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My colleagues and I feel that the only real hope for the homebound in the next decade is for us to create a central source of leadership, a training site, a research and demonstration facility, and a showplace where others can observe how the mission is performed. All we ask is for the Subcommittee to give us the tools to do the job. We know that it can be done---that the homebound can be rehabilitated. But the way to spark this country to do it is through a National Center. We ask that you please mandate such a Center in your bill. If you do, you will be making this bill a landmark in the history of America's concern for its most deprived and disadvantaged citizens.

Senator CRANSTON. Our next witness is Mr. E. B. Whitten, National Rehabilitation Association.

STATEMENT OF E. B. WHITTEN, NATIONAL REHABILITATION

ASSOCIATION

Mr. WHITTEN. I think I have clearly identified myself and my organization in the prepared statement. I would like to ask that this be inserted in the record at this point, along with the chart which you have before you.

Senator CRANSTON. Your statement along with any added information will be printed at the end of your testimony.

Mr. WHITTEN. Since the National Rehabilitation Association was the principal sponsor of H.R. 8395, we felt the obligation to prepare a statement that would touch upon virtually every point in the bill. Mr. Chairman, ideally, in our judgment, a rehabilitation program should serve all individuals whose impairments constitute substantial barriers to the achievement of their life's goals. They would be accepted where they are and helped to go as far as they can toward complete independence, self-support, and constructive living in their families and communities.

But this is not the way that our rehabilitation program started in this country. It began as a vocational rehabilitation program, and it remains a program in which objectives must be in every case achievement of a gainful occupation.

The definition of a handicapped individual has been broadened. The range of services has been broadened over the years, but this remains a vocational rehabilitation program; and it has succeeded in its mission.

There has never been in this country, however, an organized national effort to help handicapped people who may not be employable achieve their life's goals.

This does not mean, of course, that such individuals have been totally ignored. The voluntary effort has done a lot for many of them.

Public agencies, including vocational rehabilitation agencies, have helped some, but there has been no large-scale effort to help people who do not have vocational goals.

H.R. 8395, among other things, would authorize a modest beginning of such a program. In the next few minutes, I want to attempt to show how the vocational rehabilitation program works in the States and local communities, and how it will work with the addition of the program envisioned in H.R. 8395.

In so doing, I want to use this small chart, which you have before

you.

Beginning at the left-hand corner of the chart, we call attention to the fact that all physically and mentally handicapped persons will enter the system in the same way by application or referral to a local VR office. They will be referred, as you see at the bottom of the chart, by schools, physicians, hospitals, social services, manpower agencies, and self-referral.

The next step of the process is the assessment of nature and extent of disability and determination of rehabilitation potential for all applicants. This is done, of course, with the help of physicians, psychologists, rehabilitation centers, vocational evaluation centers, mental

health centers, speech and hearing centers. After this assessment, the rehabilitation goals in each case are established.

The goals may be one of a variety of kinds. For instance, they may be competitive employment, employment at home, sheltered employment, homemaker, and so forth.

Under the law as it is, if the individual's needs do not fit in with this particular range of goals, of some kind, the case has to be dropped. Under title III-and you will notice I have put red lines around the new parts of this program, which are being introduced by title III of H.R. 8395-the goals may be broader. The goal may be such things as to leave institution to live at home, independent living at home, mobility in the community, sheltered employment, and so forth.

And the specific goals will be determined, of course, by the handicapped individual himself, with the help of his family and those responsible for helping him.

Then, the goal having been set, a plan is made in every case for the delivery of rehabilitation services. The individual may require counseling and guidance, physical restoration, personal adjustment, vocational adjustment, vocational training, placement, follow along.

If the individual falls into the category of title III, the services he needs will not be any different from the services he would have received under title I; it is the goal that is different, not the service. We cannot conceive, in fact, of an individual being served under title III-that is, the severely handicapped-who would require a service that some handicapped person might need under a vocational rehabilitation program.

So this is not instituting a new series of services.

These clients are served during this preparation period through physicians and hospitals, mental health centers, workshops, comprehensive rehabilitation centers, vocational schools, speech and hearing centers. Then after services are completed and the goals are as nearly attained as possible, the cases are closed and reporting is done.

Now, the closures may be in any one of a number of statuses. If the individual is closed in employment, it will be inducture whether this is full-time compensation employment, part-time employment, home employment, sheltered employment, homemaker. If he is closed not in employment, then it will indicate whether he has been rehabilitated into independent living at home, mobility in community, sheltered employment, and so forth.

Of course, he gets his job in the community, and it is in the community that arrangements are made for any followup continuing services after the agency has completed working with him.

Now, Mr. Chairman, I hardly know how to proceed at this point without being very lengthy. I have a statement here in which I go into some depth in what I consider to be some very important aspects of this new program.

If your questions are going to bring these out any way, I have no desire to repeat myself, and I do not want to use any more time than would be necessary.

I will follow your judgment at this time. Shall I proceed in this way?

Senator CRANSTON. I wish you would place that in the record so it. will be available to us in its entirety for study as we mark up the legislation.

Mr. WHITTEN. Your questions are so intense and thorough, I had felt that this might be the best method.

Senator CRANSTON. Senator Stafford, any questions?

Senator STAFFORD. Thank you, Mr. Chairman.

Mr. Whitten, could you describe for us the persons who are rehabilitated under the current law? By this I mean, what types of disabilities do they have?

Mr. WHITTEN. One could hardly name any group of handicapped individuals who are not being served to one degree or another in the program at the present time. This includes mentally retarded, psychiatric handicapped, as well as all kinds of physically handicapped individuals.

THE SEVERELY HANDICAPPED

Senator STAFFORD. What would you classify as severely handicapped and how many are served?

Mr. WHITTEN. This is a good question and one to which I was planning to address myself at some length.

We have had a good deal said about the severely disabled in this context, and some suggestions have been made that in title I State plans require that people with severe disabilities be served ahead of individuals whose disabilities are less severe.

The problem we have with this, Senator, is that we just do not think that this is a practical approach to the problem. I would like to take a minute to give you the reasons why I think so, since I do think this is an important issue.

In the first place, vocational rehabilitation agencies are already serving many individuals with disabilities that severely restrict them in their activities.

For instance, over 20,000 people were rehabilitated this year who were adjudged by social security agencies as being not capable of any substantial gainful employment.

The venture of the rehabilitation agencies into renal disease and into cardiac rehabilitation is an indication that many severely handicapped individuals are being served.

It is also in the public interest, of course, that all individuals with disabilities that constitute vocational handicaps be helped to achieve employability, not just part of it. But in the main, I would say that we have not been able to develop any satisfactory definition of severe handicap, as related to vocational rehabilitation goals.

The projection of the administration earlier this week that 25 percent of the rehabilitants in the rehab program are severely disabled is nothing more than gross guesswork, since this agency has no accepted criteria for determining who is severely disabled as contrasted with others who may not be.

DETERMINATION OF REHABILITATION

Senator STAFFORD. Can you describe for us how it is determined and when it is determined that a person has been in fact rehabilitated? Mr. WHITTEN. An individual is called rehabilitated only when he is engaged in a substantial gainful occupation.

In the main, these are people who are working for wages. The closure report shows how much wages they are earning.

Some are rehabilitated as housewives or part-time workers and a relatively small percentage as regular employees in workshops. But there must be employment of some kind before the individual's case is closed.

Senator STAFFORD. There are cases, I presume, where a person has more than one disability. How many times can an individual be rehabilitated in 1 year for different disabilities?

Mr. WHITTEN. He can be rehabilitated only once in 1 year, regardless of the number of disabilities he has.

REHABILITATION QUOTAS AND CASE BALANCING

Senator STAFFORD. The House, in its action on H.R. 8395 took particular cognizance of rehabilitation quota systems and case-balancing programs. They noted that these policies often do not recognize the wide variations in the expenditure of time and effort needed to satisfy particular client needs.

Could you indicate these practices, what these practices are, to this committee, and how widespread they might be?

Mr. WHITTEN. Let me tell you this is a very nebulous kind of situation.

No State rehabilitation agency would testify that it required of its counselers that they rehabilitate so many a year. It just does not operate like that.

The very fact, however, that appropriations committees ask every year, "how many people did you rehabilitate last year; how many are you rehabilitating this year; how many will you rehabilitate next year if we give you so much money" leads to the conclusion, and the correct one, that Congress is looking at numbers. This is repeated in State legislatures.

About this matter of a balanced caseload and I do not know what it means. Really, it could just mean this: That if the rehabilitation agency spent $50,000 on each case, there would not be many cases served. Therefore, they cannot put all their resources into the rehabilitation of one class of disabled people, such as renal disease.

If they mean by "balanced caseloads," that the agency has in its caseloads some cases which are very expensive, some of which are less expensive, then this is the case, if it means that it tries to serve some of money classes, handicapped people, not one class, then this is the case. Some, of course, are more severely disabled than others.

BYPASSING OF SEVERELY HANDICAPPED

Senator STAFFORD. Does the pressure to produce results that you have just indicated in terms of rehabilitated clients mean that some of the severely handicapped who are questionable cases for rehabilitation get bypassed?

Mr. WHITTEN. I would not be surprised at all if this is true. After all, the program is a vocational rehabilitation program. Right now there is no result except success or failure: Success if the man is on the job, and failure if he is not on the job.

Therefore, I think it is natural that there would be a tendency toward accepting a case where there was a reasonable expectation that the individual can be made employable.

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