Senator CRANSTON. I would be interested in knowing how much we know about that.

How many individuals have been referred to regular employment outside the sheltered workshop within the last 3 fiscal years? If you don't have that, supply it for the record.

(The following information was subsequently supplied for the record :)

How many individuals have been referred to regular employment outside the sheltered workshop within the last 3 fiscal years?

Figures are available for persons rehabilitated by State VR agencies in Fiscal years 1968 to 1970, by type of work status at the time of case closure. Those not placed into sheltered employment and who were neither homemakers nor unpaid families were numbered as follows:

Fiscal year:

1970-203,772 (80.2% of all rehabilitations). 1969-190,417 (80.4% of all rehabilitations). 1968-163,394 (79.6% of all rehabilitations).

The foregoing figures represent persons placed into the competitive labor market or who were self-employed at closure.

Do you consider this figure adequate when compared to the total number of cases handled?

Yes. For example, in 1970 a total of 266,975 persons were rehabilitated. Of this number only 7,846 were placed in sheltered workshop employment, approximately 3%. Workshop placements have ranged between 2.7% and 3.1% from 1967 through 1970 despite the increased emphasis on serving the severely disabled. The overwhelming majority of cases are referred to employment outside the sheltered workshops.

Senator CRANSTON. I would like to know if you consider that figure adequate, compared with the total number of cases handled?

Do you feel that, whatever the figure is, that it is adequate, an adequate percentage?

Mr. NEWMAN. Certainly, compared to other programs and given the job market in the last couple of years, my conviction, without having specific figures before me, is that it is a very good record.

Senator CRANSTON. The Veterans' Administration has an engineering center in New York doing a great deal of work in the field of engineering new devices, as explained on page 6 of your statement. I would like to know what plans you have to coordinate what you are doing with those efforts by the VA.

Mr. TWINAME. We have a continuing and ongoing relationship with the VA, particularly at the technical level. Our employees doing research, or engaged in these projects, have first-hand knowledge of each other's work. We have developed now some research inventory on the projects that are being done in the VA, and in other HEW agencies, with impact on this field.

Senator CRANSTON. The Veterans' Administration has been a leader for a long time in this particular field. The Veterans' Administration plans to operate 15 spinal injury centers, 72 speech pathology units, 18 prosthetic treatment centers, 42 hemodialysis units, 26 home dialysis units, and a substantial number of sheltered workshops and special rehabilitation units, all in fiscal 1973.

I doubt very much that there presently is adequate coordination between your efforts and those of the VA. Could you comment on this? Mr. NEWMAN. We do have technical cooperation at the Federal level. We have joint committees with respect to prosthetics, et cetera, and cooperative arrangements around the country with both civilian and VA installations.

I think that probably there could be a better, more systematic way of cooperating in some of the programs that you just mentioned, Mr. Chairman.

Senator CRANSTON. The VA gave us a 19-page statement on this before the Subcommittee on Health and Hospitals of the Senate Veterans Affairs Committee, they do not mention in that statement work with your agency although I believe they did mention work with other agencies; nor did you mention it in your prepared statement. I think there probably is room for greater coordination.

Mr. TWINAME. There is. It is unfortunate, the segregation of cases between veteran and nonveteran. When you get down to numbers of people that are quite identifiable in the special disabilities, it seems a shame to me that we don't have a way of loosening up the use of facilities and common resources and expertise to serve both groups in a more uniform and coordinated way. I agree with you-we have some room to go here.

Senator CRANSTON. I would like to ask if you would submit for the record what you propose to spend in fiscal 1973 and how much you spent in the preceding 2 fiscal years for prosthetic and orthotic research and development.

VA proposes to spend $3.2 million in this area in fiscal 1973 and has been spending it at the $2 million level for the last several years.

Again, what coordination is presently carried out by SRS and VA research?

(The following was subsequently supplied for the record:)

What coordination exists between your research and program efforts and research and programs for veterans?

All rehabilitation engineering work through the Veterans Administration, including the VR Prosthetics Research Center in New York, is coordinated with the Social and Rehabilitation Service through a contract with the National Academy of Science, Prosthetics Research and Development Committee. This collaboration includes the establishment of specific projects for study, including joint project setting; mutual assistance in the conduct of research; training of staff; and subsequent utilization and dissemination of findings. Thus, a fully supportive, mutually beneficial effort has been established which is making a significant impact on rehabilitation engineering research, teaching, and clinical application. As an example, several civilian spinal cord injury centers have establish programs with VR units which provide for collaborative research, joint teaching appointments, and the sharing of staff. This is also true for hemodialysis, cardiovascular disabilities, and other categorical disability groups needing assistance.

Senator CRANSTON. Is there any estimate of how many more people could be served if R.S.A. was freed of the cost it now bears of public assistance recipients?

Mr. NEWMAN. We do have a number of different estimates. Senator CRANSTON. Could you submit those for the record? (The following was subsequently supplied for the record:)

Is there any estimate of how many more people could be served if H.R. 1 frees VR of the costs it now bears for public assistance recipients?

It is estimated that approximately 253,000 disabled Public Assistance recipients will be served in FY 1973. We estimate that this will increase by 25 percent in FY 1974 to 316,200 recipients served.

Approximately 18 percent of the public assistance recipients served by vocational rehabilitation are on General Assistance and would not be covered under H.R. 1. The H.R. 1-covered recipients served in FY 1974, then, would number 259,300.

The cost of serving public assistance recipients is approximately the same as that for other clients. Thus we would be free of the cost of 259,300 disabled public

assistance recipients in FY 1974 as a result of H.R. 1, and would be able to serve that number of additional disabled people not covered by H.R. 1.

Senator CRANSTON. Explain, if you would, briefly, now and in greater detail for the record, how H.R. 1 funding procedures would fit into present VR systems and your proposed changes in it as well as the system as it would exist under the House-passed bill.

Mr. TWINAME. Under H.R. 1, there would be two basic funding sources affecting the VR agency at the State and local levels.

One of these would be for the determinations of disability, a function which the VR agency now performs under the Social Security Act, for the disability cases under title II.

Under H.R. 1, it would take on the determination of disability for those qualifying for aid to the permanently and totally disabled, and for certifying the disability of those in the family program-title XXI.

The second major source of funding for the VR agency would be in the provision of services for those who are getting benefits, continuing a program now that we have under title II of the Social Security Act, where trust funds are used to purchase rehabilitation services from the VR agency at the State level.

Added to that, under H.R. 1, would be the provision of money directly to the VR agency for giving rehabilitation service to some incapacitated family members under title XXI, and a purchase of services for the disabled under the aid to the permanently disabled under title XX.

Senator CRANSTON. Even if section 2 funding were applied more vigorously to the severely handicapped as a result of funding of public assistance recipients from welfare funds, do State agencies now have qualified staff to deal effectively with the severely handicapped?

Mr. NEWMAN. They have perhaps the most qualified staff, together with the voluntary agencies that they closely work with, I would say, of any service delivery system in the country. As to whether they are qualified as they should be, I would say we should be improving and increasing the training for working with these people.

Senator CRANSTON. On page 12, you note that H.R. 8395, provides separate authority for national centers for persons with spinal cord injury.

You seem to oppose such a separate authority. Would not separate authority allow for better accountability of expenditures and more effective targeting of dollars and consolidation under section 4?

Mr. TWINAME. Separate authority is not needed to enable us to go on as we are now, being accountable, because we come to Congress in our appropriation, laying out, in specific terms, what we would foresee in each budget year.

We have asked in our proposed amendments that this be especially cited in the legislation to give evidence of the administration's intent, along with the Congress, that this should be done. And it again seems to us that this should be sufficient, and would simplify the whole appropriations process, without in any way preventing accountability for pursuing this priority.

Mr. KURZMAN. In fact, Mr. Chairman, to add to that, we would be seeking specific line items on our budget request for both spinal cord injuries and centers for deaf youths and adults.

79-885 O 72 pt. 1 -- 19

Senator CRANSTON. I think the VA has demonstrated the great success in those centers in the work they have been carrying on; the greatest breakthrough that has been made has occurred as a result of that.

Mr. NEWMAN. There is no question that a spinal cord center is comprehensive. It not only looks upon a person with spinal cord injury as a medical problem, but it can help as a way station throughout the life of the individual to try to help him to maximize his potential and to maintain his gains.

Senator CRANSTON. Your opposition to S. 3158, is based upon a belief that there will be a reorganization under new authorities, under H.R. 1, that may or may not actually be enacted into law.

Do you feel in light of the appalling unemployment among the handicapped that we can really afford to wait for such reorganization, when and if it may occur, rather than proceeding to set up an office of the handicapped as proposed in Senator Williams' bill?

Mr. KURZMAN. Mr. Chairman, our position is that we don't want to wait in our activity, in any respect, in getting the handicapped into employment. In fact, that is why we are asking for increased authorization, increased appropriation, and increased service to the handicapped under the VR program, and increased targeting on those who have the hardest job getting into employment: the most severely disabled. I guess the question really is, do we see this proposed office as an important way to achieve that goal. And I think our answer is, "No," that at least at this point we don't see reorganization being particularly helpful, although we sympathize with the goal, as I indicated earlier in answering Senator Randolph's question on this point. We have a whole series of information dispensing entities within the Department with regard to various aspects of rehabilitation and with respect to particular types of disability.

I think I mentioned the office, in the Office of Education, which handles the dispensing of information about educational activities for the handicapped. I mentioned the Office in Community and Field Services as part of the Department which deals with the mentally retarded.

I should have also mentioned the crippled children's program in the Health Services and Mental Health Administration, and the program with regard to the deaf. We have a whole series of institutions, which it seems to me is important to be pulled together in a coordinated way. I don't think it is necessarily desirable to pull them all together functionally in a single office, because as I say, there is expertise in each of these operating agencies within HEW that is really special to them, and ought to remain with them.

It is a question of making sure that the information they have actually gets out to the people who need it. As I indicated to Senator Randolph, we are trying to find some way organizationally of insuring that that kind of coordination occurs. We don't think at this point, tying the hands of the Department in anticipation of H.R. 1, or creating a specific office, is desirable.

Mr. TWINAME. Mr. Chairman, I would like to keep very much in touch with the committee on that point. I would urge the committee, for the Secretary, to allow him to move in this way which is consistent with the desire for coordination on the part of the Congress.

So many Congressmen today talk about HEW as a can of worms, impossible to administer. And each time they put a building block in

place organizationally, when we want to move in that direction. We have new circumstances, and it does limit very severely the administrative ability to flexibly respond to new possibilities for coordination. I think we are not apart from the intent of the Williams bill, if we can keep it from getting isolated as a statutory matter.

Senator CRANSTON. I don't think in that bill or in any other way, we are talking about setting up a brand new agency with operating responsibility; but we are talking about coordination at the secretarial level. The level of all these service programs that you rattled off is some indication I think, of the need for coordination.

Is it true that there are actually 50 programs in HEW to help in the handicapped, in one way or another?

Mr. TWINAME. I am sure that is probably so. The Secretary has in mind, when we disconnect the welfare program as such from the Social and Rehabilitation Service, that he would organize in the office of the Secretary some new ways of bringing about coordination for these target groups.

We have to do some figuring, for example, of how to tie in with the Office of Mental Retardation Coordination, which is now a newly formed entity for this purpose, and overlaps with the intent of the so-called Office for the Handicapped.

So the Secretary is moving and will move over the next 6 to 12 months in a way that will be responsive.

Mr. KURZMAN. Mr. Chairman, some of those coordinating offices that already exist, exist by reason of statute, and we have gotten ourselves into the situation where the adding on of specific ones after the other is part of our problem. Simplification and rationalization of these things becomes more difficult as more statutory provisions are added. Senator CRANSTON. If it is not now required by statute, what is happening with regard to coordination? Who does what?

Mr. KURZMAN. As I say, there are two things really that go on. First of all, the meetings the Secretary holds on a regular basis with each agency tracks their activity in accordance with an operational planning system.

One of the key goals of that system, for each agency, is the extent to which it can show that it is actually coordinating with other elements within HEW that have similar missions; there are very specific things that are demanded of them on a specific time frame, and that mechanism insures that they are responsive and responsible to the Secretary on this very point, on coordination.

Second, we are looking into, as I have said earlier, the possibility of using some one of the coordinating devices we now have, like the Coordinating Office for the Mentally Retarded as a point which could be expanded to include coordination of information dissemination for all handicapped, and not merely the mentally retarded: that might be an organizational locus stone.

As I say, we are terribly concerned about having still additional statutory requirements in this regard, because every time we do it causes another difficulty.

Senator CRANSTON. I recognize your concerns, but at the same time, I think the discussion this morning has shown that there may usefully be some way to get rid of coordination without imposing undue burdens on you. That is the matter I think we should look into.