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Senator CRANSTON. What is your opinion of the present information disseminated by HEW, particularly as it relates to speech and hearing?

Dr. GOLDSTEIN. There is a great inadequacy. But lest I be too critical of HEW, I speak also of the users. We talk about consumers and consumer participation. Those people who are the consumers of this information have not, to the best of my knowledge, utilized the information that has already been provided to them by HEW. Part of it is the mode in which the information is conveyed. Part of it is the desire of the recipient to have it funneled in the least painful way possible.

I think there are more imaginative ways, more creative ways of preserving the information and disseminating it. I am very much in favor of this particular aspect of the act.

In the interest of time I have deleted some comments I had very much in favor of it. I think the information, appropriately distributed, can reduce the duplication, expensive duplication, of effort, reduce the delay and delivery of services, techniques which have already been developed, and yet have not been described adequately.

I am very strongly in favor of much more imaginative and creative systems.

Senator CRANSTON. Thank you very much. Senator Stafford.

Senator STAFFORD. Mr. Chairman, I apologize. I did not hear all of the statement because of other things that required my presence elsewhere, but I think as a personal note I might tell you that one of my daughters just graduated last Saturday from Ithaca College as a specialist in speech therapy for the handicapped children. So this is a field of interest in our family.

Dr. GOLDSTEIN. Has she made any decisions as to her future career ? Senator STAFFORD. She is hoping that somebody will offer her a position somewhere that will give her a chance to make a decision.

Dr. GOLDSTEIN. I look forward to that. It is an exciting field, Senator Stafford. It really is.

Senator CRANSTON. We thank you a great deal for your contribution. Our final witness is Dr. Dan W. Rader, assistant commissioner, North Carolina Department of Mental Health, representing the National Association of State Mental Health Program Directors. We are grateful for your presence and for your patience.

STATEMENT OF DR. DAN RADER, ASSISTANT COMMISSIONER FOR MANAGEMENT ANALYSIS AND PROGRAM DEVELOPMENT, NORTH CAROLINA DEPARTMENT OF MENTAL HEALTH, REPRESENTING THE NATIONAL ASSOCIATION OF STATE MENTAL HEALTH PROGRAM DIRECTORS, ACCOMPANIED BY HARRY SCHNIBBE, EXECUTIVE DIRECTOR, NATIONAL ASSOCIATION OF STATE MENTAL HEALTH PROGRAM DIRECTORS, AND CLARKE ROSS, ASSISTANT TO THE EXECUTIVE DIRECTOR FOR LEGISLATION

Dr. RADER. Thank you, Mr. Chairman.

We are glad to be here.

I would like to introduce the people with me.

On my right is Mr. Harry Schnibbe, executive director of the National Association of State Mental Health Program Directors, and with him is his associate, Mr. Clarke Ross.

I would like to reiterate that I am testifying on behalf of the National Association of State Mental Health Program Directors, a cooperating agency of the Council of State Governments.

You have heard this before, I am sure, but collectively we manage a group of clients who, collectively, account for one of the largest, if not about the largest, drains on the American economy, both in direct costs and also in indirect costs that are proved through the losses we see through alcoholism, drug abuse, and other mental disabilities.

I would like to say that we have enjoyed an excellent working relationship with vocational rehabilitation in North Carolina. I personally have been involved in that relationship and I have some general knowledge of the vocational rehabilitation program.

In general, Mr. Chairman, we support the House passed bill. We think H.R. 8395 is a very good bill that provides several avenues that have been closed to us before, that offer opportunities to render services to groups of clients that prior to this time we have been unable to reach.

Transportation is one of these things that we are interested in. Of particular interest is the emphasis on goal setting that is in the bill.

I would like to come back to that, if I may.

Just briefly to summarize specific points of the act that the Mental Health Association wishes to speak to, we are aware of the controversy that surrounds the bill of taking language out of title III and putting it in title I, giving priority to the severely handicapped client. We are looking at both sides of that problem. We agree with certain groups that the severely disabled have not received priority service that they should have received.

On the other hand, there is the concern that this kind of amendment might disturb the basic program which is in title I.

In reading the bill very carefully, it may be that there is a solution already in it. We think so.

I would like to draw your attention to three specific paragraphs that are already in the act in title I, section 105.

Paragraph 9, which requires State plans to contain clear statements of the goals and services to be provided under the plan and to list these goals in order of priority and state it in a form that can be quantified.

Paragraph 10 contains the reporting requirements on the States. Paragraph 14 contains a statement which allows the States to engage in continuing studies for the needs of handicapped people.

If you will keep those three paragraphs generally in mind, Mr. Chairman, let me go to what I think has been the way that the Congress has tried to assure quality control and the uniformity of services in this country and prior pieces of legislation.

Usually uniformity is the route that had been taken here. In the Mental Health Centers Act of 1963 this was the route.

Unfortunately, this particular approach does not really take into sufficient account the variability that exists from place to place in the Nation.

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It becomes quite difficult sometimes to tailor that array of services to meet the specific needs of the citizens in a State or in a county where you are trying to get services developed. Sometimes the requirement for uniformity resulted in services being created where you did not really have a very clear need demonstrated for it.

I would like to suggest that the committee consider tying these three sections of the bill into a closer package.

I have some wording here to suggest, if I can read it in part. In the same section, 105, we might include a paragraph that says something to the effect that the State plan shall assure that the goals and priorities that are established in the State plan to direct delivery of services under this act are related to and derived from the studies authorized in paragraph 14, which reflects the relative need for services among those groups of eligible clients as defined in section 106. Further, that the results of the evaluation of the achievement of the goals in the preceding year be incorporated into and provided a basis for justifying State plans which are developed for subsequent years.

The intent of this paragraph is obvious; it is to assure the services that are developed closely follow the profile of the needs that exist. in a given State. It would allow the Congress to get away from the simple provision of uniformity and services, but still assure quality control, hopefully at less cost.

The bill as it is currently worded certainly authorizes the States to do the studies, but they do not have to take them into account.

As a companion amendment, regarding evaluation, title IV, we would like to suggest that a phrase be inserted in the sentence that is on page 87, line 14, that before releasing the funds for the programs and projects covered by this act, that the Secretary of HEW—and here is the amendment-with the collaboration of designated State agencies, shall develop and publish general standards for evaluation of the program and project effectiveness.

Mr. Chairman, it has been our experience that the people who were most directly concerned with the delivery of these services frequently had the most developed methods for evaluation that exist. They have not generally been heard on a scope wide enough to where their implementation can be effective, and we are trying by this amendment to assure that these methods can be heard. It has been said in testimony directed to other bills that methods of evaluation do not exist. That is not true. They do.

We share the concern of other witnesses on the definition of "severely handicapped." We feel that we have had the opportunity to work with vocational rehabilitation around severely handicapped clients and that we have demonstrated that these clients can benefit from combined services of vocational rehabilitation and mental health services and we would like to see the possibility of modifying the definition contained in title III, where it might read that: with the assistance of comprehensive rehabilitation services, these clients can reasonably be expected to improve their ability to live more independently and function more normally.

We feel this is a cost effective move in that it will probably reduce the total system cost, although it might raise the apparent cost in some

sectors of the system. We would like also to speak to the topic of sheltered workshops.

The sheltered workshop, although certainly his vocational directive represents very valuable social milieu, we think this can be taken into account and can be effectively utilized by clients who are not productive enough to actually support themselves or even contribute generally to the support of the sheltered workshop.

We realize, though, that with the report from the House that has come out, it would probably be premature at this time to suggest any particular solution in the light of that report and in a study which should follow from that.

So rather than make any comment as to what we would actually suggest on that, we would like to bring the committee's attention to a sentence in that report and hope that some real attention could be paid to this.

The study as it exists in the report is directed primarily to the area of wage payment.

The sentence reads:

It is important to take another look at the entire scope and concept behind them and re-evaluate whether they should be expanded, why, and how they work, how they can be improved, and how handicapped individuals can become more productive in them and receive better pay for their efforts.

We who support the sheltered workshop notion are not afraid of this kind of study. We feel they are effective. They are beneficial and the outcome of that kind of study can only be for the client.

Thank you.

Senator CRANSTON. Thank you very much.

Did either of you wish to add anything.

All right.

Senator Stafford.

Senator STAFFORD. Thank you, Mr. Chairman. I just have one inquiry I would like to make.

Dr. Rader, in your prepared statement you refer to the present legislation and the services that it might offer, and among others, I quote here, ... as well as disabled public offenders."

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Could you tell me what you understand the phrase "public offenders" to mean, disabled public offenders?

Dr. RADER. Yes, sir.

I think this is a group of individuals who, from time to time have gotten caught up in our legal system. This is not necessarily directed at the hard-core fellow. Certainly, I can speak from my limited experience in one part of this country, we at this point have the opportunity, given the availability of service, to work with the courts on alternatives to jailing and alternatives to active prison sentencing.

Senator STAFFORD. Are you referring here in any sense to those who are disabled public offenders by reason of use of alcohol or drugs? Dr. RADER. Yes; I am.

Senator STAFFORD. I sort of wonder, since we have some programs specifically oriented especially toward drug abuse now if we are not getting into a duplication of effort if we try to spread a program designed fundamentally to help the handicapped, I mean physically handicapped, also into a field like drug addiction?

Dr. RADER. The provision of vocational services to alcoholics, drug abusers, and these other kinds of people, hits very hard at the whole question of self-esteem. The value system in this country is directed very much toward work ethics. To offer a program to the drug offender, to the alcoholic, which does not include vocational means to where he can become self-supporting is going to fail.

Vocational rehabilitation as an agency is the most skilled in providing these kinds of services. If they do not do it, somebody else is going to, and I suspect if this opportunity is not included, then we will have a real duplication of services.

Mr. SCHNIBBE. With reference to those other programs, there are programs, for example, for drug offenders and alcoholics. I assume you are talking about the Hughes Act and programs of that type where money is available, programs are available through community

health centers.

But community mental health centers, as I think is true in North Carolina, Kentucky, New York, and a lot of States, when they get to rehabilitation aspects, especially in terms of employment, they contract out to rehabilitation services like this.

I doubt if the community mental health centers in your State are doing that type of rehabilitation in the mental health system. I believe they are contracting a lot of that out.

Dr. RADER. Very specifically, the mental health department is carefully not offering vocational services, because we feel that would be a real duplication of effort, and we have in every one of our mental health centers, a vocational rehabilitation counselor who is on the staff of the other agency.

Senator ŠTAFFORD. Insofar as vocational rehabilitation programs are concerned for the disabled in this particular context, what would your reaction be to utilizing funds from the other programs oriented toward those who are drug addicted, for example, to pay the cost or repay vocational rehabilitation programs for the cost of its effort in behalf of those who might come to it as disabled public offenders?

Dr. RADER. AS I understand the intent of the act, this is generally what they are trying to get at. Sometimes funding sources and patterns do have quite a bearing on the program because of various kinds of legal restrictions that are built into the use, depending upon their source, and I cannot respond specifically to your question, but generally I would say it is satisfactory.

Senator STAFFORD. Thank you very much.

Senator CRANSTON. Why do you feel that alcoholism and drug addiction are deemphasized in terms of the vocational services in the bill? Mr. RADER. I think that it is probably a relative stand Senator. Senator CRANSTON. What is your reason for thinking they are deemphasizing it? Does the report or the bill language indicate that to you?

Dr. RADER. Yes.

Senator CRANSTON. Which; the bill or the report?

Mr. RADER. Report.

Mr. Ross. The House report on pages 9 and 10 refer to alcoholism and drug addiction as a social, not disease, but as a social malfunction and they play down social disabilities and social handicaps in relation to other handicaps. That is where they get that impression.

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