The inclusion of contractual authority in Title IV-B would be entirely compatible with the present purchase of service arrangement under Title XX of the Social Security Act. Such a provision simply recognizes the complexity involved in delivering family support and foster family services and the resultant need to give the states considerable flexibility in how they organize to accomplish this mission. For example, in the case of the mentally retarded, it is absolutely essential that services to support the client in a family living environment are coordinated with the delivery of required daytime programs, transportation and other support services. For this reason, New York and a growing number of other states have elected to have the state mental retardation agency operate specialized foster care and family support services for mentally retarded children and adults. It would be wrong to penalize retarded persons because their state has, for quite rational and justifiable reasons, elected to organize its service delivery system in this manner.

As the experience with Title XX has demonstrated, a designated single state agency can contract with other public and private, non-profit agencies and still retain overall responsibility for the program. Since the issues are similar, we feel the Subcommittee should incorporate in Title IV-B a purchase of service mechanism similar to the one used in the Title XX program. 2. The revised Title IV-B language should make it clear that services to severely handicapped persons and their families is one of the statutory goals of the expanded child welfare program. We believe that Congress should begin by drafting a clear set of goals for the revised IV-B program. These goals should then be reflected throughout the remainder of the legislation.

Past experience with federal legislation indicates to us that human service programs frequently are not made available to severely handicapped persons unless explicit provisions are incorporated in the basic statutory authority. For this reason, we urge members of the Subcommittee to critically examine the provisions of existing law and proposed amendments to assure that services to the mentally retarded and other severely handicapped individuals are allowable under the expanded child welfare authority.

In this regard, the Subcommittee might begin by reviewing the definition of "child welfare services" contained in Section 425 of the Act. We feel the definition should be modified to make it clear that child welfare services also can be used to assist families caring for a severely handicapped child or adult in their home.

3. While the Association agrees with the proposed prohibition against using the increased Title IV-B allotments for foster care maintenance expenses, states should be permitted to use these federal funds for the provision of special in-home services, provided certain requirements are met. The capability of maintaining a severely handicapped person in a foster home is often contingent on the availability of specially trained foster parents who are able to supplement and reinforce the developmental skills the clients are acquiring outside the home. Without a supportive home environment, the only alternative for these children would be placement in a congregate care institution.

States such as Michigan and Nebraska have successfully placed scores of multi-handicapped children and adults in foster care settings who, even five years ago, professionals would have said could not be maintained in a family environment. In every case, the key to success has been the ability to purchase specific in-home, habilitative services on the client's behalf.

There is an established precedent under Title XX for considering the cost of services, above the basic foster care payment, as a reimburseable expense (Section 2002 (a) (11) (B) of the Social Security Act). We recommend that the Subcommittee include a comparable provision in Title IV-B, making it clear that the same essential safeguards against abuse contained in HEW's final social services regulations, dated January 31, 1977, should be applied to this new provision.

4. While the Association agrees with the Committee's strong emphasis on preventing unnecessary or prolonged placements in foster care settings, it is important to recognize that for a significant number of severely handicapped individuals a foster home may be the only viable alternative to institutionalization. The Association's members are keenly aware of the importance of providing a wide range of support services to the family in order to preserve the family's capability of caring for their handicapped child in the home. As programs in Washington State, Pennsylvania and other jurisidctions have demon

strated, the most humane and cost effective approach to avoiding institutionalization is to offer parents and siblings of a handicapped youngster the assistance they need to maintain the child at home.

Nonetheless, for a wide variety of reasons, it is clear that some families will be unable to cope with the pressures of raising a severely handicapped child and therefore, there will be a continuing need for out of home placements. In such instances a licensed foster or family care home may be the best or perhaps the only-alternative to admission to a large, public or private institution. In addition, as I indicated above, states like New York, which are currently engaged in massive deinstitutionalization efforts, view the expansion of foster care services as an essential ingredient to the success of their efforts.

Therefore, the Association suggests that the Subcommittee, in its zeal to prevent inappropriate foster care placements, not impede the use of Title IV-B funds to assure the orderly development of high quality foster family homes for the mentally retarded and other severely handicapped persons who otherwise would require care in more restrictive and costly institutional settings.

5. Congress should permit Title IV-B funds to be used on behalf of SSI eligible blind and disabled adults who require foster family care. The same rationale used to justify the provision of child welfare services to neglected, dependent and abused children also applies to developmentally disabled adults who require a structured living environment in order to live in the community. As many states have proven, the foster family home is one viable alternative for serving such socially dependent adults.

The Association believes that the IV-B definition of an eligible client should be expanded to include SSI eligible blind and disabled persons who, due to the nature of their physical and mental handicaps, require placement in a foster family home.

B. SOCIAL SERVICES

Last year Congress approved legislation which temporarily raises the $2.5 billion ceiling on allotments under Title XX of the Social Security Act in order to help the states comply with federal child care staffing standards. This special $200 million increase in Title XX aid, which is earmarked for child care expenditures, is scheduled to expire on September 30 of this year unless Congress acts to extend it.

The Carter Administration has recommended that the authorization for these special child care allotments be extended for one additional year (i.e., through FY 1978). While the Association agrees that additional Title XX funds are needed in most states, we feel that the current spending ceiling should be raised to $2.7 billion and the earmarking language removed from the statute.

Removal of the earmark would permit the states greater flexibility in using its overall Title XX allotment to meet locally determined social service needs and priorities. Such a move also would reinforce the original philosophy underlying the Title XX program-i.e., states should be given the discretion to determine their own expenditure priorities.

In order to facilitate statewide planning and program continuity, the $200 million increase in the spending ceiling should be made a permanent feature of the Act and an escalator clause should be added to account for annual adjustments in the cost-of-living. In states such as New York, which have been at their Title XX expenditure ceiling since 1972, the scope of services funded through federal dollars has gradually eroded as the cost of salaries and other operating expenses has increased. The fiscal burden of nicking up the slack has either fallen on the shoulders of the states and localities or. in some instances, essential services have had to be eliminated or scaled down. Equity demands that Congress take this fact into account and a11thorize a system of annual adjustments in the allotment ceiling. Basing the cost-of-living escalator on the annual percentage increase in SSI and Social Security benefits would appear to us to be the fairest approach.

C. SUPPLEMENTARY SECURITY INCOME

The Association supports the passege of H.R. 6124 (Corman), a bill to amend several provisions of Title XVI of the Social Security Act. In partieular, we favor:

(a) Lowering the age of majority from 21 to 18 for all blind and disabled recipients. The current rules surrounding "student" eligible are confusing and complex, and as a result, contain numerous inequities—especially for severely mentally handicapped youths who often receive their training in non-academic settings.

(b) Excluding certain gifts and inheritances from the SSI income test. (c) Increasing the monthly payment level to presumptively eligible individuals. The purpose of presumptive eligibility is to accelerate the process of moving individuals who clearly meet the disability and income tests into payment status without the prolonged delays often associated with a formal determination of disability. Given the low rate of "false-positives" and the administrative red tape involved in a differential payment level, it seems simpler and more humane to pay such an individual the full amount of the monthly federal payment.

(d) Extending to 90 days the period in which an individual may reside in a medical institution without loss of SSI eligibility.

(e) Expanding the exclusion of income provided by charitable organizations to individuals in community as well as institutional settings.

We appreciate this opportunity to share the Association's views with the Subcommittee. Your past efforts to eliminate barriers to the full participation of mentally retarded citizens in our society are deeply appreciated by the Association's members. For our part, we pledge our full support and cooperation as you consider the important legislation before you this year.

Mr. BRODHEAD. Thank you, Mr. Coughlin.

Are there questions for Mr. Coughlin or Mrs. Everitt?

Mr. Tucker?

Mr. Gradison?

Counsel?

Mr. Vander Jagt?

Excuse me-Counsel?

Mr. JENSEN. There was one additional thing which you had in your statement here regarding the use of IV-B funds for maintenance payments for the disabled child.

How should title IV-B funds be used on behalf of the disabled and blind?

Mr. COUGHLIN. That is in my statement, sir.

Mr. JENSEN. Yes.

Mr. COUGHLIN. I left that part out, sir. Would you ask the question again so I get a good sense of it, because I was running through the papers here at the same time.

Mr. JENSEN. Do you intend that title IV-B funds be used for foster care payments in any way for the handicapped child?

Mr. COUGHLIN, No, sir, we feel, at least in the State of New York, that there is a major effort being undertaken right now to provide such maintenance payment.

We feel that the expanded title IV-B program should be used to provide the in-home services that are needed to prevent or to enable the parents or the foster caretaker to keep the child at home rather than move him into a congregate institution, which the State is undertaking a major effort to move people out of at the

moment.

Mr. BRODHEAD. Mr. Corman, do you have any questions?

Does anyone else?

Thank you very much, Mrs. Everitt and Mr. Coughlin, and your associates. We are pleased to have had you with us today.

The next witnesses are Richard Bond, executive director, Boston Children's Service Association, on behalf of the Child Welfare League of America, accompanied by Elizabeth Wickenden, social policy consultant, and Elizabeth Cole, director, North American Center on Adoption.

Mr. CORMAN. May I make a comment at this point?

Mr. BRODHEAD. Of course.

Mr. CORMAN. I want to welcome the entire panel to the subcommittee, and on a personal note, to welcome Miss Wickenden. In all the years I have been in the Congress and involved in child welfare and related programs, Miss Wickenden has consistently testified before the Ways and Means Committee, giving us the benefit of her vast experience in the field. I am glad to see her and her associates at this hearing and look forward to learning from each of them.

STATEMENT OF RICHARD BOND, EXECUTIVE DIRECTOR, BOSTON CHILDREN'S SERVICE ASSOCIATION, ON BEHALF OF THE CHILD WELFARE LEAGUE OF AMERICA, ACCOMPANIED BY ELIZABETH WICKENDEN, SOCIAL POLICY CONSULTANT, AND ELIZABETH COLE, DIRECTOR, NORTH AMERICAN CENTER ON ADOPTION Mr. BRODHEAD. Who is to go first?

STATEMENT OF RICHARD BOND

Mr. BOND. I will, Mr. Chairman.

Mr. Chairman, and members of the subcommittee, my name is Richard Bond. I am executive director of Boston Children's Services Association. This agency has continuously served children and their families since the year 1800. It is a member agency of the Child Welfare League of America, Inc.

I appear today on behalf of the Child Welfare League of America, a national voluntary organization with approximately 380 public and voluntary child welfare agency affiliates in the United States and Canada.

I would like to note for the record, three additional organizations also endorse this statement. They are: The Council on Social Work Education, the National Council of Jewish Women and the YWCA.

I am accompanied today by Elizabeth Wickenden, social policy consultant to the league, and Mrs. Elizabeth Cole, director of the North American Center on Adoption.

The league and its members are concerned about the state of child welfare services. The present division of Federal statutory authorities and administrative responsibility has resulted in an overreliance on foster care at the expense of the welfare of children. and the best use of public funds. This has been demonstrated both in our own studies and the recent report of the General Accounting Office.

The original purpose of the increased authorization for title IV-B to strengthen preventive services in order to keep children in their own homes or move them out of foster care placement as rapidly

as possible has been frustrated by the failure of Congress to appropriate the amounts authorized.

The competition for the funds of title XX, frozen at unrealistic ceilings, has limited the amount that can be derived for these preventive services from that source.

The ultimate goal of the league is a consolidated and comprehensive child welfare service comprising in one program the necessary

elements to:

One: Protect children in danger of neglect or abuse in their own homes.

Two: Finance and provide services related to limited foster care in foster homes, group homes, and institutions when necessary.

Three: Provide the services necessary to return these children to their own homes where possible or free them for adoption where impossible.

Four: To facilitate and, where needed, provide subsidy for adoption.

We welcome the initiative of Representative Miller in his bill, H.R. 5893, pending before the committee, setting forth partial steps to this end and especially its emphasis on delimiting, controlling, and preventing the present plight of children lost in a foster care limbo.

In the meantime, however, and within the limits set for this hearing, we urge the following steps:

One: We urge that title IV-B of the Social Security Act be converted to an entitlement program at the full $266 million level of authorization with the following provisions:

(a) State matching as provided in the basic act but with the addition of a maintenance of the State level of prior expenditure similar to that spelled out in section 470 (b) (5) of H. R. 5893.

(b) That the authorization be automatically raised in future years at one and one-half times the rate of any increases in the cost of living. (c) That expenditures from the increase in funds made available under title IV-B be limited to those services, including subsidized adoption where appropriate, that protect children in their own homes, strengthen such homes when a child has been placed in temporary foster care, facilitate adoptive placement when parental care is not available, extend services to teenage parents, and other related child welfare services.

We urge that none of these additional funds be available for foster care maintenance payments as authorized in section 408 of title IV-A of the Social Security Act.

(d) We further urge that section 426 of title IV-B be amended to provide an additional $25 million to be expended by the Department of Health, Education, and Welfare for interstate functions, adoption systems, demonstrations, and other such purposes and uses as may be determined by the Secretary including the operation of a national and regional adoption information system, as included in section 474(d) (5) in H.R. 5893.

Suggested language for this change is submitted in the appendices to my statement. I respectfully ask that that be made part of the record.