate your bringing to the committee your discussion of matters before the committee. It is always very helpful to us. Thank you so much for returning again today. Miss COLBORN. Thank you. The CHAIRMAN. Mr. Hecht? Mr. Hecht, will you please identify yourself for the record by giving us your name, address, and capacity in which you appear? STATEMENT OF GEORGE J. HECHT, CHAIRMAN, AMERICAN PARENTS COMMITTEE, INC., AND PUBLISHER OF PARENTS' MAGAZINE Mr. HECHT. My name is George J. Hecht and I am chairman of the American Parents Committee, Inc., as well as publisher of Parents' Magazine. My office is at 52 Vanderbilt Avenue, New York, N.Y. I am here to represent the American Parents Committee, which is a nonpartisan, nonprofit organization working for Federal legislation on behalf of the Ñation's 67 million children. We have been in existence about 15 years. Our officers, directors, and national council members are leading citizens throughout the United States concerned with the welfare of children. Our committee heartily endorses H.R. 10032 in principle. We particularly approve of the sections of the bill devoted to (1) Child welfare. (2) Changes in the aid-to-dependent children program. (4) Increase in adequately trained family welfare personnel workers. I am not taking the time to elaborate on any of these points. I know you have enough testimony on these points from others and in the interest of brevity I am going to make my statement short. I wish to use this opportunity to express the American Parents Committee's strong endorsement of a related bill, H.R. 9299, which authorizes grants to nonprofit institutions of higher learning to do research in the fields of maternal and child health and crippled children. There are, however, certain important changes in and additions to H.R. 10032 that we wish to propose: (1) H.R. 10032 provides for increases in the authorization for the grants for Federal aid for child welfare services as provided in section 521, title V, of the Social Security Act. The increase in the authorization that is proposed is from the present $25 million to $50 million over a series of years. Title V of the Social Security Act also provides for two other Federal grant-in-aid programs; namely, for maternal and child health services and another for crippled children's services. The authorizations for these two grant programs are now $25 million each. Because of the surging increase in child population of the United States during the past decade and the big increases that is surely coming through the next decade, the authoriza tions for these two additional programs for maternal and child health services and crippled children's services should likewise be increased from the present $25 million to $50 million by 1971. Dr. Martha Eliot, who is vice chairman of the American Parents Committee and is professor of maternal and child health emerita of the School of Public Health of Harvard University and the former Chief of the U.S. Children's Bureau, has drafted an amendment to this effect. (2) Dr. Eliot has also proposed another amendment which the APC also endorses. This other amendment is to provide a new program of grants to the States to enable the States to assist large cities (100,000 population and over) to extend and improve their maternal and child health and crippled children's services. The authorization for appropriations for each purpose is to start with $10 million in the fiscal year 1963 and increase to $20 million in 1971. Dr. Eliot has prepared the exact text of an amendment embodying these two recommendations and copies have been set to Mr. Mills, the chairman of this committee. The American Parents Committee urges that this amendment be either added to H.R. 10032 or, perhaps more appropriately, to H.R. 9299. I have copies of the amendments that Dr. Eliot has proposed. Copies of these proposed amendments have been sent to Mr. Mills, and a covering memorandum explaining them in further detail here, and these are endorsed by the American Parents Committee, and if you wish I will place them in the record at this point. The CHAIRMAN. We would like to have them in the record, Mr. Hecht, at the conclusion of your statement. Without objection, they will be included. Mr. HECHT. (3) The bill, in paragraph C5 on page 8, provides that the State public assistance agencies may contract with nonprofit private agencies for necessary services for public assistance clients. The bill goes on to state that the State agencies can purchase this service only if in their judgment the necessary services cannot be as economically and effectively provided by the staff of the State or local public agency. The American Parents Committee believes that, in order to preserve both good public and good private agencies, we need to prevent the development of large quasi-public agencies administered under private auspices. If this has to be done, we would advocate some limitation on the amount of service that can be purchased from a given private agency. Perhaps this could be done through some required matching plan-for example, that the private agency must contribute a matching $1 of private funds for every $1 of public funds received, or $1 to $2, or $1 to $3 of matching. The ratio, it seems to us, is not as important as the principle. The American Parents Committee is vitally concerned with preserving both strong private welfare agencies and also good public welfare agencies. Although it believes that services to families can be improved in certain instances through the purchase by public agencies of certain welfare services to be rendered by private agencies, the present wording of the bill may not prevent an imbalance from developing. We believe that, for example, sources of private philanthropy might be dried up if there are not some restrictions on the amount of public money paid to any one private agency. We would suggest, therefore, that any given private agency so dealt with must We have a sizable portion of its funds coming from private sources. should not want to see this bill promote the development of large quasi-public agencies which, though private in name, obtain almost all of their financing from public sources. (4) In connection with the ADC program, we wish to express this word of caution: There are many ADC families in which it is not desirable to get the mothers to work; but rather that the public policy should be that mothers of very young children should stay home with their children. We received copies of bill H.R. 10032 only on Monday of this week (February 5, 1962) and neither I nor other officers and directors of our committee have been able to give the bill the detailed study that such an important bill deserves. But we hope that you will give careful consideration to the recommendations that we have made. We believe them to be in the public interest particularly for families with children. Thank you. (The statement referred to follows:) HARVARD UNIVERSITY, BOSTON, MASS., February 5, 1962. Memorandum re proposed amendments to title V of the Social Security Act. From: Martha M. Eliot, M.D., professor of maternal and child health emerita. The attached draft amendments to title V, parts 1 and 2 of the Social Security Act which I am proposing are intended to strength the program of maternal and child health services (pt. 1) and services for crippled children (pt. 2). I have submitted them to Congressman Mills, the author of H.R. 9299, with the suggestion that they be made title II of that bill. I enclose also a copy of H.R. 9299.1 The attached draft amendments provide (1) Increase in the authorized ceilings under which appropriations are now made for grants to the States for maternal and child health services (pt. 1) and services for crippled children (pt. 2) from the present $25 million each to $50 million each in 1971. The increases in authorization would occur every 2 years in the amount of $5 million for each program, thus allowing forward planning for a decade. (2) A new program of grants to the States under both parts 1 and 2 to enable the States to assist large cities (100,000 population and over) to extend and improve their maternal and child health and crippled children's services. The amendments (see underlined parts of sections 501 (b), 502 (c) and (d), 503 (a), 511(b), 512(c) and (d), and 513(a)) provide for separate authorizations for appropriation, separate allotments, and separate provisions in the State plans for the programs in the large cities. The authorizations for appropriation start with $10 million in the fiscal year 1963 and increase to $20 million in 1971. The existing programs (for which increases are proposed by the amendments described in (1) above) would retain their original and continuing purpose of enabling the States to extend and improve maternal and child health services and services for crippled children, especially in rural areas and areas of severe economic distress. This is important because there are still many unsolved problems in rural areas and health and medical services that we know how to provide for mothers and children are not yet available in many such areas of 1 H.R. 9299 amends title V of the Social Security Act by adding pt. 4. It authorizes the Secretary of Health. Education, and Welfare (presumably through the Children's Bureau) to make grants, contracts, and jointly financed cooperative arrangements for research relating to maternal and child health services and crippled children's services. H.R. 9299 was introduced on Sept. 19, 1961, by Mr. Wilbur Mills, chairman of the House Committee on Ways and Means, and is now pending before that committee. A companion bill S. 2273 was introduced by Senator Kerr and Senator Hill on July 18, 1961. the country. The existing program must be extended and improved to meet the needs of the rural areas and smaller cities. The new programs to assist cities of 100,000 population and over would encourage new and improved services for mothers and children in these large cities. Many of these are the central cities of rapidly growing great metropolitan areas. They have grave problems in their maternity care, child health and medical care programs which involve families in the lower economic groups, families which are disadvantaegd socially, and families which have recently migrated from rural areas to these central cities replacing those of higher income who have moved to the suburbs. Federal grants would stimulate new efforts and new ways to meet these problems. Letters concerning these proposed amendments to parts 1 and 2 of title V should go to Congressman Wilbur Mills, chairman, House Committee on Ways and Means, Washington, D.C. (See list also for other members.) If you wish to support the principles involved in these proposed amendments and are also in support of H.R. 9299, it is suggested that reference be made to H.R. 9299 in your letter and to the addition of the proposed amendments as title II of this bill. It is hoped that Senator Kerr will also incorporate these amendments as part of S. 2273. In his message to the Congress on February 1, 1962, President Kennedy recommended amendments to part 3 of title V-Child Welfare Services-which would increase this authorization from the present $25 million to $50 million, by 1969, starting with an increase in 1963 to $30 million. He has also recommended earmarking up to $5 million in 1963 for grants for day-care services and up to $10 million thereafter for this purpose. In my view this proposal should be strongly supported by persons concerned with all aspects of child-life for it embodies further help to the States in their efforts to provide high quality protective and other social services for children in their own homes and in foster care. It is the program under which States may also provide adoption programs, day care and homemaker services, and help meet other child welfare needs. PROPOSED AMENDMENT TO H.R. 92991 (H.R.9299 was introduced by Mr. Mills on September 19, 1961, and is now pending before the House Committee on Ways and Means) PURPOSE OF AMENDMENT To amend title V, parts 1 and 2, of the Social Security Act (1) to increase the amounts authorized for maternal and child health services and crippled children's services. especially in rural areas and areas of severe economic distress, and (2) to provide for grants to the States to enable them to assist their large cities in extending and improving their services for promoting the health of mothers and children and for medical and oher services for children who are crippled or suffering from conditions which lead to crippling Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That parts 1 and 2 of title V of the Social Security Act are amended to read as follows: "PART 1-MATERNAL AND CHILD HEALTH SERVICES "SEC. 501. For the purpose (a) of enabling each State to extend and improve, as far as practicable under the conditions in such State, services for promoting the health of mothers and children, especially in rural areas and in areas suffering from severe economic distress, and (b) of enabling each State to determine its urban trends and problems in respect to the health of mothers and children, and enabling each State having one or more cities of 100,000 population or more (hereinafter referred to as large cities) to make grants to such cities proportional to the number of live births in such cities and to their financial and other need for assistance in providing services for promoting the health of mothers and children, there is hereby authorized to be appropriated pursuant to section 501(a) for the fiscal years ending June 30, 1963 and 1964, the sum of $30.000.000, for the fiscal years ending June 30, 1965 and 1966, the sum of $35,000,000 for 1 Proposed by Dr. Martha M. Eliot. |