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States. After he retired from the governorship, he farmed the gulf coast, struck oil and left an immense fortune. His children left this fortune to the University of Texas for a foundation to be concerned primarily with mental retardation.

So, under this grant, Texas is one of the early States to work in this field, and we are proud of the fact that Dr. Barnett comes here so highly qualified representing one field in which we feel our State has made a fine contribution.

The CHAIRMAN. All right, Doctor, go ahead.




Dr. BARNETT. I appreciate Senator Yarborough's kind remarks.

As I look around the room here, I would like to have in the record, and, of course, I speak from a little different point of view than the people who preceded me. We are the implementers of the legislation and the resources that the legislature makes available to the States We have been very deeply appreciative of this and very grateful for the excellent leadership that is being given and has been given at the Federal agency level, and I would be remiss if I did not point out the honestly good work that Miss Switzer is doing now and has done in the past; and Dr. Robert Jaslow, who is here, and all of his staff, and certainly Dr. Gallagher's office, and all the agencies that we deal with through our regional offices.

I might also say that we are fortunate in Texas to have a very fine regional office in Dallas.

In order to have some perspective on what this legislation means to a State, and Texas in particular; I would like to comment just briefly. and I have submitted to the committee an official statement.

I would like to comment as to some of the points here.

The CHAIRMAN. We have your statement. You may make such comments as you see fit.

Dr. BARNETT. I think, by any measure, I would like to comment on this.

(The prepared statement of Dr. Barnett follows:)



Mr. Chairman, distinguished Committee members, my name is Charles D. Barnett, and I am Deputy Commissioner for Mental Retardation Services in the Teras Department of Mental Health and Mental Retardation, Austin, Texas. It is my pleasure to represent our Commissioner, John Kinross-Wright, M.D., and the Chairman of our Board, Horace E. Cromer, M.D., in basic support of H.R. 6430 the “Mental Retardation Amendments of 1967." Additionally, and in the capacity of Secretary, I have the honor of representing the National Association of State Coordinators of Mental Retardation Programs, Bert W. Schmickel of Hartford. Connecticut, President. The National Association of State Mental Retardatiu Program Coordinators also supports H.R. 6430, and in the comments that I sball now make, I represent both this Association and the Texas Department of Mental Health and Mental Retardation. Although most of my comments will be directed to H.R. 6430, I will also comment briefly on S. 1099 (Hill) and S. 389 (Javits), since I feel these companion bills both offer specific points of considerable merit.

From almost any vantage point, Texas has a king-size mental retardation problem. It is estimated that approximately three percent of the State's population is directly affected by this condition which means, theoretically at least, that there are some 300,000 individuals in our State who are afflicted with mental retardation. If we consider the numbers who are both directly affected as well as those immediate family members who are intimately involved with the mental retardation, the total number swells to an estimated ten percent of the population, or over one million persons. As we look at the various Texas State agencies having responsibilities for programming for the mentally retarded—and these include our Texas Education Agency, Texas State Department of Health, Texas Department of Mental Health and Mental Retardation, and the Texas Department of Public Welfare-an enumeration of known mentally retarded individuals being served by these various agencies reveals that only about fifteen to twenty percent of the estimated 300,000 individuals who are thought to be retarded are now being served in ongoing programs of one type or another. Even if one concludes that the three percent figure is high and that in actuality some smaller percentage of the retarded population in our State, or in any State for that matter, actually requires special services, we would still have to conclude that a sizeable portion of those mentally retarded individuals who are in need of services are not receiving them at this time. There are undoubtedly many reasons for this state of affairs, but probably one of the most prominent is simply the fact that Texas, like many states, until recent years has focused primarily upon the institutional approach to meeting the problems of the retarded. However, the experience of recent years has shown that such an approach is undesirable from a humanitarian point of view, uneconomical from a fiscal point of view, and is virtually impossible from logis. tical point of view. In short, we have come to realize that the continued construc. tion of institutional beds can never adequately and fully deal with the mental retardation problem but, rather, that increased emphasis on the development of a broad array of services for the retarded and their families at the community level is required. Such an approach does not place the residential institution in a polar position with community programs but views the residential center as an integral and catalytic part of the "continuum of care' which the retarded and their families require.

Let me cite some specific figures to assist in more clearly defining the problem that we are facing in Texas, and then I would like to mention briefly some of the approaches that we believe to be possible in coping with the situation. During the seven-year period of 1960 to 1966, the Texas Department of Mental Health and Mental Retardation received 10,767 applications for admission to its then existing six residential facilities or Special Schools as we call them in Texas. During this same period we actually admitted some 7,000 individuals to our institutions, this being largely made possible by an intensive construction program which added new beds at a number of locations throughout the State. Despite this increased admission activity, new applications continue to come into our Department at a rate of 1,200 to 1,500 annually, and we currently find ourselves with a waiting list of 1,500 completed applications, with another 400 applications pending completion. Based on our present care and treatment cost, we conservatively estimate that every eight admissions to a residential facility will eventually commit the Texas taxpayer to approximately $1 million in long-term support and maintenance expenses. This means, for example, that the 7,000 individuals admitted during the period 1960 to 1966 will eventually cost the State of Texas in the neighborhood of $875,000,000, and it means that the current waiting list of 1,500 represents an additional investment of over $200,000,000. One quickly notes that the total potential commitment entailed by the 7,000 admissions in the period 1960 to 1966, plus the waiting list population as it now stands, represents a total commitment of the Texas taxpayer of in excess of $1 billion-an awesome sum, to say the least.

Yet, recent studies conducted by our Department indicate that beyond a shadow of a doubt there are many individuals coming into our institutions who simply do not need to be there. For example, approximately fifty-three percent of the 876 applications to the Austin State School last year involved individuals whose intellectual functioning fell in the mild to moderate range of retardation. These individuals can and ordinarily should be cared for in their respective communi. ties in proximity to their family and homes if (1) an adequate array of services is available; (2) if these services and programs are staffed by a sufficient number of professional and technical-level personnel who are adequately trained to carry out their assignments; and (3) if there is available a continuing and stable source of support monies. The necessary services I refer to include diagnosis. parent counseling, day care programs, preschool training, special education, prevocational training, sheltered employment, and a host of other individualized services which, depending upon the retarded individual's age and needs, can be brought to bear on his situation. All three prerequisites for the development of community programs are directly related to and are supported by the “Mental Retardation Amendments of 1967."

This year the Texas Department of Mental Health and Mental Retardation will spend in the neighborhood of $25,000,000 on its programs for the mentally retarded. These programs include direct services to some 11,000 residents of six existing Special Schools, along with an array of commitments to an evolving network of community programs. As such, the Department is the official mental retardation authority in the State of Texas, and we are the agency which administers the mental retardation facilities construction monies. Additionally, we presumably would be the agency which would administer any mental retardation staffing monies that might be forthcoming. As an agency, we are deeply committed to and strongly believe in the partnership arrangement whereby local sertices and programs are initiated and funded through the cooperation of and interaction between local, state, and federal resources. We have enjoyed an excellent and productive relationship with our Region VII HEW Office in Dallas and especially with Dr. Robert Jaslow's Mental Retardation Division in the new Social and Rehabilitative Service Agency here in Washington. We have been amazed and grateful for the outstanding leadership role played by these key mental retardation groups, despite severe staffing and program support limitations.

Essentially, the Department has five chief means of delivering services to the retarded and their families or for participating in the catalyzation process which leads to the services being rendered. The media for providing these services include: (1) the provision of direct services by various programs operated out of our central administration in Austin ; (2) the provision of direct services as may be provided by our various residential centers either on a direct basis or through numerous satellite programs; (3) contractual arrangements with various private and public organizations, agencies, and individuals for specific service programs; (4) a system of State grants-in-aid to locally organized and established boards of mental health and mental retardation; and (5) the administration of available federal support programs, such as community facilities construction and staffing. You will have to pardon me for sounding like a Texan, but please believe me when I say that the problem of delivering services to a State with 254 counties and in which almost two-thirds of the total State's population reside in twenty-one urban areas separated, for example, by such distances as $64 miles between El Paso and Texarkana or the 658 miles from Amarillo to Port Arthur, is no small chore. Nor is there any single approach which can be identified as the most effective for all areas and for all populations. A customized approach is called for, and this is true in all states. Yet, certain commonalities and similarities do exist in both problems and approaches; hence, H.R. 6430 does have certain projected benefits for all of our states. Obviously, a combination of approaches is called for.

Since time will not permit any further elaboration on these points, let me summarize thus far by saying that the primary thrust of mental retardation programs in all states is to the community level and that the provisions of the "Mental Retardation Amendments of 1967" will significantly enhance the more ment toward realization of strengthened programming at the community level. I would now like to comment brifely on several of the specific sections of H.R. 6130, and in so doing. point up several specific amendments that the Texas Department of Mental Health and Mental Retardation as well as the National Association of State Program Coordinates for the Mentally Retarded feel are worthy of your consideration.

Relative to Part B of H.R. 6430. Project Grants for Construction of UniversityAffiliated Facilities for the Mentally Retarded. we applaud the extension of this program and the proposed increase in funds for fiscal years 1969 and 1970. It seems clear that, if we are to meet adequately the mental retardation problem and if we are to progress to the point of developing an adequate array of serv. ices at the community level, a significant number of new manpower training programs must be evolved. These programs will offer the potential of giving a wide range of professional individuals an exposure to the mental retardation problem, and, in so doing, will strengthen our number one resource for coping with the problem. The proposed legislation would extend the present program by broadening the scope of the centers to include certain research and also would expand the coverage relative to the individuals to be served from the retarded per se to individuals manifesting other neurological handicapping conditions frequently found in close association with mental retardation. I am advised that relative to the fourteen centers which have been approved and funded to date at a total cost of $30,310,901, it is projected that nearly 10,000 professional persons will each year receive training in the various disciplines related to the prevention and treatment of mental retardation. In short, we feel that the investment in training is a sound one and one that will have multiple benefits in dealing with the delivery of services to the retarded and their families.

Both the Texas Department of Mental Health and Mental Retardation and the National Association of Coordinators of State Mental Retardation Programs offer for your consideration a suggested amendment to H.R. 6430 which would make arailable planning grants to sclected applicants without an increase in the amount of appropriation now recommended. In looking at the fourteen projects which have been approved and funded to date, twelve had planning grants from either federal or private sources. Four planning grants were ma available from the Mental Retardation Section of the former Division of Chronic Diseases, two planning grant awards were made by The Kennedy Foundation, and six other applicants received planning grant awards from both The Kennedy Foundation and the Division of Chronic Diseases. Since the projects are university-affiliated, this means that not only must a considerable amount of time go into the planning of the precise design and programs which will be housed in the facility, but an even greater amount of effort must be directed to the problem of working out inter-relationships among the various agencies and organizations which will associate or affiliate in the project once it is completed. I am informed by appropriate authorities that the average planning effort to date resulting in a successful application has taken from nine to twelve months of intensive work and that a significant amount of continuity is given this endea vor if at least one individual assumes full-time staff responsibility for the coordination of the application process. It is our firm belief that such a system of planning grants will eventuate in more meaningful and effective applications which reflect better coordination of local or regional resources in the universityaffiliated endeavor. We would specifically propose that up to tuo per centum of the annual federal allocation be authorized for the purpose of planning grants and that planning be defined so as to include the cost of salaries, travel, consultation, and all other expenses which may be necessary for the development of a sound plan and program for the university-affiliated facility in question. The specific mechanics of this amendment could be handled by inserting in Section 121 of the bill, under Authorization of Appropriations, the words “planning and" before the word "construction” when it appears the first time and the words “or planning" after the word “construction" when it appears for the last time in Section 121. Further, and in order to maintain the spirit of the partnership arrangement, we would propose that the total amount of the planning grant would not crceed seventy-fire per centum of the necessary cost of planning, the remaining cost to be borne by the applicant organization.

Before leaving the university-affiliated program, let me also support that portion of S. 1099 which would extend the support program for training teachers of the mentally retarded and other handicapped children. It would be desirable to have this feature added to H.R. 6430, along with the provisions necessary to continue the program of research and demonstration projects in the education of the handicapped.

Part C of the “Mental Retardation Amendments of 1967” deals with grants for construction of facilities for the mentally retarded. Texas, for example, last year received a total allocation of $835,914 for the construction of community mental retardation facilities, and, as I indicated earlier, this program is administered by the Texas Department of Mental Health and Mental Retradation. Through this program, we are gradually seeing an array of new facilities and new services being developed at the local level, and the number of applications for federal funds in this program are increasing at a rapid rate. In our State, applicants must put up forty-four (41) percent of the costs of construction in order to match available federal monies. Again, both the Department I represent and the National Association of State Coordinators of Mental Retardation Programs endorse in principle the purpose of this significant section of H.R. 6430, and we are also pleased to note the program's proposed expansion in fiscal year 1970. We do. however, offer for your consideration an amendment to the proposed legislation which we feel would significantly strengthen the facilities and services which are to be developed. Our recommendation is that State agencies designated to administer this program be authorized an administrative cost allotment which would be bascd upon the amount of the annual allocation to the state in question. Specifically, we propose that appropriate wording be included in the legislation to permit tuo per centum of the annual allocation or $50,000, whicherer is le**. to be utilized by the designated state agency to sccure the staff and other resources necessary to effectively administer the program. As proposed, this amendment would not necessitate an increase in the total recommended appropriation but, rather, would be taken from each state's individual allocation for the years covered by the legislation.

The administering state agency basically administers this program for the benefit of private-non-profit or public facilities for the mentally retarded located at the community level. Each year the administering state agency must develop or update a state plan which includes a comprehensive inventory of services and facilities available in the state relative to mental retardation. In additional to the rather detailed mechanics of collecting, collating, and publishing this information, provisions of the proposed legislation call for administering state agency to develop and enforce standards of maintenance and operation on all projects approved after June 30, 1967. This enforcement program becomes effective July 1, 1969. Since the recovery clause covering thse grants remains in effect for twenty years, it is assumed that the state agency will assume responsibility for surveillance of the programs funded for a like period of time. Such surveillance and inspection procedures will necessarily require onsite visits and rather intensive program analyses involving consultants in a variety of specialty areas. Additionally, the administering state agency is required to have a state advisory council which ordinarily meets quarterly to review applications which have been submitted for funding. Staff of the designated state agency must often make several onsite visits to work with applicants regarding the application, in addition to the travel and per diem expenses that are entailed by the members of the advisory council. Had the full two percent administrative cost allotment been available to the Texas Department of Mental Health and Mental Retardation last year, approximately $16,000 (two percent of $835,914) would have been available for offsetting a portion of these costs. Obviously, this allotment would not have covered even the majority of the cost involved, but it would have been of considerable assistance in the assignment of new staff personnel to the over-all review and surveillance process.

The proposed amendment permitting an administrative cost allotment to the designated state agency administering mental retardation community facility construction monies has sound precedent. Somewhat similar federal monies were available to state agencies administering the Hill-Burton Hospital Facilits Program beginning in fiscal year 1965 (July 1, 1964). Incidentally, fifteen (15) states have different agencies administering the Hill-Burton administrative cost allotment calling for these monies to be expended over and beyond the regular expenditures of the designated state agency, thereby preventing the administrative allotment from taking place of funds normally spent by the agency, is a sound one and one that we would recommend be incorporated in the mental retardation community facilities construction program. Since a similar formula was utilized as is being proposed here, I am advised that the Texas Department of Health last year utilized the entire maximum of $50.000 made available to it for the administration of the Hill-Burton program. These monies have enabled the Department of Health to add sufficient staff to not only develop a sound plan but to effectively monitor the entire program. Many states hare no persons assigned specifically to administer the mental retardation facilities construction program, and I do not hesitate to state that without increased attention to this area, the development of adequate plans and sound applicant programs of continuing quality will virtually be an impossibility.

There is one portion of S. 389 (Javits) which we feel should be given consideration for addition to H.R. 6430, and this would allow for appropriate expenditures associated with the acquisition of a site for community construction projects to be eligible for matching federal funds. It has been our experience that volunteered or donated sites are not always the best ones.

Let me reiterate again that the requested amendments to Parts B and ( of H.R. 6130 would not require new monies over that already proposed. Both of

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