1964 Annual Report U.S. Department of Health, Hducation, and Welfare U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE As of June 30, 1964 ANTHONY J. CELEBREZZE, Secretary Ivan A. NESTINGEN, Under Secretary OFFICE OF THE SECRETARY Mian J. COHEN...s_---ass.—- Assistant Secretary (for Legislation). Putiip H. DEs MARAIS__-------~ Deputy Assistant Secretary. PAM IM. QUIGLEY ageeeys-cLL. Assistant Secretary. iisiy C. CARTER, JR. ens 2= Deputy Assistant Secretary. FROHHRT A. KEVAN 2-02 ~~ —=____ Deputy Assistant Secretary for International Affairs. Uns Mins, JRO =~. Administrative Assistant Secretary. DAMES EH ISL Sty i OO Deputy Administrative Assistant Secretary and Comptroller. VWONS Git: a arr Special Assistant to the Secretary (Health and Medical Affairs). Nina Mar GARTHUNE____-_--~--- Congressional Liaison Assistant. HY. Ropert Mrimr. 2220 i245 -+ Assistant to the Secretary. PUAROED Ive UnVY See 4. Do See Assistant to the Secretary (for Public Affairs). JOSEPH VENTURA __--..--_....— Assistant to the Secretary. ALANSON W. WILLcOx____-~_~- General Counsel. OAEeTEe i>, LUND iLf bk 22 Director of Field Administration. ravine As GUSH 22. 2o 2. Director of Public Information. FREDERICK H. SCHMIDT____-_-__-~ Director of Security. JAMES W. GREENWOOD, JR____~~ Director of Management Policy. PAE. aOMPSON..—_.-_-____ Director of General Services. ane G., ORIEN oo = So Director of Personnel. IDHANE MN DER. 22 eo ee Defense Coordinator. SOCIAL SECURITY ADMINISTRATION PPOBE TEN) ALI. Sik beak e Commissioner of Social Security. MrLCrorR CHRISTGAU_._.-—_--.—.~ Haecutive Director. J. DEANE GANNON____----- Director, Bureau of Federal Credit Unions. JOSEPH HE. McPLvAIn___--- Director, Bureau of Hearings and Appeals. WELFARH ADMINISTRATION EEE VV INGTON: 2 2u ste 2202S s: Commissioner of Welfare. WOSEPH H. MEYERS.——.92- 22202 Deputy Commissioner of Welfare. MOAT. b, ISENT.- 2 2s. sees Director, Office of Aging. IBERNARD. RUSSELL. e022. 2 Director, Office of Juvenile Delinquency and Youth Development. BOmN HS TROMAS. 222 _ Seer Director, Cuban Refugee Program Staff. KATHERINE B. OETTINGER___~-~ Chief, Children’s Bureau. Frep H. STEININGER___-------- Director, Bureau of Family Services. 1 Position filled by Shelton B. Granger, Jan. 10, 1965. 2 Title changed to Assistant Secretary for Administration, July 5, 1964. ; ee cee to Deputy Assistant Secretary for Administration and Comptroller, uly 5, : 4 Position filled by Edward W. Dempsey, Sept. 28, 1964. ill PUBLIC HEALTH SERVICE LutHeEe LL. Peeryes ee Sie: Surgeon General. DAVIDUH ORION. cee ee ee eee Deputy Surgeon General. Lo. Js GRHBIGL22-=ee nee Chief, Bureau of Medical Services. CHARLES HE, BURBRIDGE_____ Superintendent, Freedmen’s Hospital. RosBertT J. ANDERSON__~--~~ Chief, Bureau of State Services. JAMES A. SHANNON--- ~~~ Director, National Institutes of Health. Forrest E. LINDER_~-----~ Director, National Center for Health Statistics. Martin M. CUMMINGS___-_~ Director, National Library of Medicine. OFFICE OF EDUCATION FRANCIS (KEPPEL. ooo eee ee Commissioner of Hducation. WAYNE O, REED Jose eee eens Deputy Commissioner of Education. FOOD AND DRUG ADMINISTRATION GrorgE) P. LARRICK-W--~-U<--- Commissioner of Food and Drugs. JOHN@LA: ELARVIDY =e ae es ee Deputy Commissioner of Food and Drugs. VOCATIONAL REHABILITATION ADMINISTRATION Marky, BE. Swirzmr el. psseeess Commissioner of Vocational Rehabilitation. PATRIOK JA Dovel? aptees 23 Deputy Commissioner of Vocational Rehabilita- tion. SAINT ELIZABETHS HOSPITAL Date, C, CAMERON. 2222 oe ee Superintendent. VACANCY =o = ee eee ee Assistant Superintendent. FEDERALLY AIDED CORPORATIONS KINISUDAVIGs =) ee eee ee Superintendent, American Printing House for the Blind. LEOWARD, M, SOESTAD 2c. acne President, Gallaudet College. JAMES Me NABEIT, iRo esos — = President, Howard University. REGIONAL DIRECTORS LAWRENCE J. BRESNAHAN-_---~ Region I, Boston, Mass. JOSEPH B. O’CoNNOR_-----~----~ Region IT, New York, N.Y. EpMUND W. BAXTER_-~~-~--~--- Region III, Charlottesville, Va. RICHARD Hi. LYLEL se 3 ceecke Region IV, Atlanta, Ga. MELVILLE H. Hoscn=2—2=2-5-*= Region V, Chicago, Iil. JAMES W. DOARN-__-~-~-~~--~-- Region VI, Kansas City, Mo. JAMES H:\BonD222 22222 2Secee Region VII, Dallas, Tez. ALBERT H. ROSENTHAL__----~~ Region VIII, Denver, Colo. WAY W. HUNTER: 2-2 Region IX, San Francisco, Calif. iv Letter of Transmittal DEPARTMENT OF Heattu, Epucation, AND WELFARE, Washington, D.C., December 1, 1964. Dear Mr. Preswwent: I have the honor to submit herewith the annual report of the Department of Health, Education, and Welfare for the fiscal year ending June 30, 1964. Respectfully, Secretary. Tue PReEsIDENT, Tue Waite Hovss, Washington, D.C. VASVIV < lIWMAWH Qs yr nynjouoy => ne) i Tyo SGN'V1Si NIDYIA “O31 OLYINd Al \ , “N . yuriouye = | AyD sesury « us pees JaAuagq C 0 a *texor00f HA | —. ONIWO x —2NINOK» | - et ss | SIONITT ‘ \ VNVIGNI odvo4d seals. ae WLOSANNIW \ 4 vVLOuva HLYON SadijjQ pule SalJepunog jeuolsey JUVITIM ONY ‘NOILVONGS HLIWIH 40 LNIWLYVd30'S ‘Nn Contents Memmereerclary Slweport . s,s se ee 8 eas macraL security Administration. . .....+. +. - UIEMICITEISITOLLON ©. wee sw wns el MOM CHSDCTULCE ee ke ee ET ee a ae a ar Food and Drug Administration ........... Vocational Rehabilitation Administration . ..... . TSR re i eer emerLODErty CL ZALLOTE ye Fo: 4 7 is t panne 4 by ie ee ey ee ee Oe ar = 4 snd Has Ae a ae teen Pt sh lente muy ied eat Se a . Soviqaett Be ao A footie oa iusilth sah wi, seth iy Pet Spee “ne! M ‘ eg eaes i ; Fone « * * * . -"* * ( — fed .eqar #iclt To ativetaee ant te igobseit ati 3 halt eset dacs Gord» ro vegnib The Secretary's Report From THE start, the people of the United States have constantly ad- hered to two guiding ideas—the greatest possible individual freedom for each citizen and deep compassion for every fellow citizen in need. These principles are clearly reflected in the work of the Department of Health, Education, and Welfare—the Federal agency with the major responsibility for carrying out the national responsibilities with respect to health, education, and economic security. In these areas, as in other aspects of our national life, nothing is static. As some problems are solved, others emerge. Needs are con- stantly changing, and new means for meeting those needs are con- stantly being developed. Our society has been growing and changing at an unprecedented rate. So have programs to safeguard health, to strengthen education, to improve the economic well-being of the Amer- ican people. Obligations of the Department of Health, Education, and Welfare totaled $5.6 billion in fiscal year 1964. This was approximately 6 percent of the total Federal budget and just a little over 1 percent of the Nation’s gross national product for that year. Most of the Department’s funds—90 percent, in fact—were chan- neled to State and local governments, institutions, and individuals for use in improving the health, education, and well-being of the American people. An additional $563 million was spent directly by the Depart- ment for various health services and for medical and social research. At the same time, efficiency in the administration of these programs continued to increase, with administrative costs of the Department for fiscal year 1964 being held to $37 million, or less than 1 percent of the total HEW budget. 2 Department of Health, Education, and Welfare, 1964 The Department’s work, however, cannot be evaluated in terms of money alone. The value of an education, the saving of a life, greater hope for the future—these are benefits that dollars alone cannot measure. Asa result of programs administered by the Department of Health, ~ Education, and Welfare in fiscal year 1964: —More hospitals were built. —Medical research against mankind’s enemies of illness and dis- ease was advanced. —Talented and needy students were enabled to begin or advance their college education. —Needed classrooms and other facilities were added to our insti- tutions of higher education. —Disabled or handicapped men and women were enabled to go to work through vocational rehabilitation. —The battle to control pollution of our streams and rivers was intensified. —Economic security and well-being of the needy aged, disabled, and young among us were improved. —Additional steps to safeguard the purity, safety, and effective- ness of drugs were taken. In these, and in a hundred other ways, the Department reinvested 7 percent of the Federal tax dollar in this country and its people— improving the quality of American life. Moreover, in June, the last month of fiscal year 1964, the Department was paying 19 million people monthly social security benefits totaling $1.25 billion from the trust fund programs of old-age, survivors, and disability insurance. The recipients of these benefits—benefits earned and paid for by American workers—are the retired, the disabled, and the widows and orphans. The administration costs of the Federal social insurance program were 2.3 percent in 1964. Thus, it is with pride that the Department can report that many of the ill in our land are now receiving help and treatment that they might not have received, that medical research uncovered knowledge that otherwise would await discovery, that much human misery was — prevented, that the knowledge of the American people was increased, and that our land and our environment are the better—because of the Department’s work and activitiesin fiscal year 1964. This is not to say that misery does not still exist—it does, too often and among too many Americans. This is not to say that all our people live in the best of possible health—they don’t. This is not to say that the power of education is available to all our people—it isn’t. The Secretary’s Report 3 So as Americans rightly reflect with pride on that which has been accomplished, so must they weigh that which remains undone but which must be done if we are to realize the full promise of America. President Johnson has pledged the Nation’s efforts toward that goal. He has said we are a people with the energy, the resources, and the will to create for ourselves a great society and that, together, we can, in our time, achieve such a goal. In the following pages, we have detailed the progress made in the past year and the problems we face in the present one. In essence, we are talking about opportunity : —The opportunity for all Americans to grow, through educa- tion, to the full extent of their talents and desires. —The opportunity for all Americans to enjoy the best possible health and to live in an environment that contributes to, rather than lessens, good health. —The opportunity for all Americans to achieve a full measure of well-being throughout their lives, from childhood through ad- vanced age. Most Americans, at most times, have these opportunities and use them. But in a great society, most is not enough. Opportunity must be available to all Americans at all stages of their lives. To achieve such greatness takes effort, time, money, dedication, and interest on the part of every citizen, every community, every State, and the National Government. That we are willing to make this necessary investment in our future is evident from the progress of the past year and the eagerness with which we are moving to meet our unmet needs in the fields of health, education, and welfare. 4 Department of Health, Education, and Welfare, 1964 Table 1.—Grants to States: Total grants under all Department of Health, Education, and Welfare programs, fiscal year 1964 {On checks-issued basis] States Welfare Ad- ministration Public Office of Health Education Service 1 Vocational | American California_ Colorado__- Connecticut Delawaresss see ses District of Columbia__ Kentucky-- Louisiana___ Maryland. c.l-cece= Parl t- tote 820 ‘LT 6FS ‘E OST ‘Ch RL ‘G9S ee ‘T € ‘81 ELF ‘0G 0 062 L8L ‘TZ $3001 oI7°t Be be eee ee ee Z9L ‘08 900 ‘F SOT ‘82% 986 ‘Z9% Per @ 08h 900 ‘61 g "Sze 68 ‘TZ iG COR nae Sse eeg fs Tg Zr 610 ‘T 280 ‘T g Le 98 6°T 16. OS. en | ae Gt Le eee SpuBIs] ULSITA 6LL‘% ¥es 786 ‘PE 062 ‘8 rata c's 668 % 8 ‘tr PIL ‘e OObN, Le |ah cs a eat ce po een Ane =" =-qUOUldo A, 69 ‘8 L8L Sh6 ‘FS ZOE ‘6S 682 vv F19 'F Z 89 $06 ‘F ane wt. ess ae eis picky FP eae eae yen 69¢ ‘og £r8 ‘8 92g ‘Lg¢ 886 ‘129 118 ‘F 0°32 008 ‘9% 0262 IIT ‘TS Teoghaes a saves CoS o~ Se Seg eee 768 ‘86 Tze 8 ZB ‘81Z G80 ‘TSz 68% % L‘0F 822 ‘ST I 688 LIS ‘0Z S619 calhne|( Sac aa ic eed ae ae | --->""--99ssouua T, 0s9 ‘% GEL 918 ‘Fe 86I ‘8¢ 802 9'e 689 ‘F TFL 16L ‘F LLL SOT ape eee eee ejoy¥eq yng ZIE ‘06 6re % OTE ‘SIT 116 ‘OFT 068 ‘T 6% E88 6 L181 SP ‘IT (APG Medal lige began ates hk Ep Srp s eUT[OIBD YINOS ze ‘9 9% ‘T 91S ‘8 £60 ‘06 98h 8°9 618 ‘9 o°o6 cog ‘2 CwIead Woe £1 1 eee eee puRsy 9pouy eer 9 £98 O8F ‘89 992 “GL Gee 0'8T S62 °C G‘OLT 618 9 . 2 Ey a PERE Ore SEI 6 2 OE = oary OVO #90 ‘06 ge ‘ST €8I ‘8zo‘T | esc ‘est ‘T | 6869 £°16 188 ‘68 9°S88I T 0ze ‘26 Occse ce « eee a te eee eek eres [Asuueg 0F9 ‘ZI 628 ‘% 29 ‘OLT I19 ‘S8T $86 0 ‘FI 69 ‘FI LF0Z $62 ‘ST 8 '81Z eT eee. oe eee ee es ~--m03010 962 ‘8T 09 ‘% £26 ‘691 ¥E8 ‘OBL 6SF ‘T a5 4 G9Z ‘FT G °SEZ FOL ‘ST O566S et eS A eee euloyely{oO 898 ‘99 063 ‘IT 00 ‘F6L REE ‘ZLB O9T ‘¢ 092 120 ‘99 9 °226 IST ‘TL OCOORLEMel ai eae te ee hee ee --o1o OF ‘% (aay 828 ‘OP 949 ‘6P OL | rote 888 ‘ 1°29 $90 ‘F BECO TAT leas: aes? BVIStLes (ces ee. ejoxeqd YWON 963 ‘98 P68 ‘Fb GT8 ‘89S G08 “66z 1f8‘% 12g 149 ‘TS ¢ 668 88F ‘FG EME ee Shia | met Seo. VUT[OIvD YON OIL ‘FIT $88 ‘8% SLL ‘TOS ‘T | S22 ‘669 ‘T | €28 8 marae 16% ‘O81 2092 ‘T FOL ‘6ST CES ie Se waa eee a. Sa yIOK MON 9LI ‘G £09 £29 ‘GF OF SF OIF 6° 189 ‘g 9°89 166‘ hg oink le ae eS CP RES DS ‘Haas & OoTXeT, MON $L¢ ‘LE G19 ‘8 O16 ‘cog 860 (209 626 $68 FIP ‘OF 9 919 ere ‘6F CCL ee | ERC Ree 27'S as ee Aesief MON I8F ‘€ 126 . #80 ‘09 Z6F ‘F9 1oX4 6" 600 ‘g 9°ZL 182 ‘¢ QPOl age ani Ss ece s- a Fh ee Be eirgsdure yy MON 908 ‘T 198 188 ‘8T $02 ‘02 SIT 9T 699 ‘T aca 119 ‘T 0.9700 alos a sa eB = hee ee % 7-"-*"BpBAdN 660 ‘9 299 ‘T 286 ‘TCT £69 ‘621 OLF S25 661 ‘OL 8 °8ST 029 ‘OL Se a ei Ga Sip See Poa eB -~---BysBIqeN 206 ‘E LtL 108 ‘#2 OF ‘6e coe oF HS 'F g"L9 678 'F 0% aa a ae om SFO asa aos co GIO JA 44 Department of Health, Education, and Welfare, 1964 Table 3.—Old-age, survivors, and disability i insurance: Selected data on benefits, employers, workers, and taxable earnings for specified periods, 1962-64 [In thousands, except for average monthly benefit a taxable earnings; corrected to November 5, Item it =| es | 962 Fiscal Benefits in current-payment status (end of period): Waumber (O-ASI and-Di) 2. ..-1 - 55 ee 19, 470.3 18, 608.3 17, 280. 4 Nam*ber (OASD*_5 7.32.22. 2 3 0 eee 17, 954. 1 17, 226. 0 16, 128.5 Number (DI)__--------- 1, 516.2 1, 382.3 1,151.8 Old-age (retired worker) 10, 481.8 10, 037. 4 9, 347.6 Disability (disabled worker)=-*_-==. “=== = = ee Se 861.9 790. 4 679.3 Wife’s or husband’s (OASI and DI) -_--.------------------ 2,770.1 2, 723. 2 2, 596. 6 Wite’s or husband’s (OAS) =..." Sesaib dese eee 2, 595.3 2, 563.0 2, 463.9 Wife's or husband's (DI) 2222-2. -.-==--- eee 174.8 160.2 132.7 Child’s (OASI and DI)? 2, 766. 1 2, 623.7 2,407.5 Child’s (OAST)2_ 2, 286. 6 2,192.0 2, 067.6 Child’s (D])2_. =. -_ 3.0 3s ea See 479.5 431.7 - 339.9 Widow's or widower'’s..... 23... sence eee 2, 086. 5 1,939.9 1,778.1 Mother's... 3. ee ee ee See 467.3 456.6 434.6 PORGIIY Cn on ok lr wee Qe ee ea eee 36.7 37.0 36.7 Total monthly amount (OASI and DI)_----------__-_-- ----|. $1,296, 140 $1, 226, 260 $1, 128, 166 Total monthly amount (OASI)_------------------------ 1, 198, 625 1, 137, 418 1, 053, 102 Total monthly amount (DI) , 514 88, 842 75, 064 Old-age (retired worker) _-______ 810, 153 769, 481 710, 736 Disability (Gisabled workery="= - = See ou 78, 302 71, 399 60, 948 Wife’s or husband’s (OASI and DI)_-_-_--------_--------- 109, 695 107, 251 101, 821 Wit's. or hushand’s (GAS) 32 8-2 ee 104, 082 102, 086 97, 489 Wife's. of husband's (01) 3 = eee 5, 613 5, 166 4, 333 Child’sfOASI and Di)4 =e Se ee 127, 209 119, 702 110, 061 Child’s (OAS) 2.5 <2. 3 oe 113, 610 107, 425 100, 277 Child’s-(Di) 4.2 eS = Sen. ee eee 13, 599 12, 278 9, 784 Widow's Of widower @ 2.2 222 eee eee 140, 543 , 736 116, 317 Mothers. 32... 35 P eS eer eS eee ee 27, 683 27, 106 25, 797 Parent's...) ck 2 ee 2, 554 2, 535 2, 487 Average monthly amount: Old-age (retired worker)-_-=..-.-2.2- 222 =2-_-_R=EAP $77.29 $76. 66 $76. 03 Disability (disabled worker) __ 90. 84 90. 33 89.73 Wife’s or husband’s (OASI and DI 39. 60 39. 38 39. 21 Wife’s or husband’s (OASI)-_-- 40.10 39. 83 39. 57 Wife’s or husband’s (DI) _--- 32.12 32. 24 32. 65 Child’s (OASf and DI) 4. .-...2 ---s eae 45.99 45. 62 45.71 Child’s (0 ASI) 3... =... 5-3. _23..55 2 eee ees 49. 69 49.01 . 48.50 Child’s (D]l)2_... S224 Bk. SSeS 28. 36 28. 44 28.78 Widow's or-widower'é. . 3.22 2 eee 67. 36 66. 39 65. 42 Mothers: = Se ee ee a ee eee 59. 24 59. 36 59. 36 Pargnt 8s... <. 92. eee Oe ee 69. 65 68. 58 67. 68 Benefit payments during period: Monthly benefits (OASI and DI)_--.----------=------------ $15, 615, 831 | $14, 819, 929 $13, 495, 123 Monthly benefits (OASI)=.- 22. bz ic 22 ee 14, 364, 624 13, 649, 254 12, 483, 747 Monthly’ benefits G2) 2©. = 2.4, 2 te 1, 251, 207 1, 170, 675 1, O11, 376 Old-aee (retired worker) 32 4 8 oe 9, 632, 944 , 139, , 339, 881 Disability (disabled worker) -__--------.--------_--------- 997, 725 936, 816, 349 Supplementary (O ASI and)D)) _.... 25... ee 1, 671, 035 1, 618, 618 1, 485, 396 Supplementary (O:A8)) 22 8 a ae 1, 417, 553 1, 384, 670 1, 290, 369 Supplementary (DD ==.) |S oes eee 253, 482 233, 948 195, 027 Survives 3.22. wie ee ee 3, 314, 127 3, 125, 384 2, 853, 497 Lump-sum death payments_______------.------------- as 214, 563 195, 330 174, 089 Workers gob oe for OASI benefits (midpoint of period— Jan. 92, 100 90, 500 89, 100 91, 400 89, 900 , é Workers insured for disability (midpoint of peri iF 52, 900 51, 700 50, 500 Estimated number of employers reporting taxable wages, ist quarter, of fiscal year... 2-24. i. 2 te 44.370 44,330 44,260 Calendar year Estimated number of workers with taxable earnings____-_____ 77, 300 7 74, 680 Estimated amount of taxable earnings___.____________________ $235, 800, 000 | $225, 700,000 | $219, 250, 000 Average taxable earninps£ 3 = ©... te Se $3, 050 $ $2, 936 1 Benefits under the old-age and survivors insurance (O ASI) parts of the old-age, survivors, and disability insurance program are payable from the OASI trust fund to old-age insurance (retired worker) beneficiaries and their dependents and to survivors of deceased workers. Benefits under the disability insurance (DI) part of the program are payable from the DI trust fund to disability insurance (disabled-worker) benefici- aries and their dependents. 2 Includes benefits payable to disabled persons aged 18 or over—dependent sons and daughters of disabled, deceased, or retired workers—whose disability began before age 18. 3 Estimates of insured workers have not been adjusted to reflect changes in insurance status arising from: (1) provisions that coordinate the old-age, survivors, and disability insurance and railroad retirement pro- grams and (2) wage credits for militarysrevice. Estimates are only partially adjusted to eliminate duplicate count of persons with taxable earnings reported on more than 1 account number. 4 Excludes agricultural employers. Ct, a Op i ae ae Social Security Administration 45 Table 4.— Federal credit unions: Assets, liabilities, and capital, Dec. 31, 1962, and Dec. 31, 1963 Amount Percentage distribution Assets, liabilities, and capital Dec. 31, 1963 | Dec. 31, 1962 Change Dee. 31, | Dec. 31, during year 1963 1962 Number of operating Federal credit RN oS cn cn oe 10, 955 10, 632 5 oe a ee fee (Oa LCE OE ele $3, 916, 541, 104 | $3, 429, 804, 503 | $486, 736, 601 100. 0 100. 0 Loans to members---- ----| 2,911, 159, 474 2, 560, 721, 896 350, 437, 578 74.3 74.7 Tt 2A ees = ee ee ae 217, 052, 772 193, 923, 961 23, 128, 811 5.5 5e7 U.S. Government obligations_-__-__- 88, 059, 567 84, 095, 259 3, 964, 308 2.3 2.4 Savings and loan shares--_-__-- mess 599, 230, 365 493, 024, 709 106, 205, 656 15.3 14.4 Loans to other credit unions__--__--- 59, 330, 936 62, 156, 232 —2, 825, 296 1.5 1.8 A a 41, 707, 990 35, 882, 446 5, 825, 544 i 1.0 Total liabilities and capital____| 3, 916, 541, 104 3, 429, 804, 503 486, 736, 601 100.0 100. 0 Nyipe oT a 68, 061, 983 68, 656, 711 —594, 728 7 2.0 Accounts payable and other liabilities_ 21, 193, 682 17, 702, 698 3, 490, 984 -5 -5 og ari 3, 452, 615, 166 3, 020, 274, 340 432, 340, 826 88.2 88. 1 iamermeneaeLYy On = = 2-55: 191, 355, 233 160, 365, 239 30, 989, 994 4.9 4.7 Special reserve for delinquent loans___ 4, 572, 557 , 368, 204, 513 os ey! tmemmerves: so. 11, 975, 628 9, 598, 729 2, 376, 899 -3 -3 Undivided earnings ?____.-__________- 166, 766, 855 148, 838, 742 17, 928, 113 4.3 4.3 1 Reserve for contingencies and special reserve for losses. 2 Before payment of yearend dividend. Table 5.—Federal credit unions: Selected data on operations, as of Dec. 31, for each year 1934-63 * Number of operating | Number of Loans out- Year Federal members Assets Shares standing credit unions 39 3, 240 ‘ $23, 100 $15, 400 772 119, 420 2, 372, 100 2, 228, 400 1, 834, 200 1, 751 309, 700 , 158, 100 8, 510, 900 7, 343, 800 2, 313 483, 920 19, 264, 700 17, 649, 700 15, 695, 300 2, 760 632, 050 29, 629, 000 26, 876, 100 23, 830, 100 3, 182 850, 770 47, 810, 600 43, 326, 900 37, 673, 000 3, 756 1, 127, 940 72, 530, 200 65, 805, 800 55, 818, 300 4,228 | 1, 408, 880 106, 052, 400 97, 208, 900 69, 484, 700 4,145 1, 356, 940 119, 591, 400 109, 822, 200 43, 052, 500 3,938 | 1,311, 620 127, 329, 200 117, 339, 100 35, 376, 200 3,815 | 1,306, 000 144, 365, 400 133, 677, 400 34, 438, 400 3, 757 1, 216, 625 153, 103, 120 140, 613, 962 35, 155, 414 3, 761 1, 302, 132 173, 166, 459 159, 718, 040 56, 800, 937 3, 845 1, 445, 915 210, 375, 571 192, 410, 043 91, 372, 197 4, 058 1, 628, 339 258, 411, 736 235, 008, 368 137, 642, 327 4,495 | 1,819, 606 316, 362, 504 285, 000, 934 186, 218, 022 4,984 | 2,126,823 405, 834, 976 361, 924, 778 263, 735, 838 5, 398 2, 463, 898 504, 714, 580 457, 402, 124 299, 755, 775 5,925 | 2, 853, 241 662, 408, 869 597, 374, 117 415, 062, 315 6,578 | 3,255, 422 854, 232, 007 767, 571, 092 573, 973, 529 7,227 | 3,598,790 | 1,033, 179, 042 931, 407, 456 681, 970, 336 7,806 | 4,032, 220 1, 267, 427, 045 1, 135, 164, 876 863, 042, 049 8,350 | 4,502,210 | 1,529, 201,927 | 1, 366, 258, 073 1, 049, 188, 549 8, 735 4, 897, 689 1, 788, 768, 332 1, 589, 190, 585 1, 257, 319, 328 9,030 | 5,209,912 | 2,034,865,575 | 1,812,017, 273 1, 379, 723, 727 9, 447 5, 643, 248 2, 352, 813, 2, 075, 055, 019 1, 666, 525, 512 9,905 | 6,087,378 | 2, 669,734,298 | 2,344,337,197 | 2, 021, 463, 195 10,271 | 6,542,603 | 3,028, 293,938 | 2, 673,488,298 | 2, 245, 223, 10,632 | 7,007,630 | 3, 429,804,503 | 3, 020, 274, 340 2, 560, 721, 896 10,955 | 7,499,747 | 3,916, 541,104 | 3,452,615,166 | 2,911, 159, 474 1 Data for 1934-44 on membership, assets, shares, and loans outstanding are partly estimated. 2 First charter approved Oct. 1, 1934. 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SI Ga sta bapa hy) Wapatl' > ? Welfare Administration THe WELFARE ADMINISTRATION moved forward in 1964 to aid States and communities throughout the Nation to develop more comprehen- sive and coordinated approaches to welfare. Major emphasis was placed on the development of efforts to help persons who might other- wise become dependent to maintain their self-sufficiency, to help rehabilitate persons who are currently dependent, and to strengthen family life in order to achieve these objectives. During its first full fiscal year of operation since it was established in January 1963, the Welfare Administration gave special attention to: ® strengthening Federal-State public welfare programs and relationships ; ® strengthening Welfare Administration staff and operations in order to provide greater planning and technical services to aid States; ® encouraging and assisting States to take advantage of recent Federal legislation authorizing additional funds to enable States to extend and improve their welfare programs; ® encouraging public and voluntary agencies in the welfare field to develop coordinated efforts in attacking poverty and dependency ; @ assisting in the development and support of research and demonstration projects designed to provide new information on welfare problems and new approaches to their solution; ® assisting in the development and support of training and recruitment programs designed to provide new professional work- ers in the welfare field and to improve the qualifications of present welfare workers. 49 50 Department of Health, Education, and Welfare, 1964 Highlights of 1964 Among the Welfare Administration’s major actions and accom- plishments in fiscal 1964 were the following: 1. Improving assistance and services.—Significant progress was made in providing more adequate assistance and services through Federal-State public welfare programs under recent amendments to the Social Security Act in the areas of aid to the aged, blind, and dis- abled; medical assistance for the aged; aid to families with dependent children, including children of unemployed parents; community work and training; assistance for children in foster care; day care; maternal and child health and crippled children’s services; and mental retarda- tion. States and communities were encouraged to develop broader pro- grams to help meet the needs of their senior citizens and were provided with information and technical services by the Welfare Administra- tion. Several communities received Federal support in the development of planning and action programs to prevent and combat juvenile delinquency, and grants for training persons in youth work were made to a number of colleges, universities, and other nonprofit agencies. Social services designed to help individuals and families move toward greater independence which received special attention during 1964 included: day care for children of working mothers; homemaker services for deprived families and the elderly ; and counseling of school dropouts. 2. Eligibility for assistance.—Federal policy was revised to require more frequent determinations of the eligibility of families being aided under Federal-State public assistance programs. Under the new policy, eligibility must be determined at least once every 6 months rather than once a year. This is designed to guarantee greater validity of determinations and, because of a caseworker’s more frequent con- tacts with each family, to assure greater awareness of family needs and greater opportunities for constructive counseling. 3. Quality control.—In a related move, a new nationwide system known as quality control was established in every State public welfare agency to assure that eligible applicants are not erroneously denied assistance and that public welfare funds are spent in strict accordance with Federal and State laws. By applying to public welfare the type of quality control systems used by private industry to maintain high standards in manufacturing operations, State agencies are able to dis- cover the sources of any errors and to take appropriate measures to prevent their recurrence. Welfare Administration 51 4, Federal-State cooperation.—Federal staff worked closely with State welfare agencies during the year in improving clarity of policies, efficiency of procedures, and adequacy of staff. Special emphasis was placed on developing greater utilization of existing community resources, both public and voluntary, to help meet the welfare, health, and educational needs of individuals and families. Welfare Administration staff teams—composed of specialists in public assistance, child welfare, and aging—visited every State public welfare agency to confer with State directors and other principal staff members about each agency’s major needs and problems and possible steps toward strengthening of programs. Several comprehensive erientation programs were held in Washington for newly appointed State public welfare directors. Special attention was given to State problems of recruiting adequate welfare staffs to carry out programs effectively. Information on recruitment procedures used by various States was collected and communicated to all States. Materials were issued to encourage State and local welfare agencies to offer summer jobs to college students interested in careers in public welfare and to encourage students to apply for such jobs. States were encouraged to take advantage of federally aided educational leave programs to enable staff members to improve their qualifications. 5. Strengthening Federal services —A number of steps were taken to strengthen the Welfare Administration in order to be able to pro- vide better services to States and communities. Responsibilities of Welfare Administration field staff were ex- panded. Special consultants were added to the immediate staff of the Commissioner of Welfare in the areas of medical care and coopera- tion between public and voluntary agencies. Staffs of the various operating units of the Welfare Administration were also strengthened. The Division of Research in the Office of the Commissioner was fully staffed. Publication was begun in July 1963 of the monthly journal Welfare in Review, designed to communicate the wealth of research data and related information developed and compiled by the Welfare Administration. A second annual meeting was held of public information officers from State public welfare agencies to review areas of urgent impor- tance to States, such as campaigns for recruiting adequate welfare staffs, and to explore ways in which Welfare Administration informa- tion activities could be developed to assist States in their programs. 6. Supporting research and training —The Welfare Administration awarded grants totaling $26.6 million during fiscal 1964 to support 232 research and demonstration projects and 202 training programs. The 52 Department of Health, Education, and Welfare, 1964 recipients of the grants were public welfare and health agencies, non- profit organizations, and colleges and universities. The research and demonstration grants support experimental and pilot projects designed to lead to new knowledge and methods of solv- ing problems related to public assistance, child welfare, juvenile de- linquency, maternal and child health, crippled and mentally retarded children, and the aging, and to improved administration. They em- phasize the development of preventive programs to help persons avoid becoming dependent and of rehabilitative programs for persons who are dependent. Various projects, for example, deal with job counsel- ing and placement of young persons, school dropouts, and literacy training. Others are concerned with such areas as the rehabilitation of children with multiple handicaps and reducing the incidence of mental retardation. The training grants help to finance graduate study in social work and related fields and to support special training projects for personnel in public welfare, child health and welfare, and juvenile delinquency pre- vention and control. In addition to projects in the United States, the 1964 grants included 16 international research projects in social welfare and maternal and child health. Financed from U.S.-owned foreign currencies, the proj- ects are designed to be of value both to the foreign countries involved and to the United States. 7. Participation in overall planning.—The Welfare Administration played an important role in a variety of broad Federal efforts which involved welfare as a major component. These included, among others: emergency assistance for Alaska following the 1964 earth- quakes; proposals for reducing poverty and dependency in Appala- chia; rehabilitation programs for men rejected for military service; and planning for the war on poverty. Five Major Units The Welfare Administration was established in order to bring to- gether in one administrative organization the Department’s principal activities in the welfare field. This reorganization reflected the in- creased responsibilities in public welfare resulting from the 1962 public welfare amendments to the Social Security Act and other recent legis- lation. Most of the programs of the Welfare Administration are carried out through its five constituent units: the Bureau of Family Services; the Children’s Bureau; the Office of Aging; the Office of Juvenile Delin- quency and Youth Development; and the Cuban Refugee Program. Welfare Administration 53 The activities and accomplishments of each unit are described in greater detail on the following pages. The purpose of all of these programs is to help our Nation, States, and communities to meet adequately and equitably our social welfare needs, to provide new opportunities for people, and to prevent and reduce the poverty and dependency which are so costly not only to the individuals involved but to the Nation. Bureau of Family Services The Federal-State-local public assistance partnership made signifi- cant progress during 1964 in improving its efforts to help needy people. In fulfilling its responsibility for Federal leadership, the Bureau of Family Services concentrated on encouraging States to carry out the broad changes authorized by the Public Welfare Amendments of 1962. Among them were: ® strengthening and expanding the social services that help de- pendent people move toward self-care and self-support; ® recruiting and training the increased number of welfare workers that are needed to provide these services; and ® promoting experimental or demonstration programs de- signed for finding better ways of dealing with public welfare problems. The Bureau’s other important activities during the year were related to the on-going job of improving and extending the public assistance programs. They included: increasing administrative efficiency in States through such measures as the quality control program; en- couraging eight additional States to establish programs of medical assistance for the aged; urging better coordination of local public wel- fare and law enforcement agencies in the location of absent parents and obtaining support for their families: and promoting the improve- ment of aid and services to families of the unemployed. Strengthened Social Services As fiscal year 1964 ended, all States but one were providing some part of the social services prescribed by the Secretary of Health, Edu- cation, and Welfare to reduce and prevent dependency. By providing all of a minimum “package” of services, States received a 75 percent Federal share—instead of 50 percent as formerly—of the cost of the improved services. Earlier, every State had complied with the two mandatory provi- sions of the 1962 Public Welfare Amendments: (1) that a social study 54 Department of Health, Education, and Welfare, 1964 be made of each child receiving aid to families with dependent children (AFDC) to determine which have special problems or need protection and (2) that AFDC and child welfare services be coordinated on State and local levels in such areas as program planning, staff develop- ment, direct service, and community planning. Throughout the year, Bureau staff devoted considerable efforts to reviewing State plan materials on social services. One of the prob- lems that became evident was that many States did not have sufficient program planning staff to carry out their commitments under their social service plans. To help overcome this difficulty, the Bureau sent to all States a guide for program planning for social services. An- other move was to plan a national meeting with State welfare admin- istrators and State staff responsible for program planning. The meeting was held shortly after the end of the fiscal year, and all but four States were represented. To help States improve the quality of the mandatory social studies of all AFDC children, the Bureau’s welfare services specialists pre- pared a guide for conducting these studies. They also prepared guides for use in social studies of adults, thus facilitating the provision of prescribed social services under all of the public assistance titles. The guides were sent to States with a request for a year’s testing to deter- mine their usefulness. In the fall of 1963 the Bureau held a series of meetings to clarify for regional staff the new social service and staff development policies and to discuss next steps in assisting the States in progressive program development. Regional staff of the Children’s Bureau also partici- pated. It was concluded that the major areas in which State program development directors needed further technical assistance were com- munity planning, volunteer services, homemaker services, and the de- velopment of training materials. The Bureau of Family Services and Children’s Bureau continued joint efforts to clarify policy and guide materials on public assistance and child welfare service responsibilities and relationships under the 1960 and 1962 amendments. Policy questions were discussed at a joint field staff meeting for the purpose of identifying areas in which further guides are needed by States in effecting the coordination of services under aid to families with dependent children and child wel- fare services. CASE CLASSIFICATION To help States improve their program planning and staff utilization, a special Bureau committee drafted preliminary guide materials for a case classification system that could be administered by local agencies. The objective of the system is to enable agencies to screen their case- Welfare Administration 55 loads and identify cases that require various kinds of services. It would then be possible to assign workers with the kind and degree of skill required to deal with these cases. The committee also is developing a case schedule for nationwide use by States. It would be used to summarize key social information from social studies, for case action controls, and for feedback to guide agency administration and community planning. The committee is exploring the use of the schedule for simplified case analysis and recording, and for operational research purposes, including continu- ing evaluation of casework goals and accomplishments. COMMUNITY WORK AND TRAINING As fiscal year 1964 ended, more than 15,000 adults were engaged in community work and training programs in nine States: California, Illinois, Kansas, Maryland, Ohio, Oregon, Pennsylvania, Washington, and West Virginia. A tenth State, Kentucky, was providing com- munity work and training in nine Appalachian counties under a demonstration project. The 15,000 families included about 57,000 children and 14,000 other adults. All were recipients of aid to fam- ilies with dependent children. Most of the 10 States provided education, training, and other serv- ices to improve the employability of the work-project participants. To encourage wider adoption of the program, Bureau staff made con- sultation and factfinding visits to a number of States. Staff also maintained liaison with such related Federal agencies as the Area Redevelopment Administration; the Office of Rural Areas Develop- ment, of the Department of Agriculture; the President’s Appalachian Regional Commission; and the President’s Task Force on the War on Poverty, forerunner to the Office of Economic Opportunity. SERVICES FOR THE AGING The Bureau discussed with the American Public Welfare Associa- tion, the National Council on the Aging, and several State depart- ments of public welfare the design for a series of demonstration proj- ects. The purpose of the projects is to clarify and evaluate the local welfare agency’s role in carrying out protective services for the aging and to test some of the methods and techniques involved in the pro- vision of protective services. A Bureau staff member served as chairman of the Task Force on Protective Services of the President’s Council on Aging and carried major responsibility for developing a brochure on protective services. A report on guardianship status of beneficiaries of Federal programs who are unable to manage their money was completed and submitted to the President’s Council on Aging. Guides on the purpose and 56 Department of Health,. Education, and Welfare, 1964 standards of protective services were published late in the fiscal year. Guides for foster family care were under development. Staff have been involved in the review of State plan and other ma- terials relating to removal of older persons from State mental hospitals and caring for them by other means. In Ohio, Pennsylvania, and California special plans and proposals have been made. The Bureau’s specialists in services to the aging are accumulating examples of State experience as a basis for reviewing existing policy on assistance to individuals in public institutions, services to older persons removed from institutions, and establishment of geriatric units in local public welfare agencies. COMMUNITY PLANNING A preliminary statement outlining the role of the local public wel- fare agency in community planning was developed for use of State public assistance programs electing to provide prescribed services under the 1962 amendments. Factfinding visits were made to four States to observe local planning activities. A Bureau staff member was appointed to serve as the Department liaison officer to the Inter- departmental Study Group on Rural Development. Other activity in the field of community planning included assist- ance in the development of several community planning demonstra- tion projects. Bureau specialists helped to establish a training pro- gram for community planners in North Carolina. The results of this program are to be made available to other State community planning personnel. Close working relationships were maintained with the several national community planning groups, out of which it is antic- ipated that some national conferences and meetings will emerge. A guide on community planning is in preparation. VOLUNTEER SERVICES A Welfare Administration task force to provide support for volun- teer services in public welfare was established under the leadership of a Bureau staff member. This specialist provided consultation to several States, participated in national and regional meetings on © volunteer services, and carried out factfinding explorations with State agencies and related programs. HOMEMAKER SERVICES A Bureau staff member served as conference secretary for the Na- tional Conference on Homemaker Service, held in Washington, D.C., in the spring of 1964. The meeting attracted over 700 participants. The Committee on Homemaker Services of the Welfare Administra- tion has been active in promoting and coordinating homemaker serv- Welfare Administration ive ices. A number of interpretive materials were issued to States during the year. SERVICES TO THE RETARDED In the field of mental retardation, the Bureau’s emphasis has been on the implementation of Public Law 88-156, which authorizes grants to States “to plan for and take other steps leading to comprehensive State and community action to combat mental retardation.” A member of the Bureau serves on the Secretary’s Committee on Mental Retardation and participated in the White House Conference on Mental Retardation in September 1963. The same staff member is assigned to work with the newly formed Mental Retardation Branch of the Division of Chronic Diseases, Public Health Service. She serves as a member of the committee that reviews States’ applications for mental retardation planning grants. This Bureau specialist also provided individual consultation to three State agencies to assist them in developing acceptable plans. CONCERTED SERVICES PROJECTS A member of the Bureau’s staff continued to serve as cochairman of the Joint Task Force on Concerted Services in Public Housing, spon- sored by the Department of Health, Education, and Welfare and the Housing and Home Finance Agency. Other Bureau staff also serve on the several committees of the task force. The objective of the task force is to raise the level of living—economice, social, educational, and cultural—of the approximately 2 million persons living in public hous- ing developments in more than 2,100 communities in the United States. During the year, three additional concerted services demonstration projects were started. They were located in public housing develop- ments in New Haven, Conn.; Pittsburg, Calif.; and Miami, Fla. The first such project, in St. Louis, Mo., has been considerably expanded. The Joint Task Force’s committee on use of program resources, of which a Bureau staff member is chairman, published the pamphlet Services to Families in Public Housing. It has had a second printing and approximately 40,000 copies have been distributed. A selected bibliography has been prepared as a supplement to this publication. LOCATING ABSENT PARENTS During the year, the Bureau called a second meeting with judges, attorneys, and representatives of public welfare departments to con- sider the coordination of welfare departments and law enforcement agencies. A report of the meeting was issued in a booklet form. An outline was developed for a demonstration project involving better coordination of community efforts to locate absent parents. A sched- 748-869—65——5 58 Department of Health, Education, and Welfare, 1964 ule was issued to State agencies for a report on their activities in lo- cating parents. The Veterans Administration and the Department of Health, Edu- cation, and Welfare agreed upon an experimental 12-month project to test the feasibility of using information from Veterans Administra- tion records to locate absent parents of children receiving aid to families with dependent children. The results will be evaluated to determine the applicability of the procedure throughout the Nation. CHILDREN IN FOSTER CARE With participation of the Children’s Bureau, the Bureau completed the first phase of factfinding and evaluation of States’ experience in implementing the 1961 and 1962 amendments authorizing foster care of children under the AFDC program. A report was made to Con- gress on use of public agencies other than public welfare for placement of AFDC children in foster care. Following further planning with the Children’s Bureau, factfinding was continued in States that elected to provide institutional care under aid to families with dependent children. As the year ended, 23 States were making AFDC payments in be- half of children receiving foster care. Nearly 5,000 children were receiving an average of $72 per month in assistance payments. By far the largest proportion were in foster family homes, with the re- mainder receiving institutional care. Staff Development To further the growth of State staff development efforts, the Bureau assigned a specialist in staff development to four of the nine regions. The effectiveness of this move lies in the greater accessibility and continuity of consultative services. Also, the specialists are acting as a clearinghouse for the interchange of ideas and information between the community, the State, and the region. In the four regions, they have received far more requests for assistance than had originally been anticipated. Five other specialists are assigned to work out of the Washington office, serving the other five regions. In cooperation with the National Commission for Social Work Careers, the Bureau continued to promote recruitment for professional careers in public welfare. This brought to the surface the problem of insufficient facilities in schools of social work to meet present and future needs for trained workers. The Bureau therefore recommended that the schools make major expansions in their physical plants, faculties, and field instruction. Welfare Administration 59 The Bureau has also encouraged States to develop summer career programs for college students to interest them in employment with public welfare agencies. Reports from State agencies indicate that they are continuing to make progress toward determining how many training personnel are needed, developing internal agency training programs, designating the positions that require professional or technical education, and planning how to fill these positions. Bureau specialists in staff development continued to prepare guide materials for use with State training personnel. One, for instance, is a syllabus that was prepared for the training of local directors of welfare agencies. Two other projects nearing completion are “Edu- cational Standards for Functional Responsibility” and “Interim Guides for Functional Job Assignments.” During the past fiscal year, the Children’s Bureau and the Bureau of Family Services held two training workshops for newly appointed State and local staff development personnel. The objective was to present basic knowledge that could be used in teaching the skills re- quired for any job in public welfare operations. The Bureau continued to participate in the Department of Health, Education, and Welfare Task Force on Social Work and Manpower. One of the contributions was preparation of a report on need for re- search in manpower problems. Administration As fiscal year 1964 began, Bureau staff were heavily engaged in encouraging and helping States to correct the administrative problems that had been found by the nationwide review of eligibility in the program of aid to families with dependent children. By midyear, all 50 States were carrying out a three-pronged followup on the findings of the review. QUALITY CONTROL SYSTEM The first of these measures was the new system of quality control of case actions. By January 1964 it was in effect in every State. The purpose is to insure that the Nation’s annual expenditure of $4.5 billion for public assistance conforms strictly with Federal and State laws and that the program serves all those for whom it is intended. Under the new system every State public welfare agency has a fully manned quality control unit which continuously reinvestigates a sta- tistical sampling of all eligibility decisions made by local public assist- ance agencies throughout the State. The sampling includes decisions where assistance was denied as well as those where assistance was approved. Thus, the system assures that no eligible person is turned 60 Department of Health, Education, and Welfare, 1964 away and no ineligible person receives aid. It also makes sure that the amount of the assistance payment is neither too little nor too much. Each reinvestigation of eligibility includes a visit to the home of the person involved and a careful evaluation of living expenses, income and resources, and other factors affecting eligibility. When the State quality control unit discovers errors in local agency case actions, not only is the individual error corrected, but any necessary administra- tive changes are made to prevent such mistakes from happening again. The quality control system is under the close guidance of Bureau field staff. OTHER EFFORTS BY STATES The second of the Bureau’s actions to carry out the findings of the 1963 nationwide eligibility review was to require States to redetermine © the eligibility of all AFDC recipients every six months instead of once a year, as formerly. One reason for this move was the fact that most of the ineligibility and overpayment found in the 1963 review resulted from the frequent changes in circumstances that occur in AFDC fam- ilies. The new requirement automatically doubles the number of re- determinations made each year in most States. The third major move to carry out the 1963 review’s findings was the actions by each State to correct its own eligibility determination problems. The Secretary of Health, Education, and Welfare directed each State to develop and put into effect a plan of corrective action directed toward its own particular problems. With the assistance of Bureau of Family Services field staff, each State determined the sources of any errors, developed plans to remedy them, and drew up a time schedule for putting the plans into effect. Many States began the process of assessment and corrective action in advance of the Department’s call for action. In addition, several States had already begun to hire additional caseworkers and build up their staff training programs, in response to the 1962 Public Wel- fare Amendments. Considerable progress was reported by States in correcting their eligibility programs. In brief, the measures taken fall into these classes: © clarification and improvement of program policies and instruc- tions (simplifying assistance standards for determining family need and improved instructions for recording eligibility substantiation) ; @ strengthening personnel resources (increasing the number of staff, extending training, and improving supervision) ; and © improved administration of public welfare (agency reorganiza- tion and staff reassignment, and more efficient management and controls). Welfare Administration 61 The Bureau’s program operations staff took strong initiative in assuring that States complied with Federal quality control require- ments. They provided extensive consultative advice and training to all States. Regional training meetings for State quality control staff were held in Regions I, ITI, V, VI, and IX. In the other four regions, training was carried out through State-by-State visits. Central office specialist staff visited all but three regions in the installation process. SIMPLIFIED PROCEDURES Further effort to improve the administration of public assistance included sponsorship of a work group of State and local public wel- fare staff to plan ways of simplifying the job of the caseworker. This group, meeting with administrative specialists of the Bureau, identi- fied major problems and complexities that impede caseworkers in the performance of their job. Among the recommendations were greater use of auxiliary personnel to free caseworkers from clerical duties, simplification of procedures and forms, and greater experimentation, including use of demonstration projects to try out new and simplified administrative methods. The Bureau’s specialists on administration and on welfare services met with States in Region VI to diseuss simplification of standards of assistance. To help States purchase and use most effectively the many new kinds of automatic data-processing equipment, the Bureau appointed a committee to develop policy on the rental or purchase of data- processing equipment. Under consideration is a proposal to require that States have feasibility studies made by qualified systems analysts as a condition for Federal participation in the cost of purchasing or renting the equipment. Bureau consultants assisted in systems surveys of the welfare de- partments of Kentucky, Pennsylvania, and North Carolina. The con- sultants helped to organize and direct task force studies of automatic data-processing operations to develop the framework for new ADP systems or to solve special ADP problems. ADVICE AND ASSISTANCE In advising and assisting States, the Bureau’s regional staff con- centrated on implementation of the 1962 amendments and the general improvement of public assistance administration. A regional office team visited each State agency to explore ways in which existing public welfare resources at both State and Federal levels may be used to combat poverty. The team consisted of the Bureau’s regional representative (who is also the principal Welfare Administration regional representative) and the regional representa- 62 Department of Health, Education, and Welfare, 1964 tives of the Children’s Bureau and Office of Aging. The team re- viewed the current situation in the State, the major obstacles to full utilization of Federal resources, and current planning for greater utilization of existing resources. The comprehensive reports of these visits provide excellent blueprints for future work. A draft statement on coordinated field supervision of public assist- ance and child welfare services in States was distributed to regional representatives of the Bureau of Family Services and the Children’s Bureau for use in consultation with States. Guides were developed on State responsibility for local operations and on policy manual improvement. Others underway were guides on case recording and administrative aides to the caseworker. Typical of the technical assistance provided to States was the help given by Bureau staff in reorganizing one State department of public welfare. Bureau staff recommended organizational changes aimed at stronger coordination of the department’s units. Staff also urged the State to centralize its staff functions—such as personnel, research, and financial management—to permit greater effort on program devel- opment and supervision of operations. Chief fiscal officers of State public welfare agencies met with the Bureau of Family Services and other Welfare Administration units to explore ways of simplifying fiscal procedures and methods. Topics discussed included transmittal of public assistance recipients’ checks to them in the authorized time, prompt payment of bills for medical services provided recipients, and maintaining a recordkeeping and reporting system that accurately reflects expenditures. GRANTS TO STATES In fiscal 1964, the Bureau of Family Services channeled $2.9 billion in Federal grants to States for public assistance, States and local governments furnished about $1.6 billion, for a total of $4.5 billion spent throughout the Nation during the year. Administrative costs for the Bureau during this period were only $4.5 million—or less than one-sixth of one percent of the Federal costs of the programs. The regular schedule of checking and processing the States’ quar- terly estimates and expenditure statements, and the monthly certifica- tion of grants for payment by the U.S. Treasury Department continued throughout the year for the 228 public assistance programs in opera- tion in the States and other areas. In the administration of Federal public assistance grants, one of the Bureau’s main concerns during 1964 was the continued review of State plan material resulting from the 1961 and 1962 amendments to the Social Security Act. States submitted plans at an accelerated rate in a wide range of program areas, particularly social services. Welfare Administration 63 Demonstration Projects Through orientation meetings, conferences, and State letters, the Bureau urged State public welfare agencies to make greater use of demonstration projects to provide new approaches, techniques, and methods to reduce or prevent dependency. The projects were author- ized by Section 1115 of the 1962 amendments to the Social Security Act. By the end of the year, 97 applications had been received, 36 approved, and $1,305,000 in special demonstration project funds obligated. The 36 approved projects were from 21 States and the District of Columbia, and included 10 back-to-school programs, 5 vocational training projects, and 3 service projects on behalf of aging citizens. Other projects covered various phases of welfare services, training and education of social workers, and the administration of public assistance agencies. The Bureau’s Advisory Committee for Demonstration Projects, which is made up of eight officials from several of the Nation’s leading educational and research institutions, as well as from State public assistance departments, formulated criteria and priorities to guide the program. The projects ranged in size from a $2,400 back-to-school program in Vermont to a $405,000 program for unemployed parents in Kentucky. The following examples illustrate the wide variety of demonstration projects approved during the year. A North Carolina project provides funds for 25 community services consultants to coordinate local and State resources for needy persons. A West Virginia project aids vocational rehabilitation in an urban area of that State. A project in Maine provides summer camp experience for several hundred children from families receiving public assistance. In Georgia, a demonstration project provides academic and vocational training to AFDC youngsters between the ages of 16 and 19. As the fiscal year ended, 42 demonstration projects were in various stages of preparation and action in the States. Medical Care During fiscal 1964, the Federal and State governments took numer- ous steps to insure the provision of adequate medical care to needy people. With the costs of medical care continuing to rise, public welfare agencies in many States increased payments and improved medical services to public assistance recipients. The program of medical assistance for the aged (MAA) was put into effect in eight more jurisdictions in 1964. This brought the year- end total to 37 States and other jurisdictions. Shortly after the close 64 Department of Health, Education, and Welfare, 1964 of the year, new State programs raised the total to 41. Only 7 States then lacked the legislative authority for MAA. The program, au- thorized by the Kerr-Mills amendments to the Social Security Act, had gone into effect in October 1960. A development with great potential for providing medical care to the needy was the move to initiate retroactive vendor payments by 18 States. This 1962 amendment allowed Federal participation in the costs of retroactive vendor payments for medical care under various programs and for varying periods up to 3 months before the date of application. Initiation of the new combined program of aid to the aged, blind, and disabled (AABD) by 12 States increased the rate of Federal participation in medical vendor payments under the aid to the blind and aid to the disabled programs by applying the same formula used in old-age assistance to this unified program. Uniform eligibility requirements and use of the same standards of assistance for these adult groups are substantial advantages. The comprehensive document developed last year for reviewing medical services in all assistance categories, including medical assist- ance for the aged, was used by Bureau staff to complete a pilot review in Pennsylvania. The review experience is providing the basis for revising the document so that it can be used by States to report on medical care programs. A review of medical factors of eligibility in the program of aid to the permanently and totally disabled (APTD) was completed in the State of Washington; a similar review was done in the District of Columbia. This year, the Bureau completed a study and review in Texas of the State welfare agency’s contractual arrangement with Blue Cross-Blue Shield for the administration of its medical care program. ‘This analysis was of particular importance because it can serve as a model for future reviews of such arrangements. Technical assistance to States was an important Bureau method for improving the quality of medical assistance and services to needy and low-income people. The Kentucky departments of health and welfare, | according to contract, share a joint responsibility for the provision of medical care to public assistance recipients. A Federal team assisted these agencies in setting up an automatic data processing system to expedite payment to vendors and supply the range of facts and figures that are needed to successfully operate a program of this scope and importance. Consultants on medical care administration from the Bureau visited several States to assist in the orientation of new State medical directors and medical staff members. Bureau personnel also Welfare Administration 65 assisted States in improving nursing home care for assistance recipients. To extend and improve hospital services to recipients of old-age assistance and medical assistance for the aged, the Bureau and the American Hospital Association sponsored two regional meetings of State welfare directors and State hospital association officials. They were held in Atlanta, Ga., and Boston, Mass. The objective was to clarify the mutual responsibilities of hospital and State welfare per- sonnel and to explain the role of the Bureau under the Kerr-Mills Act. The Bureau’s advisory committee on medical matters met in Wash- ington, D.C., twice during the fiscal year. Among the topics con- sidered were: the medical needs of children, care of the mentally retarded, use of health insurance, the determination of medical eligi- bility, and pharmaceutical services for public assistance recipients. Research The Nation’s increasing concern for the plight of poor people has brought about a rising demand for new knowledge about public welfare needs and programs. Bureau efforts-during the fiscal year were in these main areas: basic research in the causes and nature of poverty, increased output of statistical and analytical data for guidance of programs, and development of cost allocation methods for the new 75 percent Federal financial participation in the cost of prescribed social services. To build a closer working relationship with State public welfare research units, the Bureau’s regional research specialists met with central office staff on several occasions. Among the projects involving State cooperation are the forthcoming characteristics studies of re- cipients of old-age assistance and medical assistance for the aged, the compilation of information found in the nationwide social studies of recipients of aid to families with dependent children, the statistical aspects of the new quality control program, and the proposed study of unmet needs among public assistance recipients. An advisory committee of State research and statistics directors met with Bureau staff in May to discuss plans for the study of old-age assistance recipients. On the basis of this and other advice, it was decided to use a mail questionnaire as a supplementary data collecting device. New procedures for processing the survey data also were developed. States are to place the information on puncheards, sending a duplicate set to the Bureau. In the central office, cross-tabulations of data—by States, regions, and Nation—will be prepared by computer. yc ee ee lee oe ee 0 0 bh ns 0 0 0 0 0 bo 0 6 0 0 6 o 4 0 0 0 0 0 0 0 ole . ee ed ce oe 0 0 0 of se 0 0 0 0 0 ele 0s 0 6 0 0 ele 0 0 6 0 6 0 6 A] yyy | TOTAL AFDC CHILDREN F Depariment of Health, Education, and Welfare, 1964 faa} Ww Ee < E OF are o Ww tI wy S a 24 Eee fa} a Lu a a w > fo} = [rote Xe wus rd -E 2 ons 0 3 | | AFDC CHILDREN BY STATUS OF FATHER CHILDREN BY STATUS OF FATHER, JUNE OF EACH YEAR, 1940 TO DATE | | | | = ae SoBe NUMBER OF AFDC CHILDREN PER 1,000 POPULATION UNDER AGE 1|8 40 42 44 ‘46 48 50 ‘52 '54 ‘56 ‘558 60 ‘62 '64 ' \ | = hens — eS CHART. 1.—NUMBER OF CHILDREN RECEIVING AID TO FAMILIES WITH DEPENDENT MILLIONS OF CHILDREN Cee 66 ° ngs oan ou ° x 0 Welfare Administration 67 Plans for further study of the program of medical assistance for the aged also were discussed with the State research and statistics direc- tors. The decision was reached to conduct a study in fiscal 1965 of the characteristics of recipients and the kinds of medical care they received. The Bureau’s research staff completed the processing of State re- ports and issued national totals and detailed State tables on the characteristics and financial circumstances of recipients of aid to the blind and aid to the permanently and totally disabled. Staff also planned detailed cross-tabulations of recipient data from punchcards furnished by States on these studies. The Bureau released the report Public Assistance in the Counties of the United States, which presents the relative positions of counties in respect to recipient rates and average payments in old-age assistance, aid to families with dependent children, and aid to the permanently and totally disabled. Based on State reports and 1960 Census data, the county-by-county report shows that the highest proportions of persons assisted are in declining rural areas, especially in the southern and border States. Lowest average assistance payments are in the same areas. Highest average payments are in the far west, north central, and industrial northeast areas. Consultation to States included helping the West Virginia public welfare department design a demonstration project on redetermina- tion of eligibility by means of a mail questionnaire to be completed by recipients of old-age assistance. Bureau staff also consulted with the University of Kentucky and the State welfare department on their study of the effects of long-term poverty on families assisted by the community work and training demonstration project in nine eastern Kentucky counties. 1964 Program Trends Nationwide, about 7.2 million persons were receiving aid under the federally supported public assistance programs in June 1964. This was about 350,000 more than in June 1963. The year’s rise was at- tributable largely to the increase of 280,500 (7.1 percent) in aid to families with dependent children. In that program, there was an increase of 85,600 recipients (28.5 percent) in families aided because of a parent’s unemployment, resulting from 5 additional States ex- tending their programs. The number of recipients in families aided for other reasons rose 194,900 (5.4 percent). For the year, assistance payments for all programs, including vendor payments for medical care, amounted to $4.5 billion, an in- crease of $294 million from the previous year. Total payments to 02, 69, 89, 29, 99, S9, 9, £9, 29, 19, 09, 6S, BS, 4S, 9G, SS, HS, ES, 25, IS, OS, 6b, Bb, Lb, 9b, Sb, bh, Sh 2h Ih Ob, GE, BE, LE, 961 ro a = 0 a gv. freee + - | {| [4] = = : 00v V7 SN C\ stsdarerts : 1k ooe'| 000'2 002'2 00v'2 009'2 008'z ooo‘¢e o0z'¢ ene a Oov'e 009‘ a39V 3H1 YO4 ZONVISISSV TWOIG3N — VW : NIN 3HL OL iv — av 008s ot Qa 1eVSIG ATIVLOL ONV ATILNANVWY3d SHL OL div — GidV ‘ 000'b ZONVLSISSY IWYSN39 — V9 ; FONVLSISSY 3ov-d10 — vo \ coe & att N3YGTIHO LNSGN3d30 HLIM SaMIWV4 OL diy — oG4v 00v'b *O0N39371 ce FEEL Department of Health, Education, and Welfare, 1964 t jee alee = : i 009" | IS 008'b aS = | | CI H 000'S all | He: | | 009'S SONVSNOHL | HH 0or's He JLVG OL 9E6L ‘YWIA HIV AO YIIWIDIG GNV INA ‘WVADOUd AG SLN3ldI9IY JINVISISSY DJI1GNd JO YIGWNN—'Z LYVHD 68 Welfare Administration 69 recipients rose $115 million (8.0 percent) in aid to families with de- pendent children; $95 million (32.8 percent) in medical assistance for the aged; $56 million (14.3 percent) in aid to the permanently and totally disabled; $27 million (1.3 percent) in old-age assistance; and $2 million (1.8 percent) in aid to the blind. Recipients of old-age assistance numbered 2.2 million in June 1964— 0.8 percent fewer than in June 1963. The year’s decrease of 17,000 reflected primarily the transfer of aged persons (generally those living in nursing homes) to programs of medical assistance for the aged in 5 States. Income from old-age and survivors’ insurance continued to be a factor in the decline. Nationally, the average monthly OAA payment was $78—an increase of more than $1 for the year. In June 1964, payments of medical assistance for the aged were made in behalf of 187,100 persons in 37 States, 51,000 more than in June a year earlier. Transfers from old-age assistance and eight new State programs accounted for more than half of the June-to-June increase. The average payment was $197 in June 1964. In aid to the blind, the number of recipients (97,400) was 1.0 per- cent smaller than in June 1963. An increase of $2 brought the average payment to $84 in June 1964. About 501,400 persons were receiving aid to the permanently and totally disabled at the end of the fiscal year—39,900 more than in June 1963. Alaska established a program for the disabled during the year; there are now 53 jurisdictions administering such programs. Nationally, the average payment rose from $75 in June 1963 to more than $78 in June 1964. Aid to families with dependent children in June 1964 assisted 4.2 million persons, including 3:2 million children. This was 280,500 more recipients than in June 1963. During the year, five States ex- tended their programs to include persons in need because of a parent’s unemployment. In the 5 States, 18,700 families were receiving as- sistance under this extension in June 1964; most of them were trans- ferred from general assistance programs. For all families receiving aid to families with dependent children in June 1964, the national average payment per recipient was $33—an increase of $2. 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Emergency Welfare Services In 1964, the Bureau of Family Services continued its efforts to develop a national standby program of welfare aid and services to provide the necessities of life to the homeless in event of enemy attack. The program was carried on under authority delegated by the Secre- tary of Health, Education, and Welfare and the Commissioner of Welfare. As the year drew to a close, the Bureau’s emergency welfare services staff was readying for publication a wide assortment of technical manuals. With this work completed, the emergency welfare services program was ready to move into the next phase—planning for State and local use of the manuals in promoting emergency welfare readiness in the community. Among the materials that were ready for the printer was the basic program manual “Emergency Welfare Services—Guidelines and Structure.” Also ready was the series of guides and standards on emergency social services, emergency lodging, emergency feeding, emergency clothing, emergency welfare registration and inquiry, and fallout protection for welfare institutions. Bureau staff coordinated the emergency welfare aspects of the pro- totype civil defense planning study of Montgomery County, Md., which was sponsored by the Department of Defense, Office of Civil Defense. With the cooperation of the Montgomery County Depart- ment of Public Welfare and the county civil defense office, Bureau staff completed development of the Emergency Welfare Annex (in- cluding eight appendices) to the Montgomery County Operational Survival Plan. After clearance and publication by the Department of Defense, the annex will be used nationally as a guide for county emergency operations. To determine the role public welfare departments should have in fallout shelter utilization and how much support they could give generally to civil defense operations the Bureau conducted studies in eight cities across the Nation. This project was requested by the Department of Defense, Office of Civil Defense. The findings will be issued in fiscal 1965. Bureau staff continued with the development of plans for the reception, temporary assistance, and related services for U.S. citizens 72 Department of Health, Education, and Welfare, 1964 ONY ‘NOIYZITWLIdSOH ‘SVD TWOIG3W ONIAIZOD34 SNOSY3d 40 Y38WNN NMONYNN SIONIONI /S -DILYvd WY30Rs LNOHLIM 30VW SLNSWAVd JO SLN3IdID3Y S30NIDNI /P “SBLVLS ONINIVW3Y Ni NOLLVY3dO Ni WWH9O¥d ON ‘Oidy HOI SBLWIS £S 4OJ ONY WWW HOJ SAIWLS LE HOJ WIV NO O3Sva /2 P al HIN 31 v “ONI weno ce MO! 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To strengthen the cooperation of the Department of Health, Education, and Welfare, the Department of Defense, and the Amer- ican National Red Cross, the second and third in a series of inter- departmental and regional meetings were held. One of the results was a proposal to broaden the health, welfare, and other services provided to Department of Defense-sponsored evacuees. Also, work was initi- ated on a substantial revision of the emergency evacuation plan in accordance with recommendations made at the regional meetings. At the close of the year, 19 large national voluntary welfare organi- zations had executed memoranda of understanding with the Bureau of Family Services. The memoranda provide for the organizations’ assistance in developing a nationwide emergency welfare service pro- gram. Negotiations with three additional national organizations were underway as the year ended. Repatriates and Refugees In 1964, the Bureau’s repatriation program gave emergency and continuing help to 428 cases of needy Americans returned from over- seas because they were ill or without.funds. The help was provided through State and local welfare departments at major ports of entry, such as New York, Miami, and San Francisco. Assistance included meeting the repatriates at the dock or airport, arranging for emergency lodging and feeding, and—depending on need—hospitalization or transportation back to the home State. The program operates under a 1960 law which authorizes the Secre- tary of Health, Education, and Welfare to provide care and treatment to mentally ill persons whom the State Department brings home from foreign countries. Other legislation in 1961 extended assistance to United States citizens and their dependents returned because of desti- tution and illness of any nature. A review of the average caseload of 55 chronically ill repatriates in Saint Elizabeths Hospital disclosed that some could be discharged or transferred to other facilities. One repatriate who had been a patient for several years was transferred to a Veterans Administration Hos- pital. Another was released to her family in Canada. Similar plans are underway for other repatriates. Following exploration by Bureau staff, repayment of assistance was received from eight patients who had such resources as old-age and survivors insurance, postal savings bonds, and health insurance. Since a number of families returning from Cuba are composed both of United States nationals and Cuban nationals, it was necessary to determine whether they should be assisted under the repatriation or 748-869—65——6 74 Department of Health, Education, and Welfare, 1964 Cuban refugee program. Citizenship of the male spouse, if he is in the United States, will determine the program from which assistance will be furnished, it was decided. Other international activities included consultation to the American Benevolent Society of Mexico City, which administers a program of social services to destitute American citizens. At the request of the Agency for International Development, Bureau staff met with partici- pants from Indonesia, Nepal, Pakistan, Thailand, Turkey, and Vene- zuela to discuss Bureau responsibilities. Work-training experiences of from 2 to 4 months’ duration were provided for nine Spanish-speaking social work supervisors from five Latin American countries. During the year, two additional Bureau publications were translated into Spanish and republished for readers in Latin America and in Puerto Rico and other United States jurisdictions with Spanish- speaking populations. Work With Other Agencies The growing complexities of the public welfare program and the increase in services to needy people have increased the Bureau’s respon- sibilities for maintaining relationships with other agencies with similar objectives and programs. Liaison with a variety of national organizations in social welfare and related fields made it possible for the Bureau to learn of new developments and, in turn, to keep professional groups and the public informed of the latest Federal activities. For example, Bureau staff members served with President’s Council on Aging committees on group residence facilities, budget standards, and protective services. Other staff members served on the advisory committee of the American Association of Homes for the Aged and on the Urban League’s com- mittee on aged members of minority groups. Staff also worked with the Secretary’s Committee on Alcoholism. Similar work was done with family and child organizations, such as the Interdepartmental Committee on Children and Youth, the Presi- | dent’s Committee on Mental Retardation, the Child Welfare League of America, and the International Council of Home-Help Services. The Bureau of Family Services and the Family Service Association of America worked together during the year to bring about a closer collaboration between public and voluntary agencies at both the national and local levels. The effort took the form of a proposal to establish a joint national ad hoc committee to advise on ways to improve and extend understanding and cooperative work at the local, State, and national levels. Welfare Administration 75 Within the Department, continuous relationship was maintained with the Vocational Rehabilitation Administration in an effort to restore the employability of the greatest possible number of assistance recipients. Bureau staff participated in several regional meetings with staff of State vocational rehabilitation and public welfare agen- cies and in the development of joint demonstration projects by such agencies. To further this work, a joint guide document on cooperative agreements between State welfare and rehabilitation agencies was developed. Work with the Department of Agriculture centered largely on the surplus food and food-stamp plan, including studies now being made on use of the stamp plan method to improve food consumption. The Bureau also has had a representative on the Panel on Consumer Educa- tion for Persons with Limited Incomes, sponsored by the President’s Committee on Consumer Interests. Work with the Department of Labor concerned activities of the Women’s Bureau on needs of domestic service workers and on the long-term project to develop guidelines for a national standard of assistance. Continued close relationships were maintained during the year with the American Public Welfare Association, American Home Economics Association, United Community Funds and Councils, National Council on Homemaker Service, American Medical Association, American Hospital Association, American National Red Cross, and National Social Welfare Assembly. In addition to these organizations, Bureau staff have served with such national groups as the National Association on Services to Unmarried Parents and the National Committee on Coordination of Statistical Reporting of Social Services. Children’s Bureau The legal base for the Children’s Bureau services to the children of the United States is contained in two acts. Under its basic act of 1912, the Bureau is charged with investigating and reporting “upon all matters pertaining to the welfare of children and child life among all classes of our people.” The Bureau studies many types of condi- tions affecting the lives of children, makes recommendations to improve practices in child health and child welfare programs, and helps estab- lish standards for the care of children. Under Title V of the Social Security Act, as amended, the Bureau assists the States, through technical and financial aid, in enhancing and protecting the well-being of many children through child health and welfare services. 76 Department of Health, Education, and Welfare, 1964 Stemming from these two acts, but interwoven into one program, are the purposes of the Children’s Bureau today: To assemble facts needed to keep the country informed about children and matters adversely affecting their well-being. To recommend measures that will advance the wholesome de- velopment of children and will prevent and treat the ill effects of adverse conditions. To give technical assistance to public and voluntary agencies and to citizens’ groups in improving the conditions of childhood. To administer the grants appropriated each year under Title V of the Social Security Act to aid in building the health and welfare of children. The Bureau’s approach to the problems of children proceeds from a concern for the child with his family or wherever he may live. The interrelationship between the physical, emotional, and social factors in child growth, child health, and child welfare permeates all that the Bureau does and stimulates others to do in research and action for children. Legislative Developments MATERNAL AND CHILD HEALTH AND MENTAL RETARDATION PLAN- NING AMENDMENTS OF 1963 The passage of the Maternal and Child Health and Mental Retarda- tion Planning Amendments of 1963 to the Social Security Act ex- panded substantially the Bureau’s services in behalf of children. The amendments provided for: Increasing the authorization for annual appropriations for maternal and child health services from $25 million, in steps of $5 million, to $50 million for fiscal year 1970. Similarly increasing the authorization for annual appropria- tions for crippled children’s services. A 5-year program of grants to provide medical care to women who during the maternity period are unlikely to receive necessary health care because they are from families with low incomes or for other reasons. Also included is health care to mothers and infants following childbirth. The health care is available particularly to prospective mothers who have or are likely to have conditions associated with childbearing which increase the hazards to the health of mothers or their infants, including those which may cause physical or mental defects in the infants. Grants for research projects relating to maternal and child health and crippled children’s services. Welfare Administration 77 Grants to assist States in developing plans for comprehensive State and community action to combat mental retardation. Implementation of this legislation is the responsibility of the Chil- dren’s Bureau, with the exception of the grants to assist States in de- veloping plans to combat mental retardation. These planning grants are administered by the Public Health Service. 1964. APPROPRIATIONS The amounts appropriated for the Children’s Bureau for fiscal year 1964 under Public Law 88-136 and Public Law 88-268 were: SSUES EH WE SBS OLE NCTE Hai ae ae eae ee Se $3, 776, 000 Grants for maternal and child welfare_____--__----____--__-- 99, 443, 000 Maternal and child. health services__=— 2. -2.2-_—--_ +=. — 30, 000, 000 CeEunedeculdTen s SCLVICCS 2. on ooo oo eee ene eee 30, 000, 000 Special projects for maternity and infant care_____________ 5, 000, 000 Research projects relating to maternal and child health and SEippledtehildren’s SCrvices (2a seb Seats eo a ek 1, 500, 000 @hildwwellare. services. s2...25..- 257 ts sie Sn es 29, 000, 000 Research, training, or demonstration projects in child SLi PO ct a a at a ie eee ee ee earn 3, 948, 000 Interdepartmental Committee on Children and Youth Created at the request of President Truman in 1948, the Interdepart- mental Committee on Children and Youth is composed of 37 Federal agencies having programs concerned with children and youth. The Chief of the Children’s Bureau is Acting Chairman of the Committee by delegation of the Secretary of Health, Education, and Welfare, who is its Chairman. The Bureau also provides the secretariat for the Committee. The monthly meetings continued the emphasis of the previous year— rapid changes in our life and their impact on children and youth. During the past year, particular attention was given to children dis- advantaged because of poverty, isolation from the mainstream of American life, migration from rural to urban communities or from one rural community to another, or social and cultural or educational deprivation. The Subcommittee on Community Services for Selective Service Registrants was abolished when a new Federal program was author- ized by the President to provide community health, education, coun- seling, and employment-placement programs for registrants for Selective Service who cannot meet the minimum requirements for in- duction into the military service. A Subcommittee on Services for Adolescent Girls was created. 738 Department of Health, Education, and Welfare, 1964 The Subcommittee on Parent and Family Life Education concen- trated its attention on services to members of low-income families. It proposed that a small group of leading practitioners become actively involved during the next fiscal year in parent and family life educa- tlon programs with low-income families (1) to improve communica- tion between local and Federal specialists in this field and (2) to de- velop guidelines for programs. United Nations International Children’s Fund ( UNICEF 3 In January, the Executive Board of UNICEF met in Bangkok. This was the first time the Board had met in a developing country in the 17 years of its existence. Prior to the meeting, small groups of Board members were guests of the Governments of India, Iran, Indonesia, Pakistan, Thailand, and the Philippines to see UNICEF projects and to become better acquainted with UNICEF programs in the field. The Executive Board approved program assistance of $23 million in commitments and $21 million in allocations to 127 projects. About two-thirds of these were continuation or extension of ongoing UNICEF-aided projects and one-third were new projects. Health services and nutrition programs continued to form the bulk of UNICEF assistance—80 percent of the allocations at this meeting of the Executive Board. Aid to education increased, and training continued to be an important part of all programs. Mr. Frederick DelliQuadri was Chief of the U.S. Delegation to Bangkok, and Dr. Katherine Bain of the Children’s Bureau served as alternate. In April UNICEF held a roundtable conference on Planning for the Needs of Children in Developing Countries at Bellagio, Italy. The Children’s Bureau prepared a paper on the United States experi- ence in providing for the needs of children and youth. In June, the Executive Board approved 267 projects, of which 51 were new ones. Eighteen percent of the commitments were for aid to — education. Expenditures by UNICEF in calendar year 1963 were $39 million, exceeding income by about $7 million and representing the fulfillment of the directive to the Secretariat to utilize funds on hand in order to put the resources of UNICEF to work more rapidly. In 1963, 118 countries contributed to the UNICEF Fund, and there was increasing support from private sources, amounting to about 20 percent of total income. For the first time, a private contribution for a specific proj- ect was accepted. Welfare Administration 79 National Conference on Smoking and Youth In the spring of 1964, the Bureau called nationwide attention to the problem confronting youth, their parents, and other adults as a result of the report to the Surgeon General on Smoking and Health. One hundred sixteen teenagers were brought to Washington from most of the States and some of the Territories to consult with the Children’s Bureau about the implications of this report to themselves, their peers, and their families and to suggest what the Bureau might do to help them. The purpose of the conference, as phrased by the group of young people who planned it, was “To Reflect Upon the Issue of Smoking From the Perspective of the Young People of America.” From April 30 through May 2, these young people lived and worked together, learning facts, sharing ideas, and drawing conclusions that would help them return to their home communities ready to help other young people, parents, teachers, and youth workers to develop infor- mation programs and a social climate that would encourage decisions about smoking with full knowledge of the scientific facts and under- lying emotional factors. Two publications—Y our Teenage Children and Smoking and Smok- ing, Health, and ¥Y ou—were issued as an outgrowth of the conference. Programs of the Bureau RESEARCH IN CHILD LIFE From many sources, the Children’s Bureau gathers all the facts and figures that will help children’s workers and citizens in the United States to know the size of their wealth in children, the extent of con- ditions that are adverse to them, and the trends in our society affecting child life. In addition to its own studies and cooperating in joint studies, the Bureau stimulates other agencies to undertake research in child life by formulating questions needing study, developing re- search methods, and providing technical assistance. Some Facts and Figures About Children and Parents The child population under 18 years of age in the United States increased from 67,331,000 on July 1, 1962, to 68,674,000 on July 1, 1963. An estimated 4,081,000 babies were born in the 12 months end- ing April 1964 as compared with 4,130,000 for the previous corre- sponding period. The infant mortality rate in 1963 was provisionally 25.2, slightly lower than in the years 1960, 1961, and 1962. Infant mortality continued to reflect differences in levels of living and acculturation. The third of the States with the lowest per capita income in the period 1960-61 had an excess in infant mortality rate 80 Department of Health, Education, and Welfare, 1964 of 17*percent over the national average. The rate for the middle per capita income group of States was 3 percent below the national aver- age, and for the higher per capita income group, 7 percent below the rate for the country as a whole. _ Counties with 1,000 or more live births and lowest infant mortality levels had, in the majority of cases in 1960, populations with median family incomes above those of the States, with higher numbers of years of schooling, and lower propor- tions of the labor force unemployed. On the other hand, counties with infant death rates as high as 40 or more per 1,000, in most cases, presented the reverse of this picture. In the United States as a whole, the incidence of prematurity (birth weight 2,500 grams or less) increased from 7.5 percent of live-born infants in 1950-51 to 7.9 in 1960, 7.8 in 1961, and 8.0 in 1962. Among nonwhite infants, the incidence increased from 10.7 in 1951 to 13.1 in 1960. (Better reporting may have accounted for some of this in- crease.) Among white infants, the incidence hovered about 7.0 percent. According to U.S. Bureau of Census projections, the ratio of chil- dren to adults will increase from 673 children under 15 years of age per 1,000 adults 25 to 64 years of age in 1960 to 737 per 1,000 in 1985. The marriage rate jumped from 8.5 per 1,000 for the 12-month period ending April 1963 to 8.9 per 1,000 for the corresponding per- iod ending April 1964. The divorce rate has remained an almost steady 2.2 divorces per 1,000 population for the last 6 years. Of the 47 million families in 1962, one-fifth (some 9.3 million fam- ilies) had total money incomes below $3,000, the figure used as a de- marcation of the poverty line. These families contained more than 11 million children under 18 years of age. When, however, the poverty line was so calculated as to take account of differences in family size and composition and differences in cost of living on farms and in urban areas, considerably more children were found to be living in poverty— about 17 million. More than 1.1 million of the 9.3 million families with an income under $3,000 were raising four or more children. More than 1 million . children were being raised in large families (six or more children) by parents whose income was less than $2,000. About a third of the families with women breadwinners in 1962 had incomes under $2,000. About half a million women breadwinners whose husbands were ab- sent were rearing school-age children. In March 1963, there were 9.3 million working mothers in the United States. One out of every three mothers with children under 18 years of age was in the labor force. These included 3.6 million mothers with children under 6, and 5.7 million with children 6 to 17. Even Welfare Administration 81 the mothers of very young children often worked. One out of five mothers with children under 3 years of age was in the labor force. When there was no husband in the home, the mother was much more likely to work; for example, one out of three such mothers with chil- dren under 3 was working. According to data from the 1960 census, 88 percent of the child population under 18 years of age lived with both parents, 9 percent lived with one parent (8 percent with mother only and 1 percent with father only), and 3 percent with neither parent (most of them with other relatives). Child Welfare Research and Demonstration Grants During the year, 24 new projects were approved, and 26 ongoing projects were approved for continuation of supplementary funds. A total of $2,123,692 was awarded. Seven of the new projects repre- sented programmatic research, which is research to study long-range and coordinated approaches to basic problems in the provision of services and determination of the effectiveness of services. Final reports were received on three studies: “Children in Group Day Care—The Effect of a Dual Child-Rearing Environment (An Exploratory Study) ,” “Intensive Post-Partum Casework With Unwed Mothers,” and “The Role of the Social Worker in a Child Protective Agency.” Child Health Research Grants Nineteen grants totaling $1.5 million were awarded for child health research. The major portion of the funds will be used to develop programmatic research in seven schools of public health. Howard University Study of Nursery School Under a grant from the Children’s Bureau, Howard University in Washington, D.C., began an experiment in day care for children in low-income families, converting its long-established nursery schoo] to this purpose. The aim was to improve the children’s likelihood of adequate achievement in school. The research component of the ex- periment will be supplied by the Children’s Bureau. The children will attend 5 days a week for 2 years and will have a “classic” nursery school program. An adult activities program for their parents will attempt to enlist parental efforts in activities that will give an impetus to the ultimate school achievement of their chil- dren. A comparison group will be tested before, during, and after the program, and later during their school years to see whether and how much this kind of early enrichment program contributes to later school achievement. 82 Department of Health, Education, and Welfare, 1964 The project was based on theory and experience in relation to de- prived children, their school achievement (or lack of it), and the consequences of poor school achievement on their later lives. As edu- cation became more essential to satisfactory work experience and as it because more evident that children from slum neighborhoods were at a disadvantage by the time they started school, it seemed increas- ingly clear that it would be valuable to make up the deficit before they entered first grade. The present project will attempt to find out whether the kind of nursery experience that middle-class children receive as a matter of course would serve to make up that initial deficit. If so, then these children can be helped without the necessity of special and expensive training for a large corps of teachers. The | program will be repeated after 2 years in order to validate the findings. Unmarried Mothers The review of findings from studies and demonstrations concerning unmarried mothers and their children continued. Births out of wed- lock to a great extent seemed to involve the problems of poverty; the corollary implication was that alleviation of poverty would probably help to alleviate problems of illegitimacy. Children in Institutions An analysis was in progress of recent trends in institutional care based upon the last two decennial censuses. The data being analyzed cover children in all types of institutions. Statistical Reports During the year, the Bureau compiled and published current statis- tical data on crippled children’s services, institutions for delinquent children, child welfare services, and juvenile courts. MATERNAL AND CHILD HEALTH SERVICES Maternal and child health programs continued to broaden and ex- pand. All States, the District of Columbia, Puerto Rico, the Virgin Islands, and Guam received Federal funds to improve services for promoting the health of mothers and children, especially in rural - areas. Approximately 271,000 expectant mothers were provided medical, prenatal, and postnatal clinic services by State maternal and child health programs in calendar year 1963. In addition, 39,000 mothers were given hospital inpatient care for complications of pregnancy. Public health nursing was provided for 534,000 maternity cases during 1963. These nursing services, which were provided in the homes or Welfare Administration 83 CHART 5.—MATERNAL AND CHILD HEALTH SERVICES, 1947-63 OTHER CHILDREN SERVED ego BY WELL CHILD CONFERENCES THOUSANDS at INFANTS SERVED BY WELL CHILD CONFERENCES MOTHERS SERVED BY MATERNITY MEDICAL CLINIC SERVICE 100 — MOTHERS ATTENDING PRENATAL CLINICS et tH an 1947 1949 1951 1953 1955 1957 1959 1961 1963 elsewhere in the community, were in addition to nursing services at medical clinics where physicians were present. Formalized courses in maternity care and care of the newborn were provided in 36 States. In 1963, 83,000 expectant parents attended these classes, an increase of over 30 percent for the previous year. Well child conferences in 49 States, the District of Columbia, Puerto Rico, the Virgin Islands, and Guam provided consultation and health supervision for 1,490,000 children. Among this group were 593,000 infants. Public health nursing service was provided for 2,831,000 children. Dental treatment was provided for 516,000. There were large numbers of children screened under school health programs: 7,866,000 were screened for visual defects (an increase of more than 361,000 children over 1962) ; 5,221,000 were screened for hearing defects (an increase of over 430,000 children) ; and 3,091,000 were screened for dental needs (a decrease of 40,000). Almost the same number of children were examined by physicians under school health programs in 1963 as in 1962—2,447,000 for 1963 and 2,441,000 for 1962. Some 4,274,000 children were immunized against diphtheria under State programs; 2,499,000 against whooping cough; 4,576,000 against tetanus; and 2,592,000 against smallpox. 34. Department of Health, Education, and Welfare, 1964 Implementation of Maternal and Child Health and Mental Retardation Planning Amendments of 1963 All States were using the new funds made available under the pro- visions of the 1963 amendments for a wide range of significant pro- grams to provide needed additional services in the area of mental retardation. These amendments, which were adopted in response to recommendations made by the President’s Panel on Mental Re- tardation, were part of a broad program for combating the problem of mental retardation along four major fronts—preventive service, care and treatment, research, and community planning. By the end of the fiscal year, seven comprehensive maternity and infant care projects, totaling $4,682,686 in Federal funds, were ap- proved with State health departments providing a minimum of 25 percent of the cost of these projects. These projects provided for an increase in the quantity and quality of services in prenatal clinics, improved accessibility of these clinics, payment for hospital care of mothers with complications, and hospitalization and followup of high- risk infants. There was a wide variation among the maternity and infant care projects: Some provided for staffing of health department prenatal clinics by staff of teaching hospitals; one enrolled young pregnant women in a prepayment group practice clinic as private patients; another included a neighborhood center and provided for continuing care by the same obstetrician in the clinic and hospital on the same basis as private patients; another provided for a special adolescent clinic and hospital program for teenage girls; several employed nurse- midwives and also offered night clinics. Fifteen new and revised publications implementing the 1963 amend- ments were issued or sent to the printer: 7’he Steps Ahead: Report of a Conference on Mentally Retarded Children, April 9, 1963; The Care of the Retarded Child—Therapy and Prognosis; Phenylketonuria— Detection in the Newborn Infant as a Routine Hospital Procedure; Health Services for Unmarried Mothers; Historical Perspective on Mental Retardation During the Decade 1954-1964; Clinical Programs for Mentally Retarded Children; The Clinical Team Looks at Phenylketonuria; Feeding Mentally Retarded Children: A Guide for Nurses Working With Families Who Have Mentally Retarded Chil- dren; Galactosemia—A. Selected Bibliography, 1963; Grants for Ma- ternity and Infant Care Projects—Policies and Procedures; A Guide for Public Health Nurses Working With Mentally Retarded Chil- dren; Institute on Nutrition Services in Mental Retardation Pro- grams, Institutionalizing Mentally Retarded Children: Attitudes of Some Physicians; The Nurse’s Role in Counseling Parents of Mentally Welfare Administration 85 Retarded Children; and Phenylketonuria—A. Selected Bibliography, 1963. Mental Retardation Services in Maternal and Child Health Programs Major staff effort was expended in improving and extending serv- ices to mentally retarded children. In general, increased appropri- ations gave immediate impetus to rounding out clinical services for mentally retarded children and in meeting whatever deficiencies existed, such as insufficient nursing and nutrition services, neurological and psychiatric consultation. speech and hearing evaluation service, and dental treatment. States were able to continue to extend their services for mentally retarded children into areas in which diagnostic, evaluation, treat- ment, and followup clinic services previously were not available. Seven States began to operate clinics for mentally retarded children, and six States were in the process of developing new clinics. By 1964, there were almost 80 clinics supported in whole or in part by Children’s Bureau funds. Countrywide, there were 115 clinics under various auspices. Field Trials for Screening Infants for Phenylketonuria Because of the possibility of preventing the mental retardation caused by phenylketonuria, an inborn error of metabolism, the Chil- dren’s Bureau supported a special project for screening newborn infants for PKU. The field trials of the inhibition assay method developed by Dr. Robert Guthrie and his associates at the Children’s Hospital, Buffalo, N.Y., were completed as of December 31, 1963. More than 404,568 newborn infants in 29 States were screened in the period from early 1962 through the end of December 1963; 39 cases of PKU were found, a ratio of 1 out of 10,347, a higher incidence than had previously been expected. A report of the field trials was published. The success of the field trials in detecting PKU in the newborn stimulated the initiation and expansion of screening programs in many States. Four States enacted legislation making screening of newborn infants for PKU mandatory. Other States instituted screening by requirement of the State health departments. The Children’s Bureau supported efforts to develop screening tests for other metabolic disorders in newborn babies. Genetic Service Laboratories A significant development which occurred as a part of mental re- tardation demonstration programs was the establishment of support- ing laboratory services to aid in the diagnosis, evaluation, and followup 86 Department of Health, Education, and Welfare, 1964 care of children suspected of having hereditary diseases. Nine spe- cialized laboratory projects were approved to provide chromosome analyses and specialized biochemical examinations on selected children and members of their families. Each of these services was located in a university and was associated with a clinical program for mentally and physically handicapped children. Each project will also utilize the laboratory services for training a variety of professional personnel in genetics and mental retardation. Appalachia The low economic areas in Kentucky and West Virginia were given special attention by Federal, State, and local governments during the year. At the regional level, all Federal government agencies (with support from headquarters offices) made a concerted effort to muster resources to combat the many problems facing this area. ‘The Children’s Bureau committed $200,000 for a “crash” program to bring emergency maternity care and pediatric services to selected counties of Kentucky. As a result, special services in the depressed area of Kentucky were expanded to include: Three pediatric clinics staffed by professional personnel from the University of Kentucky Medical Center. These clinics pro- vided diagnosis, consultation, and treatment. Where indicated, hospitalization was arranged. A regional hearing center located in Knox County and serving a 20-county area. Comprehensive maternity and pediatric care services focusing on two counties with extension planned for three additional counties. Prenatal dental services in one county. Children’s Bureau funds were made available to West Virginia to purchase a second mobile unit to house maternal and child health clinics for remote rural areas. The mobile clinics were used in the school health program and in examination of preschool children as well as in casefinding activities for the maternity and pediatric programs. CRIPPLED CHILDREN’S SERVICES All States (except Arizona), the District of Columbia, Puerto Rico, the Virgin Islands, and Guam participated in the crippled children’s program during fiscal year 1964. An increasing number of children received care under the crippled children’s program in 1963—about 400,000. Over half of the children diagnosed in the program were children with nonorthopedic defects. Deformities of a congenital nature con- Welfare Administration 87 CHART 6.—CHILDREN SERVED IN THE CRIPPLED CHILDREN’S PROGRAM, 1937-62 400 + 250 -+- number 150 + SY, number of children (in thousands ) i] r=) rs +— _ So o 50 TZ Japun goot red ajzer Oo + Bek Sao BES SOSEES SEES OES RON SS ERA B SEES SeeRe 0 1937 39 41 43 45 47 49 51 53 55 57 59 61 62 tinued to be the largest single group of primary conditions among children served by the program: nearly 30 percent of all children served. Roughly 20 percent of conditions present at birth consisted of malformations of the heart and circulatory system. Implementation of the 1963 Amendments Because funds for crippled children’s services had not kept pace with increases in child population, with increases in cost of hospital care and professional services, and with new medical knowledge, the in- creased funds authorized by the Maternal and Child Health and Mental Retardation Planning Amendments of 1963 helped all States to continue to extend their services to groups of children not previously covered. Development of Services for Children With Multiple Handicaps Because in the special clinical programs for mentally retarded chil- dren a high incidence of associated physical handicaps was found, because some crippled children’s funds were earmarked for mentally retarded children, and because there was increased collaboration be- tween maternal and child health and crippled children’s services, States expanded medical care services for mentally retarded children with multiple handicaps. In 20 States which submitted detailed reports, 251 children with monogolism and 2,194 with other mental deficiencies were reported 88 Department of Health, Education, and Welfare, 1964 as receiving services under the State crippled children’s program in calendar year 1963. State crippled children’s services paid increasing attention to men- tally retarded children in institutions. One State initiated orthopedic clinics at the State school for mentally retarded; one expanded its clinical services to children in the State institutions. Another gave service routinely to institutionalized children. Two States established traveling clinical teams to serve the State institutions for the mentally retarded. Another planned for local public health nursing followup of children on waiting lists of institutions for the mentally retarded; public health nursing visits resulted in some emergency admissions to institutions. Many States reported a closer working relationship between State institutions for the mentally retarded and clinical serv- ices for the mentally retarded supported by the Children’s Bureau. For example, in two States the majority of first admissions to State institutions are from these clinics. An important development was the collaboration of maternal and child health and crippled children’s services in some States to provide total pediatric services, particularly to the mentally retarded. To illustrate, in Prince Georges County, Md., a multiservice center was de- veloped to integrate the well child conferences, pediatric service, and service for the children with multiple handicaps with a mental retardation component. In Puerto Rico, the service for children with multiple handicaps was an accepted part of the ongoing maternal and child health and crippled children’s services. Cystic Fibrosis During the past 10 years, the number of States which included cystic fibrosis in their crippled children’s programs increased from 3 to 26. At the end of the fiscal year, 22 of these 26 States had com- prehensive programs of care; 12 of these had been added since 1960. By July 1963, the cumulative number of children with cystic fibrosis receiving services through these 26 State programs was about 1,500 and ranged from 2 in Alaska to 452 in Massachusetts. : Many States which included this disease in their programs had funds earmarked for the purpose by their legislatures. CHILD WELFARE SERVICES The fiscal year was characterized by an increasing public awareness and concern by professional and lay groups about the social and eco- nomic problems affecting child life and child welfare. The 1962 Public Welfare Amendments continued to be instrumental in this increase in public interest and action on behalf of children. Welfare Administration 89 CHART 7.—CHILD WELFARE AGENCIES PROVIDE SERVICES FOR CHILDREN, 1963 TOTAL IN OWN PUBLIC VOUNTARY HOMES AGENCIES AGENCIES IN FOSTER FAMILY HOMES IN INSTITUTIONS IN ADOPTIVE HOMES ELSEWHERE 0 100,000 200,000 300,000 400,000 300,000 600,000 On March 31, 1963, about 619,000 children were receiving services from public and voluntary child welfare agencies and institutions in the United States, or 6 percent more than the number served 1 year earlier, Of the total number of children served, 412,500 (or 67 per- cent) were served primarily by public agencies, and 206,500 (or 33 percent) were served primarily by voluntary agencies. Two-fifths of all children served lived with parents or relatives or in independent arrangements, nearly one-third in foster family homes, one-sixth in institutions, and one-tenth in adoptive homes. The 1963 statistics showed three chief trends: An increase in the rate as well as the number of children reached by child welfare pro- grams; a greater increase in public than in voluntary child welfare services; and, in public programs, more increase in service to children living with parents or relatives than to children in foster care or adopted. State and local public welfare agencies spent an estimated $267.8 million in fiscal year 1963 for public child welfare services, This amount included expenditures of $135.8 million from State funds (or 51 percent of the total), $105.9 million from local funds (or 39 per- cent), and $26.1 million from Federal funds (or 10 percent). An estimated $180.8 million (67 percent of the national total) was used to pay for foster care of children; $71.5 million (27 percent) for personnel; $2.4 million (1 percent) for educational leave to pro- 748-869—65——7 90 Department of Health, Education, and Welfare, 1964 vide professional education for promising workers; and $13.1 million (5 percent) for other purposes. All States, the District of Columbia, Puerto Rico, the Virgin Islands, and Guam received Federal funds to improve child welfare services. Implementation of the 1962 Public Welfare Amendments The first full fiscal year of operation under the 1962 Public Welfare Amendments represented a landmark in the history of public child welfare services. Planning for the extension of child welfare services under the 1962 amendments began with an assessment of the public child welfare program by each State. Soon after the assessments were completed, a series of four regional conferences (covering all States) were held — with representatives from State welfare agencies, regional representa- tives from the Bureau of Family Services, and representatives of the Children’s Bureau to consider what needed to be done for progressive extension of child welfare services. Approximately 9,348 persons were employed full time in profes- sional positions in the child welfare programs of State and local public welfare agencies on June 30, 1963. Even though this was a rise of 7 percent over the number employed a year earlier, the lack of professionally qualified staff was the greatest unmet need in child welfare programs in all States. Forty-two percent of all the counties in the United States did not have full-time public child welfare services available, not even under multicounty arrangements that spread these services over several counties. These counties without child welfare services, in which 15 percent of the Nation’s children reside, were mainly rural—about five rural counties for every urban county. Progress in providing addi- tional geographical coverage was varied because of difficult problems of insufficient funds, shortage of qualified personnel, and lack of dy- namic leadership. All States reported that their legal bases were reasonably adequate to permit the extension of child welfare in the four dimensions re- quired: (1) Public child welfare services in every geographical area, (2) a broad range of services within the State’s child welfare program, (3) the availability of child welfare services to all children who need them, and (4) the provision of services by trained personnel. How- ever, in most States the laws did not clearly require that public child welfare services of the kind and extent desirable be provided. Almost all States needed substantive legislation to enable them to assure the range of services needed to meet the needs of all children. Welfare Administration 91 Day Care Services Significant results came from the States’ first full year with ear- marked day care funds. The continuing increase in the number of working mothers, the drive to eliminate poverty, and the effort to improve the educational experiences for deprived children affected the development of day care services. While evidence indicated that progress was being made in all parts of the country in the expansion of day care services, there was great variation among the States in the development of such programs. Some States had many com- mercial facilities but were starting to develop day care facilities under public welfare auspices. Some States were beginning to develop standards for day care in both family day care homes and day care centers and to license private and commercial day care foster homes and group homes. The 46 States with approved plans for providing day care services through public welfare agencies moved in a variety of ways. Eight- een States planned to operate day care centers under the auspices of the public welfare agencies; 34 States planned to provide family day care for children; and 28 States planned to purchase day care in already existing day care centers. Emphasis was placed on providing day care for children whose mothers must work to support them or to supplement the fathers’ low earnings. A number of States developed projects to provide day care for deprived children while their mothers were being trained for employment or were learning homemaking skills which would improve the families’ living standards. Migrants continued to be a deprived group for whom more day care services were needed. Of the 46 States planning to use Federal day care funds, 16 planned to establish or to increase day care services for children of migrants. The quality of day care was a serious problem. Emphasis needed to be placed on raising standards and supporting efforts to establish high-quality services under public welfare agencies. Increased efforts were needed to develop standards for day care services to handicapped children, particularly mentally retarded children, and to establish more services for these groups. Six publications on day care services were issued or sent to the printer during the year: Day Care for Your Child ina Family Home; Day Care for Other People’s Children in Your Home; Day Care Services; What Is Good Day Care; and Fees for Day Care Services, which was issued, revised, and reissued with the title Determining Fees for Day Care Services. 92 Department of Health, Education, and Welfare, 1964 Child Welfare Training Grants Fifty-six schools of social work and two other institutions of higher learning received $1,805,444 in grants for 53 full-time field instruction units, 5 other faculty members, 288 traineeships, and 19 short-term training projects. This new program of grants to institutions of higher learning for training personnel in the field of child welfare was enthusiastically welcomed by agencies, schools, and social workers. Broader efforts directed toward recruitment of workers and of candidates for social work education were initiated. Schools of social work sought con- sultation from the Bureau not only about their specific requests for training grants but also about their overall program in relation to child welfare. Attack on Poverty To meet the social and economic problems affecting family and childlife and to provide the services which parents and children need, child welfare staff must participate actively in community planning endeavors. While the factors that create social and economic prob- lems frequently seem insurmountable, the emphasis in fiscal year 1964 on the eradication of poverty helped child welfare staffs to refocus on prevention and rehabilitation rather than stopgap treatment. Better communication and cooperation among agencies, groups, and indi- viduals interested in the various segments of services resulted. Representing the Welfare Administration, regional staff of the Office of Aging, the Bureau of Family Services, and the Children’s Bureau made a series of team visits to each State welfare agency to consider what could be done through effective use of public welfare resources to improve the levels of living. The focus was on evalu- ating the current welfare program and deciding what action was needed to extend and strengthen the services provided. Public attention was focused on the special needs of children and youth living in conditions of poverty in both urban and rural areas. Child welfare was intimately and daily involved in the problem of poverty. For example, one of the Nation’s most severe problems of poverty was located within the Department’s Region IV. Five of the States (Georgia, Alabama, Mississippi, Tennessee, and South Caro- lina) were ranked among those with the lowest per capita income within the Nation. Four of the States in the region were among the six States with the highest infant mortality rates for the Nation. Five of the States were among the seven States paying the lowest AFDC grants in the Nation. Child welfare workers in States like these were faced often with assisting families to secure the basic Welfare Administration 93 essentials of shelter, food, and clothing before helping them to be better parents. Mental Retardation Services in Child Welfare Programs The extension of child welfare services under the 1962 amendments, the earmarked funds for day care services, and the training grants in the field of child welfare contributed to resources for providing special services. for mentally retarded children. Two States developed day care centers for mentally retarded children. In one State, many parents who had their children on waiting lists for the State institu- tion for mentally retarded children removed the children’s names when day care became available and proved to be the supplement needed so that the children could remain in their own homes. The National Conference on Homemaker Service emphasized home- maker services as another resource in providing services for mentally retarded children. Increased attention was given by welfare agencies to other ways of helping these children lead happy lives in the community. Physically Abused Children There was continued concern and interdisciplinary planning to meet the needs of the physically abused child. Early in the fiscal year, the Bureau issued Zhe Abused Child— Principles and Suggested Language for Legislation on Reporting of the Physically Abused Child. Approximately one-third of all States have passed legislation which required that all cases of suspected child abuse be reported to the appropriate police authority by the doctor who sees the child. Homemaker Services A National Conference on Homemaker Services was held in Wash- ington on April 29, 30, and May 1, 1964. The cooperative work of the Bureaus within the Welfare Administration and the new National Council for Homemaker Services set a structure for continued coop- erative efforts. The conference created a ground swell of interest in expanded development. Foster Family and Group Care of Children Reports from the States indicated that many child welfare agencies found that the underfinanced and underserviced type of foster family care which had been the usual pattern would no longer suflice to meet the needs of children. Many children were going into this type of care by default when they needed another type of care. Many in urban areas Were remaining for long periods of time in shelter care and in hospitals because agencies had not recruited and retained sufficient numbers of foster family homes. 94 Department of Health, Education, and Welfare, 1964 These problems of insufficient numbers of foster family homes and misuse of foster family care were due to many factors: The increase in the number of working mothers; movement to urban and suburban areas; limited space; and administrative inattention to the problems. Additional breakdown in families meant that more children coming into care were emotionally upset and in need of a better quality of family care and casework service. Interest increased in agency-operated group homes, which combined some of the best features of the foster family home located in a com- munity and the small institution used for diagnosis, treatment, and sound group care. This type of facility was increasingly being used for the care of adolescents. Publications on the subject of group homes were prepared in re- sponse to widespread inquiries. One set of publications, Agency Operated Group Homes, included a summary of trends in these new facilities throughout the country and a casebook describing and evaluating 15 of these facilities. Asa result of the joint Child Welfare League of America-Children’s — Bureau project to promote standardized cost analysis methods for child-caring institutions, standardized methods were being planned or were adopted by public institutions in four States. Similar methods were being adopted by voluntary institutions in eight States. The Children’s Bureau called an all-day conference in April 1964 to prepare guide materials for child-caring institutions considering acceptance of children from minority groups. Representatives from national voluntary and sectarian organizations affirmed the need for integration. They concluded that the pace and methods used in institutional integration would have to relate to local school and church integration. Unmarried Mothers The 1962 estimated number of births out of wedlock was 245,100 or 5.9 percent of all live births. The ratio per live births had been ris- ing gradually over recent years although improved reporting accounted for part of the increase. The rate had been rising also, having gone from 8 to 21 per 1,000 unmarried women of childbearing age between 1942 and 1962. The majority of women who bore children out of wedlock were not teenagers but rather women over 20 years of age. Some States had been trying to plan for social services to be given to unmarried pregnant women, but, according to reports, many of the services reached only a small percentage. In State after State, Negro unmarried mothers were still receiving few or no casework services. Maternity homes were crowded, but only a small number of Negro women were cared for through this resource. Welfare Administration 95 While there were individual differences in communities as to their provision of educational opportunities, more and more school districts were taking responsibility in planning educational opportunities for the unmarried pregnant girl. Maternity homes in general provided or arranged for schooling, for which there was a wide variety of fi- nancial plans. Adoption Services About 121,000 children were adopted in the United States during 1962, or 6 percent more than in the previous year. It was estimated that 62,900 of them (52 percent) were adopted by nonrelatives and 58,100 (48 percent) by relatives. In nearly two out of every three nonrelative adoptions, the child was placed in the adoptive home by a social agency. Four-fifths of all nonrelative adoptions and one-third of all relative adoptions were of illegitimate children. Reports continued regarding the decline in adoptive applicants. Although the number of applicants had declined, the number of chil- dren adopted had increased. More flexible policies on the part of agencies in many States prevented a crisis. Cuban Refugee Children The Children’s Bureau continued to carry overall responsibility for child welfare services, including care and protection, for unaccom- panied Cuban children. The Florida State Department of Public Welfare, acting as agent for the Department of Health, Education, and Welfare, was responsible for overall supervision and administra- tion of the program through contractual arrangements with four voluntary agencies which accept children for placement in group or foster family care. The program gradually declined from a peak of 4,100 children just before the Cuban missile crisis in October 1962 to the low point of 2,474 children reached on June 30, 1964. Neither unaccompanied children nor the parents of children already in care had been able to come to the United States in significant numbers since the regular commercial flights from Havana were stopped in October 1962. Of the total of 7,773 children who had received care since the beginning of the program, 68 percent had been discharged from care, the majority to their parents or close relatives. JUVENILE DELINQUENCY SERVICES National interest in and concern about juvenile delinquency prob- lems continued. About 555,000 juvenile delinquency cases (excluding traffic offenses) were handled by juvenile courts in the United States in 1962. The 96 Department of Health, Education, and Welfare, 1964 CHART 8.—TRENDS IN JUVENILE COURT DELINQUENCY CASES AND CHILD POPULATION 10 TO 17 YEARS OF AGE, 1940-62 (semi-logarithmic scale) 900 800 delinquency cases (including traffic) delinquency cases (excluding traffic) delinquency cases (in thousands) w oOo oO + - *. o* ° “- * seen eeeeeeenee” child population (10-17 years of age) child population 10-17 years of age (in thousands) NS pg el a ee a a ae ES em eee ey MIRE ie LO 1940. 42" 9 44-465 485" «50. 5209054" 56) 58 oO mae Welfare Administration 97 estimated number of different children involved in these cases was 478,000 (the same child may have been referred more than once dur- ing the year). These children represented 1.8 percent of all children aged 10 through 17 in the country. The year 1962 showed an increase in delinquency cases over the previous year. The increase for 1962 was 10 percent while the child population aged 10 through 17 increased by only 314 percent. The upward trend, noted every year beginning with 1949 except for 1961, continued. While the overall national increase in 1962 was 10 percent, the rural courts experienced a greater increase in the number of delinquency cases handled that year than did the urban courts—16 percent increase for rural courts and 10 percent for urban courts. The rate of delinquency cases (the number of cases per 1,000 child population aged 10 through 17) was about three times higher in pre- dominantly urban areas than in predominantly rural areas. Courts in predominantly urban areas handled more than two-thirds of all the delinquency cases in the country. More than one-third of the delinquency cases referred to courts serving large cities were dismissed with warning or adjustment. Delinquency cases continued to be primarily a boys’ problem: Boys were referred to courts more than five times as often as girls. Approximately 38,500 children were living in public training schools for delinquent children on June 380, 1963. This is a decrease of about 1 percent from 1962. The average length of stay in these institutions was 9.5 months. The average annual per capita operating expenditure for caring for a child was $2,760, an increase over $2,625 for 1962. Training school staff turnover continued to be high. Over one-fifth of all employees left their jobs in 1963, the majority of whom were treatment and educational personnel. Training Needs Administrators of State agencies and superintendents of institutions continued to point out the lack of trained personnel in institutions and to request funds and technical assistance for developing inservice training programs. Reports indicated that inservice training pro- grams reduced the high turnover rate of personnel in institutions. State, regional, national, and international organizations concerned with delinquency opened up new channels of communication through institutes and conferences devoted to a study of manpower and training needs. The many disciplines working in the correctional field found areas of agreement and in June 1964 formed a Joint Commission on 98 Department of Health, Education, and Welfare, 1964 Correctional Manpower and Training to serve for a period of 3 years. The Commission will study the issues connected with the manpower shortage, educational preparation, recruitment, orientation, and re- tention. The interdisciplinary approach to both the staffing of agen- cies and the training of personnel lessened the tensions existing among personnel in the various agencies serving youth. School personnel, court staff, police, and social workers all have difficulty in understand- ing the appropriate functioning of the other members of the com- munity’s “team” serving youth. “ Forestry Camps An effort to identify the specific values of forestry camp experience for delinquent boys was planned in conjunction with the Training Center at Southern Illinois University. The purpose behind this national workshop included defining: (1) The place of the forestry camp in the total State rehabilitation program; (2) the criteria for selection of boys for placement in the camp; (3) the personnel require- ments for the various staff needed at the camp; and (4) the effect of campsite location on programs and on stafling. Treatment Resources There was a need in the majority of States for a variety of treatment resources. The institution was the only treatment resource in a num- ber of States. Some States have strengthened their programs by estab- lishing forestry camps and halfway houses or group residences. How- ever, other recommended resources (such as diagnostic study centers, small residential treatment centers for seriously disturbed delinquents, facilities for care of defective delinquents, foster family homes, and group homes) were in existence in only a few States. Inasmuch as a diversified program can help meet the problems of overcrowding and permit the establishment of more homogeneous treatment groups of delinquent children, States were encouraged to diversify their services. Programs for female delinquents were less developed than those for delinquent boys. States were encouraged to strengthen their ~ resources for the care and treatment of these girls. INTERNATIONAL ACTIVITIES The Bureau reaffirmed its longtime interest in and sense of respon- sibility for children in other countries with the establishment of a new position of Assistant Chief for International Cooperation. The As- sistant Chief will be responsible for developing the Bureau’s inter- national program and for administering the Division of International Cooperation. Welfare Administration 99 Cooperative agreements between the Agency for International De- velopment and the Children’s Bureau to utilize the technical compe- tence of the Bureau were being developed. The Children’s Bureau was represented at the XII Pan-American Child Congress, Buenos Aires, December 1-7, 1963; the IX Congress of the Société Internationale de Chirurgie Orthopédique et de Trauma- tologie, Vienna, August 4-10, 1963; the XIII International Course in Criminology, Cairo, June 22—July 10, 1963; the Institute on Child Development in the Kibbuzim, Israel, August 4-10, 1963. International Research Eight projects in the field of maternal and child health were ap- proved during the year under the program of international research made possible by the Agricultural Trade Development and Assistance Act of 1954, as amended. Three of these projects (in Pakistan, Po- land, and Israel) on phenylketonuria will supplement the Children’s Bureau study in the United States. Consultation was given by five Bureau staff members to projects in Egypt, Israel, Poland, Pakistan, India, and Yugoslavia. International Training Training and observation programs were planned for 65 foreign professional students—47 followed programs relating to the health or medical care of mothers and/or children, 11 followed programs relating to child welfare, 4 to psychiatric and medical social work, and 8 to juvenile delinquency. In the health professions, Indonesia and Senegal sent the largest number of participants. Most of them were physicians from medical school faculties who wanted to learn American methods of medical education as well as acquiring additional clinical skills. A total of 258 visitors from 49 countries visited the Children’s Bureau for short-term programs (from 1 hour to several weeks). Of these, 154 came in groups, the others individually. The largest single group, 93 Japanese (most of whom were connected with the Japanese Embassy in Washington), visited the agencies of the Welfare Administration. Summary “New” was the key word—“newness” was the theme—of the Chil- dren’s Bureau’s philosophy, policies, programs, and actions during fiscal year 1964. New patterns of service were inaugurated to carry out more effi- ciently the Bureau’s manifold responsibilities to protect the well-being 100 Department of Health, Education, and Welfare, 1964 of all of our Nation’s children. The year hit a new high in terms of the increased scope of our services. The first full fiscal year of operation under the 1962 Public Welfare Amendments brought expanded child welfare services throughout the Nation. The appropriation of $4 million for day care services in fiscal year 1964 brought closer together, for a common cause in local communities, the public and voluntary health, education, and welfare agencies; the churches; housing officials; parents; and especially the concerned citizens. Forty-six States with approved plans for day care received $3,983,355. The new program of grants to institutions of higher learning for training personnel in the field of child welfare was enthusiastically received by agencies, schools, and social workers. New and broader programs were made possible when President — John F. Kennedy signed the Maternal and Child Health and Mental Retardation Planning Amendments to the Social Security Act on October 24, 1963. These amendments were succinctly described in the Act itself as being for the purpose of assisting States and communi- ties “. . . in preventing and combating mental retardation through © expansion and improvement of the maternal and child health and crippled children’s programs, through provision of prenatal, mater- nity, and infant care for individuals with conditions associated with childbearing which may lead to mental retardation, and through plan- ning for comprehensive action to combat mental retardation. . . .” New research programs in child welfare, maternal and child health, and crippled children’s services were made possible by both the 1962 and the 1963 amendments to the Social Security Act and by funds appropriated by the Congress in fiscal year 1964. A new high was reached in appropriations for the programs admin- istered by the Bureau. In fiscal year 1964, the Congress appropriated almost $100 million for grants-in-aid to the States for maternal and child health, crippled children’s, and child welfare services—more than double the amount appropriated for fiscal year 1960. Fiscal year 1964 gave the Bureau new tools with which to work, new resources on which to draw, new dimensions to our programs, and new direction. . Cuban Refugee Program Substantial progress was made during 1964 in enabling Cuban refugees in the United States to become self-supporting, in alleviating the burden of refugees on Miami, Fla., and in reducing the Federal expenditures required on behalf of the refugees. Welfare Administration 101 Background of Program Cuban refugees have fled to the United States since the Castro regime took power in Cuba on New Year’s Day of 1959. This has marked the first time in history that our Nation has become a country of first asylum for large numbers of refugees. Almost all of the refugees have arrived in Miami in a state of destitution after having been stripped of their possessions and funds by the Cuban government. During 1959-1961, the refugee stream was composed primarily of professional persons, business executives, managerial and technical personnel, and office and skilled workers. For more than 3 years, however, every socioeconomic group on the island has been significantly represented among the refugees. The Cuban Refugee Program was established in February 1961, after it had become clear that the growing number of refugees in the Miami area had exceeded the capacity of State and local, public and voluntary agencies for effective help and the capacity of the local labor market to provide employment. The program has two basic objectives: (1) To provide necessary health, educational, and welfare assistance to Cuban refugees in the United States, primarily in Miami; and (2) to arrange for the resettle- ment of refugees from Miami to other parts of the Nation where they will have opportunities to become self-supporting during their exile. The program provides the following: Financial assistance and health services to needy refugees in the Miami area; fifty percent of the costs incurred by the Dade County (Miami) public schools in ac- commodating refugee pupils; the cost of foster care of refugee children who are in the United States unaccompanied by parents or close rela- tives after having been sent out of Cuba by their parents in order to avoid Communist indoctrination; loans to needy Cuban college stu- dents in the United States; free English and vocational courses in Miami designed to increase the potential of refugee adults for reset- tlement and employment; and special retraining projects in Miami and other cities for selected groups of professionals to enable them to meet requirements for employment in this country. Resettlement is necessary because of the lack of sufficient job oppor- tunities in Miami. The resettlement program is really an American people’s program. It is carried out by four national religious and nonsectarian agencies working under contract with the Federal Gov- ernment: Catholic Relief Services; Church World Service (Protes- tant) ; United HIAS Service (Jewish) ; and the International Rescue Committee (nonsectarian). Resettlements are arranged when local churches and civic organiza- tions agree to sponsor refugees in their communities, to find jobs and at 102 Department of Health, Education, and Welfare, 1964 least temporary housing for them, and to orient them to the new com- munity. The Cuban Refugee Program provides funds to cover ad- ministrative expenses of the national resettlement agencies, trans- portation costs of refugees from Miami to the city of resettlement, and, to refugees who are receiving Federal assistance in Miami at the time of resettlement, a transition allowance of $100 for a family or $60 for a single person, to help them get started in their new location. The local resettlement arrangements are carried out generally on a volun- teer basis, by citizens who are concerned about the plight of the refugees. In order to prevent a refugee from becoming a burden to the com- munity in which he resettles, because of loss of job or severe medical expenses, public assistance is made available to him through the local office of the State or county welfare department which is then reim- bursed from Federal funds. The assistance to needy Cuban refugees is based on the same standards of need as apply to American citizens. Progress During 1964 The following figures are indicative of the progress made during fiscal year 1964: A total of 6,249 refugees registered for the first time with the Cuban Refugee Center in Miami, while a total of 16,742 were resettled from Miami to other areas. The number of refugees in Miami decreased by at least 10,000 as a result of the resettlement pro- gram; the actual decrease is estimated to be somewhat greater since a number of refugees are known to have relocated on their own initia- tive outside the regular resettlement procedures. Local estimates placed the Miami refugee population at approximately 80,000 in June 1964. The number of refugees receiving Federal assistance in Florida declined steadily, from 27,683 cases (families and single persons) dur- ing June 1963 to 15,573 cases during June 1964. The number of re- settled refugees requiring Federal assistance rose slightly, from 1,703 cases to an estimated 2,283 cases, but remained at approximately 5 percent of those resettled. Federal obligations for the Cuban Refugee Program decreased from $56,027,000 in fiscal 1963 to $46,012,000 in fiscal 1964. A further re- duction is anticipated in fiscal 1965. By the end of fiscal 1964, a total of 172,572 refugees had registered at the Refugee Center in Miami, and 79,230 of these had been resettled in every State, the District of Columbia, Puerto Rico, the Virgin Islands, and 24 foreign countries. Resettlements had been made in more than 1,800 communities. Welfare Administration 103 Out of the total number of refugees who had registered, 33 percent required Federal assistance during June 1963. By June 1964, only 19 percent required assistance. New Directions in 1964 Prior to October 23, 1962, refugees were arriving in Miami at a rate of about 1,800 persons a week, primarily via commercial air flights from Havana. On that date, at the time of the confrontation regard- ing missiles in Cuba, all flights were suspended. Since then, the lack of transportation facilities from Cuba to the United States has greatly reduced the number of arrivals of new refugees. Asa result of this factor and of the continuing resettlement of refu- gees from Miami to opportunities in other areas, the problems con- fronting the Cuban Refugee Program have changed. During the latter half of fiscal 1963 and during fiscal 1964, the program has been dealing with a rapidly decreasing caseload of needy refugees in Miami. This is a situation typical of the later stages of any refugee program— a situation in which the number of persons needing help has been re- duced, but one in which the problems of those remaining tend to be perneently more complex. In order to be able to plan effectively to aid the remaining caseload, the Cuban Refugee Program carried out a comprehensive study dur- ing 1964 of the casa aeage of refugees receiving Federal assistance in Miami. Information on each case was recorded for automatic data- processing and is kept up to date on a monthly basis so long as a case continues to receive assistance. This has been designed to provide a readily accessible central file of information that will enable the Gov- ernment and the resettlement agencies to identify the resettlement potential of each case and the problems that exist and to establish priorities in the resettlement processing of different types of cases. The setting up of this central file was completed during the first half of fiscal 1964 and proved of great value during the latter half. For example: During the spring, it facilitated the identification of employable single men and enabled the resettlement agencies to concen- trate on this group. During the summer, emphasis was placed on the resettlement of families with school-age children so that schooling would not be interrupted. The identification of a group of 700 single women who lacked knowledge of English and any occupational skills led to plans for the establishment of specially designed English and vocational courses which will help them to become employable and to be resettled during fiscal 1965. Asa result of identifying a group of men who would have been able to be resettled except for possible medi- cal problems, a special medical-processing unit was established for a 104. Department of Health, Education, and Welfare, 1964 2-month period; the unit examined 980 cases, found that 48 percent did not suffer from any medical problems which affected their con- sideration for resettlement, and identified a number of medical con- ditions for which it was possible to arrange for treatment. During the year, special emphasis was also placed on the establish- ment of retraining programs which would enable professionally trained refugees to fill positions as Spanish teachers in various States where qualified local applicants were not available. Such programs were arranged in cooperation with colleges and universities in Indiana, Towa, and Kansas, with training ranging from 8 weeks to 1 year. Programs were also arranged in Oregon for refugee optometrists and in Kansas for librarians. In Miami, training courses which had been previously established for physicians and teachers were continued dur- ing 1964. These projects have proved highly successful in enabling profes- sionally trained refugees to secure the additional training necessary to enable them to fill professional positions in the United States. Some of the projects will be repeated in fiscal 1965 and additional projects for teachers will be offered in Montana, Oregon, and Pennsylvania. Outlook for 1965 During 1965, assuming that no change occurs in the availability of transportation from Cuba, the Cuban Refugee Program anticipates further decreases in the number of refugees in Miami and the number requiring Federal assistance. Emphasis will continue to be placed on the resettlement of refugees for whom appropriate opportunities can be found in other areas. New emphasis will be given to additional possibilities for suitable training programs for refugees who lack sufficient knowledge of English and job skills to become self-supporting and to more comprehensive planning for refugees who because of age or disability may be unable to benefit from resettlement. The program will continue to provide assistance and services for new refugees who reach our shores after escaping from Cuba and making the perilous voyage in small boats across the - Florida Strait. Office of Aging The field of aging is a broad one, involving the general well-being of 18 million people in the United States. The Office of Aging works for these people by stimulating individuals, groups, and organizations in the field, and by providing consultation, guidance, and technical Welfare Administration 105 assistance. ‘The Office’s nine Regional Representatives on Aging de- vote most of their time and effort to such activities, working closely with States and local communities to establish and develop programs for the elderly. The Office, through its wide knowledge of Federal programs, is often able to steer organizations and communities with worthwhile projects to other Federal agencies able to provide financial backing. For ex- ample,.one of the Office’s Regional Representatives on Aging was instrumental in the planning and execution of a successful demonstra- tion project in aging located in the rural community of Earlham, Iowa. The demonstration was financed by a grant from the lowa State Health Department from money allotted to the State by the Public Health Service under the Community Health Services and Facilities Act. Other Regional Representatives have functioned in a similar way in their regions to the advantage of both the Federal program and the organization or community. During the year, the Office initiated a new series of brochures de- scribing available Federal assistance for research, demonstration, and training projects in aging. Six of the series were published, covering programs in the Welfare Administration and the Social Security Administration; the Office of Education; the Vocational Rehabilita- tion Administration; the National Institute of Mental Health, Public Health Service; and two in the Bureau of State Services, Public Health Service. Cooperation at the Federal Level The Director of the Office is the Chairman of the Secretary’s Panel of Consultants on Aging. In March 1964, the panel was convened to discuss the impact of poverty on the older population of the Nation. A number of recommendations made at the meeting were prepared and submitted to the Secretary of Health, Education, and Welfare. The President’s Council on Aging, which sponsored Senior Citizens Month during May of this year, delegated responsibility for preparing promotional materials for the Month to the Office of Aging. More than 660,000 printed pieces, including the Presidential Proclamation, @ poster, and a community program guidebook, were distributed, and recorded television and radio appearances of the President were broad- cast throughout the country. Reports received during May and June indicated intensive local observation of the Month across the country. The Governors of 21 States and mayors of many cities issued proclamations, and activity centers, local councils on aging, and other organizations conducted 748-869—65——8 106 Department of Health, Education, and Welfare, 1964 month-long programs of events and activities in honor of older Americans. Throughout the year, the Office worked closely with the President’s Council on Aging. Representatives of the Office met regularly with the Council, and staff members served on most of its major committees, including those on housing, senior activity centers, and social services. The Office provides secretariat services for the Departmental Com- mittee on Aging and the Director of the Office serves as its Chairman. The Committee was especially active this year in n planning for Senior Citizens Month. The Office was represented on Ge recent ea committees on con- sumer protection, standards in housing, vocational education for jobs in the aging field, and'social manpower needs. The Office worked directly with other Government agencies on a number of projects. Staff members served with the Joint Task Force of the Department of Health, Education, and Welfare and the Housing and Home Finance Agency to bring haute social, educational, and related services to people in public housing in selected demonsiaaeean! The Regional Representative on Aging in Kansas City was assigned this year as the principal Departmental representative at the dem- onstration in the Pruitt-Igoe Public Housing Development in St. Louis. This was the first demonstration initiated by the Joint Task Force in 1962. Other members of the staff have been active in the fourth demonstration, located in five housing developments in Miami, Fla. This is the first one limited to housing built specifically for older persons. Jointly with the Public Housing Administration, the Office devel- oped a concept of congregate housing and services for low-income older people. This was embodied in a Memorandum of Understanding issued jointly by the Commissioner of Welfare and the Commissioner of Public Housing. The Office has continued to work closely with the Public Housing Administration on project proposals submitted under this program. The Regional Representative on Aging in Charlottesville, Va., © participated in the Appalachian Development Program which in- cluded planning for the provision of a variety of services for older persons living in this depressed region. The Office played a leading role in planning a Symposium on the Senior Driver and Pedestrian, which was conducted jointly by the University of Denver; the Office of Aging, Welfare Administration; the Vocational Rehabilitation Administration; the Office of Educa- Welfare Administration 107 tion; and the Gerontology Branch of the Division of Chronic Diseases, the Division of Accident Prevention, and the National Institute of Mental Health, all of the Public Health Service. At the request of the Department of Agriculture, the Office prepared a series of kits of selected publications on housing, health, and employ- ment of older people for the use of Agricultural extension specialists in stimulating programs throughout the country. Working With States The Fourth Annual Conference of State Executives on Aging, spon- sored by the Office of Aging, was held in late April in Washington, D.C., just preceding Senior Citizens Month. As in previous years, the conference was planned to help strengthen State agencies in aging. The theme for this year’s conference—“Creating Opportunities for Older People’—was adapted from the theme for Senior Citizens Month. The conference served as an inservice training session for many of those attending and also provided an introduction to activities already planned to honor older people in States and local communities. A new National Association of State Units on Aging was formed during the year and held its first formal meeting during the confer- ence. The Office will work closely with the Association, which is scheduled to hold its major meeting again next year during the An- nual Conference of State Executives on Aging. In fiscal year 1964, four States—Florida, Hawaii, Mississippi, and West Virginia—established new State commissions on aging. In ad- dition, the Governors of Oklahoma and North Dakota designated the State welfare departments as the point of contact on aging within those States. Also, the Commissioners of the District of Columbia appointed an Interdepartmental Committee on Aging to be respon- sible for planning service programs for the elderly. State units on aging are now included in a total of 41 States and 2 territories. During the year, the Office collected comprehensive data on pro- grams in aging from every State and territory. This information has been used to prepare a Handbook on Aging in the States, which was scheduled to go to press early in fiscal 1965, At the request of State officials on aging, the Office initiated the Highlights of Legislation on Aging series last year. During the 1964 fiscal year, five publications were issued in this series. The Regional Representatives on Aging were in part responsible for the addition of specialists on aging to the staffs of five State welfare departments. 108 Department of Health, Education, and Welfare, 1964 Working With Voluntary Agencies The Office devoted special efforts to encouraging increased interest in the field of aging on the part of national religious organizations. Conferences were held with officials of several denominations; a packet of materials on “The Older Person and Organized Religion” was prepared for the use of religious leaders; and a brief bibliography, Organized Religion and the Older Population, was prepared and pub- lished in the Selected References on Aging series. Joint activities were conducted with such orgartizations as the Amer- ican Public Welfare Association, the National Council on the Aging, the National Urban League, the Young Men’s Christian Association, the American Association of Retired Persons, the National Council for Senior Citizens, the AFL-CIO, and the National Association of Housing and Redevelopment Officials. The Office worked with the Southern Regional Education Board, the Western Interstate Commission for Higher Education, and sev- eral universities to stimulate the offering of professional education and training in gerontology. For example, in one region alone, four major universities initiated courses or programs in aging during the year, and two more were making plans for the 1965 fiscal year. Office of Aging staff assisted in the organization of, and participated in, the Sixth International Congress of Gerontology, the 17th Uni- versity of Michigan Conference on Aging, the annual meeting of the American Geriatrics Society, George Washington University’s inserv- ice training programs for nursing home administrators, an extended seminar at San Jose College, Calif., two semiannual meetings of the American Public Welfare Association’s Committee on Aging, and the annual meeting of the Gerontological Society, Inc. General Information Services The Office serves as a focal point for the collection and dissemination of knowledge about aging and the older population, as well as infor- mation on new approaches and activities in the field. Two new case studies were published this year in the Patterns for — Progress in Aging series. Planning for Retirement—A University- Labor Union Program, Case Study No. 16, describes a course for persons preparing to retire, which was arranged and conducted by a labor union and a university. A major purpose of the publication is to suggest ideas to communities on preretirement programs. A Rural County Cares for Its Aging: The Story of Aitkin County, Minn., Case Study No. 17, is a report of a successful program for older Welfare Administration 109 people carried out by a citizens committee on aging in a rural county with a large and scattered population and meager financial resources. During the year, the Office issued two publications in the Facts of Aging series, Supplement No. 1 to Facts on Aging No. 7, Zncome of Older People, 1962, and No. 8, The Older Farm Population, 1962-1963. A number of special statistical analyses were also prepared for workers and organizations in the field of aging. The Office also published Aging in the Modern World—An An- notated Bibliography, compiled for it by the Departmental Library, and another publication in the Selected References on Aging series— Basic Reference Books and Journals in Gerontology. Aging, the official publication of the Office of Aging, this year started using picture stories on its center spread. By permission of the Bureau of the Budget, both the number of copies printed and the number of pages used during the year were increased. A special issue in March was devoted to California programs for the aging, and another in May gave a roundup on Senior Citizens Month. The November issue, carrying a lead story on the Earlham Care Program was in such demand that the story was reprinted, the first of a planned series of reprints from Aging. Early in the year, the Office produced a publication describing its work, entitled The Office of Aging and the Many Faces of Age. The Office produced three copies of a table-top exhibit illustrating its pro- gram for elderly people for use at national conferences and meetings. Completed in January, all three exhibits were booked solid from March until the end of the fiscal year. A new Welfare Administration service to magazine, television, and radio writers was initiated by the Office with the publication of Futures and Features. The two issues published by the Office last year carried indications of new trends in the field and brief stories on developments of interest. Consumer Reports, Reader’s Digest, Geriatrics, Journal of the American Geriatrics Society, Gerontology, Harvest Years, and other national magazines carried articles for which the Office had furnished material, and the Jnternational Social Science Journal carried an article by a staff member. The National Broadcasting Company fea- tured the Office and programs for the aging on its “Today” show in January. At the end of the year, a new specialist was added to the Office’s staff to work on the rapidly expanding area of preparation for retirement. 110 Department of Health, Education, and Welfare, 1964 Office of Juvenile Delinquency and Youth Development The Office of Juvenile Delinquency and Youth Development ei ministers the Juvenile Delinquency and Youth Offenses Control Act of 1961. The Act authorized $10 million a year for 3 years, to be made for demonstration and evaluation projects, for training personnel, and for technical assistance services. The Act was passed to help local communities stem the rising tide of juvenile delinquency and to meet the great shortages of trained personnel working with youth. The Office of Juvenile Delinquency and Youth Development, work- ing closely with the President’s Committee on Juvenile Delinquency and Youth Crime, has viewed delinquency as a multifaceted problem. Unemployment, school dropouts, poor housing, family breakdown, racial discrimination are all closely related to delinquency. Demonstration Projects These problems are especially serious in the slum areas of our large cities. It is in these areas, therefore, that the Office of Juvenile De- linquency and Youth Development has concentrated its efforts. How- ever, of the 18 grants to communities to develop and/or carry out comprehensive projects, 2 have been given to rural areas. The grants were awarded to communities judged to have the capac- ity for developing innovative programs and able to meet the basic criteria of: (a) Comprehensiveness in scope of planning; (b) wide involvement of important local groups such as public and private agencies, universities, city government, and neighborhood leadership ; (c) financial commitment; (d) transferability to other areas; and (e) built-in evaluation. These communities have gathered staffs com- petent in research and program planning to develop integrated pro- grams of social action and social services, which flow logically from a sound body of research data and a viable theoretical formulation. By June 30, 1964, six of the communities—New York’s Lower East — Side, Cleveland, New Haven, Boston, Los Angeles, and Syracuse— were engaged in large-scale action programs to deal with these prob- lems and to coordinate the activities of governmental and voluntary organizations which deal with children and youth. Training Projects Closely connected with the demonstration project efforts are the training projects being supported under the Act. The training pro- gram is seeking to help fill the shortages of trained workers by im- ot aes Welfare Administration 111 proving both the quality and quantity of training, by building new knowledge, and by organizing and communicating more effectively the knowledge that is currently available. During the first 3 years of operation, 12 university-based training centers have been established across the country. Curriculum develop- ment projects are underway in 21 locations. Workshops, institutes, seminars, and related training activities have been conducted by 32 institutions and agencies. Each project may receive—and in a num- ber of instances projects have recelved—more than one grant. To date, some 12,500 persons have been trained in youth work from such areas as law enforcement, education, welfare, and recreation. Technical Assistance Technical assistance services provided by the Office of Juvenile Delinquency and Youth Development have been geared to help com- munities and institutions to design and carry out both the demonstra- tion and training programs. The Office has supplied intensive consultation to all communities which have received grants, as well as to numerous communities which have requested assistance but which could not be given grants. A bill to extend the Juvenile Delinquency and Youth Offenses Con- trol Act was passed by Congress on June 29, 1964, and signed by the President on July 9. The new legislation extends the Act for 2 more years, with provision for a special study of the effects of school at- tendance and child labor laws on juvenile delinquency and with $5 million earmarked for a demonstration project in the District of Columbia. Operational Programs in the Office of Commissioner In addition to functions related to administration, management, long-range planning, legislative and informational considerations, and emergency welfare services, the Office of the Commissioner of Wel- fare carries operational responsibilities for international activities and for social welfare research. International Activities Social welfare has become a priority program in almost every country in the world, and the Welfare Administration, in response to many requests from abroad, has expanded its resources for sharing experience in social welfare administration and related fields. Of the 122 countries with independent national governments, 86 now have 112 Department of Health, Education, and Welfare, 1964 some focal point at the national level for the administration of wel- fare services. The shortage of social workers to man the new services in the developing countries is creating an increasing demand for the expansion of training opportunities and exchange of research on so- cial problems and for the recruitment of American experts to help train staff for new social institutions. Intercountry research is an excellent vehicle for exchange. Thirty- one projects have been initiated overseas through the Welfare Admin- istration’s international research program, 16 of which were initiated — during fiscal 1964. The projects are authorized under Public Law 480, 83d Congress, under which U.S.-owned foreign currencies derived from the sale of surplus agricultural commodities are used in the countries involved. Hight of the new projects are in the social wel-— fare field; the other eight, in the field of maternal and child health. All are designed to be of value both to the United States and to the foreign country. Applications for grants continue to reflect special interest in the training of welfare personnel, prevention and treatment of juvenile delinquency, and alternative methods of providing com- munity services for families and children. Among the new areas of study included in the projects initiated in 1964 are phenylketonuria and the needs of the aging. In the exchange-of-persons programs, the Welfare Administration had contacts with professional workers from 90 different countries, primarily in providing and arranging training services for them. A total of 1,171 visitors from other countries received services from the Welfare Administration in 1964, as compared with 931 visitors in 1963. The visitors came to the United States on study grants made available by the United Nations, the Organization of American States, the U.S. Cultural and Educational Exchange, the Agency for Inter- national Development, their own governments, and various voluntary agencies. Especially impressive was the growth of interest in countries of Africa, 22 of which sent representatives to the United States for training during the fiscal year. An increase in the number of international visitors financed by AID was largely for the purpose of participation in group seminars on urban development, social welfare planning and administration, health and welfare services, and youth development activities, The authorization for these groups in the social welfare field reflects the heightened interest of the United States in social aspects of country development. The number of international visitors in the field of maternal and child health also increased, and teams continued to be sent for training. Welfare Administration 113 The Welfare Administration serves as a recruitment resource for Department of State programs using social work experts or scholars and for the United Nations. With the surge of interest in social wel- fare throughout the world, particularly in the developing countries, _ and the shortage of trained personnel, the need has become increasingly evident for systematic information on social work openings in other countries and candidates from the United States available for such positions. To help meet this need, the Welfare Administration es- tablished a clearinghouse in 1964 to handle inquiries from USS. social workers seeking oversea opportunities and to suggest candidates for ‘such assignments. A preliminary survey of the current role of Amer- ican social workers abroad showed 225 Americans to be working in bona fide social work positions in 56 countries. The Commissioner of Welfare convened two ad hoc advisory groups during 1964 to provide guidance for the expanding international work of the Administration. One group, composed of social welfare ad- ministrators, economists, and social scientists, was established to assist in the development of a comprehensive document on social develop- ment and the role of social welfare in various countries. When com- pleted, the report is expected to be of-value to the United States in providing guidance for U.S. participation in international meetings and in international technical assistance activities. The second ad hoc advisory group, composed of social work edu- eators with oversea experience, was convened to review current needs in international training and to develop recommendations with re- spect to the potential contribution of U.S. schools of social work in helping to meet social welfare manpower needs internationally. Two social welfare attaché posts were established in 1963 ing U.S. Embassies in New Delhi and Rio de Janeiro. During 1964 both social welfare attachés have provided a wide variety of services to the Wel- fare Administration. They have furnished excellent reports on cur- rent developments in India and Brazil; have assisted in the selection of exchange persons coming to the United States; and have represented their embassies in interpreting U.S. social welfare programs to key community groups in their countries of assignment. During the year, the Welfare Administration continued to co- operate with international organizations, both governmental and non- governmental. Among the major international conferences in which the Administration participated were the meeting of the Executive Board of the United Nations Children’s Fund (UNICEF) in Bangkok in January 1964 and the International Gerontological Congress in Denmark in August 1963. 114 Department of Health, Education, and Welfare, 1964 The Commissioner of Welfare was formally designated by the De- partment of State as U.S. representative on the United Nations Ad Hoe Group on Social Welfare to meet in advance of the U.N. Social Commission. Welfare Research Major efforts of the Research Division of the Office of Commissioner were directed toward: Recruitment of a multidisciplinary research staff and development of effective staffing patterns; delineation of re- search areas which can best meet the needs of the Welfare Adminis- tration and which can serve to integrate intramural research with the extramural grants programs; initiation and carrying out of selected priority studies; development of the monthly publication Welfare mn Review ; and coordination of research information and activities with- in the Welfare Administration. Several studies were completed during the year. The first report prepared by the Division, Converging Social Trends—E' merging So- cial Problems, was published in May 1964 in connection with the Na- tional Conference on Social Welfare. Working Paper No. 1, “Chronic Dependency : A Conceptual Analy- sis,” was completed and published. Also completed during the year and scheduled for publication in fiscal 1965 were: Working Paper No. 2, “Alcoholism and Low-Income Groups”; Research Report Series No. 1, “Low-Income Counties and States”; and Research Report Series No. 2, “Cost of Drugs—Administrative Implications.” A number of research papers prepared by the Division were pub- lished in Welfare in Review. Among the studies in process is a major intramural research project which was initiated as part of a national longitudinal survey of high school youth. As a first step in the study, data on the health, education, and welfare status of some 15,000 youths in one county will be col- lated for the purpose of assessing the school and work achievements of youth from families receiving public assistance. Other studies in process include: Changing trends in general assist- ance; use of the indigenous nonprofessional in social welfare; work opportunities and job progression among mothers receiving Aid to Families with Dependent Children; family structure and low-income; and exploratory work in community development and community center methods in public welfare. Under the Cooperative Research and Demonstration Grants Pro- gram which is authorized by section 1110 of the Social Security Act and administered by the Welfare Administration in cooperation with the Social Security Administration, 87 grants totaling $1.5 million Welfare Administration 115 were made during fiscal 1964. These grants supported research in such areas as dependency and public assistance, gerontology, and de- privation of children and youth. Research plans for fiscal 1965 place increased emphasis on: (1) The study of specific administrative and legislative questions of central concern in the public welfare field; and (2) programmatic research directed toward building a base of knowledge about the nature of the low-income and economically dependent population and the effective- ness of various methods and programs for prevention and reduction of dependency. 116 Department of Health, Education, and Welfare, 1964 Table 1.—Public assistance: Recipients under Federal-State programs, by pro- gram and State, June 1964 State Guanig ec. Kentucky Louisiana New Hampshire..-----=--_.--___ INOW Jer seyenseaeeceee ceeteaee New Mexico-- North Carolina. pie Dakota-- OTGSON! 22 see oases cee Vermont Wireinia io a eee seen oe eee Medical Aid to the Old-age assistance Aid to the permanently assistance | for the aged blind and totally disabled 2, 181, 957 187, 141 97, 409 501, 429 110, 275 1, 761 14, 522 1, 394 106 154 13, 331 » 832 2, 922 58, 234 1, 960 9, 245 271, 876 12,564 49, 348 48, 777 6 6, 044 7, 722 312 7,155 1, 252 306 431 2, 405 202 3, 072 72, 028 2, 581 16, 162 02° 018) |oe eee 3, 182 26, 185 1 130 5 1, 160 544 79 1, 048 4, 655 2, 053 132 2, 807 58, 406 1, 475 2, 550 28, 119 931179, | eee ee eS 1, 763 1, 116 28, 686 3, 467 1, 190 1, 185 21, 862 2, 250 500 4, 609 56, 750 7,929 2, 434 9, 931 130, 250 647 2, 828 18, 868 11, 125 668 339 2, 230 397 7, 402 2, 275 11, 856 1, 683 7, 574 1, 093 3,478 2, 898 17, 414 4, 574 14, 692 246 1, 279 651 2, 473 165: |2---c2 eee 4, 464 1, 337 262 582 13, 948 5, 092 957 8, 390 LET) WY fl oe ee Ce 345 3, 630 56, 255 34, 202 3, 186 35, 363 AS) 612} | Seen eee oe 5, 070 21, 981 5, 387 1,081 81 1, 464 S51 86u)| eee eee 3, 347 18, 727 83, 469 989 1, 678 13, 169 11, 055 3, 529 420 7 7U 46, 761 7, 848 17, 893 19, 683 32, 133 3,478 1, 494 21, 294 DA ObSi| seer eee 9 2, 761 26, 113 2, 381 1, 786 8, 605 7, 237 106 121 1, 102 45, 469 3, 694 2,197 12, 612 250 321 epee n ene 4, 800 9, 291 5, 061 2,073 170 4, 739 5, 447 107 113 1, 086 461 35 15 13, 413 1, 196 1, 136 6, 732 33, 760 9, 283 680 18, 422 14, 666 12, 150 819 6, 120 BOND LD | eae eo eee 810 5, 873 2, 539 20 60 611 Aid to fami- lies with dependent children 1 1 Includes as recipients the children and/or both parents or 1 caretaker relative other than a parent in families in which the requirements of such adults were considered in determining the amount of assistance. : Welfare Administration 117 0 in ti ee a et a a eS Table 2.—Public assistance: Average payments to recipients under Federal- State programs, by program and State, June 1964 Medical Aid to the Aid to State Old-age assistance Aid to permanently | families with assistance | for the aged the blind and totally | dependent disabled children $78. 44 $196. 84 $84. 09 $78. 50 $32. 51 67.16 253. 51 64. 68 46.16 11.69 OSTEO! 22 eee see 81. 46 133. 71 34. 76 Gi Nisa 2 eee ea 72.53 67.25 29. 07 63, 91 56. 82 70.77 59.12 16. 92 107.74 295. 72 129.28 112. 80 43.11 LOUNT 7) (es coew se. See 88. 68 77.77 36.25 75. 31 193. 94 109.18 68. 29 43.38 64500! |e eee bee ee 80. 84 73.47 27.74 88. 64 282.72 72.70 78. 84 32.62 66.47 353, 04 67.46 71.38 16. 02 6. 86: someon. 58. 61 59. 53 22.24 30. 25 17.51 1 25.90 12.99 82.61 348.17 120.20 146. 09 37.38 75. 70 138. 68 74.46 57. 53 37. 86 88. 03 518.47 90. 21 93. OL 43. 63 SD. 90: ft ee ee 83. 08 116.27 29.75 91.42 124. 83 102. 59 82.90 38.49 86. 09 152.39 91. 64 104. 37 37.38 1G he 61.72 30. 23 70. 61 75, 22 25. O01 Dob See) 85.13 202. 23 82. 05 58. 55 23.03 SUR Tlie aoe oe 84. 60 87. 64 29. 02 Maryland. 80. 68 77.88 32. 65 Massachusetts 132. 93 143, 97 47.43 IMUM (CLAN Peg) Rs as 86.15 107. 54 35. 04 WVEInITeSOUssoeck ee ka) 131. 50 61.11 52. 53 Mississippi 46.43 43.53 10. 60 PMISSOUL oe seer 75. 00 70. 08 24.16 WViontang!asseeeasesins bol 85. 50 78. 51 35. 21 INGOTOSKS. 3.222.) .<_....-—. . 106.18 93.18 30.25 UNOVadhaseeees- sees occ l2 fs. 2. EOO? [stceoy ie eee. 421), SH" |pee ewes ees 31. 67 New Hampshire_-____..-.______. 100. 63 54. 86 105, 97 114, 50 42. 88 ING Wid CsOyseseessssoscc5-—-+-W2. 80. 27 215.41 84. 48 95.28 48.37 Ne Wwe MLOxIGOreu s225--2-4---- 8 BSE70) eee ce 74,10 69. 66 34.34 92. 56 313. 80 112. 64 128. 28 44.45 SONGS: [Sates eet a 67.79 72.20 24.24 89. 51 213.20 73. 86 114. 52 41.98 lie ay aoe eee 81. 46 73. 83 30. 68 95. 54 146. 60 121. 55 110. 77 34. 67 68.37 143.16 83.27 63. 64 38.15 74.42 241.00 74. 84 71. 54 29. 84 9, 32 29.39 8.44 8.68 4.14 Bock. [osama sere 86. OL 91. 01 40.38 58.13 200. 34 67.40 59. 51 17.23 84. 53 40. 00 68. 52 69. 78 30. 66 52.08 59. 08 52.36 50. 84 20.02 20:08" |as tee eee ook 69, 39 57,24 17.86 69. 23 113.75 78.70 69. 68 82. 53 85.14 251.09 87.60 83.95 29. 88 Wal hoi Cine a i ari 34, 42 1 1) 33.27 16.96 Vib ili 3s ee See 62.61 139. 44 69. 43 66. 64 24.12 1 Average payment not computed on base of fewer than 50 recipients. 118 Department of Health, Education, and Welfare, 1964 em — —— ———— Table 3.—Public assistance: Total payments to recipients under Federal-State programs, by State, fiscal year 1964 Aid to the perma- nently and totally disabled (000) Aid to families with dependent dren Old-age Medical Aid to State Total assistance | assistance | the blind (000) (000) for the aged (000) (000) Ota). 2 8-s=. ees ee $4, 491, 783 | $2, 030, 945 $383, 648 : $96, 665 PANGAN A Sekt forge nn oe) 111, 248 88, 736 767 . 1,109 ANASKR esc ste s 3, 486 1426) [ode eee Boe 96 AVON Go. Jos ete ce 27, 143 0,970 fuseus=-s222 729 Arkansas: .! seh. 222 4 58, 214 43, 239 1, 603" 1, 609 atOrnig.. <5. sapere 3 es 718, 092 347, 196 80, 069" 19, 073 Walerado = 5. soe . 82, 308 Aik ta ee es ee as 258 Connecticut_-_--_--.-- 58, 507 7, 928 13, 957 413 Melswaresees Fo 4, 523 032" | Shee. 22 267 District of Columbia i 14, 562 2, 589 1,714 167 IORIOS geen dee bos ace ee ee eS 91, 865 55, 336 1, 402 2, 057 98, 026 GL ed |o Bee ea 2,197 21 61 15 2 10, 183 1, 012 1, 657 101 13, 731 4, 278 2,910 111 233, 670 62, 105 5, 160 2,875 41,135 21, 878 3 s2eueaae = os 1, 793 52, 180 31, 227 1, 375 1, 474 47, 578 25, 484 1, 446 569 76, 442 40, 074 2, 108 1,991 173, 425 129, 316 984 2,750 22, 388 11, 089 1, 307 379 44, 423 g 377 178, 963 r 8, 545 Piighigan: =... 52-2 138, 014 1, 671 Minnesota_-_______ 86, 521 i, 419 Mississippi- ------- 54, 519 1, 581 Missouri_-_.------ 129, 998 4,077 Montana. --.__-- 9, 036 254 Nebraska___- 21, 350 799 Nevada__.__._- 4, 758 234 New Hampshire__-__---------- 9, 248 5, 440 589 330 ING Wid CINE oon. oe coca eee 86, 203 13, 196 11, 043 927 Newe MOmG0S 3 35-5 acnacecdeka 25, 403 OC O12) eee eee 359 IN Gie OF eee 9 at aun eee ba 483, 906 61, 192 120, 343 4, 209 INOrEnCAPOUNS 22 seer oaks 83, 720 29, O49 fo. e ese 3,911 Notun akora. 21.200 .-2.2.55 13, 917 5, 895 2,670 83 CO Sc ce a eat cease wee 162, 346 86,298 | seat eas ae! 3, 370 Olkighomeses so osteo 2c ek 146, 284 96, 012 1, 793 2, 457 Oregon peck ee eee soe 35, 261 9, 696 5, 865 405 207, 299 42,397 21,081 16, 096 16, 428 3, 673 970 155 20, 036 6, O84 |" seep 102 30, 869 16, 254 1, 984 1, 273 12, 107 7, 281 4 106 57, 603 28, 938 2, 065 1, 425 220, 751 191,048 | 2ose-s=e-—5 4,078 19, 299 yet 2, 959 160 8, 691 5, 512 339 95 §28 221 26 6 29, 207 9, 923 478 926 WASHINPLON 22 2e ae ae sconas 89, 944 32, 889 16, 103 728 West Virginia. 2-2 2.5555 54, 548 8, 569 2, 842 483 Wisconsin_-_._-- 66, 910 36; 6104) acts 950 Wi YOmine ese sna 4, 767 , 580 53 55 | "Welfare Administration 119 Table 4.—Public assistance: Aid to families with dependent children, unem- ployed-parent segment; recipients and average payment, June 1964, and total payments, by State, fiscal year 1964 Total pay- Recipients | Average pay-| ments, fiscal State June 1964 ment June year 1964 1964 (000) Oo eS ee ee 385, 925 $30. 50 $124, 920 i Once ein ee a 58, 098 32. 65 11,173 pecnactioat 2 eh ee 12, 270 31. 69 4, 760 Moelaware.-:--...--=.--- 2, 064 26. 75 656 Ee Ee eee 1,995 29. 92 759 PnOIs *.. 8s 2252-5223 =5 45, 883 40. 39 23, 880 LOUTEEC Si eae es 1, 948 29, 26 594 Maeryland.. ...2=522=5-- 2, 562 28.15 1, 095 Massachusetts 3, 687 35. 43 1,441 Michigan’ - 2222-5... 24, 416 28. 98 1, 756 Brera yy ORK So to son co 86, 769 31. 50 32, 547 oe See eee a a Mike shag He ate ae 3, 796 37.34 1, 727 Pennsylvania___--_--- 51, 072 23. 31 17,193 Rhode Island_-_------- 3, 312 34, 46 1,414 “cinemas gin] Ba) ONsS snceess2=% H 26. A Westy Panta 58, 778 27.15 19, 842 Table 5.—Public assistance: Aid to families with dependent children receiving foster care, number of children and average payment per child, June 1964, and total payments fiscal year 1964, by State Number of Average Total pay- children payment | ments, fiscal State receiving per child, year 1964 foster care, June 1964 (000) June 1964 4, 961 $72. 02 $3, 587 12 (4) 6 43 (1) 21 179 58. 09 97 965 92. 21 1, 088 877 91. 95 781 114 38. 87 39 55 91. 65 34 7 (1) 2 402 62. 05 272 362 69. 04 248 36 (4) 10 170 85. 92 114 73 31.75 9 62 64. 24 52 35 @) 21 286 45. 59 134 140 67. 76 129 196 68. 46 46 183 52. 03 119 38 (4) 23 504 54. 31 175 56 52. 27 28 166 61. 03 141 1 Average payment not computed on fewer than 60 children. Department of Health, Education, and Welfare, 1964 120 180 246 908 (929 ‘er 10 ‘8€8 POL ‘8p9 ‘8 £69 ILTE 2 O8T ‘0E8 'T LVL CoG p £68 ‘810 ‘2 88I ‘600 '¢ GIP ‘689 ‘T 002 ‘T€9 ‘OT 093 ‘9e9 ‘T £89 ‘O16 % 688 599 616 ‘geo 6F0 ‘069 ‘8 898 ‘F28 ‘T 188 ‘CST OF6 ‘ZT 670 ‘FEI FL LOF ‘8ah ‘Z LG ‘826 ‘T PLS ‘996 | 619 ‘F06 ‘F 820 ‘979 'e 120 ‘L866 ‘8G O8€ ‘E9T 'G 964 ‘TPT Ose ‘LFF ‘9 OLE ‘G66 ‘She$ PeTqestp Ajje101 pue Ayyueueursed oY} 0} PIV aS Sar one es “coTToued aN os Se ee a ~~"""BUT[OIBC) F410 NT Gowen s ‘aa Basson et os SS} OOTXOTA MONT tat “aust Se (ots ta fe ee AOSIOf MON A Se oo eae: eo ee elysdmey MON wane nanan nanan - +--+ ----------------------------- LMosst Ay none nanan anna n-----~---------------------------- IddIsstsst fy wen ann 2+ --------------------------------------- BOSOUUT PT wo nono 2-2 ---- === ---------------------------------- UBSTYOI YL ~-2------------~------------------------------ S}JOSNYOVSSe A were nnn nnn nanan - 22 - === === == =~ == ----- === - puvyAre py SPRUE ee a ete ce aes ee ee Bt Pas Gist. See Se 3 a BuUvISINO'T 2 teh ike be a ee eS ee Ayonquey at era he es Oe eS SS 3 Dice Pe Se meng) 918 ‘80 O€G ‘98I 'Z G18 ‘810% P98 ‘888 ‘F 2o8 749 ‘6 £68 ‘TST '€ P86 ‘691 22 via ae macquee | SAL 807 9G Se nee a 969 ‘OFF ‘89 8E9 ‘083 G00 ‘TTL ‘PL PLg ‘LP ‘G9 OLT ‘9¥6 ‘Th oe Ree ee “| 199 ‘90T “¢2z TE ‘19 188 ‘6L1 6 hee. pene (SOL) 100) Di 968 ‘F908 GG8 ‘GPS ‘61 868 ‘299 629 ‘919 ‘9 208 ‘898 ‘9 Ch rOR6 38) wage ee “| LL8 ‘CLL ‘LP LGP ‘LOT. 666 ‘GL1'T 929 “608 PEO 120 oa oo “S""") BLL ‘GOT 'G 08 ‘6IT 968 ‘6LE ‘T pa te oe C1G708 7 | ae ae a pe PEL PIE ‘2 980 ‘LTP OZT ‘606 '€ ce 08 SCS nPLaee leet ees 616 ‘899 ‘FT O0L ‘CLT, £69 ‘FO '% Pe nec WeRcerb ia |MOVS OP Gea emcee me ern 991 ‘Lh ‘9 698 ‘892 £92 ‘E9T ‘FZ er. a) Snes SOURCSS (00! etee lige roe oe PSP ‘086 ‘66 GPL ‘P08 ‘T 00F ‘106 ‘8 rae, S75 g CU Ce dl Sa ew O89 ‘FIT ‘Lh £86 ‘819 OLE ‘6EP ‘ST Peres ai 198: 069/(08 ite Bo es 069 ‘FPS ‘OF PLP ‘596 | L8T ‘694 ‘GE L9F ‘LTL OT YS 197 6G: wearer bo BIL ‘SF8 ‘08 920 ‘ThE ‘T 80F (969 (96 998 ‘898 FG 189 169 98 eke a P98 ‘S90 ‘6 08g ‘GAT 282 ‘920 ‘8T 982 ‘T16 ‘T 129 ‘89 ‘F 822 ‘O18 ‘G 990 ‘T60 ‘08 PPG ‘846 | 462 ‘288 PSP ‘FP6 90F ‘02a ‘8 GLE ‘06 989 ‘086 ‘OT £28 ‘GPS ‘T $99 ‘ogg ‘9a LEP '98Z_, £62 ‘209 ‘26 ie tae “"| L@h ‘929 ‘set 998 ‘618 GOP ‘FOE ‘0Z $16 ‘O19 ‘T 106 ‘TTL ‘2 998 ‘OFF ‘08 828 ‘066 ‘19 988 ‘eee L60;726 Sh amu een $26:'006 OLA ae ae ae oe OFY ‘Z9T ‘6z 629 ‘CLL TOE ‘69 ‘TT P8h CEL 16 ‘969 ‘02 5 oh eee oe PPO ‘COP FE SPF ‘62 ‘T SFG ‘889 ‘ZI her Ret se ul aon 968 ‘299 FT fb eee OL8 ‘£06 ‘82 91Z ‘288 SLL ‘861 ‘FL ZBI ‘OFZ 099 ‘T9F ‘TZ gs8‘eso'Ts —_|- 029 ‘Tee ‘81 986 ‘08 698 ‘8&8 *% 869 ‘OTT ‘Z GF8 ‘920 ‘8 ee ee £96 ‘CIP ‘6 648 ‘EL 002 ‘289 '€ 808 ‘O18 092 (99T SIL ‘098 'T LIL ‘1819 I6L ‘T 129 ‘99 £66 '9 988 ‘Te ewe pee anni (089 611, 106 ‘902 ‘T CEOLCOL Caen |i ee ae TL 2OL0 8). as |e | 86 ‘61Z ‘82 186 ‘268 ELL ‘108 ‘LT 699 ‘226 999 ‘192 ‘OL 969 ‘219 Tr ___| 190 ‘080 ‘bz £98 ‘CTL 96 ‘ChE 'S LGS ‘686 £09098 Le “melee aie eos eee 629 ‘926 ‘OL 9GP ‘F8T GIL ‘888 'Z 5 anaes kong ag GBP ‘E19 | eS ee L6I ‘809 ‘8 699 ‘TST 206 ‘199 ‘oT O€F ‘129 ‘9 POL ‘826 ‘g Moa Reena real ar DL S686) 090 ‘6ST 916 ‘T&T IL pee eet aS BLE ‘¥E9 08 Raion eee ee 9GE ‘199 ‘Sh POE ‘628 ‘2 614 ‘IP SC £26 ‘S10 68 LS bs 2 0SC LT ae | eae cand OT8 ‘062 ‘828 O89 ‘FFG ‘T 109 ‘82 ‘7 800 ‘9SF ‘T £06)'CG6. 08) Mt limieee ae eee GCE ‘886 (LP SP9 ‘989 FCC L0G al te Os liense stow as ek O8F ‘6LP L j PPL ‘689 (0 £96 ‘ST 666 ‘29T ‘T Ditoes oad L¥8 ‘026 , CLL VOL ee ILI ‘€¥6 $98 98 999 ‘996 ‘IT P19 ‘OF9 6F8 ‘P28 ‘89 G89 ‘280 ‘88 193 ‘19Z ‘o#$ 080 ‘400 ‘810 ‘T$ | BIT ‘S64 ‘LOZ$ | ZBL ‘289 ‘Zea ‘T$ | E98 '80F‘ZLT$ | GOP ‘OD ‘Te6 ‘ZS eIp[iqo pulyq {uopuedep pose oq} toy 90UBISISSB z P2qesIp 10 94} 0} Pry =| -W4TM Sorprumey gouRysisse 988-PIO purq “pose ON A 0} PIV [BOIpeT ou} 0} PIV 94845 1 P96L 4nak yosyf “upssoid X4Q *Sa1vDIg 0} stuDIs [DAapay saauvjsisspD 9149QNg—'9 2[qUI, 121 istration umn Welfare Adm OFF ‘O28 eT “509 ‘g 89T ‘220 ‘€ FES ‘FL ‘6 £18 (966 ‘F £90 ‘12 886 ‘689 , L6S ‘146 % 023 ‘TL6 *F OPE ‘FLT 9 899 ‘902. | 98¢ ‘826 ‘F 16L (018 , £98 ‘ThP T TLP ‘LEL ‘OL 182 ‘LTP 859 ‘886 ‘T OFF ‘780 ‘TT 9aT ‘28 PFI 629 286 ‘068 186 ‘868 GLs ‘ZL 802 ‘% 6L0 ‘29 TRL ‘TIT I8T ‘810 ‘¢ 698 ‘Zot ‘T 86 ‘08 STP ‘+86 SF6 ‘08 £68 ‘ZOL 168 ‘G82 810 ‘842 896 ‘G12, #81 ‘002 % *re0X oT} JO 41ed IO} Polqestp Jo ‘purtq ‘pese oy} 04 pre Jo urvsZoI1d Jepun pus Iwod Jo 4red OJ GOULYsTSSB Jo sod Ay pogtoods JapuNn posoUBAPsB YSBO ¢ *saqe1g 014 Aq pojiodel spuny [esopa,g WOT soIngIpuedxe IveA [eOsy MOI AWYSYs JoyIp Avur ‘vod oY} JO} pooUBAPB Ysed UO poseg 1 999 ‘OF6 , 660 ‘ZOT ‘ZT £28 ‘STL ‘08 LUG ‘GES LT 960 ‘LT ‘OT 190 ‘EFT | L8I ‘96% T ¥60 ‘F6L 9 68E ‘889 ‘LT £06 ‘80T ‘ST SCL ‘L10 ‘8 GPS ‘OGP ‘g SIL ‘989 ‘9 S19 ‘TLS ‘g OTL ‘TS8 18 G0 ‘L€9 'S ¥8S ‘FOE ‘TZ 693 ‘008 ‘GF 819 ‘£92 ‘2 490 ‘Eeh ‘8 606 ‘T2L ZL8 ‘TE HOF ‘TIG | 329 ‘268 ‘T 890 ‘489 ‘T soy £0 ‘828 ‘T GeL ‘CLF Zee ‘006 ‘Or LEL ‘Ger % T16 ‘Tt ‘T L99 ‘e9L ‘T 688 ‘899 ‘0Z 206 ‘810 ‘2 STZ ‘PLL ‘TZ 100 ‘T9T ‘8 622 ‘9CT 882 ‘COL ‘e OF6 ‘226 % SLL ‘OST ‘OFT O6T ‘950 ‘Fa 809 ‘ore '¢ SFT ‘182 ‘ET L8L ‘290 '% 889 ‘890 ‘Z £0b $80 162 OTF ‘Zar ‘L PLL ‘092 ‘ST FOF ‘TIS ‘Es 9F6 ‘CLT 'E SF6 ‘E08 ‘98 869 ‘TTP (8h 120 ‘669 ‘29 POE ‘619 ‘FZ €L6 ‘PCE, 92z ‘ZES '9 ¥L6 ‘899 ‘ET £99 ‘FEL ‘TAT 806 ‘OLT ‘SF 869 ‘OLT ‘6 PEL ‘C68 ‘SZ 6PL ‘9FL ‘ZT FEL ‘089 6 SIS ‘668 ‘OFT 968 ‘678 ‘2% ¥8T ‘800 ‘86 916 ‘968 ‘60T THISTOOST AA. BIUISILA 489A Tae RE REO" SE Se ae Se Sa ae ae ae oe Ka oe u04ZUTYSB NM Mme ehaeS MS se ease erUysITA ee Re Ee DS ee * See OE quOuIIO A Byoyed yINog 7 WER Pets we ee ee eulporeg WyNog es ee eer ee ae SS a --"puRys] epouy --oory OJON ape Ss etsy Sansa en Sa ~~ Poa SIUGATASUUO Bos bBaLcet Seer pean ne acer es -e ce--— — WOs0A() ap a Shee Ae ince ak ae seo St a eee CULO 748-869—65——9 122 Department of Health, Education, and Welfare, 1964 Table 7.—Public assistance: Selected way data relating to payments, fiseal year UI State otal 2-2 oad: 6 se ee ee Soe eee Alabama. (OCK gibi oS ee "eee Se ee ee eee ASUS. = donc seeuttcnakeasncsse$ WRANSAS? 2 case aceon as eee se Kentucky onisiangi) 32 oe oes ee. Sen Michigan Missourians to hoiae. noc. INGw Tiampabile soe oe. Sone tense anepence DIGW JOTeee =o eke ce = Oklshomalaeot aes Orecon ie 2. eee IPennsvivaninssss, seer we. psu ccabbetneuaekaaud PUCTLO MICO. cauaepece cence a scoseweesmconceaeas, Rhode Island_- South Carolina South Dakota Utah. s8e-%. 2 ese Virginian ne fee catia nal mat ence koncoussccene WASTUNDUON 22 ook anchiedocck nenhcbabeatintes neue West Virginia Average per capita income, 1963 12) () Expenditures for assistance payments from State and local funds, fiscal year 1964 Per inhab- itant 6. 52 i _ a) oy to POSN HAMA NOR OW SNP ANS PNA POP ORONNES NAEIONNoP SSSQ SRRVSSSERS RSSRESSNAS SRSSSSSRLSS SESRSSES _ Per $1,000 of personal income, 1963 1.97 SoSaBRes R SRLESSReSS _ NESONON PONN PNP WWOAN SPO NOWWrOnNN NP PN, SNN PP =z 3 wo PPYPPPr, SITS RAS DOWWONAIIWO -PIBSCOBN SOIMRAR ADH = S od <7 -] NeW Com IT Sasa Percent of accistange payment from Federal funds, fiscal year 1964 g nw SHe35 > iguss N PASSSRSRSH FESSASASS RSs B ~ S35 BSS88s PONS ANCHOUPDDO HHORMNDENHW WDANMWOARON RBWODHOOHOR HOTIOHOORWH S333 SSN3sx38 1 Excludes Guam, Puerto Rico, and the Virgin Islands, data on per capita and personal income not available. 2 Data not available. Welfare Administration 123 Table 8.—Maternal and child health and welfare services: Grants for maternal and child health services, crippled children’s services, and child welfare serv- ices under the Social Security Act, by program and State, fiscal year 1964? [In thousands] State eA I ee a nwo aa ne bowen osama asonasee n= (Ura 2 Se, a ee ee ee ae era eee Sa OS 2 2 re a ae CT VTL EAT pas =o a ES a oO a re LOPES PLU (CG 6 107 3) 2 Sa en aS es Se Sa a nance ana soaneese SN So a ages ebsa sas seaan anaes QI Giit ee eee eee Ute ee By Ce ee ee ee aed OV OO. a tae Va CGA Oo ee a ee eee: Soa ee Rhode Island_-- South Carolina. RONG Oleeo sce coo 2- ose oe Wiig olre hh Se ae ee Visi.) A Ae eT a ae ee ane VOT VIS da 2) i a a a a MUL Cano ay 2) Se eee Maternal and child health services Crippled children’s services $27, 738. 9 Child welfare services $28, 975. 6 1 Based on checks-issued basis. Additional payments were made for special project grants to institutions of higher learning and to public or other nonprofit agencies and organizations as follows: Maternal and child health services, $1,301.4; crippled children’s services, $1,359.5; child welfare research and demonstration, $1,145.5; child welfare training, $987.0; and maternity and infant care, $597.9. the * * 1 bows danas “Westiias bs ot +a «4 tts jeho srs t I 2¢ : ’ Ww - det fcag¥es?. 6 SF) Public Health Service Health of the Nation In THE PAsT yxEAR, the Public Health Service continued its efforts to improve health programs and services in the United States. A num- ber of new responsibilities were given to the Service in response to the increasing complexity of health problems and social change. Two significant new programs, signed into law by President Ken- nedy, had funds appropriated for their implementation in fiscal year 1964. The Health Professions Educational Assistance Act of 1963 (Public Law 881-29) authorizes the Service to help in the construction of professional health schools and to administer student loan pro- grams. The Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 (Public Law 88-164) launched a major new attack on the problems of mental illness and mental retardation. This measure authorizes Federal aid in the con- struction of community centers for the care of the retarded and men- tally ill and provides for increased research and training in these fields. On December 17, 1963, President Johnson signed the Clean Air Act (Public Law 88-206), which provides increased assistance to State and local governments to meet the problems of air pollution. It also authorizes accelerated research, training, and technical assistance in the field of aid pollution. Several important health measures were also enacted in 1964. The Nurse Training Act of 1964 (Public Law 88-581) provides for the construction of new schools of nursing and the expansion of existing schools. It also authorizes loans for nursing students, provides funds to aid in curriculum development, and extends and expands the exist- 125 126 Department of Health, Education, and Welfare, 1964 ing program of traineeships for professional nurses. The 1964 Amendments to the Hill-Burton hospital construction program (Pub- lic Law 88-443) extend this program for an additional 5-year period, authorize Federal aid in the renovation and modernization of hospitals in large cities, and encourages area-wide planning of health facilities. The professional public health traineeship program was also extended (Public Law 88-497). Early in 1964, the Surgeon General’s Advisory Committee on Smok- ing and Health sea its report and concluded that: “Cigarette smok- ine is a health hazard of sufficient importance in the United States to warrant appropriate remedial action.” 'The Public Health Service, and many State, local, and voluntary organizations, are developing programs of research and education in response to this Report. Re- search on the properties of cigarette smoke and its effect on living tissues is in process and programs of public information and education have been developed. A National Interagency Council on Smoking and Health, formed by several leading national health and education agencies, has agreed to develop and implement plans and programs aimed at combating smoking as a health hazard. The Public Health Service meets its responsibilities for protecting and improving the Nation’s health through the following organiza- tional components: the Office of the Surgeon General, the National Library of Medicine, and three major operating bureaus, the Bureau of Medical Services, the Bureau of State Services, and the National Institutes of Health. The Bureau of Medical Services administers the medical care, foreign quarantine, and related programs of the Services. The Bureau of State Services works with States and communities to develop and improve community health and environmental health services. The National Institutes of Health is the principal research bureau of the Service, and administers a wide-ranging program of research grants and fellowships. In carrying out its responsibilities, the Public Health Service works in close partnership with State and local agencies, voluntary and professional organizations, colleges and universities, hospitals, industry and labor, civic groups, and others interested in health. The activities and accomplishments of the Public Health Service in fiscal year 1964 are described in detail in the following pages. Health Record Health Interview Survey estimates for 1963 indicate that 22 mil- lion persons, or 12 percent of the Nation’s civilian population, are limited in their activities as a result of chronic disease or impairment. Limitation of activity refers not only to the major activity of a per- 127 Public Health Service SBIIAJBS Yyoipesay | sodsNOsSy yf sail 1904 yoipesay SjUDIS) ysipesey ABojouyre | *Y Yyospasey jayndwo> SpJDPUDIS so1Bojoig *SUOISIAIG Jajus>) joorul|> sseupul|g BS saspasiq o21Bojoinany 4Y4]O3H joyueyw J1D8}H seaualosg [OOLpPEWw Joseusd Yyripssay jos4E8q juauidojanag UDWAH 7B 44129H PI!YD 4J99uUD>) saspasig D1jOqojyay PY SHYLY saspasig snoijoayu) gp ABal\y TSAPM}I YSU] |DUCIJON| 44]99H JO SBINJI4SU] |OUCILONY “! aulsipey jo Aipiqr] |OUOL}OK 4304S |D}Dedg puo sdnoidy Alosiapy [0U194u| sdnoss) AltosiApy |0us04x3 ‘upjd uoljpziupBi0es ayy sapun snveing sworeq pjnom sBuidnoib esey] ¢ *upjd uoljpziupGi0es eyy sepun pesodoid sj oulipay jo Aipigi] JOUCHHON eYy Of AD]IWIS snynys jDUOIJDZIUDBiO |yoIndas 1 [ 8821440 |oUC!IBaYy SHd 6 | uolypsuadwos saaXojdug yo noeing 7304D011q |DOIPAaW suosiid Jo NDBINg 440}9911G |DIIPEW paons) 4s00> *489133Q [PO1PEW J214D Ys], 98} UDIpU] sj oy1dsoy SusjUDIONE UBlaI04 ISUOISIAIG t— 3891A19$ |Oo1pew phe) npeing 4991JJO BALNDEXA [D’aUuesd suoaBing junjsissy Josauas) uoabins Ayndaq |D1ausd uoabing [D1ausmd UoEBbins BUPIS SOLO eseIpouns| v96L—ADIAUAS HLIVSH DI18Nd—L LYVHD puo Burjeaui6uz joyuswuos!Auz Sess eeeeecnencessuecnusnesecoucsupeeseseunT e3 |Do1payy pun jolidsoyy saosnosay Pub YF}PeH S1/9Nd joued SadIAlasg yyjoe}H Ayunmwo;y Jajuay aspas}q 3|qo2junwwo> saspasiq 2jUuary> UOIjUsAaIg JUSP]DIV senecessouee JOuguor Wos4n||Og pun Ayddng sayon, 4i]D9} [2160] 0]poy Ys] Dap{ |OUdIyodND9Q) UO}JIA4O1g Poof UO! |] Og NY SUOISIAIG, yypoay Aysunwwory SUOISIAIG Yj]Oa} [OyU@WUOLIAUY Perret Oy SODIAIBS B4O}S jo nosing Spousaw Yy]Da}H 21/qg UO!IDZI|IGOW 4YE}OoH JIpmy jousayu] a@uDUI4 SODIAIBG BAI{DIySIULWIPY tSUOISIIG, SO14S1JDJS YJ[D@} JO} 49jUSD |DUCIYON) Jauuosiag 4O 2214jO YsJOIH [OUOIWDUIAZU] 4O 921jJO SUOLJDII|GNg PUD UOLYOWIOJU] JO 3214j}O o19ued uoebing $0 92150 SI9D1JJO [OUOISSAJZOIg JO14D 128 Department of Health, Education, and Welfare, 1964 son, e.g., working, keeping house, or going to school, but also recrea- tional, social and similar activities. Limitation was attributed most frequently, in order of decreasing importance, to heart conditions, arthritis or rheumatism, mental and nervous conditions, orthopedic impairments, or high blood pressure. In the year ending June 1963, Americans (exclusive of the armed forces and inmates of institutions) experienced an estimated 401 mil- lion acute illnesses or injuries requiring medical attention or causing restriction of activity for at least 1 day. About 233 million of these, or 58 percent, were respiratory in nature, including 83 million cases reported as influenza. The average American experiences in a year about 16 days of re- stricted activity from chronic or acute conditions, including injuries. Of these, 7 days are spent in bed. Time lost from work or school due to illness amounts to 6 days which may or may not also be bed days. From data collected in the year ending June 1963, it is estimated that about 70 percent of the civilian noninstitutional population main- tains hospital insurance and 65 percent had surgical insurance coy- erage. The average American spends approximately $129 annually for hospital care, medical and dental services, medicines, and other health-related services and products. This estimate includes amounts which may have been paid for by insurance. Because the United States underwent an outbreak of influenza in early 1963, about 75,000 more deaths were recorded in January—April than during the corresponding period of 1961, the most recent year without serious influenza outbreaks. After allowing for population growth over the 2 years, the excess number of deaths during the first four months of 1963 associated with the epidemic was approximately 58,000. The year’s 1,813,000 deaths gave a death rate of 9.6 per 1,000 pop- ulation.t Over the last 10 years the rate has been 9.5 or 9.6 in years when respiratory diseases were more prevalent (1963, 1962, 1960, 1958, and the latter part of 1957). Other years in this decade have had | lower rates, but none below the 1954 rate of 9.2. Crude death rates like those just given are affected by the age distri- bution of the population for which they are computed. Age-adjusted rates are rates which would have resulted had the mortality during the year for each age group been experienced by a standard population. The estimated age-adjusted rate for 1963 was 7.6 per 1,000, or about the same rate as for 1962 (7.5), although higher than the 7.3 rate for the relatively influenza-free year of 1961. After a marked decline from 1Except as noted vital statistics frequencies and rates are for the calendar year. - ee Public Health Service 129 10.8 in 1940 to 8.4 in 1950, and a further decline to 7.6 in 1960, the age- adjusted rate has shown little change in recent years. An estimated 130,610 persons died in 1963 from violent deaths— from accidents, suicides, and homicides. This was 3 percent more than the number in the preceding year. More than half of the increase results from motor vehicle accidents. For 1963, in addition to higher death rates for influenza and pneumonia and for motor vehicle acci- dents, significant increases also were registered for the following causes: malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues (“cancer”), bronchitis, other bronchopulmonic diseases, and cirrhosis of liver. The death rate for hypertensive heart disease, which has declined almost steadily over the last decade, was about 5 percent lower for 1963 (82.0 deaths per 100,000 population) than for 1962. The infant mortality rate for 1963 (25.2 deaths per 1,000 live births) was about the same as for 1962 (25.4). In 1963, as in 1962, about, one infant in 40 died within a year of birth, as compared with one in 10 during 1915. There were an estimated 1,510 maternal deaths in 1963 as compared with 1,465 in 1962, with corresponding rates of 3.7 and 3.5 per 10,000 live births respectively. The number of maternal deaths per 10,000 live births for 1940, 1950, and 1960 were, respectively, 37.6, 8.3 and 3.7. In 1963 the expectation of life at birth was 69.9 years, slightly under the. 70.0 figure for 1962, again because of the greater incidence of respiratory disease in 1962. The 1963 expectancies by color and sex were as follows: white males, 67.5 years; white females, 74.4 years; nonwhite males, 60.9 years; nonwhite females, 66.5 years. In recent years the average length of life has been increasing at a faster rate for women than for men, and at a faster rate for the nonwhite popula- tion than for the white population. Births, Marriages, and Divorces There were 4,098,020 registered live births in the United States in 1968, slightly under the number for 1962 and only five percent below the record number of about 4.3 million in 1957. The number of births has remained relatively stable at between 4.0 and 4.3 million per year for the past ten years. In 1963 the birth rate was 21.7 per 1,000 population, about three percent below the 1962 rate. The general fertility rate, or number of births per 1,000 women 15 to 44 years old, was 108.4 in 1963 as com- pared with 112.1 in 1962. Although the 1963 rate is somewhat below the high levels of the late 1950’s, it is well above the 73 to 79 range of the 1930’s. 130 Department of Health, Education, and Welfare, 1964 Most childbearing is concentrated among women in their 20’s. Thus in 1963 about three out of five births occurred to women 20-29 years — old. According to Census Bureau projections, the number of women in this age group will rise from 11.3 million in 1963 to 14.4 million in 1973, an increase of over 25 percent. With a rising number of women in the childbearing ages, the annual number of births in the United States is unlikely to drop very much, if at all, on the present level of a little over four million. In 1963 an estimated 1,651,000 marriages were performed, as com- pared with 1,580,000 in 1961. The marriage rate rose to 8.8 per 1,000 population, after remaining at 8.5 from 1959 through 1962. This rise in rate is associated with the increasing numbers of children born after World War II who are now becoming old enough to marry. There were an estimated 413,000 divorces in 1962, as compared with 414,000 in 1961. The divorce rate was 2.2 per 1,000 population in 1959, 1960, and 1962, but was 2.3 in 1961. Funds The total funds available to the Public Health Service in fiscal year 1964 amounted to $2,144.6 million. (See table 1, p. 226.) Appropri- ations and authorizations accounted for about $1,721.8 million of this amount. The balance was made up of repayments for services given to other agencies and of unobligated balances from previous years. Almost half of the total available funds were obligated, in the form of grants and research contracts to State and local agencies, private institutions, universities, hospitals, and individuals outside the Fed- eral government. The remainder of the funds was used to support the direct responsibilities of the Service, such as hospital and medical care for legally designated beneficiaries, foreign and interstate quarantine, and Indian health services. Office of Personnel i hgag hy nied sh asta Reorganization of the Office of Personnel was completed to the extent — permitted by available funds and manpower. Personnel offices were established at the bureau levels. Now all of the Service’s operating bureaus have personnel staffs and extensive authority for management of their civil service personnel. The Office of Personnel made progress in establishing sound and effective personnel services. Positions occupied by commissioned officers were described and evaluated. Career development com- mittees improved recruitment, training, utilization, and career plan- ning and counseling. Existing recruitment activities for the Com- “ ‘Public Health Service 131 missioned Corps and the civil service employment systems were brought into closer coordination and Service-wide recruitment activi- ties were improved. Long-term training for Commissioned Corps and civil service personnel was brought under joint review and coordi- nation. This change is expected to result in greater uniformity and balance between the two systems and in greater responsiveness to the needs of the Service. The Office intensified its efforts to apply auto- matic data processing techniques to personnel operations. Increased use of automatic data processing has already improved the processing of applications to the Commissioned Corps. Personnel statistics of the Public Health Service are shown in Tables 2 and 3 on pages 228 and 230. Management Progress The Public Health Service gave increasing emphasis to improving the effectiveness of its work force. Early in the year, a drive was initiated to emphasize cost consciousness at all levels of supervision. Supervisors and employees joined in a common effort to increase effec- tiveness and improve performance. The goal was performance of more work without a corresponding increase in employment or costs. Reporting procedures were established so that achievements of one part of the Service could be made known to other parts, and useful developments could be applied in new areas. Adoption of mecha- nized procedures was stimulated and employees were encouraged to find new ways by which they could get their jobs done faster, better, and more economically. The results of the drive ranged from making simple money saving improvements in laundry operations to the development of new kinds of laboratory equipment and new applications for technical equip- ment (particularly computers). New program applications of com- puters have ranged from their employment as a biomedical research tool to their use in solving highly complex problems of water quality management for watersheds through mathematical model simulation. These were in addition to new applications for administrative pur- poses such as property and supply management, statistical reporting, and processing controls. Several significant organizational changes were made in the Office of the Surgeon General. A new Division of Internal Audit was created to assist in maintaining surveillance over the discharge of fiscal and administrative responsibilities throughout the organization, and to evaluate compliance with requirements set by law, regulations, or other authority. The Division of Administrative Services was 132 Department of Health, Education, and Welfare, 1964 ] strengthened by internal reorganization and a new Systems Analysis Branch was established to give increased attention and support to computer and other mechanized systems development throughout the Service. The Office of Personnel strengthened its staff functions and delegated significant operating authority to the various bureaus where such work can be performed closer to the work site and be more re- sponsive to the needs of management. The National Center for Health Statistics was reorganized to strengthen its data collecting and proc- essing activities, and particularly to make more effective use of com- puter facilities available. Through these changes, the Office of the Surgeon General was provided with the means for more effective management of the Service as a whole. National Center for Health Statistics The National Center for Health Statistics provides national leader- ship and cooperates internationally in gathering, analyzing, and dis- seminating basic statistical information on the health of the country and its demographic characteristics. A major reorganization accom- plished early in the fiscal year regrouped the Center’s statistical pro- grams according to their rather different techniques of obtaining data. It also centralized all the activities of data handling, from reception through all phases of preparation, including computer printout and making the material ready for final publication. The reorganization also involved a number of executive changes to improve administrative support of the Center’s program units. A Deputy Director maintains continuing oversight in planning and executing the Center’s substantive programs, while an assistant Direc- tor for Professional Relations has charge of such extramural activities as the Public Health Conference on Records and Statistics and the allocation of blocked-currency funds under Public Law 480 to inter- national statistical projects. The Center maintains a vigorous program of research designed to develop an improved statistical methodology and to evaluate presently used statistical methods. Besides maintaining basic quality controls, current research includes special studies of computer simulation tech- niques, procedures for reporting discharges from hospitals, household interviewing, the nature of health indices, calibration of devices for physical measurement, and the variability of observations. During the fiscal year, 16 statistical publications were prepared for printing in the Center’s new publication series, in addition to vital statistics data for calendar years 1960, 1961, and 1962 and regular monthly publication of provisional vital statistics. 2 ee | 4 Public Health Service 133 DIVISION OF VITAL STATISTICS The Division cooperated with other parts of the Center in holding the Tenth Biennial Meeting of the Public Health Conference on Records and Statistics. More than 300 people drawn from different parts of the Federal Government, the vital statistics registration areas, other State and local agencies, and private organizations met for five days to consider demographic and public health statistics matters of current concern. A primary concern of the Conference was con- sideration of proposals for revision of the standard certificates of live birth, death, and fetal death, and the standard records of marriage and of divorce or annulment. During the fiscal year, birth and death tabulations were maintained on a current schedule, while some success was registered in bringing the preparation of marriage and divorce data more nearly up to date. Much effort also is being expended toward extending the coverage of the marriage and the divorce registration areas, so that the country may obtain truly national statistics as soon as possible in the important social areas of family formation and dissolution. DIVISION OF HEALTH INTERVIEW STATISTICS The Health Interview Survey is conducted within a design which provides continuous sampling of the civilian, noninstitutional popu- lation through household interviewing. Its objectives are to provide data on: (1) illnesses, impairments and injuries of persons; (2) the use of medical, dental and hospital facilities; and (3) allied health- related topics. In addition, a continuing program appraises the effectiveness and efficiency with which the Survey meets its objectives, devises collection methods for new types of health-related data, and designs pilot projects for development of new and improved collection and evaluation techniques. The relationship of family income and family size to the extent of hospital insurance coverage is shown in the figure below. DIVISION OF HEALTH RECORDS STATISTICS This Division is composed of three major programs: 1. The Institutional Population Survey collects health and related statistics on institutionalized persons and the services they receive. Data on a first residence place survey have been collected and are now being analyzed, covering mental institutions, long-term hospitals, nursing homes, various specialized homes, and penal institutions. A second residence place survey has been initiated covering institutions that provide services to the aging population, 2. The Hospital Discharge Survey is a continuing survey of a national sample of short-term hospitals using data abstracted from 134 Department of Health, Education, and Welfare, 1964 eT CHART 2.—RELATIONSHIP OF FAMILY INCOME AND FAMILY SIZE TO THE EXTENT OF HOSPITAL INSURANCE COVERAGE Family Income HBB vncer $2,000 FEZ $2,000- 3,999 FEE=] $4,000-6,999 (MM) $7,000+ 91.1 Hl i 60}— 20;— PERCENT OF PERSONS WITH HOSPITAL INSURANCE | 4 "9 boa FAMILY SIZE hospital records. The survey is designed to produce national hospital statistics which will have administrative uses and also will provide statistics on hospital morbidity. 3. The Vital Records Survey is a continuing mortality and natality survey to supplement and enrich the statistics reported on vital rec- ords. In the fiscal year, data collection for the 1963 surveys were completed on hospital utilization during the last year of life and the radiological examinations performed on expectant mothers. In 1965, the 1964 mortality survey is collecting data on socioeconomic differ- entials in hospital utilization during the last year of life, while the natality survey is gathering information on conception histories and the expected completed family size plans of women giving birth to live infants. DIVISION OF HEALTH EXAMINATION STATISTICS The Health Examination Survey attained its planned three-level operation during the fiscal year, involving simultaneous analysis of data from one program or “cycle” of health examinations, conducting examinations in a second cycle, and planning a third cycle. Findings from the first cycle, published during the year, based on examinations of a sample population of adults aged 18 through 79 years, included reports on overall response, glucose tolerance levels, visual acuity and levels of blood pressure. In preparation are reports ~~ Public Health Service 135 on the prevalence of heart diseases and osteoarthritis, dental findings and other topics. Following a series of pretests, in July 1963 the second cycle was initiated on a sample of children aged 6 through 11 years, with empha- sis on factors of growth and development. Detailed examinations for visual and auditory acuity, examination by a pediatrician and a dentist, psychometric tests by a psychologist, and a variety of other specific tests and measurements were made. Planning for the third cycle, on children and youth aged 12 through 17 years, was begun near the end of the fiscal year, and methodological studies to develop and calibrate portions of the examination have been started. OFFICE OF HEALTH STATISTICS ANALYSIS A comprehensive study of recent changes in the death rates in the United States was completed during the year. This study suggests that the leveling off of the death rate is not a transient phenomenon. It appears that large declines in mortality in the Nation cannot be expected in the future without major breakthroughs in the prevention of deaths from the chronic diseases. Investigation is continuing to ascertain the underlying reasons for the Mutivorable status of infant mortality in the United States as compared with the experience in a number of other countries. Preparatory work on the Eighth Revision of the International Classification of Diseases is in its final stages. Work has begun on the study of health and socioeconomic status, and on problems in the development of an index of health. DIVISION OF DATA PROCESSING In addition to processing the regular workload, a large volume of mortality statistics were effectively completed to provide a basis for a series of scientific monographs sponsored by the American Public Health Association to delineate problems of concern in all major areas of public health and demography. National Library of Medicine One of the more important high points of the National Library of Medicine’s activities during fiscal year 1964 was the activation of the Medical Literature Analysis and Retrieval System (MEDLARS). In December 1963, on schedule, MEDLARS began producing /ndex Medicus, the NLM monthly listing of articles from the world’s bio- medical literature. Approximately 14,000 articles a month are being indexed through the system with the annual total expected to exceed 175,000 by the end of this fiscal year. 136 Department of Health, Education, and Welfare, 1964 In January 1964, the Library began laying formal plans for the | uses of MEDLARS to produce recurring bibliographies in fields of © immediate importance to medicine. Work has continued in this regard particularly in respect to the development of criteria for these uses of MEDLARS for the private and public sectors of the biomedical community. As of the end of fiscal year 1964, MEDLARS had car- ried out over 600 demand searches, in'response to selected requests, for test purposes. ; In June 1964, the final major piece of MEDLARS equipment was installed. This was the Graphic Arts Composing Equipment (GRACE) which is the fastest computer-driven phototypesetter in existence at a speed of 3,600 words per minute. It was developed on NLM’s specifications under the overall MEDLARS contract. It is used to set and compose the type for offset printing of /ndex Medicus and recurring bibliographies. Demand searches are printed by the computer’s own high-speed printer. Plans call for the medical com- munity to be given greater access to the services and products of MEDLARS during the latter part of calendar year 1964. The directorship of the Library changed hands during the year. At the end of August 1963, Dr. Frank B. Rogers retired to become Professor of Medical Bibliography and Director of the Denison Memo- rial Library at the University of Colorado in Denver. On January 1, 1964, the directorship was assumed by Dr. Martin M. Cummings, for- merly of the National Institutes of Health, where he was Associate Director for Research Grants and Chief of the Office of International Research. In March 1964, the Surgeon General authorized new activities for the Library including particularly the establishment of the Data Processing, Publications and Translations, and Research and Train- ing Divisions. The latter two divisions are in reflection of the Library’s expanded extramural programs. Division of Public Health Methods The Division of Public Health Methods conducts studies and investi- | gations to identify actions needed, under changing social, economic, and scientific conditions, to maintain or improve the effectiveness of the Public Health Service in meeting its responsibility for protecting the Nation’s health. The Division’s charge also includes planning, policy coordination, and program development and analysis within the Service. Finally, the Division advises and assists on Service legis- lative matters, reviews and clears reports and comments on legislative proposals, and provides legislative reference and resource services, except for appropriations; coordinates and analyzes plans of the eee Public Health Service 137 several Service programs for substantive survey projects; and provides staff services to deal with current problems as they are required. STUDIES Two reports and several papers based on health manpower studies have been published during the year. “Medical groups in the United States, 1959” reports on a question- naire survey of medical group practice which was begun in the latter part of 1959. It was designed to determine trends in the numbers and characteristics of medical groups since the time of the comprehensive Public Health Service survey in 1946, and to provide an up-to-date description of groups as they existed in 1959. Section 17 of the Health Manpower Source Book Series, “1960 Industry and Occupation Data,” presents basic data on the health services industry (hospitals, clinics, health organizations, private offices, laboratories, and remaining places where medical and other health services are provided) and on 18 health occupations as reported in the 1960 Census of Population. “Trends in Medical School Staffing,” published in Public Health Feports, is based on three surveys: a 1942 survey of the Procurement and Assignment Service, a 1951 survey of the Association of American Medical Colleges and the Office of Civilian Defense, and a 1960 survey of the Association of American Medical Colleges. “Negro Students in Medical Schools in the United States” was pub- lished in the Journal of Medical Education. “Manpower for the Health Field: what are the prospects?” was published in Hospitals. A report on trends in the salary rates for medical technologists was published in Gist, a publication of the National Committee for Careers in Medical Technology. This is the third of such analyses; the others dealt with studies made in 1954 and 1959. “Sanitarian Manpower,” prepared in cooperation with the Bureau of State Services (Environmental Health) was published in Public Health Reports and the Journal of Milk and Food Technology. ‘The report was based on analyses of data on sanitarians which were obtained, along with data on other health occupations, in collaboration with other units of the Service and several national professional orga- nizations. All of these data were organized and tabulated by this Division, primarily for use by the National Resources Evaluation Center of the Office of Emergency Planning. Among the other health occupations on which data were tabulated were pharmacists. a) eine ~ a ne habe - : 7 rerihamels. ae S06, poe seee ae ® > 4 ‘5 > “ie —— oe = wim «+ A 64 gee a . tite we he i oe baepevaban. es ona ie * at | 2 Th 4 oeeene a . et - 7 = ' 7 . ‘ | enews : e y "a ' e ioe, + e ; 7 i , ‘ . 5 . . ra w te Pee 4 " ’ ws e ert "AJ ie yo se ‘t ' - aaa : ; Doe ong ae 4 res ” é ie > = = bd rt ' > = ‘ i -_ iy > =e . bags ve aie a3 4 bs . : 7 orem». » | Mf I . es il ‘4 ote _ < - . , 4 ~ i F a4 « am +e - 2 ae « = | ’ gy st F wy er . — = % ” hy te by o doe s = - — - . — : — ae et “ : eat $ihy L6G set) oe0 pete 210 orp vied at me ial : amt Thue ionic ine cages te tama - per denaais 7 ho | uha VL dae H tale 7% al - ; Beitr 2 yrdiiehye! .tagetl ‘Nettie atin ‘ ; ok : a0" ctincwntaaT ay Si: Sine } a 5 + 5 ered . ms, ed icin per ust Lubna ve tater ep, al —_——e 7 aes , 20S galemgee ee ory Ye . zee") ot a ity 4 ot om aePrs A SUAS giitrreitigr? ae iano) eee - ‘ ‘ yy artes wren 1) yte , 1s ag), mys H feiealvebes sitigrhasn'i fed abe) sels ee i : 7 } oy ates Gate atmtss rin tS tol clogs? ee =) a : ai i Pee Wily A eR ese tsi eevet H Dilan dar, Na. .e a eet Sife, et note: wht 74 «ved die} oe @ - bd : - ‘ ~ j ; yt i ‘ ; ‘ea tae] Miic . FAUT > actrees re rd TM AE ral * yer eee ens “90, wes Yliesrnipe set 7S = | ; cme alse Bec, erat gine oe ert Seale AG, TR LATE todl ty custingas Uvy Aes iy er CPOE) tory hehel > Went fe So abs Gp WHI GE ONE 64 eetyeng Ftgat a Ones tertew : : i . - } : . ANE) Aiea wel © 3 RN 9 CF Whom ASAD 4iefegtemeenetT aig irate kits < { — ose 1) ) dagy plate ites! ny ald cio tices yess J ~ : h feta f oD 37) S008 ie sete SMe ilw WS ak cofeaiern! * ‘ead mubiotee tel qtlatic ‘ } ep ti ile na * ; ’ Pied #3 —— ’ ’ thy owt Al * “Ty -t : - e : - 2 , 7 =" > Ss > af ’ f ay = -~ a ; - as” Gee a 7 = _ "> > j oa a ee ey oe Office of Education From Advice to Action As Tum Nation began to look to education as one of the principal means of assuring the long-term growth and safety of our democratic society, a responsibility far more challenging than it had ever known in its nearly 100 years of life was placed upon the Office of Education. From a more or less consultative and advisory role, the Office was asked by the Congress to turn to programs aimed at actively advancing and strengthening the Nation’s educational system. The first great step in this direction came with passage in 1958 of the National Defense Education Act. Carrying an appropriation of $115,300,000 for the Office of Education, this seemed at the time to be a giant stride. In the sense that it represented a tangible recognition of the Federal interest in education, it was indeed that. In terms of financial commitment, however, it has been dwarfed as the Congress placed greater and greater responsibilities upon the Office of Educa- tion. These responsibilities are consonant with an increasing recogni- tion of the part that the Federal Government must play, as a partner of States, communities, and higher educational institutions, in pro- viding more and the best of educational opportunity to all Americans to the extent that they can benefit from it. This recognition reached new heights with approval by the 88th Congress of a new array of education legislation, together with renewal on expanded terms of legislation enacted in the preceding 5 years. Under new legislation, the Office of Education is given the task of administering programs which will help to expand the facilities of higher education, to broaden adult education, to raise the qualifications of teachers, to strengthen vocational and technical schools, to improve 235 236 Department of Health, Education, and Welfare, 1964 public library services, to extend school guidance and counseling, and — to promote research into sound methods of improving education generally. To carry out these new programs, and to continue older ones, predicates an appropriation of about $1.5 billion for the 1965 fiscal year, double the amount appropriated for the fiscal year ended June 30, 1964. Nearly all of this, like fiscal year 1964 appropriations, is for grants-in-aid and loans to States, localities, institutions, and in- dividuals, and for contracts made with them. This report is an ac- counting of how these grant, loan, and contract funds were spent on programs of (1) educational assistance, (2) educational research and development, and (3) international education in fiscal 1964. Educational Assistance Educational assistance—defined broadly as assistance to schools and colleges for instructional programs and buildings rather than for, say, research—is administered within the Office of Education by the Bu- reau of Educational Assistance Programs. Assistance programs are carried out under seven general categories : 1. Those programs falling under titles II, IIJ, IV, V, and VI of the National Defense Education Act (NDEA).1 2. Vocational and Technical Education. 3. Compensation to “federally impacted areas.” 4, Payments to Land-Grant colleges and universities. 5. Training under the Area Redevelopment Act and the Manpower Development and Training Act. 6. Grants for educational television facilities. 7. Aid to Cuban refugees. National Defense Education Act Titles IT and IV, part B of title V, and title VE of NDEA are con- cerned with higher education activities. All these titles, due to expire June 30, 1964, were extended for another year under Public Law 88-210, signed by the President on December 18, 1963. As a matter of convenience, they are considered together here, with discussion of titles III and V—A following. 1 Title I enacts and authorizes the entire NDEA program. Titles VII and X bearing on research and statistics, are administered by the Bureau of Educational Research and Development of the Office of Education. (See page 256.) Title VIII, dealing with voca- tional education, was made a permanent law by the 88th Congress (No. 2 above). Title IX, providing grants for science education, is administered not by the Office of Education but by the National Science Foundation. S Office of Education 237 TITLE II—STUDENT LOANS Since the beginning of the program in 1959, approximately 600,000 college and university students have borrowed about $453 million from NDEA loan funds. Federal allocations have totaled $400 million and institutional contributions another $44.5 million, bringing the aggregate National Defense Student Loan fund to $444.5 million over the 6 years. That the total amount actually borrowed is in excess of that sum is explained by the fact that repayments on loans are de- posited in the various institutional funds and become available for relending. In fiscal year 1964, Federal capital contributions totaling $108.4 million were made to National Defense Student Loan Funds estab- lished at 1,574 colleges and universities, and this amount was aug- mented by another $12 million contributed by the institutions in accordance with statutory requirements. During the same year, ap- proximately 247,000 needy students borrowed about $119.5 million. The average loan was $484. By the end of fiscal year 1964, about 63,000 former borrowers had applied for partial loan cancellations in the amount of $8.1 million under a provision forgiving 10 percent of a loan for each year (up to 5 years) that a borrower teaches in public elementary or secondary schools. As of the same date, collections by institutions amounted to $20.6 million. Amendments to NDEA contained in Public Law 88-210 effected the following major changes in the Student Loan Program: (1) Increased the authorization for Federal contribution to $125 million for fiscal year 1964 and $135 million for fiscal year 1965; (2) increased the ceiling on the Federal contribution to any one institution from $250,000 to $800,000 per year; (3) extended teacher forgiveness provisions to teachers serving in elementary and secondary overseas schools of the U.S. Armed Forces and in schools conducted by the Federal Govern- ment within the States; and (4) extended deferment on loan interest and repayments to students continuing their education in colleges or universities outside the United States. TITLE IV—GRADUATE FELLOWSHIPS The purpose of this program is to increase the number of well-quali- fied college and university teachers by awarding fellowships (the majority for 3 years) to graduate students working toward their doctoral degrees in preparation for academic careers. In addition, financial assistance is given to those institutions where title IV fellows are enrolled to enable the schools to expand and strengthen their graduate programs. In approving programs for NDEA support, the Office of Education is also concerned with encouraging more wide- spread geographic distribution of graduate level training facilities. 238 Depariment of Health, Education, and Welfare, 1964 Award of 1,500 new fellowships in 1964 brought to 8,500 the number given over the first 6 years of the program, at a total cost of approx- imately $101 million. The 1,500 new appointees are enrolled at 156 institutions in 695 pro- grams and represent the following distribution among academic areas: Sect sciences, 384; humanities, 355; biological sclantee 208; physical sciences, 258 ; engineering, 160; and education, 135. In addition, under authority contained in Public Law 88-210, 29 fellowships vacated prior to completion have been reawarded in 1964 — for the periods remaining on the original awards. Previously, uncom- pleted fellowships lapsed. All told, more than 4,100 title IV fellows will be studying in 1964-65, in 1,052 programs at 168 graduate schools, with total support estimated at $21.2 million. TITLE Y—B—COUNSELING AND GUIDANCE TRAINING INSTITUTES Under this program, the Office of Education contracts with colleges — and universities to conduct short-term and regular-session institutes for improving the qualifications of personnel engaged, or preparing to engage, in the counseling and guidance of students in the Nation’s schools. In December 1963 the program was broadened to extend eligibility for training to include counselors or prospective counselors of 7th- and 8th-grade students as well as of those in grades 9 through 12. The 64 institutes approved in 1964 at a cost of $7.25 million provided for about 1,920 enrollees—1,170 at short-term institutes designed for the professional upgrading of personnel who have already completed an appreciable part of a counselor education program. Of the 25 regular session institutes, 21 were designed for teachers with little previous training in counseling to complete a full year of preparation in the field; the remaining 4 provided training beyond the first graduate year. During the first 6 years of NDEA, enrollments at 480 Counseling _ and faanes Training Institutes antl about 15,700, at a cost of nearly $37 million. TITLE VI—LANGUAGE DEVELOPMENT This title aims to strengthen instruction in modern foreign languages at all levels of education through four allied activities—language and area centers, modern foreign language fellowships, language research, and language institutes. Language and Area Centers The purpose of these Centers is to stimulate the study of critically needed languages and of subjects related to the areas where these ee ee ae Ve REP es pe Sera Office of Education 239 languages are spoken, which are necessary for full understanding of a culture. At present 55 centers, located at 34 colleges and universities, are receiving NDBA assistance. Federal funds support instruction in nearly 70 of the more than 90 languages offered at the Centers. (Some centers offer work in other languages without Federal support.) Instruction in Arabic, Chinese, Hindi-Urdu, Japanese, Portuguese, Russian, and Spanish receive the largest proportion of Federal aid. In 1964, allocations from the Office of Education to the Centers amounted to $2.58 million, making a total of $11 million obligated over the 6 years of NDEA. Federal funds are used primarily for instruction and must be matched by contributions from the participat- ing colleges and universities. Modern Foreign Language Fellowships Fellowships are awarded to students preparing for college teaching, government service, or for employment in a professional or technical activity (nonprofit and nonsectarian) which contributes significantly to the conduct of the Nation’s economic, cultural, educational, scien- tific, social, or political relations and in which proficiency in the lan- guage studied under the fellowship is highly desirable. In 1964, 1,074 modern foreign language fellowships were awarded, mostly to graduate students, at a cost of approximately $3.6 million. Undergraduates accounted for 196 of the grants made for intensive summer study of certain critical languages. Postdoctoral fellowships for a full year of language study were awarded for the first time in 1964 to 13 liberal arts college teachers to assist them in administering or teaching undergraduate programs of non-Western studies. Over the 6 years of NDEA’s operation, more than 2,600 students have received NDEA title VI fellowships to study over 60 languages, at a cost of more than $16 million. In addition, Fulbright-Hays awards for study and research abroad were offered for the first time in 1964 to advanced graduate students and NDEA Language and Area Center faculty members. (See page 264 in section on International Education.) Language Research and Studies Under this program the Office of Education awards contracts to institutions, organizations, and individuals to conduct surveys and investigations of language needs and resources, to develop and eval- uate new methods of language instruction, and to prepare specialized foreign language teaching materials, such as basic courses, grammars, readers, and dictionaries. 240 Department of Health, Education, and Welfare, 1964 Projects approved in 1964 include: A survey by Yale University of — intensive programs in the uncommon languages, summer 1964; a trial program to test the effectiveness of a self-instructional course in Spanish among high school students by the Inglewood Unified School District, Inglewood, Calif.; and preparation of a reference grammar for Hindi and Urdu, the most important languages of India and Pakistan, by the University of Chicago. . Forty-seven language research and studies contracts were awarded in the fiscal year 1964, costing $1,819,986. Over the 6 years of the program, 295 such contracts have been awarded for 271 projects involving about 125 languages at a cost of — over $14 million. ‘ Modern Foreign Language Institutes These institutes are designed to improve the quality of foreign lan- guage instruction in the Nation’s elementary and secondary schools by _ providing teachers with advanced training, particularly in the use of new teaching methods and instructional materials. Institutes are conducted by colleges and universities under contract with the U.S. Office of Education ee are held both during the sum- mer and academic year. In December 1963 the NDEA institute provision was broadened to authorize institutes for teachers of English as a second language. Two such institutes were held during the summer of 1964, enrolling 108 elementary and secondary school teachers engaged in teaching English to children for whom it is not the native tongue. In 1964 funds totaling $7.25 million were obligated for the support of 85 institutes enrolling approximately 4,368 teachers. Over the 6- year span of the program, some 17,400 elementary and secondary school language teachers have attended 386 NDEA-supported insti- tutes held both in the United States and in foreign countries, at a cost of about $33 million. (This concludes discussion of those parts of the NDEA pertaining to higher education which are administered by the Bureau of Edu- cational Assistance Programs of the Office of Education. Following are reports on the two other parts which are administered by that Bureau.) TITLE III—INSTRUCTION IN SCIENCE, MATHEMATICS, AND MODERN FOREIGN LANGUAGES To strengthen elementary and secondary school instruction in science, mathematics, and modern foreign languages, the NDEA authorizes the use of Federal funds under this title for two purposes: (1) To pur- chase equipment and materials and to do minor remodeling of space Office of Education 241 where they will be used, and (2) to expand or improve State super- visory or related services to public schools in these areas, and to ad- minister the State plan for improvement in instruction. For these pro- _ grams, the Congress appropriated $47.75 million, in the fiscal year 1964, and all States and Territories except American Samoa, Arizona, the Canal Zone, and Wyoming participated. Under the first part of this program, grants may be made to public schools and loans to nonpublic schools. The Federal grants to public schools must be matched 50-50 by States or localities. In fiscal 1964 for such grants, $42.63 million was allotted to the States, and $18.44 million was paid tothem. In addition, an amount of $34.9 million was obligated from the 1963 appropriation which was available in fiscal year 1964, of which $33.4 million was paid to the States. The States reported a total expenditure of $130.96 million, including $62.49 mil- lion in Federal, $1.25 million in State, and $67.27 million in local funds. These figures include estimates for 7 States. State educational agencies approved 70,126 projects submitted by local districts and estimated to cost. $131.3 million in Federal, State, and local funds. Projects in science represented 73 percent of the cost, those in mathematics, 10.8 percent, and those in modern foreign languages, 16.2 percent. These data include estimates for 5 States. The number and cost of projects to buy equipment greatly exceeded those to remodel space. Under amendments to title III in December 1963 the U.S. Com- missioner of Education was authorized to reallocate to other States the allotment not required by any particular State, and the provision that a State’s allotment would be available in the fiscal year following that for which it was made was rescinded. Published materials other than textbooks, test-grading equipment, and specialized equipment for audiovisual libraries were included in equipment on which funds may be spent. Thirty States reported that among them they would not need approximately $15 million of their 1964 shares of funds for equipment. Under his new authority, the Commissioner reallotted $10 million of this money to 18 other States which had asked increased grants. For loans to nonpublic elementary and secondary schools, $750,000 was available for allotment to the States. Forty loans totaling $520,780, were approved. Three in California totaled $16,950; two in Colorado, $16,400; one in the District of Columbia, $17,000; two in Florida, $5,020; four in Tlinois, $36,760; one in Indiana, $5,100; one in Kansas, $9,000; two in Massachusetts, $75,000; two in Michigan, $50,250; three in Minnesota, $18,350; one in New Jersey, $4,000; eleven in New York, $119,250; one in Oklahoma, $1,100; one in Pennsyl- 242 Department of Health, Education, and Welfare, 1964 vania, $36,350; one in South Carolina, $8,400; one in Texas, $46,900; — one in Virginia, $3,500, and two in Puerto Rico, $51,450. Repayments since the program began have aggregated $1,065,602 — of $3,649,579 lent. In fiscal year 1964, six loans in the total amount of $42,655 were repaid in full, bringing to 20 in number and $176,179 in amount the loans repaid in full. Federal funds for State supervision and administration are in the form of grants to States which must be matched 50-50 by the States. — In fiscal 1964 the States were allotted $3.37 million, of which $3.0 million was paid to the States. Expenditure of $6.43 million was re- 4 ported by the States, $3.11 million in Federal and $3.32 million in State funds. Figures include estimates for 7'States. The States employed the full-time equivalent of 222 special super- visors of science, mathematics, and modern foreign languages. There were only 33 such specialists before the National Defense Education - Act was passed. Now there is the full-time equivalent of 97 in science, 69 in mathematics, and 56 in foreign languages. Twenty-three States said they would not need a total of $654,191 for supervision and administration, and under his new authority the Commissioner reallotted $269,761 for this purpose to 18 States. TITLE V—A—GUIDANCE, COUNSELING, AND TESTING Grants to State educational agencies to assist them to establish and maintain programs of testing and guidance and counseling are author- ized under this part of NDEA. Public Law 88-210 increased this authorization for fiscal year 1964 and the succeeding one to $17.5 million from the $15 million previously authorized. Special arrange- ments also may be made to give tests to nonpublic secondary school students. The new law also increased from $20,000 to $50,000 the minimum allotment to any State, authorized the U.S. Commissioner of Educa- tion to reallocate to other States amounts allotted to but not used by any State, and extended the programs of testing and guidance and counseling downward to include seventh-grade students. In fiscal year 1964 allotments to the States were $15 million, pay- ments to them were $14 million, and expenditures reported by them were $169.5 million, including $i4.9 million in Federal, $8.1 million in State, and $146.5 million in local funds. Expenditures include esti- mates for 1 State. Although only 50-50 matching is required, State and local resources overmatched the Federal contribution by a ratio of 10 tol. Under the title V—A program, 22 million aptitude and achievement tests were given to public school students. In addition, 156,000 tests | Office of Education 243 were administered under contract with the U.S. Office of Education to more than 136,000 students in 779 nonpublic secondary schools in 87 States, the District of Columbia, and Guam at a Federal half-share cost of $47,652. The States gave an additional 600,000 tests to students in nonpublic secondary schools. The full-time equivalent number of public secondary school coun- selors increased to about 29,000, about 142 percent over the estimated 12,000 before enactment of the NDEA. Since 1958-59 the ratio of full- _ time counselors to secondary students in public schools has much im- proved. In 1958-59 there was 1 to every 960 students. There is now 1 to every 528. Schools with guidance and counseling programs meet- ing State standards enrolled 11,000,000 out of the 15,000,000 students reported by the States in secondary grades during 1963-64. Members _ of professional guidance staffs in State educational agencies have in- creased 242 percent while the NDEA has been in effect—from 100 to 342. Forty-nine States, the District of Columbia, and three territories took part in the title V-A program. American Samoa, Canal Zone, and Wyoming did not participate. Vocational and Technical Education The aim of vocational and technical education is to provide man- power with the skills and education needed to support the growing and changing American economy. This goal was not changed during fiscal year 1964, but the scope of Federal-State cooperative programs of occupational training was broadened by the Vocational Education Act of 1963. The new act is built upon several previous statutes, basically the Smith-Hughes Act of 1917 and the George-Barden Act of 1946. Title VIII of the NDEA, which established the area vocational education program, actually was an amendment to the George-Barden Act but, as part of the NDEA, was on a 4-year renewable basis. The new law made the area program permanent as part of the George-Barden Act, and title VIII passed out of existence as such. The area program is centered principally on the training of highly skilled technicians— laboratory assistants, certain specialized draftsmen, and other workers who require somewhat more training, and at a higher level, than does the skilled laborer. Most of this training is given at a level above high school. The new act declares that the purpose of the program is to maintain, extend, and improve vocational-technical education to assure that persons of all ages in all communities have access to vocational training or retraining of high quality. The training must be suited to their 244. Department of Health, Education, and Welfare, 1964 needs, interests, and abilities and be realistic in view of actual or anti- cipated opportunities for gainful employment. The act increased the authorized amount of Federal matching grants to States. Among other things it also authorized: Experimentation with residential vocational schools; work-study programs for those who need part-time earnings to stay in school; teacher training and develop- ment of curriculums and other instructional materials; research and experimental and pilot projects to solve educational problems, especially those of the socioeconomically handicapped; and area voca- tional school construction. No funds were appropriated for new activities in fiscal 1964, but Federal-State vocational and technical education programs continued to operate under the Smith-Hughes and George-Barden Acts and other statutes. Under these laws, Federal funds are allotted to the States and territories for vocational education in Agriculture, Distrib- utive Occupations, Home Economics, Trades and Industry, Practical Nursing, and Fisheries Occupations, and for the Area Vocational Edu- cation program. Vocational education programs provide training for youth and adults in regular day schools and through extension courses. Meanwhile, preparations were made by the Division of Vocational and Technical Education to put the new act into effect as soon as funds were voted. AGRICULTURAL EDUCATION Agricultural employment opportunities today extend beyond on- farm occupations. They include the field called “agri-business,” which covers services to farmers and the processing, manufacturing, and distribution and marketing of agricultural products, machinery, and chemicals. Trained workers for agri-business are needed in addition to highly skilled farmers and agricultural technicians to utilize scien- tific and technological developments in agriculture. A decrease in the number of farms in recent years has resulted in fewer young men and women with farming backgrounds, and in- creasing numbers of rural nonfarm and urban youth are being enrolled in vocational agriculture courses and are being placed for occupa- tional experience on farms and in other agricultural establishments. Since 1960, enrollments of youth in high school vocational agricul- tural classes have increased 25,865 to reach a high of 488,624 in 1963. Approximately 75,000 of these students completed three or more years of vocational agriculture training. This number falls short, however, of meeting the estimated 125,000 farming replacements needed an- Office of Education 245 nually and the demand for workers in agri-business and professional occupations in agriculture. Enrollments in young farmer and adult farmer classes have risen by only 6,929 since 1960. This means that these courses at present reach less than 7 percent of eligible farmers. HOME ECONOMICS EDUCATION Home economics instructional programs serve two major purposes: (1) Preparation for homemaking and (2) preparation for gainful employment in occupations involving knowledge and skills in home economics subjects. Such programs are provided for in-school and out-of-school youth and adults. During 1963-64, emphasis in secondary school homemaking pro- grams was on making home economics instruction more widely avail- able to students of varying academic abilities and with diverse vocational and career interests. Instructional programs have been re- designed to give greater attention to the study of home management and related consumer problems, child development, family relations, health and nutrition, and housing. A major focus of the Home Economics Branch was on a long-range curriculum project to identify basic concepts in home economics ap- propriate for secondary schools. Two-week curriculum workshops held in cooperation with four institutions of higher education included high school home economics teachers, home economics teacher educa- tors, supervisors, specialists from colleges representing home econom- ics subject matter fields, and specialists in related and supporting dis- ciplines. Estimated enrollment in home economics continued to be approximately 2.5 million youth, of which well over 1 million were enrolled in vocational day school programs. During 1963-64 home economics education instruction was provided to help women prepare for the dual role of homemaker and wage earner. There was a continuation of cooperative efforts among wel- fare, health, housing, and educational agencies designed to meet home- making education needs of different groups and adults. These special types of instructional classes were attended by approximately 675,000 adult women and men. Examples of occupations for which curriculum guides have been prepared are: Child Day-Care Center Worker, Visiting Homemaker, Companion to an Elderly Person, Homemaker’s Assistant. Post high school programs are being designed to prepare persons for supervisory and managerial positions such as Food Service Supervisor, School Lunch Manager, Child Day-Care Center Assistant, Management Aide, in Low Rent Housing Project, and others which require more highly 246 Department of Health, Education, and Welfare, 1964 specialized training than is offered in the secondary school program but at less than a college degree level. TRADE AND INDUSTRIAL EDUCATION Enrollment in trade and industrial education programs, based on a sampling of States, is estimated at slightly over 1 million youth and © adults, with considerable gains noted over, the past year in preparatory programs for the unemployed and workers in obsolescent occupations threatened with loss of employment. a As some occupations become obsolete, new ones develop. It is esti- mated that several thousand new jobs will be cataloged in the latest © edition of the U.S. Department of Labor’s Dictionary of Ocewpational | Titles. To fill resulting employment needs as rapidly as possible and — provide up-to-date instruction, a number of States are stressing part- | time cooperative programs in which students spend half of their time ~ in school and the other half learning new trades through supervised ~ on-the-job training. ; Rapid technological advances in industry have caused changes in — still other occupations. This was reflected in growth in evening ex- — tension programs, with increased numbers of workers availing them- — selves of opportunities to update their knowledge and skills to meet : continuing employment requirements. Programs for in-school youth — continued to expand, with a growing emphasis noted in pilot programs i in semi-skilled or single-skilled occupations for students lacking re- § quirements for regular skilled trades. ‘ In order that State and local personnel in the fields of supervision and teacher-education might be better prepared to implement the new Vocational Education Act of 1963, a national clinic was held with rep- resentatives from 50 States and the Territories. Methods were dis- cussed for meeting problems of rapid program expansion. Serious shortages were reported by several States of trained per- sonnel to fill leadership positions required at State and local levels to ~ implement program expansion. To meet this need, a national leader- ship clinic was devoted to the many areas involved in program administration. DISTRIBUTIVE EDUCATION Increased employment opportunities in the service industries, as reported by the U.S. Department of Labor, accounted for greater emphasis on training programs in merchandising and marketing. Cooperation with other Federal agencies has served to implement export trade programs with the U.S. Department of Commerce, sea- food merchandising with the U.S. Department of Interior, and instruc- Office of Education 247 ' tional materials in management training with the Small Business Administration. Major State activities have included the following: _ 1. A Governor’s Conference on Education for Distribution in ~ Indiana.. _ 2. Experimental programs for American Indians, school dropouts, rehabilitation clients, and continuation school enrollees. 3. Programs focusing on job opportunities which require the co- operative efforts of distributive educators, and vocational educators _ from the fields of agriculture, industry, and home economics. 4. Student marketing studies implemented by major marketing organizations. 5. Post-high school programs in 25 States as contrasted with 6 in 1959. 6. The establishment of teacher education programs in nine addi- tional institutions. OFFICE EDUCATION The office education program supports training for a field engaging inore than 10 million persons, some 15 percent of the employed. The program covers such fields as automation, data processing, operational systems, and the coordinating and communicating of information. The office education program provides consultative services to States, encourages the development of office training, and supports special vocational programs established by Congress. These special pro- grams are under the Area Redevelopment Act and the Manpower Development and Training Act. In both of these, office occupations has been one of the most popular areas of training. Curriculum guides were prepared in cooperation with the manpower development and training program for stenographic-secretarial, clerical and record- keeping, and peripheral data processing occupations. The 1963 Vocational Education Act included authorization for training in office occupations also. The potential of this program is indicated by the fact that, of all June 1963 high school graduates who got jobs, 37 percent entered the world of work through the office. TECHNICAL EDUCATION In making permanent title III of the George-Barden Act, the Congress recognized the continuing need for highly skilled technicians and the accomplishments of these federally assisted technical edu- cation programs. It authorized $15 million annually for such programs. 248 Department of Health, Education, and Welfare, 1964 To achieve one of the objectives of title III, a number of States have made provisions to implement vocational-technical education on an area basis to serve better the needs of entire States. Fifty-two new area vocational-technical schools began operation in September 1963, and 132 new schools were under construction or in the planning stages in fiscal 1964. State educational structures are being revised to ac- commodate the need for 2-year post-secondary technical education programs. Under title III Federal funds stimulated the purchase of equipment required for laboratories to instruct technicians in such occupational fields as electronic data processing, electronics, instrumentation, chem- istry, and metallurgy. Area programs are now well established as an important part of vocational education in 49 States, the District of Columbia, and Puerto Rico. In fiscal year 1964 over 66,000 students were enrolled in post-secondary programs and over 13,000 in secondary programs. Graduates of technical education programs numbered 11,612 in fiscal year 1964. Of those graduates available for placement, 75 percent were placed in the field for which they were trained, 23 percent in a field related to their training, and only 2 percent were unemployed immediately after graduation. The average annual starting salary for post-secondary graduates was approximately $4,860, and for high school graduates $3,804. Studies are being made by the States and communities to review current operations and to determine the potential for extending techni- cal education; to analyze the extent, character, and capacity of tech- nical education in the States; and to review current training articu- lation and to recommend appropriate structural modification. With the advent of automation, increased efficiency, and economic change, certain employment opportunities are disappearing from the labor market. Technical courses to upgrade and update employed adults are being conducted in all of the States, the District of Colum- bia, and Puerto Rico. In fiscal year 1964, over 116,000 such persons were enrolled in technical education extension courses. The changing pattern of manpower needs has begun to focus atten- tion on new programs in engineering and related occupational fields. Agricultural and life science, medical and biological, and forestry, pulp and paper technologies are among the emerging fields. Elec- tronic data processing for science, engineering, and business is one of the newest and one of the fastest growing areas. The acute shortage of teachers in this area resulted in a cooperative effort by six institu- tions, State boards for vocational education, and the U.S. Office of Education to provide training in a minimum length of time. | ——— a) ae Office of Education 249 To assist in the development and improvement of instruction in technical education programs, the Technical Education Branch is preparing or planning suggested curriculum guides in chemical, metal- lurgical, instrumentation, and civil technologies and in scientific data processing. A previously published curriculum guide in electronic technology is being updated. The importance of adequate library facilities for students in technical education programs is being stressed by the preparation of a library guide for technical and related programs. Federally Impacted Areas Federally impacted areas are localities which have been heavily affected by the fact that large Federal installations, military or civil- ian, have increased the load of school children while at the same time, in many cases, removing large areas of land from local tax rolls. In recognition of the burden imposed on these localities, the Con- gress in 1950 passed two public laws, one (Public Law 815) provid- ing Federal money to assist in construction of local schools, and the other (Public Law 874) providing funds to assist local schools with operating expenses. PUBLIC LAW 815 From fiscal year 1951 through fiscal 1964, the Congress appropriated $1,175,345,000 for school construction. State and local sources added about $715 million, making a total of approximately $1.9 billion to house more than 1.7 million children. During fiscal year 1964, Federal funds were reserved in the amount of $11,129,559 for 67 school districts to construct 80 projects. To these funds the school districts were to add approximately $6.8 million, the total to be used to construct 645 classrooms and related facilities for 18,000 children. In addition, the Federal Government authorized con- struction for projects located on Federal property which will provide 177 classrooms to house an estimated 5,180 children. PUBLIC LAW 874 In the 1964 fiscal year 4,076 school districts were found eligible for $284 million in Federal funds, about 5.3 percent of the total current operating expenses of schools eligible for Federal assistance under the act. These funds were paid to support schooling of 1.9 million feder- ally connected children. The eligible school districts receiving this assistance had an estimated attendance of 12,555,430 pupils, about 14 of all public elementary and secondary school children in the Nation. In addition, a little over $17 million was allocated to other Federal 748-869—65——17 250 Department of Health, Education, and Welfare, 1964 agencies to provide school services for 42,406 children residing on Federal property. Some $2,029,124,000 has been appropriated for this : program since its enactment in 1950. SUITABLE FREE PUBLIC EDUCATION Under section 10 of Public Law 815 and section 6 of Public Law 874, if no local educational agency is able to provide “suitable free public education” for children residing on Federal property, the Commis- sioner of Education is required to make such arrangements as may be necessary to provide education for these children. In March 1962 the Secretary of Health, Education, and Welfare announced a ruling that local public education which is segregated by race is not “suitable free — public education” and that arrangements would be made in appropriate situations to provide “suitable” education by September 1963 for chil- dren residing on Federal property. During the fiscal year 1963 the Department and the Office of Educa- tion took steps to carry out the ruling by (1) seeking voluntary com- — pliance of local educational agencies in the assignment of children re- — siding on Federal property to their schools, without regard to race; — or (2) arranging for the Federal construction and operation of schools on Federal property in case such compliance could not be secured and it appeared to be both necessary and feasible to make such arrange- ments looking to September 1963. During the fiscal year 1964, under the “suitability ruling,” con- struction was completed on eight projects for elementary children on military bases in four States where local educational agencies could not give assurance that on-base children would receive suitable free public education. These projects were at Fort McClellan, Fort Rucker, and Maxwell Air Force Base in Alabama; Fort Stewart and Warner Robins Air Force Base in Georgia; England Air Force Base in Lou- isiana; and Fort Jackson and Myrtle Beach Air Force Base in South Carolina. These schools were operated by base commanders. The total cost for construction of the eight school facilities was $4,003,600, and the operating cost in fiscal 1964 was $1,593,299. There was a total of 4,412 children in average daily attendance at these eight on-base schools. vi Land-Grant Colleges Through the Division of College and University Assistance, pay- ments aggregating $14,500,000 were made in fiscal year 1964 to the 50 States and Puerto Rico for distribution among the 68 land-grant colleges and universities. This total amount is composed of a perma- nent appropriation of $2,550,000 authorized by the Second Morrill Act, as amended, and the following annual appropriations authorized by Office of Education 251 the Bankhead-Jones Act of 1935, as amended : $7,650,000 for payments in equal shares to the several States and Puerto Rico, and $4,300,000 for allotments on the basis of population. _ Area Redevelopment and Manpower Development and Training Acts While the focus of each of these acts is sharply different, the train- ing offered under them is quite similar. The Area Redevelopment Act of 1961 (Public Law 87-27) is aimed at assisting whole geographical areas designated by the Secretary of Commerce as areas of persistent or chronic unemployment. If such areas have an overall economic development plan, they are eligible to receive funds for the training of unemployed or underemployed per- sons in occupations holding employment opportunities for these per- _ sons. The Secretary of Labor designates such occupations, and the _ Secretary of Health, Education, and Welfare is responsible for pro- viding training programs, which is done through the Office of Education. The Manpower Development and Training Act of 1962 (Public Law 87-415), as amended by Public Law 88-214 in December 1963, is aimed _at assisting unemployed or underemployed individuals, wherever lo- cated, and to upgrade the skills of those who face technological unem- ployment. Training must be in occupations in which there is reason- able expectation of employment. The Department of Labor identifies the employment possibilities and selects the trainees, and the Depart- ment of Health, Education, and Welfare is responsible for arranging with State agencies for training programs. AREA REDEVELOPMENT ACT TRAINING Occupational training projects were approved for operation in 37 States and Puerto Rico during fiscal year 1964 under provisions of section 16 of the Area Redevelopment Act. A total of 304 projects was approved for the training of 11,603 unemployed and underem- ployed persons, at a cost of $3,121,445 exclusive of training allowances. The chart below furnishes a comparative study of ARA training during the 3 fiscal years of its operation: Fiscal year No. of No. of No. of HEW costs States 1 projects trainees Cy bs ts Sey Bea 8 Sk ge ok Re 36 154 9, 200 $2, 881, 000 HAM, Se a eae ae See eee 42 316 13, 754 3, 280, 000 wo Ls OR es ph Sadek SE EEE eee eee 38 304 11, 603 3, 121, 445 1 Including territories. 252 Department of Health, Education, and Welfare, 1964 i Thirty-seven percent of all the projects were in the five States of Michigan (29), North Carolina (26), Oklahoma (23), West Virginia — (18), and Ohio (17). Approximately 60 percent of all projects and trainees were in 10 States. These projects required the expenditure of $1,948,117 or 62 percent of the total approved costs for fiscal year 1964. Eight States had only one project each. The health occupations made the most extensive use of ARA train- ing of all the employment groups and in the greatest number of States. Sixty-three projects were approved in this area for the training of 1,916 persons in 21 States. These represented almost 21 percent of the total projects and 16.5 percent of the 11,603 trainees. Fifty of © these projects were for the training of Nurse Aides and five for Psy- chiatric Aides. The following tabulation shows the major fields of employment for which ARA training was approved : Different Number kinds of Number Field of employment of projects courses of States Health oceupa tions sae a> see a = ae a eee 63 5 21 Agriculture 22 Sete cas Sa eee a oe eee 39 14 11 Building construction, maintenance, etc_.-------_- 33 16 9 Officeroccupationss=sse ees oso es eee eee 28 6 11 Manufacturing, miscellaneous industries__________- 27 16 8 Apparel Industry =e Se Seats eS ee eet ee 26 4 13 Wielding: 222 ~ tse Sos ae ee Sacer 24 4 13 Automotive service, maintenance, and operation____ 23 9 15 HOOd servic see == oo eee eee se. See 19 2 10 Machine tool operations:2222 sace Stee st cae eee 17 5 9 Home.servicest 2a et es ee a ee ee 5 4 4 Some 15 miscellaneous projects were approved in 17 States for train- ing 794 persons in 15 different occupations including: Floral designer, vocational adviser, State timber improvement specialist, stevedore, band instrument repairman, women’s garment salesperson, and glass- blower. ARA provided training for Indians on 14 reservations in Arizona, Minnesota, Montana, New Mexico, North Dakota, South Dakota, and Wyoming. ‘Twenty-two projects and supplements were approved to train 660 persons in such occupations as arts and crafts, beadwork, building trades, ranching, feather decorating, nurse aids, and sheep- shearing. MANPOWER DEVELOPMENT AND TRAINING ACT During fiscal year 1964, a total of 114,659 individuals were referred to institutional training projects in 49 States, the District of Colum- bia, Puerto Rico, and the Virgin Islands. J Office of Education 253 More than 60,000 were enrolled in training classes in more than 400 different occupations. The 1,938 approved training projects were funded at a total cost of $79,261,697 for the institutional training. Manpower training programs have experienced a high comple- tion rate. Some 6 out of 10 of all trainees who started courses have completed them. Placement rates are averaging approximate- ly 70 percent of trainees completing training programs. To meet the needs of the large numbers of unemployed youth and adults with deficiencies in reading, writing, and arithmetic and other socioeconomic problems, additional time has had to be allotted to the usual occupational training courses. The first steps toward meeting these problems were taken in 1963, in a few institutional experimental and demonstration projects in which literacy training and guidance and counseling were included. Programs were expanded in fiscal year 1964 to provide large-scale multiple training projects where more basic education, counseling, and guidance for all youth and adults could be provided. Experimental and demonstration projects sponsored by the Division of Vocational and Technical Education of the Office of Education to provide for the problems of youth and adults from disadvantaged groups were established in St. Louis, Philadelphia, Chicago, Tuskegee, Ala.; El Mirage, Ariz.; Hunters Point, Calif.; Hartford, Conn.; Wilmington, Del.; Washington, D.C.; Miami, Fla.; Carbondale, IIl.; and many other cities. These projects ranged from providing guid- ance, counseling and skill exploration to disadvantaged youth in large urban centers to programs for rural youth. Other projects were for older workers who were displaced from mining and other occupations. Statewide residential programs were established at Niles, Ohio, and Camp Atterbury, Ind. In order to assist the States in improving the instructional programs in the new and emerging occupational areas, 37 curriculum guides were developed or begun in cooperation with State staffs; institutions of higher education; and business, labor, and industrial representa- tives. Subjects ranged from Hotel and Motel Housekeeping Aide to Forestry Aide and Machine Operator. Educational Television Facilities Public Law 87-447 provides for matching grants to assist in the construction and expansion of noncommercial educational television broadcast stations. The act authorizes a total of $32 million for these purposes over a 5-year period, terminating June 30, 1967. Federal 254 Department of Health, Education, and Welfare, 1964 grants may be made for up to 50 percent of the reasonable and neces- — sary cost of an eligible ETV project, plus an additional amount of up © to 25 percent of the cost of eligible transmission apparatus owned by iy the applicant on the date the application is accepted for filing. ; Authority to recommend action with respect to grants is delegated | to the Commissioner; processing and evaluation oe applications is | delegated to the Educational Television Facilities Program in the ~ Bureau of Educational Assistance Programs. ‘ The appropriation for the fiscal year 1964 was $6.5 million. With — $1.5 million appropriated in the last few months of fiscal 1963, the total appropriation by the end of fiscal 1964 was $8 million, of which — $7.7 million was available for ETV grants. F During fiscal 1964 a total of 69 applications, representing 34 States, _ ] was accepted for filing, requesting a total of $13,463,355 in Federal — matching funds. (Among these were 19 States from which two or ; more applications had been accepted.) : A total of 33 grants was recommended for approval by the Com- missioner, involving an obligation of Federal funds amounting to . $5,423,381. Among these were 18 grants for proposals to activate new — ETYV stations in 13 States. Estimated population to be served by — these new stations is 26 million persons. Grants ranged in amount from $59,222 to $468,790; the average activation grant was $185,348. A total of 15 recommendations were for proposals to expand facili- ties of existing ETV stations in 12 States. Population served by expansion projects is estimated at 19,560,000 persons. Grants in this category ranged from $14,351 to $323,077. The average was $150,175. ETV funds which are appropriated but which are not obligated by the end of the fiscal year continue to remain available for grants. Cuban Refugee Assistance Since 1961 the Commissioner of Education has administered three programs in support of education for Cuban refugees: (1) For ele- mentary and secondary pupils, and adults needing vocational training, (2) for college and university students, and (3) for professional persons. ELEMENTARY-SECONDARY AND VOCATIONAL STUDENTS These activities are carried out by the Dade County (Florida) Board of Public Instruction. The Office of Education pays 60 percent of the cost of educating children from kindergarten through 12th grade, and $0.48 per hour for class instruction and $0.60 per hour for shop instruction for adults. Office of Education 255 4 Approximately $5.7 million was provided as the Federal share of the cost of educating about 17,000 children during fiscal year 1964, and $50,000 was paid toward the cost of textbooks and instructional materials. During the year $1,167,635 was provided towards the cost of giving about 25,000 adults more than 2 million hours of instruction in English and in vocational subjects and special training programs which give the greatest promise of preparing Cuban refugees for jobs on a re- settlement basis. | The Government also pays part of the salaries of Cuban refugees who are employed by Dade County as aides to interpret instructions, policies, and requirements of the public schools to the Cuban refugee students and their parents or guardians, and to help the students make the best adjustment possible. In fiscal 1964 this came to approxi- mately $382,000 for 280 such aides. COLLEGE AND UNIVERSITY STUDENTS Aid to Cuban refugees who wish to enter U.S. colleges and uni- versities is through loans. The terms of these loans were brought into general conformity in fiscal 1964 with those governing loans to U.S. students under the NDEA. (See page 287.) More than 2,000 Cuban students received Federal loans totaling $1,717,288 during fiscal year 1964, and 3,186 have borrowed over $4 million since the beginning of the program. A total of 370 colleges and universities enrolling Cuban students have participated. Institutes for Cuban Refugee Professional Personnel.—Purpose of this program is to assist exiled Cuban doctors, lawyers, teachers, and other professional persons to improve their qualifications and to pro- vide them with instruction in English. Support is also given to research projects for studies in Cuban economics. Direct grants are made to universities to cover the costs of this pro- gram. Fiscal year 1964 funds amounting to approximately $755,000 were allocated to seven institutions of higher education for support of a medical training program, Cuban economic research, and eight teacher training programs. Five of the teacher training programs were designed specifically to prepare enrollees to meet standards re- quired for holding positions as instructors of Spanish in U.S. high schools. Arrangements were made in fiscal 1964 to make available to Cuban professional persons enrolled in the institutes the same type of loan which is offered to college and university students. 256 Department of Health, Education, and Welfare, 1964 Educational Research and Development Financial support of programs administered by the Bureau of Edu- cational Research and Development of the Office of Education are in five areas: 1. Cooperative research. 2. Education of handicapped children and youth. 3. Library services and construction. 4. NDEA title VII (new educational media) and section 1009 of title X (state educational statistical services) .” Cooperative Research The purposes of this program are to develop new knowledge about major problems in education, to devise new applications of existing knowledge in solving such problems, and ultimately to improve the educational program at all levels in the Nation’s schools. To carry out these purposes, the Commissioner of Education is authorized to “enter into contracts or jointly financed cooperative arrangements with universities and colleges and State educational agencies for the conduct of research, surveys, and demonstrations in the field of education.” , Funds for the support of research are distributed through contracts to colleges, universities, and State educational agencies on the basis of proposals which they submit. The cooperating institution or State educational agency contributes to the total cost of the project. Proposals for research projects are submitted under one of six programs: (1) Basic research, (2) curriculum improvement, (3) dem- onstrations, (4) small contracts, (5) research and development centers, and (6) developmental activities. Specialists from outside the Office of Education evaluate the proposals, after which a Research Ad- visory Council reviews the evaluation in terms of overall cooperative research policy and the need for research information in particular areas. The Commissioner of Education then approves those projects which he believes should be supported, taking into account the recom- mendations of the Council. In its 8-year history, the program has received over 4,000 requests for support of research and development projects. Of these requests, more than 900 have been approved. One hundred and sixty-four colleges and universities and 25 State education agencies have par- ticipated in cooperative research projects. These projects have been 2See pp. 236-243 for information on other titles of NDEA. Other sections of title X contain miscellaneous administrative provisions. hme Cota Office of Education 257 ili a Se = conducted in every State, the District of Columbia, the Commonwealth of Puerto Rico, and the Territory of Guam. 1964 General research support...---_---------------------------------- $6, 516, 562 Areas of special emphasis: Language, arts, and HUMAN tess lee re ee eee 1, 740, 883 REIMER TTICCS See 2c a eee aes 1, 054, 209 EEAMETGROUTCOS 2. 2 oo na a eee 857, 127 Teacher preparation___--_----------------------------------- 330, 186 RE ee ee Roe ae 3, 982, 405 Research and development centers___---------------------------- 998, 769 Total obligations_----------------------------------------- 11, 497, 736 Two important new programs were started in 1964. One, the Small Contracts program, provides support for small-scale research or de- velopment with a minimum of delay for proposal review. Projects in this program may not exceed $7,500. Another program, which sup- ports Research and Development Centers, is designed to concentrate resources on a particular problem area in education over an extended period of time. These centers require the services of a permanent core of professional staff members supplemented by the efforts of practicing educators for 5 to 10 years. Two such centers were established in 1964 and three more are planned for 1965. One center will apply the results of scientific research to educational processes, develop im- provements in methods of instruction in light of this research, and make these improvements available to interested schools. The other center currently in operation is designed to uncover much of what is now unknown about the relations between schools, the public, and edu- cational decisions, and also to find practical approaches for dealing with many of the difficulties facing educational administrators. Basic research projects have produced significant findings in such areas as English, social sciences, talent development, and teacher edu- cation. Results are being applied under the curriculum improvement and demonstration programs. The English program continues to pro- duce many important new developments; there are now over 75 co- operative studies in literature, language, composition, and reading skills, covering preschool to college years. There has also been an increasing interest in projects in social science. Handicapped Children and Youth Handicapped children include those who are mentally retarded, deaf, hard of hearing, speech impaired, visually handicapped, seriously emotionally disturbed, crippled, or otherwise impaired in health, who by reason thereof require special education. Major emphasis in pro- grams of the Division of Handicapped Children and Youth is placed . 5 258 Department of Health, Education, and Welfare, 1964 ut on intramural studies and extramural research and demonstration | projects and the preparation of professional personnel in the edu-— cation of handicapped children and youth. Grants to aid in the preparation of professional personnel for the — education of handicapped children are made to public or nonprofit institutions of higher learning and to State. educational agencies. Grants for research and demonstration projects in areas related to the education of handicapped children are made to institutions of higher © learning, State educational agencies, local education agencies, and — other nonprofit private or public educational or research agencies and organizations. Funds distributed for the preparation of professional personnel — during the 1964 fiscal year totaled $12,992,758. The total of funds awarded for extramural research and demonstration projects was $999,739. The 50 State education agencies and 154 colleges and universities — were authorized to make a total of 4,909 awards to teachers and stu- dents during fiscal year 1964. The total included 2,126 students to receive senior year traineeships or graduate fellowships for the full 1964-65 school year, 1,851 teachers of handicapped children to receive summer session traineeships, and 933 teachers of handicapped children to receive traineeships for ‘short-term institutes on new developments in special education. -Grants to stimulate the development of new training programs were made to 42 institutions of higher learning. A total of 34 research and demonstration projects was approved. Eleven of these were in the field of the mentally retarded. Four re- lated to emotionally disturbed children, one to children who are crip- pled or have other special health problems, five to visually handicapped children, three to children with speech and hearing handicaps, six to deaf children, and four to children with several types of handicaps. In another type of program, the Division produces, acquires, and distributes films with printed captions superimposed so that the spoken material can be read by deaf viewers. With this modification, these films serve educational and recreational needs of groups of deaf individuals, adults as well as children. The program also engages in research and training in the use of film media as they apply to the deaf. Film captions are produced by individuals or agencies working by contract with the Office of Education. Prints are deposited in forty locations throughout the United States and are available on applica- tion by an approved group or agency. Some 17,500 filmed items were available during the 1964 fiscal year. During the 1964 fiscal year $1.5 million was available for the cap- tioned films program. Seventy-five prints each of 59 educational titles / Office of Education 259 and 12 prints each of 44 general interest titles were acquired for dis- tribution during fiscal year 1964. There are now 95 educational titles and 190 general interest titles, totaling 9,330 motion pictures. Other items contained in the library include filmstrips, TV kinescopes, slides, transparencies, and other related materials. Expenditures were as follows: Pimcamomuleand |training films-=t=*-_?2 to00.) Los c eevee wie $378, 581 OSES GIs Se eS te 406, 000 SPRITES ARID 00 8 es a i ee 345, 936 RUMI RI Se 8 Se ee ee ee 160, 027 Barren es 31) 1 AL Oa BLU Sheree 34, 864 Sr MIaNN ET s HUaCME CP ets CP Le ee SS rt te NS toe ee 5 oe er ee 116, 000 cpexeremeeee eee OFT BN Ts eee ee ee eee ee 1, 441, 408 Captioned films were used by 968 civic and social groups, schools and classes for the deaf, and religious deaf groups as compared with 771 groups in the 1963 fiscal year. A total of 401,406 deaf individuals viewed one or more of the films. Library Services and Construction Public Law 88-269, the Library Services and Construction Act of 1964, signed by President Johnson February 11, 1964, renamed and amended the Library Services Act of 1956. The purpose of this act is to promote improvement and development by the States and terri- tories of public library services and facilities in areas without such services or with inadequate services. The earlier legislation dealt only with rural areas and was confined to improvement of library services. The new law extends the Library Services Act to urban areas and adds a new provision of Federal assistance to the States for the construction of public library buildings. ‘The Congress provided no funds to implement the new provisions during the 1964 fiscal year, so only rural areas were benefited during that year. Federal funds of $7,500,000 were allotted to the 50 States and 4 out- lying areas, of which $7,455,000 were matched and claimed by all eligible jurisdictions. Matching funds of States and outlying areas totaled more than three times the amount required to receive the Federal grants. ' The act provides that each State receive a minimum allotment of Federal funds and that an additional amount be alloted in proportion to its population and be matched by the State in proportion to its per capita income, with 66 percent as the maximum Federal share and 33 percent as the minimum Federal share. 260 Department of Health, Education, and Welfare, 1964 er t Budgets submitted by the States and outlying areas indicated that the total of Federal, State, and local funds used in the program would — be expended as follows: $14,418,132 for salaries; $9,011,734 for books and library materials; $829,138 for equipment; and $5,307,708 for all other operating expenses. As a result of the act, State libraries have improved their abilities to carry their responsibilities of statewide leadership and service; local library systems of service have increased in number; more | cooperative programs between local libraries have been established; new professional librarians have been trained in addition to many ~ librarians participating in in-service training programs; and, finally, additional States have conducted statewide surveys of libraries which have resulted in new library programs. New library legislation in the States, responsive to the stimulation of the Federal program, has been impressive in amount and sub- | stance. A new graduate school for the training of professional li- brarians has been approved in Maryland. Local library tax maxi- mums set by State law have been raised in Idaho and North Carolina. Connecticut, Florida, Kansas, and Rhode Island have new State laws reorganizing, coordinating, and strengthening State library func- tions and services. New Mexico and North Carolina have appropri- ated funds for new State library buildings. Maryland and Rhode Island have been the first States to appropriate funds for State grants for local library construction. California has a new State aid pro- gram for public library services, and Delaware tripled its financial support for local service. New Educational Media This program is carried out under provisions of title VII of the NDEA. Part A provides for research and experimentation, both basic and applied, in the educational uses of such communications media as television, radio, motion pictures, printed and published materials, and related media. Part B provides for the dissemination of information concerning these media. Funds are distributed through grants and contracts. (See table 1.) In fiscal year 1964, the total appropriation for title VII was $5 million, of which approximately $2 million was obligated for part A and $3 million for part B. A statutory advisory committee meets twice a year to review and approve part A proposals and to review and make recommendations concerning part B dissemination activities. SS Office of Education 261 RESEARCH AND EXPERIMENTATION In fiscal year 1964, 34 grants and 2 contracts were awarded, plus 32 continuations and amendments. Most of these were concerned with television, programed instruction, and simulated educational experi- ences. Among the latter, studies are in progress on the effectiveness of teaching principles of engineering design through a digital com- puter, on the educational application of management “game” theory _ inbusiness administration, and in teacher education through simulated conditions. Recommendations by the Advisory Committee to support institu- tional research projects up to a maximum of $10,000 has resulted in the awarding of several grants to institutions for determining the most effective use of new media within the context of the institutions’ own curriculums and objectives. These include classroom observa- tion of preservice teachers through television, videotape, and motion pictures, as well as the use of various media in teaching courses. DISSEMINATION OF INFORMATION Thirty-four contract agreements were negotiated for dissemina- tion projects, with 38 amendments and continuations. Emphasis has been on the following programs: 1. Training for Media Use—Contracts for development of experi- mental curriculums to train teachers, researchers and media special- ists. 2. Exhibits and Reports—Publication of interpretive analyses of re- search. 3. National Media Service Projects—Support of an Educational Research Information Center at Western Reserve University, Nation- al and Regional Instructional Television Materials Libraries, and publication of the H'ducational Media Index; support of studies on automated cataloging, computerized teaching, and systems for storage, retrieval, and dissemination of information. 4, Advisory and Assistance Activities—Studies of the need for and implementation of better utilization of new media. 5. Demonstration Activities—Workshops, seminars, films on uses of media. 6. Development of Educational Materials—Experimental curric- ulums for field testing; a feasibility study to investigate the establish- ment of a learning laboratory for hard-of-hearing children. State Statistical Services Section 1009 of title X of the National Defense Education Act is concerned with the improvement and expansion of statistical services of State education agencies. The act provides for annual grants not 262 Department of Health, Education, and Welfare, 19 to exceed $50,000 per State, with Federal participation amounting © to one-half the cost of approved activities. 5 As of the end of the 1964 fiscal year, 53 State plans had been ap-— | proved. Forty-nine States participated during fiscal year 1964 to | the extent of approximately $1,807,000 in Federal funds. Nineteen — States used the maximum amount of $50,000, with some of these — States reporting overmatching of Federal funds. (See table 2.) Under this program State education, agencies are working with | local school districts and the U.S. Office of Education in improving | the comparability, accuracy, and timeliness of educational informa- | tion. Emphasis is placed on uniformity of definitions as set forth in cooperatively developed national handbooks of standard termi- nology. Major activities under this program include an increase in statistical personnel in the States, revision of data-collection procedures, instal- A lation and operation of data-processing equipment (including com- P puters), and improved methods of disseminating educational data. ; A number of State agencies have made considerable progress toward a system whereby local school districts report data to them in machine usable form. During fiscal year 1964 a majority of the States coop- © erated with the U.S. Office of Education in a developmental project on reporting teacher data on an individual basis in machine-usable form (punchcards or computer tape) direct to the U.S. Office of Education. International Education Financial grant activity of the Bureau of International Education — was expanded in fiscal 1964, when section 102(b) (6) of the Mutual Educational and Cultural Exchange Act of 1961 (Public Law 87- 256) went into operation. This act, better known as the Fulbright-Hays Act, consclaiaiam | and enlarged various provisions of several separate acts authorizing international education and cultural programs. Section 102(b) (6), the only part of the act delegated to the Office of Education, provides for “promoting modern foreign language training and area studies in United States schools, colleges, and uni- versities by supporting visits and study in foreign countries by teach- ers and prospective teachers in such schools, colleges, and universities for the purpose of improving their skill in languages and their knowl- edge of the culture of the people of those countries, and by financing visits by teachers from those countries to the United States for-the Office of Education 263 _ purpose of participating in foreign language training and area studies in United States schools, colleges, and universities.” While the entire act is fundamentally concerned with international understanding, this section is specifically oriented toward improve- ment of modern foreign language instruction and area study in Ameri- can schools, colleges, and universities, Two other kinds of grant programs are administered by the Office of Education. Under Public Law 83-480, the Agricultural Trade Development and Assistance Act of 1954, the Bureau utilizes foreign currencies available in various countries to finance research in those countries which is of value to American education. On behalf of the Department of State and of that Department’s _ Agency for International Development, and with funds transferred to it by them, it operates three programs dealing with teacher training and exchange. Fulbright-Hays Act The amount appropriated for operations under section 102(b) (6) of this act was $1.5 million. With this money, five distinct types of grants were made: SUMMER SEMINARS ABROAD Fifty-five elementary school teachers of French and Spanish par- ticipated in two summer seminars, including 6 weeks of study at the Universities of Strasbourg (French teachers) and Costa Rica (Spanish teachers), and 2 weeks of educational travel to places of cultural and historic interest in France and Central America. Kighty-four grants for four summer seminars devoted to Japan, Mexico, the Middle East, and West Africa were made to secondary school teachers and college instructors and assistant professors whose fields of instruction include world and regional history, geography, economics, and comparative government. The host institutions for these groups included the International Christian University in Tokyo, Japan; the Instituto Politecnico Nacional in Mexico City; the Ameri- can University of Beirut in Beirut, Lebanon; and the University of Nigeria at Nsukka, Nigeria. Approximately $214,000 was allocated for these summer seminar grants. STUDY AND RESEARCH Twenty-five elementary and secondary school teachers of social studies and modern foreign languages were awarded grants for ad- vanced study and research for 10 months in France, Mexico, Spain, 264 Department of Health, Education, and Welfare, 1964 East Africa, and Switzerland, with approximately $200,000 allocated — for this purpose. NDEA-RELATED RESEARCH Arrangements were made for 49 university faculty members asso- ciated with NDEA-related Language and Area Centers to study and do research abroad. Approximate allocation : $402,000. NDEA-RELATED GRADUATE WORK Arrangements also were made for 85 graduate students who had been awarded NDEA Title VI Fellowships, and who are prospective college-level teachers of non-Western language and area studies, to conduct research and study abroad, at an allocated cost of approxi- mately $519,000. FOREIGN SPECIALISTS In a different approach to the philosophy of the act, that expendi- — tures should be aimed at the improvement of American education, 15 language and curriculum specialists were recruited in Colombia, France, Uruguay, India, Mexico, Spain, Chile, Argentina, and Costa Rica to assist in improving and strengthening language and area studies programs. Assignments were made to the State departments of education of Colorado, Georgia, Michigan, New York, North Caro- lina, Pennsylvania, New Hampshire, and Oregon and to county and city school systems in Hamilton County (Ohio), Detroit, Akron, Syra- cuse, and Baltimore. The amount allocated for this activity was $165,000. Foreign Currency Programs Currency was available in six countries as a result of agricultural trade development and assistance transactions, and the following proj- ects were financed with an appropriation of $500,000: 1. Projects on scanning, translation, and annotation of educational publications and documents were continued in Burma, Poland, Yugo- slavia, and Indonesia. 2. Foreign currencies were used to finance travel for three education specialists who are currently preparing comparative education studies on Indian and Israeli education. These three manuscripts are planned for publication in fiscal year 1965. 3. In India, nine contracts were negotiated in September 1963 with the National Council of Educational Research and Training, New Delhi, for individual projects ranging from a “Survey of Achieve- ment in Mathematics at Three Levels of School Education” to “Evalu- ative Criteria for Inspection and Supervision of Secondary Schools.” 4, In Israel, six projects were established with the Hebrew Univer- sity of Jerusalem, the Henrietta Szold Foundation for Child and Office of Education 265 Youth Welfare, and the Israel Institute of Applied Social Research. Projects ranged from a study of “The Identity and Cultural Values of High School Pupils in Israel” to “The Identification of Intelligent and Creative Students from Culturally Deprived Homes.” Transferred Fund Services During the 1964 fiscal year the Department of State provided the Office of Education with $1,312,000 to administer educational grants on its behalf, and its constituent Agency for International Develop- ment (AID) provided $3,227,000 for the same purpose. Programs conducted by the Bureau of International Education for these two agencies were : 1. International Teacher Development Program (State). 2. Teacher Exchange Program (State). 3. Technical Assistance Training Program (AID). As an additional service to the Department of State, the Office pro- vided statistical tabulations on grantees sponsored by the Bureau of International Educational and Cultural Affairs of the Department of State. These tabulations covered such information as country of origin in the case of foreign grantees and State in the case of U.S. citizens, destination, fields of specialization, age groupings, and mili- tary status. They showed that 5,000 foreign nationals from approxi- mately 86 countries had the opportunity to live and work with Ameri- cans in all of the States and territories and that some 2,000 Americans studied in 60 foreign countries in 150 specialized fields. In addition to this statistical information, the Office prepared rec- ords giving the name, address, category, specialty, occupation, and in- stitution of placement of every foreign grantee entering this country under the international educational exchange program. TEACHER DEVELOPMENT PROGRAM In 1963-64, the International Teacher Development Program brought 707 teachers and school administrators to the United States for training and for visits to schools. Representatives from 76 coun- tries and dependencies took part in the program, and 13 colleges and universities cooperated with the Office of Education in arranging special seminars. Thirteen groups of teachers, teacher trainers, and school adminis- trators were interested in the following fields: four groups in the teaching of English as a second language; two each in elementary edu- cation, American civilization studies, secondary education, adminis- tration and supervision, and one in science education. 748-869—65—18 266 Department of Health, Education, and Welfare, 1964 Three workshops in elementary, secondary, and vocational educa- tion were held at the University of Puerto Rico for 115 educators from South and Central America. In addition, 279 teachers and school administrators participated in 11 short-term special projects in rural education, social science, teacher training, and elementary and secondary education arranged at 7 college and university centers. : TEACHER EXCHANGE PROGRAM re In 1964, the staff of the Teacher Exchange Program provided pro- fessional services for approximately 675 elementary and secondary school teachers, as follows: One hundred and thirty-two U.S. teachers exshanged teaching posi- tions with the same number from abroad—a total of 264. One hundred and ten U.S. teachers were assigned abroad on a one- way basis. Sixty-nine foreign teachers were placed in the United States on a one-way assignment. Two hundred and thirty-two American teachers participated in 10 overseas summer seminars. These were held for teachers of Spanish in Colombia and Spain; teachers of German in Germany; teachers of the classics and teachers of the Italian language in Italy; and teachers of history in Brazil, France, Greece, India, and Iran. The seminar in Iran was held for the first time in 1964. Interchanges of teaching positions were arranged with the following 13 countries: Australia, Austria, Belgium, Luxembourg, Canada, Chile, Germany, Italy, the Netherlands, New Zealand, Sweden, the United Kingdom, and Uruguay. One-way assignments (for either American or foreign teachers) were arranged with the following 35 countries: Afghanistan, Austria, Belgium, Bolivia, Burundi, Denmark, El Salvador, Finland, France, Germany, Greece, Iceland, India, Indonesia, Iran, Italy, Ivory Coast, Japan, Jordan, Korea, Laos, Liberia, Libya, Morocco, Nicaragua, Norway, Pakistan, Paraguay, Peru, Spain, Sweden, Turkey, United Kingdom dependencies (considered as one country), Uruguay, and Vietnam. TECHNICAL ASSISTANCE TRAINING PROGRAM During 1963-64, the Office of Education supervised programs for 790 participants from 53 countries, including participants from minis- tries of education or similar offices who came on short visits. There were also many long-term academic placements, and degrees were awarded to 117 participants, of whom 26 came from the Near East, 52 from Africa, 26 from the Far East, 12 from Latin America, and one from Europe. x Office of Education 267 Countries with the largest number of representatives were Vietnam (103), Tunisia (62), Thailand (59), Sudan (51), and Turkey (45). Training was arranged for educators in approximately 150 training centers located in almost every State, the District of Columbia, and Puerto Rico. It is estimated that in 1964-65 the Office will arrange programs for 900 educators. Aside from supervising programs in the United States for foreign grantees, the Office assists in recruiting American educational special- ists for both AID and UNESCO (United Nations Educational, Scien- tific and Cultural Organization), which between them require a con- tinuing overseas staff of approximately 1,000 such advisers. The Office also provides professional consultative and support serv- ices to the AID professionals already stationed in foreign missions. This involves either consultation or correspondence with officials of colleges and universities, professional education associations, book publishers, school equipment manufacturers and distributors, State and local school systems, and various Federal departments and agen- cies. Periodically, packets of current educational materials are for- warded to the various overseas missions for their information and use. Civil Defense Adult Education The Civil Defense Adult Education program is administered by the Office of Education under a contractual agreement with the Of- fice of Civil Defense of the Department of Defense. The Office of Education contracts with State departments of education desiring to conduct programs of education for adults, in the basic principles of civil defense. The program is completely funded by the Office of Civil Defense. Forty-three States, the District of Columbia, and Puerto Rico con- ducted CDAE programs during the fiscal year. Individuals who completed courses numbered 194,801. Accomplishments of the pro- gram were as follows: Number of adults who completed courses__________---_-_---- 187, 626 Number of teachers trained as instructors__-_______-_____---- (Paleia ianiper or. local classes completedi i=. 2 6, 613 Higher Education Facilities Public Law 88-204, the Higher Education Facilities Act of 1963, authorizes Federal grants and loans to assist eligible public and other nonprofit institutions of higher education in financing construction, 268 Department of Health, Education, and Welfare, 1964 i rehabilitation, or improvement of certain academic and related facil- ities. Assistance is to be principally for the construction of classrooms and laboratories which will result in a substantial expansion of needed student enrollment capacity. Assistance is authorized, also, to improve or establish graduate schools and cooperative graduate centers to in- crease the Nation’s supply of critically needed professional personnel. Certain academic structures are excluded from receiving financial assistance under the act. They are: (1) any facility intended pri- marily for events for which admission is to be charged to the general public; (2) any gymnasium or other facility designed for athletic or recreational activities (other than for an acadamic course in physical education) ; (3) any facility to be used for sectarian instruction, as a place for religious worship, or primarily in connection with a program of a school or department of divinity; or (4) any structure to be used ~ by a school of medicine, dentistry, osteopathy, pharmacy, optometry, podiatry, nursing, or public health; such buildings are provided for under the Health Professions Educational Assistance Act of 1963 (Public Law 88-129). The authorization for fiscal year 1964 to carry out these programs was: 1. Two hundred and thirty million dollars for grants for construc- tion of undergraduate academic facilities. (a) Fifty million six hundred thousand dollars allotted for use in providing academic facilities for public community colleges and public technical institutes, and (b) One hundred seventy-nine million four hundred thousand dollars to institutions of higher education other than public com- munity colleges and public technical institutes. 2. Twenty-five million dollars for construction grants to assist in- stitutions of higher education to improve existing graduate schools” and cooperative graduate centers, and to assist in establishing such schools and centers of excellence. 3. One hundred twenty million dollars for loans for construction of both graduate and undergraduate academic facilities. Institutions or agencies eligible to receive grants described in items 1 and 2 above are also eligible to receive loans. No less than one-fourth of the develop- ment cost of these projects must be paid out of non-Federal funds. Funds to initiate this program were not made available in fiscal year 1964. Office of Education 269 Table 1.—Funds obligated to States for media research and dissemination, fiscal year 1964 Title VII-A | Title VII-A | Title VII-B | Printing Total grants contracts contracts UG ee ee $1, 608, 721 $297, 829 $3, 063, 218 $28,318 | $4, 998, 086 26, 882; |a=<<5-sseap~ 67, 282 9058) [-xec5 see 9, 058 Beas Onc oumbite...-.-..---.... 12{236 (24 eee See. So 481,810 28, 318 522, 364 iS Ned cow So os Soe [one mnw eons oareoau ese ede ear beewoes | Sete eee aee SURO. ae FO;OSO ee anes oes 00; OM eee nase 129, 731 OG eee ee 0} 086: ib 222082 Eee aoe eae eames 9, 936 Oo ag sues nine = pea ee ee ee) Gee ee oe eee eee! eee eed bn. ee CURE. Se NS eee 29, 741 120, 702 11 OBS Ven sceenaa nee 228, 106 PNGIEN ase saase aos etcs.s2.-------- 101) 086) |ponee et 22 2sto5 | nntashaseeatu| een een canes 101, 036 CUED caste JS oe SS SS Oe ee (ee a ena eee eens Reece cree rege REET ee Re an an eee Spt secon a ok sctewiea- | anasnceuoace| accssncanane|aaptaseekeee EET 0 ont aR an RR ES, [Spare SIE ere ees (rele tm oy Sel fo oe ee ee ee RE ete ea SACs C2. | Soe okwance-|acsc—n ones es [on stsbaueand [be sancoeecs |p Seeeaeeeee= OMe ee co eos 82 9) Be ee ne ee See ee ee Pe ee See ee ee eee eae eee sa) eee SOR MOOI ose 65;'026) = se eo seen O) B00! |posecnenaae 3 68, 826 OG POG CL rr ie caer alee 230 DO4t eee ce eeeee 230, 594 UL ais SS 68, 573) |= -@ aes 333; 284 '|oas2scescee8 401, 857 DQM Gi 0S 3 ee ee CA ial ie ee ee a eS Ce 41, 653 OSS ESL 5 oie Oi ee a ee i na eee eae Se ITS) Sig al i a a a 64, 164 14,802) |S aseucssene 138, 966 CAT ASTT D0 Sun ee ee ees) ee ele pee meen pede as, oe iodo LE a be ce ee eee ee 269, 426) |=-=--ceecees 269, 426 LOE MD Stee eee ee er eee ees eee 5 eee ee ee as) ee eee eee Soe Se ICME Ita Rhein te So) So Soe ae as Sees |= ot ieee a apen |eonun etm deen | sak sageew den | a eee DAL LGD cE yn O27D0 fe. see cee 27,310) |< Seco ae 37, 060 car We Coy ee A Ee he Seen oe cee) (ean RR eee 60: ToSh seo aee eee 60, 158 ofa ne Shs SS ee 260; 945)\| 2-282 =. e355. 206; O43) | 22 oe as oe 556, 988 SIL EHUM PONT NUNES. feo 288 ooo ncn | sneer mene sese | ses non mee aee sl eansae cen enae | aecneeneceecoe maneanenen NE EGTRD 5 oR SES epee ee ep tree, ere ee ek me eee | Pers tre oe) (veers ae om Oe onli nee nes os. oe 182; 163),|222 2225222-5- 232,206 (SiS se seese 364, 458 CUA UG SY? | | a ee ene eee emer 92; 438, | an aceancee 32, 438 riponeeere ters. 2. 25.52--255-=.---. 78, OGL onside ase te 42, 400) 1k eo Scce 83, 341 eReU LURE ee se ee. ane 385; 61I poo a ree 261 207 \aceaccansece 644, 888 nreECene elperret mmr tte 8, LP 8S NELE. Soe cn! ear ce eee ane eo apent deltune b-Seewaseuce |) ea socseet coi lt “0D a a i ee Se a ee ese Eee eee ereee | eee ees eee eS BORLE PSK OlGs. 2 2coo ks OE S40 pee eae Rae Soeeee a ee eee eS 9, 840 no GEG. a ee ee Rae eee) Peer eee eee Emenee eo ae ee ee oe Se ee ee) ee ee 43,808) setae eeces 43, 308 OM. oo ee ee 71, 563 2B; Sb0 Pssencamene S 95, 400 |. i enanes (eeaaennsaiciaia InianSAcnsTOiaN les esi ool earn Bek caeer ae Se tooo a aos e bs |e one ese os | oan ne asesen lows aessseseeen | rose sew neas|seucoeaceane Oa hot (01 ey Spe eSB Be SARS re Se a be ep aoa ee Pees ee RR ne a oe eas | Matera ene ase | Che eee een ene seperate ek eecaeae ee unre macees With" ol hilt. . 2 68) S65) eee ee cee | hess see ecee|Sencocseonce 68, 365 270 Department of Health, Education, and Welfare, 1964 Table 2.—State participation for improvement of State statistical services, fiscal year 1964 Federal funds requested and State 1 paid Motalzes see tse $1, 806, 723 Ala Dama eee eel 6, 240 Alaskai or see ees ee 39, 000 PAPI Ce eee we ee 50, 000 Arkansasoaseeas-ee 15, 400 California. 226s -3 Oe eS 47, 521 COLOTANG=. eon ees 50, 000 Gonnecticut Ss aa es 17, 148 Delawareees. = eae 42, 500 District OL Columbigess— ©) oo Oni das pss eee te et 50, 000 COOP rigs asks ms tae 50, 000 (SES gS Gk ees 5 50, 000 Gr isYr ete See See 12, 100 LUinGis=2 ete ee ee 50, 000 Indiane ste. 2. Seo 25, 000 LOWS seat ee te ek 50, 000 ACATISES = be eee eee 30, 1384 WKWenfire ky Vg ae eee S 50, 000 MOGISIONA Qs eet co ee Main Gr ween cae eee = eae 50, 000 Mar yIan = soo eee 39, 472 Niassa chusetts=.2. eee — 50, 000 Michigans: ==2- 223s As 35, 000 Minnesota =.= Sse se. — 31, 493 MiIssissipples.- 5 aee oe 380, 000 MissoUtic: fies oe 15, 862 1The following States did not participate financially: District of Columbia, Louisiana, Nevada, Virginia, Wyoming, and the Canal Z one. Federal funds requested and State 1 paid Montana_. 22 $50, 000 Nebraska. 5 eee 24, 125 Nevada.__=_..._- ee New Hampshire__—-----~ 9, 631 New Jersey. 2222 eee 41, 752 New. Mexico_=.- 2) sane 35, 981 Nevs York_i222-.22--2ee 50, 000 North Carolina ’=2222seee 42,184 - North Dakotalss = =ss2a— 10, 600 Ohio_.. 28222=2. 3 ee 50, 000 © Oklghomal. 22-2 2=aee—e 50, 000 Oregon 2226.5 =e 42, 500 Pennsylvaniasss2 esses 50, 000 Rhode Island=--=. 2222 50, 000 South Caroling—-— S2ee= 47, 543 South Dakota_..-—=---<= 16, 807 Tennesseels a ee 47, 500 TeXASi 2445. 3 er 50, 000 tah. 14,414 - Vermont: 22+ <3 6, 164 Virginia._._._.______._--_ = ee Washington... 2225-2 50, 000 West Virginia__—-= == 50, 000 Wisconsin__.22__ = ee 49, 088 Wyoming. 2222. +o See Guam_ ft 3 eee 19, 402 Puerto, Rico. =. ee 42, 080 Virgin | Islands:--===s=e= 20, 082 Food and Drug ~ Administration FDA’s Expanding Role in Consumer Protection A Growine Porutation, an expanding economy, new technology, and scientific breakthroughs have created new challenges and respon- sibilities for the Food and Drug Administration. The mission of the Food and Drug Administration is to protect consumers by insuring the safety and integrity of food, drugs, thera- peutic devices, and cosmetics. FDA’s authority in these broad areas of human concern is vested in laws, which are implemented through regulations. The agency also relies on public education and informa- tion to encourage voluntary compliance with the law to achieve a high level of consumer protection. The problems of protecting the public have increased with the population growth. Today the American population is in excess of 192 million. The Bureau of Census predicts that our population will number between 216 and 244 million by 1975. Two important trends in the distribution and character of the popu- Jation during the past 30 years have had a major impact on FDA’s responsibilities and programs. These are: (1) The major shift from farms to urban centers, which brought a phenomenal increase in the preservation, packing, and distribution of foods, and (2) the dramatic increase in number of citizens 65 years and older, who depend a great deal more on drugs and special dietary preparations. They are often victims of charlatans and quacks. Expansion of the economy is illustrated by growth of the Gross National Product from $90 billion in 1988 to an estimated $625 billion in 1964. Personal expenditures for food, drugs, and cosmetics have increased accordingly (see charts 1, 2, and 3). There are more than 271 272 Depariment of Health, Education, and Welfare, 1964 : 24,000 supermarkets today supplying an affluent population with a_ larger number and greater variety of products than ever before. ; New technology and scientific breakthroughs have created signifi- cant new problems, particularly in the field of drugs. These respon- sibilities and workloads fall essentially into four broad areas: 1. Premarketing control of clinical investigations of new drugs — and proof of their safety and effectiveness ; 2. General control of the purity, potency, labeling, and promo- | tion of drugs. This is accomplished through inspections, sample collections and examinations, education, and consultation. 5 3. Attempts to curb illegal sales of prescription drugs; and 4. Work directed against quackery. ° It is estimated that 90 percent of the drugs used on prescription today were not on the market 15 years ago. In addition, the growth of the drug industry is indicated by the extremely sharp increase in © consumer spending for prescriptions. This has grown from $150 million in 1940 to approximately $2.2 billion today. On an average working day, FDA receives about 8 proposals for clinical tests to determine the safety and effectiveness of new human CHART 1.—RETAIL SALES OF DRUGS IN THE UNITED STATES, CALENDAR YEARS 1954-63 — Billions E $6 EEO 1954 1955 1956 195718 1958 1959 1960 1961 1962 1963 Food and Drug Administration 273 and veterinary drugs, as well as 20 proposals to change previously granted approvals of drugs now on the market. More than 2,000 human and veterinary New Drug Applications were received during fiscal year 1964. Once drugs are marketed, the Food and Drug Administration con- ducts inspections and sample examinations to determine their purity and potency, the adequacy of their labeling, and the propriety of pro- _ motional methods employed for them. FDA has an obligation to inspect almost 14,000 drug establishments (exclusive of the producers of medicated feeds of which there are over 12,000) once every 2 years. Inspections are followed by collection and examination of samples to confirm the observations made in the factory. For drugs there are also two additional requirements : 1. That drug labeling give full disclosure of the adverse effects and contraindications as well as of the claimed benefits; and 2. That the advertising of a prescription drug give a brief sum- mary relating to side effects, contraindications, and effectiveness as required by regulations. Under the provisions of the Durham-Humphrey Amendment, FDA is attempting to control distribution of dangerous and potent drugs which should be sold only on prescription. This is a growing respon- sibility largely because of the increasing misuse of drugs, such as am- phetamines and barbiturates. On an average, 90 percent of all illegal drug sale cases referred by FDA to the Justice Department involve these drugs. Traffic accidents, juvenile delinquency, and other social problems have frequently been linked to illegal use of these products. A relatively conservative estimate indicates that about $500 million is spent every year by American consumers on worthless or extrava- gantly misrepresented drugs and therapeutic devices. In many cases these fake products are sold to people suffering from chronic illnesses who are easy victims of unscrupulous pitchmen, but who could obtain greater relief from bona fide drugs and medical care. In many other cases, people who are suffering from illnesses that could be cured are worsening their condition by depending on these fake remedies. The safety and nutritional values of foods is another area of concern to consumers. About 88,500 interstate establishments produce, process, package, distribute, and store foods. Each is subject to FDA inspec- tion and in 1964 the agency inspected 35,288 of them. One major trend in the food field has been the growing use of chemical food additives. There are today an estimated 2,200 chemicals used by 73,000 food establishments that operate under FDA’s jurisdiction. These food additives are used as preservatives, emulsifiers, and for a host of other purposes. They are used in the production of our 274 Department of Health, Education, and Welfare, 1964 modern convenience foods. Under the 1958 Food Additives Amend- ment to the Food, Drug, and Cosmetic Act, FDA has the job of estab-— lishing safe conditions for use including a fety levels, where paisa | for each food additive. Annually, some 450 million pounds of pesticides are used by over 5 © million agricultural employees on crops grown in the United States, and each year there are approximately 2.5 million interstate shipments — of raw agricultural products that have probably been treated at some time or other with an agricultural chemical. FDA sampled analyzed over 25,000 shipments—or 1 percent—for the last 2 fiscal years. . There are an estimated 500 chemicals used today in approximately 55,000 formulas registered with the U.S. Department of Agriculture. Of these, approximately 375 chemicals and 40,000 formulations are specifically for use on food crops. However, since almost any chemi- cal applied for nonfood purposes may accidentally contaminate foods, © most of these chemicals and formulations are of concern to FDA. FDA also has the immense task of protecting consumers against filthy, insanitary, and harmful foods, and from the unscrupulous fringe, that is to be found in all walks of life, who try to short-change the American public by deceptive packaging, misleading labeling, and the like. During fiscal year 1964 over 19 million pounds of foods were seized in the course of 395 actions because of filth and insanita- ee SCO CHART 2.—RETAIL SALES OF FOOD IN THE UNITED STATES, CALENDAR YEARS 1954-63 Billions $100 80 60 40 20 1954" PAGS5 1956 RAY far at bec 1959 1960 ~=—-:1961 1962 1963 Food and Drug Administration 275 tion, and over 3 million pounds in 65 actions because of direct health factors. In addition, over half a million pounds were seized in 62 actions because of economic cheats. This year approximately 860,000 shipments of foods, drugs, and cosmetics worth $6 billion will reach U.S. ports from abroad. FDA will sample approximately 4 percent of these shipments. There has been a significant trend during the past 30 years in the administration of the national pure food and drug laws toward fuller utilization of preventive measures. The 1906 law was punitive in the main, whereas the 1938 law adopted in its provisions the concept of preventive enforcement and promotion of voluntary compliance for which administrators of the old act had been striving. It made color certification mandatory for coal tar colors used in foods, drugs and cosmetics. It authorized the establishment of standards for food thus recognizing the value of the earlier advisory definitions. It author- ized (in a way that had to be improved later) the establishment of tolerances for toxic materials required in food production. And particularly, it required premarketing clearance of new drugs for safety. This basic philosophy has been reflected in various amendments to the 1938 law. FDA/’s entire rulemaking process, which today is very extensive, is designed to acquaint the manufacturer with steps he can follow to comply with the law. With this evolution of law has come CHART 3.—RETAIL SALES OF COSMETICS IN THE UNITED STATES, CALENDAR YEARS 1954-63 Billions $2.5 2.0 1.5 1.0 0.5 1954 1955 1956 1957 1958 1959 =: 1960 1961 1962 1963 276 Department of Health, Education, and Welfare, 1964 an evolution of administration. IDA seeks increasingly the assist- ance of the scientific community in resolving questions presented by new science and technology. Administrative Progress The enforcement appropriation for fiscal year 1965 is $39,200,000. This compares with $35,805,000 for fiscal year 1964, representing a net increase of $3,395,000. It provides for 215 new positions, bringing the authorized enforcement staff to 4,039. This does not include employees | assigned to certification services and pesticide petitions. These posi- | tions are financed on a self-supporting fee basis. Fifty positions will help handle workloads in FDA’s drug program that have been created or increased by the Kefauver-Harris Drug Amendments of 1962 and new regulations of that year concerning in- vestigational drugs. This includes (1) work on projects concerned with drug records and reports; (2) evaluation of investigational drugs and drug efficacy; (8) improvement of management of medical activ- ities in FDA; (4) research and developing methods for scientific proj- ects concerned with drugs; and (5) planning drug programs, register- ing drug firms, and other regulatory activities at headquarters to im- plement the Kefauver-Harris Amendments. A total of 63 positions will help improve scientific communications and data processing within FDA and provide for exchange and avail- ability of research and other technical data outside the agency. To carry out this improvement these projects will include (1) reporting adverse drug reactions; (2) developing medical liaison; (3) providing new drug information to physicians; (4) reviewing medical literature; (5) developing scientific data systems; (6) using the automated data system more effectively and efficiently in FDA’s field districts. Addi- tionally, plans are under way to implement the recommendations of the science communications study undertaken in fiscal year 1964 by Arthur D. Little, Inc. . The study had as its general goal (a) to determine the feasibility of an integrated, agencywide scientific information retrieval system, and (b) to complete a preliminary design for an information storage and retrieval system. As a result of the study, the following conclu- sions were reached : 1. An integrated agencywide system for handling scientific in- formation is feasible for the FDA. An integrated but decentral- ized system was recommended, 2. 'The recommended system is composed of a centrally located Central Retrieval Index subsystem, realized on a computer, which Food and Drug Administration 277 CHART 4.—BUDGETED POSITIONS FOR FOOD AND DRUG ENFORCEMENT OPERATIONS ‘ (EXCLUDING FEE-SUPPORTED CERTIFICATION SERVICES), FISCAL YEARS 1955—65 j Thousands 4.5 4.0 3.5. 3.0 2.5 2.0 1.0 0.5 195Sa 1956 1957 1958 1959 1960 1961 1962 ©1963 1964 1965 interconnects four other subsystems whose manual and mechanized files are located at different sites in the agency. 8. It is technically feasible to design and implement a major portion of the system before Fiscal Year 1969. On the basis of this study, FDA is moving rapidly to develop a de- tailed design of such a system and to create a science information unit to administer and implement it. Toimprove FDA/’s food programs for protecting consumers’ health a total of 53 positions will be assigned (1) to work on research prob- Jems involving adulteration, sanitation, and food poisoning; (2) to train field bacteriologists; (3) to evaluate food manufacturing prac- tices; (4) to continue research on food additives; and (5) to main- tain the bacteriological surveillance program in the field to help avoid 273 Department of Health, Education, and Welfare, 1964 food-poisoning problems such as those recently connected with tuna and smoked fish contaminated by botulism organisms. A longstanding effort toward more efficient use of professional man- power will be aided by the addition of 18 positions to achieve a better balance between professional staff and supporting personnel. For example, increasing the number of inspector aides will relieve profes- _ sional inspectors from the simpler tasks connected with their duties © and provide more efficient staffing of FJDA resident inspector posts. A total of 17 positions will permit FDA to improve its programs for © consumer and industry education, information, and voluntary compli- | ance with the law. The remaining 14 positions will be used tq strengthen FDA/’s ad- ministrative supporting services in recruitment and classification, © training, fiscal operations, and records management. | A new headquarters building for FDA across the street from the HEW Building is now partly occupied. At Beltsville, Md., a new special pharmacological anima] laboratory is now in operation. Construction is being planned for additional headquarters labora- tories at Beltsville. The building to house these facilities will supple- ment laboratory facilities that will be available for headquarters scien- tific staff when the headquarters buiding is fully occupied in 1965. By that time, its laboratory facilities will be insufficient for FDA needs. — In the past year, three new district office and laboratory buildings have been dedicated. These are in Boston, Buffalo, and Minneapolis. New quarters in Baltimore were dedicated after the end of the fiscal year and the New York building was nearly ready for occupancy. This is part of the program to provide up-to-date facilities in each of the 18 districts of the FDA field operating force. The renovation of FDA district facilities is continuing. With the completion of two districts in 1965, FDA will have 138 of its 18 districts housed in new and modern facilities. Extensive changes in the organization and operations of the Food and Drug Administration have been undertaken in the last 2 years. Organizational changes were made within the Bureau of Medi- cine in 1962 to help meet its increased responsibilities. Following — this, and consistent with the principles recommended by the Second Citizens Advisory Committee, a major reorganization of the entire Food and Drug Administration was begun on November 1, 1963. This has been the most significant organizational reorientation of FDA in the last half century and is now nearly complete. The plan was designed for progressive strengthening over the next 10 years of consumer protection in regard to foods, drugs, medical devices, cosmetics, and household chemical products. ~ Food and Drug Administration 279 An important feature of the reorganization is the appointment of a National Advisory Covncil to the Food and Drug Administration. The Council will comprise representative citizens who will advise the _ Administration on national needs and the effectiveness of program policies. - A new Associate Commissioner, who will be a scientist, will give leadership from the Office of the Commissioner to the programs and functions having to do with medicine, science, and research. Two new Bureaus with scientific activities have been established: A Bureau of Scientific Research which supports FDA’s long-range consumer protection program and a Bureau of Scientific Standards and Evaluation, which handles safety clearance of pesticides, food additives, and colors; tests and certifies insulin, antibiotics, and colors; and develops scientific data used in setting standards and tolerances. These Bureaus replace the former Bureau of Biological and Physical Sciences, Enforcement activities have been consolidated into the Bureau of Regulatory Compliance, replacing in part the Bureau of Field Administration and the Bureau of Enforcement which formerly shared enforcement responsibilities. Part of the staff of the former Bureau of Program Planning and Appraisal was also assigned to this Bureau. Educational functions of FDA were emphasized in the creation of a new Bureau of Education and Voluntary Compliance. It contains two units, the Division of Consumer Education and the Division of Industry Advice. The staff and functions of this new Bureau formerly operated as parts of the Bureau of Program, Planning and Appraisal, the Bureau of Enforcement, the Division of Public Information, and the Office of the Commissoiner. Press and public information services are now handled by the new Office of Public Information. FDA has been fortunate in recruiting physicians and scientists to complement the talents available within the organization. During fiscal years 1963 and 1964, 66 physicians and 654 other scientists were recruited. A number of positions are being filled by scientists who are equipped by training and experience to exercise strong leadership soon after joining the Administration. Several key posts are still to be filled. To improve the capabilities of the present staff many training pro- grams have been conducted on the job and during the employees’ own time. Some examples are: The first university training course on drug manufacture for Fed- eral Drug Inspectors was held during the summer of 1964 at the University of Rhode Island. The University’s School of Pharmacy : 286 Department of Health, Education, and Welfare, 1964 has a modern pilot plant with the latest drug manufacturing equipment. About 250 chemists are participating in a graduate-level, home- study course in drug analysis. The course, designed and written by an FDA senior scientist, includes laboratory exercises and seminars at the end of each lesson. It takes about 30 hours of an employee’s own time to complete one of the lessons. In January 1964, the FDA Institute for Advanced Analytical Chemistry was opened at Georgetown University in Washington, D.C. Fifty-seven FDA chemists, including 41 from the field, attended the first two 12-week courses on advanced instrumental analysis. , Selected groups of FDA inspectors have been taking a 2-week course in self-defense tactics and investigation techniques sponsored by the Los Angeles County Sheriff and held at the Sheriff’s Academy. FDA inspectors are not authorized to carry firearms even though they are engaged in undercover investigations of criminals, such as dangerous drug peddlers, who are often armed. As a result of these and many other training programs FDA em- ployees received 152,000 hours of training or about 38 hours per em- | ployee during fiscal year 1964. This is exclusive of normal on-the-job | training. The Department of Health, Education, and Welfare believes that © the Nation’s consumers of foods, drugs, and cosmetics can best be © served by a combination of strong Federal, State, and local enforce- | ment of uniform laws and regulations. FDA has long had an active © Federal-State relations program, which has been strengthened by an © increased staff in recent years. } It was reported last year that FDA had obtained authorization for — an independent, Government-financed study of State and local laws, programs, and facilities. This study was proposed and supported by — the Association of Food and Drug Officials of the United States. The study, due to be completed in January 1965, is expected to result in additional Federal-State cooperation in uniform enforcement of food and drug laws. Food, Drug, and Cosmetic Act ON THE FOOD FRONT Radioactivity in Foods The number of domestic and import food samples collected from — major growing areas and monitored for radioactivity in 1964 was half that of 1963. Analysis showed a small but steady increase in the radio- — active contamination level (probably resulting from the 1961 Soviet — and the United States testing of surface and atmospheric nuclear — Food and Drug Administration 281 weapons). The level is still well within guidelines established by the Federal Radiation Council as acceptable for lifetime consumption under normal peacetime conditions. After developing a selective system based on knowledge of which plants concentrate radiation, FDA decreased sampling quotas for strontium 90 by 80 percent and cesium 137 by 90 percent. Import samples are now limited to tea and sampling reduced by 25 percent. The Total Diet Program to measure radiation in the diet of a typical 18-year-old boy continues in Washington, D.C. and nine district areas. Radioactive contamination trends were similar to those found in un- processed foods noted above. Leafy vegetables and forage crops were examined for 2 months in the fall of 1963 for gamma and gamma-emitting isotopes (iodine 131 and cesium 137) by 10 districts equipped with semiportable scintilla- tion spectrometers. Results indicated less than twice normal back- ground radiation and the program is temporarily discontinued. Early in the year, FDA sanctioned the use of gamma rays from co- balt 60 radiation to sterilize insect eggs in wheat and wheat products. No radioactivity remains in the irradiated wheat and extensive tests on animals and human volunteers show no lessening in the nutritional value of the grain. Natural Disasters A major earthquake on March 27 and the huge tidal wave that fol- lowed laid waste to Anchorage, Alaska, and severely damaged many cities and islands as far away as Hawaii and the California coast. About 30 percent of the Alaska fish, shrimp, and crabmeat canneries were located in the affected area and were heavily damaged or com- pletely destroyed. Actual examination of 365 tons of food, followed by salvage or de- struction of damaged and contaminated foods and drugs, was super- vised by local and State health officials with assistance from Seattle District inspectors. Two weeks afterwards, a ship arrived in Seattle with 185 tons of frozen crabmeat, 8 tons of frozen shrimp, 37 tons of canned crab, and almost 14 tons of canned shrimp. All had been watersoaked in a Kodiak warehouse during the quake. The lots were sorted under State and Federal supervision and some were reprocessed, others destroyed. During the annual Ohio River basin floods, a 2-day, 7-inch rain caused a small creek which courses through Louisville, Ky., to over- flow its banks. Flooding and backed-up sewers resulted in heavy food losses, including a $200,000 candy and sugar inventory by a candy manufacturer, and $250,000 in damaged canned hams, frozen turkeys, and other foods by a cold storage plant. A cake-mix firm hauled 375 748-869—65——19 282 Department of Health, Education, and Welfare, 19 tons of flour, sugar, spices, and other items to a dump, and a distillery destroyed 46,000 cases of bourbon whiskey worth $2 million. : In Montana, excessive rains and melting snows caused extensive flood damage to roads, dams, rangelands, and homes, but relative- ly slight damage to food and drug stocks. Seattle District inspectors assisted local health department personnel in salvage operations. 1 Six major fires required inspectors in five field districts to super- | vise the destruction of drugs valued at almost $400,000 plus 24,- 000 surgical sutures, and almost 2,009 tons of damaged foods plus” an $114,000 inventory of peanuts which had to be plowed back into the soil by Louisiana farmers. al In addition, a train wreck in November damaged a carload each — of flour, bulk corn, wheat, and evaporated milk, requiring destruc- tion supervised by State and FDA inspectors. Chemicals in Food Food Additives—FDA inspectors routinely check on the kinds and 4 levels of additives used in foods as a part of each food plant in- spection. Relatively few violations occur, however, considering the enormous amount of additives being used in the United States as preservatives, sweeteners, emulsifiers, etc. A check is also made to determine whether color additives being used comply with the Color Additive Amendments of 1960. During fiscal 1964, 23 food products were seized because of food additive violations. Most of these were vitamin products; one was an amino-acid product seized for containing folic acid in excess of the 0.1 milligram permitted in products not labeled for prescription sale only. Folic acid has been known to mask the symptoms of perni- cious anemia when used in excessive quantities. One vitamin product, seized at Salt Lake City, Utah, contained an unsafe food additive, menadione. Six of the seizures made under food additives provisions are dis- cussed under the Pesticides section of this chapter. Five hundred thousand pounds of jams, jellies, and fruit sirups were withheld from interstate shipment by a California firm be- cause they contained the defoaming agent, dimethylpolysiloxane, be- fore its use was permitted for certain products. In Hawaii, 1,000 gallons of raw milk were dumped into a sewer by State authorities after an assay indicated the presence of an antibiotic drug. Pesticides —FDA’s objective is to sample and examine a minimum of 25,000 lots of raw agricultural commodities for pesticide residues, or about 1 percent of the estimated 21% million shipments of food en- : ood and Drug Administration 283 tered annually into interstate commerce. This goal has been exceeded for the past 2 fiscal years. ' Samples are collected from farms, packinghouses, trucks, railroad cars, and ultimate consignees. They involve lots collected on a sur- ‘veillance basis, with no prior knowledge of whether the pesticides were “used properly, and lots which were definitely listed for sampling be- cause FDA suspected excess residues prior to shipment. During the fiscal year, 34 seizure actions were accomplished against foods and feeds containing illegal pesticides—28 of raw agricultural commodities and 6 of processed articles. Largest in volume was 662 tons of bulk wheat and barley con- taining seed grain treated with a mercurial fungicide. Leafy vegetables seized included cabbage, cauliflower, parsley, and broccoli, all because of excessive or unpermitted residues of toxaphene or endrin. Carrots and potatoes were seized because of excessive aldrin and dieldrin, or endrin which has no residue tolerance for these crops. In Texas difficulties were encountered with endrin on carrots and other vegetables about to be harvested. A program, developed with State officials, called for sampling all fields in the affected area to prevent either interstate or intrastate shipment of commodities with illegal residues. State officials and the industry association held a meeting with the growers at which it was agreed that where FDA reported illegal residues on the vegetables from a particular field, that field would not be harvested until after the pesticide weathered, or if delay would be impossible, then the crop would be plowed under. This action, which was most effective, represented a major operation in consumer protection through voluntary compliance. This incident led to a long-range improvement. Prior to the sum- mer of 1963 there were no commercial laboratories in Texas equipped with gas chromatographic apparatus suitable for examining raw agri- cultural commodities and soils for pesticide residues at the levels of eurrent interest. Through the efforts of State officials and the indus- try association, there are now five laboratories offering this service to industry for a fee. Research is being conducted by State scientists on the problem of take-up of pesticides from soils where other crops had received previous pesticide applications, which was found in some of the high residue cases investigated. The most significant change in the enforcement picture resulted from improvements in pesticide detection and measurement. FDA is now able to show the presence of pesticides at levels considerably below those previously detectable for enforcement purposes. These methods I . 4! 284. Department of Health, Education, and Welfare, 1964 are used to insure that milk conforms to the FDA requirement that it contain no pesticide residues. A comprehensive program covering about 4,000 samples of milk and 2,400 samples of manufactured dairy products uncovered a num- ber of specific problem areas. To determine the sources of residues found in milk, about 800 samples of hay and silage were analyzed. Alfalfa hay was found contaminated with DDT, toxaphene, or heptachlor, and 174 tons were seized in possession of dairy farmers to | prevent its use as dairy cattle feed. In the spring of 1964 heptachlor epoxide was discovered in milk in the Washington-Baltimore area and city and State officials revoked © marketing permits of a number of farmers pending correction of the | situation. Feeding of alfalfa chaff to milk cows in a Western State resulted in dieldrin in cheese in a localized area. The chaff was a byproduct of the production of alfalfa seed which requires heavy use of pesticides. Following seizures of the cheese, the State banned for — an indefinite period the use of certain pesticides in the county in which the cheese plant is located. Other processed foods seized under the food-additive provisions because of unpermitted pesticide residues were frozen broccoli with — endrin and flour with lindane and methoxychlor. The President’s Science Advisory Committee recommended an expansion of FDA’s Total-Diet Study to detect actual levels of pesti- cide residues as they appear in foods after normal preparation for con- sumption. The 1963 study, reported in July 1963, showed that pesti- cide residues detected were well within the amounts expected from compliance with safe limits (tolerances) established for individual] crops. In the spring of 1964, FDA inaugurated a new Total-Diet Study concentrated in Boston, Kansas City, and Los Angeles to cover foods marketed in these three different areas of the country. FDA inspec- tors obtained market basket samples of various fruits, vegetables, and other commodities recommended as a moderate-income diet for 18- year-old boys, the heaviest eaters in the country. The foods were then prepared by trained dietitians and cooks, and turned over to FDA laboratories for examination in 12 commodity groups. The results will be announced when the analyses are completed. In the chlorinated organic area, FDA scientists use a multiple- detection procedure able to demonstrate the presence of 25 pesticide compounds. Each food group is also examined for organic phosphate pesticides using paper chromatographic and polarographic methods. = Food and Drug Administration 285 FDA scientists can also detect six herbicides and certain carbamates, bromides, and arsenic residues in the tested foods. The three FDA district offices will each run six of these market basket tests per year, and two additional districts will participate in 1965. Other Harmful Contaminants Food Poisoning—Two outbreaks of botulism poisoning resulting from the consumption of smoked whitefish and chubs were investi- gated by FDA during the year. The outbreaks occurred in Kalama- z00, Mich., and in the Nashville-Knoxville, Tenn., area. The Michigan outbreak involved two persons and resulted in two deaths. Smoked bulk-packed whitefish was the implicated food. A - portion of the suspect product recovered from the home of the persons who died was found to be positive for Clostridium botulinum, Type E. The processor of the fish was not determined, but it was believed that the fish was purchased from a small roadside stand in Michigan. The outbreak in the Tennessee area involved 24 persons in all and resulted in 7 deaths. Smoked packaged chubs were the source of the botulinus toxin. In this instance, the product was distributed by a chain store. The processor was identified and an intensive nationwide recall, involving 13 FDA districts, was initiated to remove possibly dangerous products from the market. FDA was aided by State and local authorities in the recall. Excellent cooperation was also received from TV, radio, and the press. As a result of these outbreaks, FDA appointed a committee (Ad- visory Committee on Botulism Hazard), to recommend emergency measures to cope with the botulism hazard from smoked fish. The Committee drafted recommended processing and handling procedures for the smoked-fish industry. The procedures received concurrence of the National Fisheries Institute and were voluntarily adopted by the smoked-fish industry. The recommendations were to be followed until processes could be developed to control the botulism hazard. Research contracts have been negotiated with the University of Wisconsin to investigate the possible occurrence and distribution of the type E botulism organism in the Great Lakes area and with Ore- gon State University to conduct a similar investigation of west coast areas. These studies have demonstrated the organism to be present in fish and in the environment of some areas tested. Washington labora- tories of FDA are conducting research to determine methods for isola- tion and possible control of the organism. FDA field laboratories, during the past year, have examined about 1,200 samples of domestic and imported fish found on the market and will continue this program into the coming year. 286 Department of Health, Education, and Welfare, 19 In addition to the outbreaks of botulism involving smoked fish, FDA investigated 38 outbreaks of food poisoning involving 1,164 persons. — One outbreak of four cases and one death occurred in (PES and | shipments of liver paste to the United States were quickly recalled. FDA examination of samples from these lots failed to reveal the pres- ence of C. botulinum but decomposition by other micro-organisms was observed in a number of the cans. Botulism from home-canned foods was responsible for 7 outbreaks involving 22 persons and resulting in 8 deaths. * Salmonella contamination resulted in 5 outbreaks affecting 568 per- sons. Three outbreaks involved products (meringue pie, cream filled © donuts, and turkey rolls) or ingredients moving interstate. These were removed from the market by seizure or recall. One outbreak © occurred from mishandling of the food and one was of unknown cause. © Two outbreaks affecting 35 and 250 persons, respectively, were | caused by Bacillus cereus and Clostridium perfringens resulting from — insanitary handling of dried whipped potatoes and canned pork and — juice. Examination of parent lots revealed no evidence of contamina- | tion in them. : Salmonella program.—Concern over the worldwide increase in sal- ; monella food poisoning from egg products prompted a regulatory \ program in September aimed at dried and frozen eggs and foods con- | taining eggs. The first action under the new program resulted from — an outbreak of food poisoning among students at a Washington col- lege. State and local authorities along with FDA inspectors traced the cause to frozen eggs used in meringue pies prepared by a Spokane bakery. The eggs were the product of a Spokane commercial creamery company which had never been licensed by the State to produce frozen eggs. FDA inspectors located and sampled interstate shipments from the creamery seizing three lots in Montana. More than 14,000 30- pound tins of frozen eggs from the firm were embargoed by the State. During the following 10 months samples were collected from 142 frozen . and dried egg producers and food manufacturers using these products. Four seizures of contaminated frozen or dried eggs and two seizures of commercial foods prepared from contaminated eggs were made because of contamination with salmonella organisms. To Keep Food Clean Sanitation in food plants requires constant surveillance and a large part of enforcement time. Inspectors report increasing awareness by management of the need to keep foods clean and wholesome. Com- pliance through cooperation is becoming more and more significant. The food industry continues at an ever-increasing rate to make changes in operations and facilities that contribute to sanitary opera- Food and Drug Administration 287 ‘tions. Some examples of voluntary corrections are: Large sums of _ money are being spent for modern equipment and improved facilities. Some firms have abandoned old quarters and constructed entire new plants. In 1964, there were 355 plant improvements costing more than $22,086,900 reported to FDA inspectors. This compares with 283 plant improvements costing slightly more than $11 million dur- _ ing the previous year. _ An increasing number of food manufacturers are instituting vigor- ous sanitation programs. The food industry voluntarily destroyed 30,710 tons of food, or diverted it to nonfood use, in 1,380 actions after FDA inspectors pointed out that it was unfit for human consumption. During the previous year, the food industry voluntarily destroyed 2,272 tons of food, or diverted it to nonfood use, in 1,077 actions. About the middle of March, FDA inspectors began encountering substantial decomposition in Japanese swordfish steaks. This is the principal form in which Japanese swordfish is marketed in the United States. By the end of April, 50 to 75 percent of the shipments were being detained at the port of entry. This amounted to more than 300,000 pounds in some series of shipments. Representatives of the importers and the Japanese shippers visited the districts where these shipments were stopped and agreed with FDA analysts that the deten- tions were justified. The Japanese visitors said that corrective action was necessary in Japan to prevent future shipments of unfit sword- fish. Since then relatively few detentions have been required. In enforcement actions, the volume of unfit food seized—9,842 tons in 395 actions—included 3,750 tons of safflower seed which became in- sect infested and contaminated by birds while in storage. The seed was reconditioned under a consent decree. Another 16,230 tons of the seed was referred to State authorities and placed under embargo when its interstate origin could not be established and 130 tons of reject ma- terial was destroyed. The firm has since constructed storage bins and other facilities at a cost of $3,800,000. Coffee and cocoa beans also have been found insect infested while in storage. Seizures of rodent- and insect-contaminated bulk wheat and other grains totaled 3,39414 tons. The sale of frozen eggs made from incubator rejects is so lucrative that it may never be entirely eradicated. Federal prosecutions seem to have driven the operations out of FDA jurisdiction. Warehouse stocks, when encountered, are usually of intrastate origin and are referred to State agencies for disposition and regulatory action. Criminal prosecutions terminated, based on unfit foods, totaled 58, bringing fines ranging from $40 to $7,000. The longest jail term was 8 months, in (ae 238 Department of Health, Education, and Welfare, 1964 — Table 1.—Actions on foods during fiscal year 1964 Seizures ac- Criminal Injunction Projects complished | prosecutions | petitions instituted Notalsi¥_cc8ivs Ad as ese bok eee eee ees 512 52 8 Code 01 Beverages and beverage materials__...-_-..----------- 9 2 1 02 Bakery, ready to eat cereal, macaroni prod__.__-_-____ 16 7 1 Cereals, grain prod., and feeds: 03 Human use 103 10 6 14 Animal use 4 | co Se cheese eeeeeea ere eee 05 Chocolates, sugars, and related prod-_- 9 tly | no Sa ue one Dairy products: 06 Butter, and.churning cream 22... 5.222252 ne- 2 5 pe eee ef 07 Cheese and other dairy prod__--.----.------_--.-- 6. [Loe Se oe ee 09) + Eggs and ge prods-= 2, 225. ee a oa ee tee 34 l Vat See 4 12 Flavors, spices, and condiments__....._-.------------- rt eee ees Ot 13 -Erults'and frult, prodiice = Soe aoe ree ee eee nee 27. | 3 -sesseeoee eee 16\ Meat, Meat prod. and poultfycsiace evenness eee 11 1 16, Nuts; and nntiprod aes eee ee ee (46 1 17 Oils fats, and oleomargarine!1i 2-2cn_ees.s4-52>- eee 4 V2 2 seen ee a Yn Penn SY (oTere EGR aa) <*> Ta a) |e sow —w bi — - —— a ‘ 4 t Se - iM mike a a ‘5 eriieits Ag yi? i.oym * ¢ £ ' - - _ ~ a bas eririfete. bee 1 ase apthinas: rite fr FALt ‘peti ris tect oy id am ifs tibia Piiaery \ if t ¢ tiot ; a : TH 3 : ai ite i fs ied | : i pha b rf if ‘7 td ii f {95 t , iv? : fy, ts | wry t ys dive Hath (Guiloltant a £ ef) 1. ool An fake) f] a) lee ; i if : > : Civitigy Ot yt eet wares 4} UPD secre cry loswiatae | Walead no Whi ree he ¥ en) Obs luo ait! ints ty Ys ‘Resided aed Saat in sedmund »s) if ° — . amt end - 7 | “hh : ] inh { : j ' \ he | a 5 ¢ i ri i ».f j - c 4 Io 79 v) WIRD PVs note! ate the on ait ele 4 i94" oh pw itl oles ined olde igi, Ad Spite sow alle hemaal forth Sti) odo Dat sAele Joe ce (aie ot - ® ov vA rT ci mre? yer . i : : ’ ’ § ¢ 5 ‘ wy ion. Weise sia) Rak (Abbin sitio alenoen Sietsaltles” cobenen “$i BOCL wey Inve geno ~~ 4 Vocational Rehabilitation - Administration In 1964 THE PUBLIC program of vocational rehabilitation for disabled men and women reached a record level of achievement in its 44-year history. Easily the most rapid period of its growth was concentrated in the past 10 years. During the fiscal year that ended June 30, 1964,' a total of 119,708 disabled persons was prepared for productive activity and placed in successful employment through the services provided to them by their State vocational rehabilitation agencies. It was a new high mark, 9 percent more than the previous year—and more than double the total of 1954—and it marked the ninth consecutive year in which a substan- tial gain was made. The nationwide vocational rehabilitation program began in 1920. Its basic concepts remain, though there were important amendments to the original law in 1943 and in 1954 that greatly expanded its scope and its usefulness. The program is a partnership between the Federal Government and the governments of the States, the District of Colum- bia, Puerto Rico, Guam, and the Virgin Islands, in which vocational rehabilitation agencies in those jurisdictions prepare mentally and physically disabled people for jobs and homemaking. The Federal Government, through the Vocational Rehabilitation Administration, provides national leadership and grants-in-aid to the States. The Vocational Rehabilitation Administration also administers a rehabili- tation research program and a program to train professional rehabilita- tion personnel. The past 10 years have been particularly fruitful in many areas that were opened through the legislation enacted in 1954. The States had 1Throughout this report, reference to any year indicates fiscal year unless otherwise indicated. 327 328 © Department of Health, Education, and Welfare, 1964 CHART 1.—REHABILITATIONS BY YEARS Barden- LaFollette Act . 1925 1930 1935 1940 1945 1950 1955 1960 1964 new incentives to broaden the base of their rehabilitation activities, and the State-Federal partnership was so strengthened and revitalized that the annual totals of rehabilitations climbed swiftly, as shown in chart I. The 1964 total of almost 120,000 was a long step toward a goal of 200,000 annually. For an understanding of the public program’s past decade of achievement and expansion, it will be necessary to go back to August 1954 for a review of the amendments then enacted, known collectively - as Public Law 565. Under these amendments, new responsibilities were placed upon the State rehabilitation agencies and the Vocational Rehabilitation Administration. —To effect new fiscal relationships within the State-Federal part- nership to give the public program a sounder base for broad action. —To provide support for research and demonstration projects to find new ways to rehabilitate disabled persons for jobs. —To establish and provide support for the training of professionals with skills in vocational rehabilitation to meet serious shortages in this kind of personnel. “ Vocational Rehabilitation Administration 329 —To evolve approaches to new concepts of the public program and its usefulness. . In the following 10 years, the results were : The number of people rehabilitated annually increased from about 55,000 in 1954 to nearly 120,000 in 1964. Combined Federal and State spending on services rose from $35,411,124 to $138,259,534 in that period. The number of research and demonstration projects grew from 18 in 1955 to 795 in 1964, with Federal funds increasing from $298,900 in the first appropriation to $15,179,000 in 1964. Training activities were expanded from the total of 77 teaching programs and 201 student traineeships that were given support in 1955 to 447 teaching programs, and 3,259 traineeships and research fellowships in 1964. The initial appropriation for training activities in 1954 was $900,000. In 1964 the sum of $16,528,000 was expended in the training program. The Benefits What this expanded activity meant to the rehabilitated persons themselves in the enhancement of personal dignity through the ability to work is incalculable. But the program also has values readily meas- ured in dollars. Over 70 percent of the almost 120,000 disabled persons rehabilitated into jobs in 1964 were unemployed when they began to receive services. Most of the others had comparatively low earnings. Moreover, about 16,000 of those persons rehabilitated in 1964 were receiving public assistance at the beginning of or during their reha- bilitation, and about 5,200 resided in tax supported institutions. Pub- lic assistance payments to the 16,000 persons were at an estimated $18 million annually. Conversion of most of these persons from tax consumers to economic independence through the public program cost about $16 million in a one-time outlay, thus saving many millions of dollars in Federal and State public assistance funds. There is still another way of looking at the economic worth of re- habilitation for the disabled. Those who entered employment through the public program in 1964 will pay, during the remainder of their working lives, an average of five dollars in Federal income taxes for every Federal] dollar expended for their rehabilitation. New Concepts Arise During the last 10 years there arose new concepts of vocational rehabilitation and its usefulness for the individual and for the Nation, and resources for the program were increased enormously. State 748-869—65——22 330. —. Department of Health, Education, and Welfare, 1964 CHART 2.—PRINCIPAL CAUSES OF DISABILITY AMONG 1964 REHABILITANTS AMONG 1964 REHABILITANTS 11 ane 19% Muscular, peseee % Skeletal . Amputations 37% Defects 5% Mental “TT ‘ \ Blindneseiaae Retardation 6% Visual Impairment 6% Mental III 9 ea Bessa Deafness 2% Hearing and Speech 6% agency staffs grew from about 2,700 in 1954 to more than 7,000 in 1964, with greater selectivity and higher standards for the partici- pating professions. Special emphasis was placed on rehabilitation of those with more severe forms of disability. Amendments to the Hill-Burton hospital construction legislation that were adopted in 1954 provided aid to scores of communities and organizations for construction of comprehensive rehabilitation centers, special centers — for specific disabilities, clinics in connection with hospitals, and work- shops of several kinds for various purposes; scores of community and statewide facilities were built with the aid of funds available for States’ basic programs. New patterns of service were developed, not only for the rehabilitation of those already disabled, but for the broader purpose of early detection and diagnosis of disabling condi- tions among those preparing for the world of work. Prevention of dependency through vocational rehabilitation meas- ures—a target in the attack on poverty—has become a principal aim of the program. The movement toward that goal has become one of its strongest trends. It extends through accentuation of youth pro- EE Vocational Rehabilitation Administration 331 grams, through the great volume of services for those disabled per- sons in their prime working years, and through the mounting total of older persons in our population beset by chronic illness and infirmities. Effect of Disability Within the Family There was growing recognition of the total effect of disability on family units—on the added burden of handicapped children, on moth- ers unable to give proper care to their children, on fathers unable to provide for their families because of a vocational handicap. Measures were put into effect with cooperation of national, State and local wel- fare organizations to hold these family units together while appro- priate rehabilitation measures were taken. School systems in States and communities collaborated with their rehabilitation agencies to identify and evaluate handicapped students and provide special courses to stimulate their interest in furthering their education, thus combating dropouts and possible delinquency. In many places simultaneous academic education and vocational train- CHART 3.—MAJOR OCCUPATIONS OF PERSONS REHABILITATED IN 1964 iy e sont mosaenuanneennge SEP Department of Health, Education, and Welfare, 1964 ing and experience were provided for mentally retarded students, and occupational training centers in more than 30 States were preparing large numbers of retarded youths for jobs consistent with their abilities. Special classes and extraordinary steps were taken by rehabilitation agencies to participate in early aid to youths handicapped by visual, aural, or speech problems. For those with such disabilities as epilepsy, cardiac disorders, emotional disturbances, cerebral palsy, polio, and orthopedic handicaps, measures were put into effect that will lessen the load on rehabilitation programs of the future as well as make for a harvest of individual benefits for those whose handicaps have been identified in their early years. The growing proportion of older persons in our population prompted the need and development of services designed to prepare them for full or partial employment, or lessened dependence on family or public funds. Research and demonstration projects have shown that many older persons—some beyond 65—can be rehabilitated into employment compatible with their condition. Other projects have demonstrated that many persons who had been confined to bed in public or private institutions could be rehabilitated into self-care and considerable inde- pendence, thus reducing the enormous number of hospital and similar facilities held for these purposes. A measure of the success of these programs within age groups can be demonstrated with a few figures. Among those disabled persons of 20 years or less the volume of rehabilitations grew from about 9,800 in 1954 to some 27,500 in 1964; and 875 disabled persons of 65 years or more were rehabilitated in 1954, compared to about 1,900 in 1964. This left, in 1964, around 90,000 disabled persons who were rehabili- tated during their prime working years—more than 58,000 between the ages of 20 and 45, and some 32,000 between 45 and 65, Among those groups were many persons disabled from birth, or by accident or disease; some were disadvantaged by lack of educational . or economic opportunities, in addition to a vocational handicap; others had natural aptitudes or abilities, and needed counseling and guidance as the top requisites for overcoming their handicap for employment; still others were socially adrift, handicapped by both disability and lack of motivation for employment. Rehabilitation vs. Public Assistance Most of these disabled people were among the segment of our popu- lation for whom there is mounting national concern because of the persistence of poverty and economic deprivation in a time of general prosperity. Congress gave expression to'this concern in 1962 with Vocational Rehabilitation Administration 333 the passage of amendments to public welfare legislation, which re- flected, among other things, a growing sentiment for rehabilitation rather than relief for those disabled persons receiving public assistance payments. State rehabilitation agencies by 1964 had mounted a strong attack within this phase of the public program. The first step was training of their staff in methods compatible with joint aims and procedures developed with welfare agencies, and the strengthening of interagency relationships. The second step was assignment of special counselors to serve mentally or physically disabled public assistance clients. CHART 4.—SOURCES OF REFERRALS AMONG 1964 REHABILITANTS Self or other individual Hospitals, Rehabilitation Centers, Health Agencies @ Physicians Welfare Agencies Education Institutions State Employment Service imma BOASI Workmen's Compensation Other Among several States making a strong attack in this direction were Tennessee, which assigned work counselors for such duties in its four largest cities; Pennsylvania, which placed a score of counselors in this work; Montana, mounting a pilot effort in 11 counties; and Minnesota, preparing to enter this phase of rehabilitation by the end of calendar 1964. One of the most practical activities in this area is the cooperative efforts developed and maintained between State rehabilitation agen- 334 Department of Health, Education, and Welfare, 1964 cies and State and local welfare departments to mobilize the total of their own resources with those of community groups and agencies, so that disabled public assistance recipients in need of rehabilitation services may be identified. There were many complexities in this effort. Many of these persons were found to have long-neglected multiple disabilities as well as eco- nomic and dependency problems of considerable proportions, and pilot research and demonstration projects were conducted in Florida and Georgia to find a pattern for attacking the problem of the disabled public assistance client. By the end of 1964, demonstration projects of this kind sponsored by State agencies had been initiated in 23 communities—10 in 1963 and 18 in 1964—enabling scores of persons to build new lives for them- selves. California took a slightly different approach: with the aid of a VRA demonstration grant, it has been concentrating on early identi- fication of disability among applicants for public assistance, and re- ferring them promptly to its rehabilitation program. Another approach was used in St. Louis, beginning in 1963. There the Missouri agency undertook to discover disabled persons living in a large public housing development and to offer them rehabilitation services designed to place them in employment. By the end of 1964 more than 50 residents in this housing had been rehabilitated into successful employment. The principles of this project have been adopted in similar developments in Miami, Fla.; New Haven, Conn.; and Pittsburg, Calif. Screening Military Rejectees A significant development in 1964 affecting young persons was a greatly expanded effort to rehabilitate men rejected for military serv- ice because of physical or mental disabilities. The assumption was that many of these young men could be prepared for civilian employ- ment. . There were two approaches used in this effort: First, the develop- ment of working arrangements between the Federal and State agencies involved; second, experimental projects that would determine the size of the probiem and the proper procedures. At least six State rehabilitation agencies have made arrangements with the Selective Service System through which physically or mentally disqualified registrants could be brought to the attention of their State rehabilitation agencies. Several other States have shown interest in this direction, and, on a national scale, the Vocational Re- habilitation Administration, the Public Health Service and Selective Vocational Rehabilitation Administration 335 Service are working jointly toward establishment of cooperative proj- ects throughout the country. The rehabilitation agencies in Arkansas, Georgia, South Carolina, and West Virgina, with support of VRA demonstration grants, have initiated such experimental projects. All but the first project in- volved the screening of rejected registrants at Armed Forces Examin- ing Stations. In Arkansas, the procedure was somewhat different, in that assigned personnel work with local Selective Service boards to identify disabled registrants and assess their potential for rehabilita- tion. Plans were afoot in several other State agencies at the end of the year for similar activities in 1965. Expansion and Use of Facilities Rehabilitation facilities are an indispensable part of the expanding public program, for they provide an unequaled means for evaluating, treating, and serving the severely disabled. There are many types: Large centers for training or treating persons with practically all forms of severe disability ; speech and hearing cen- ters; optical aid clinics; centers for the blind; halfway houses for pa- tients discharged from a mental hospital who are adjusting to commu- nity life; and workshops for various purposes. State rehabilitation agencies have authority to establish facilities, with the funds they have available for basic rehabilitation services. Since 1954 they have spent about $17 million to establish more than 300 State-operated or private facilities. Forty-six States have used funds in this way. In addition to the variations in physical size and in broad or specialized purposes, some are medically oriented while others lean to the vocational side. What- ever the scope or capacity of these facilities, they greatly increase resources for aiding the disabled. Some States have reported that the increase in facilities has had a most profound influence on the char- acter of their rehabilitation programs. The use of facilities by State agencies has increased 10 times in the past decade. In 1955 the agencies paid for services at rehabilitation centers for some 2,400 persons. In 1964 the total was more than 30,000 and over the country about 18 percent of State agency expendi- tures for services was made to facilities and workshops. Since 1954 the Hill-Burton law has permitted Federal financial help for construction of rehabilitation facilities as well as for building new hospitals. Funds for the rehabilitation facilities are jointly approved by the Vocational Rehabilitation Administration and the Public Health Service. 336 Department of Health, Education, and Welfare, 1964 In all, 304 rehabilitation projects have been approved under Hill- Burton provisions—32 of them in 1964. Total cost of the 304 projects was $189,500,000; the Federal share was more than $64 million, or about 30 percent. A reflection of the increased interest in rehabilitation of the mentally disabled is that 10 of the 32 construction projects of 1964 are for the mentally retarded or mentally ill, and 3 of the 10 are for halfway houses for ex-patients from mental hospitals—a rapidly growing phase of rehabilitation for these people. As the program progressed to the point where a better perspective could be taken on the capabilities of disabled persons, a diversity of ways has been devised to cope with individual disabilities. The re- habilitation workshop is one of the ways. There are, essentially, two kinds of workshops. In one, the prin- cipal goal is to move disabled workers into private employment. The other is the long term shop, where work may be adapted to individual abilities and capacities and where a disabled person—unable to com- pete in private industry—may earn all or part of his livelihood. This is called a sheltered workshop. There is rising demand for more workshops, and the VRA, the State agencies, and private rehabilitation groups are attacking many prob- lems that have arisen in expanding this phase of the program. Research is providing some of the solutions to these problems. Proj- ects have been initiated to find answers as to whether a multicommu- nity workshop is feasible; to find methods of obtaining contract work; methods of applying marketing principles to workshop products; to study the feasibility of establishing statewide systems of workshops; and a number of similar matters that will help the workshop to come into its proper place in the program. An estimated 800 workshops of various kinds are in existence over the country, and a considerable proportion of them are members of the National Association of Sheltered Workshops, which, with the Na- tional Rehabilitation Association, has completed a study of workshops: on a national scale, supported by a VRA research grant. 1962 1963 1.964 340 Department of Health, Education, and Welfare, 1964 of jobs and the kinds of employees that are needed to fill them; the effect of the burgeoning population; shorter work hours; the increased demand for skills; the rising place of the scientist, clinician, and the technician ; the decline of “common labor” as a means of livelihood, and the fewer number of persons required in agriculture. There is deep meaning here for the rehabilitation program, for these factors influence greatly the course of vocational training and the placement of those persons restored to employability. Many of the answers are found through the wealth of imagination and effort that has been shown in rehabilitation research and demonstration. At the end of 1964 a total of 795 research or demonstration projects had been completed or were in operation. Federal funds made avail- able for research and demonstration in 1964 amounted to about $6.5 million for new projects and $8.6 million for continuation of other projects. In the years since this activity became a part of the public program more than 1,600 projects have been submitted by State agencies and by private nonprofit groups to the VRA. The almost 800 that were approved as worthy of Federal support because of their promise of adding knowledge about rehabilitation, or proving the validity of an idea or technique, were screened and evaluated by VRA in two ways. A study section reviews applications for their technical aspects and desirability in a particular field, and makes recommendations to a National Advisory Council on Vocational Rehabilitation, composed of persons knowledgeable in rehabilitation and its allied fields, and headed by the Commissioner, which has final approval authority and can make grants in amounts deemed to be appropriate. Research Prepares Disabled Persons for Modern Em- ployment Many services have been developed—principally through research— that enable those with specific disabilities to be fitted into modern employment according to their capacities. Research into the rehabilitation of those with cardiovascular dis- orders has shown ways of measuring work tolerance, and a cardiac work classification system is bringing more satisfactory placements. Methods have been devised for measuring the potential abilities of severely disabled cerebral palsied adults, and for intensive workshop programs to prepare them for industry, or for meeting the problems encountered by palsied college students. Seven work classification and evaluation centers have been established in as many States to pre- pare palsied persons for employment and place them in jobs. Vocational Rehabilitation Administration 341 Epilepsy has come under more intensive study, to develop methods of community organization for enhancing employment opportunities, for evaluating all the employability factors of this handicap, and for combating employer prejudices against hiring persons with epilepsy. Among more than 40 research and demonstration projects in ortho- pedic disorders are measurement methods for energy expenditures of these disabled persons in various kinds of work, for demonstrating the ability of amputees to operate trucks and other equipment, and for the development of assistive devices that will aid these persons with limb malfunctions. Expanding the Fight Against Mental Retardation Rehabilitation research has been a big factor in the fight against mental retardation and the results are becoming evident. The number of mentally retarded rehabilitated into employment in 1964 was 20 percent greater than in the previous year—about 7,500 against 6,000. As a further reflection of the great activity in this field, the amount of Federal funds for services to the mentally retarded as part of the basic grants to States in 1964 was about $5.5 million, or more than 55 percent greater than the 1955 total. Training grant funds for mentally retarded programs also took an enormous jump in 1964, the total of some $800,000 being about 5.5 times that of 1963; and grants in support of research and demonstration projects in this field increased from about $1.5 million in 1963 to $2.25 million in 1964. These figures add up to a total of some $8,550,000 expended by the Federal Government during 1964 for mentally retarded people served in the public program, an 80 percent increase over the $4,775,000 of 1963. The pace of research activity on mental retardation is made clear by the number of research and demonstration projects on this disability. Thirty new grants of this kind were approved in 1964. Combined with 35 other grants already in operation, the total of 65 projects represents a highly intensive effort to move forward the rehabilitation of these people. Much of the research and demonstration activity is centered on combined academic education, vocational training, and actual work experience for retarded youths of high school age. Such programs have two effects. They prepare well-motivated, retarded youths for a vocational future; among others they combat some of the mounting problems of school dropouts and the probability 342 Department of Health, Education, and Welfare, 1964 of delinquency among handicapped youths by counseling and pro- — viding good motivation. Within recent years such projects have been carried on or are cur- rent in Florida, Texas, and Georgia; in Milwaukee, Minneapolis, Detroit, and Champaign, Ill.; and Montgomery County, Md. These kinds of projects are designed to bridge the gap between the close of a retarded youth’s schooling—usually in the last year of high school and entrance into the field of work. These activities were broadened in 1964 by a variation which com- bines academic education with alternate workshop experience. Fifteen such projects have been initiated in 10 States. Among them are seven in West Virginia and Kentucky, as part of the effort to help areas where economic and cultural deprivation has come to national attention. Many extension and improvement grants made to States have pro- vision for better services for the mentally retarded and other dis- abled persons. Of the 123 E&I grants made to States in 1964, 17 had the specific purpose of serving the retarded. They carried a total of $185,000. Among the uses to which these grants were put, New Jersey had fostered a broad expansion of workshops, six of them exclusively for the retarded and seven for retarded and other disabled persons, New Mexico has made outstanding use of these projects to coordinate education and vocational services for the retarded. One of the earliest kinds of selected demonstration projects for the mentally retarded was establishment of occupational training centers by State agencies or private groups where retarded young people of various backgrounds can be evaluated and vocationally trained. The centers have shown a steady growth, and many of them have out- grown the need for Federal support. In 1964 there were 48 occupa- tional centers in more than 30 States. Hundreds of retarded youths were prepared for vocational success in these centers. Jobs for the Mentally Ill Vocational rehabilitation of the mentally ill through the public pro- gram is principally in three directions: Work with hospital patients before discharge to evaluate their abilities and prospects for employ- ment; helping them to adjust to noninstitutional life and into work situations; and helping mentally ill persons outside hospitals with services that help them remain in the community. In 1964 more than 11,000 persons who had been mentally ill were rehabilitated into employment in the public program. Many of them owe their rehabilitation to the great volume of re- habilitation research. The upsurge of interest in mental health in a ee’ Vocational Rehabilitation Administration 343 the past 5 years brought a total of 84 projects in this field—for half- way houses, work therapy, and screening of hospital patients for re- habilitation potential; outpatient counseling and hospital aftercare; and evaluation, training, and placement for emotionally disturbed persons. More than 100 VRA research or demonstration projects have dealt with mental illness, costing more than $10 million. Close to half the projects are in the area of special counseling to deal with problems of the hospital patient. The rest are concerned with a multiplicity of matters outside the hospital. The largest obstacle to adequate expansion of services to the men- tally ill is lack of specially trained personnel. One acute shortage is among psychiatrists. In order to improve this situation the VRA has supported a series of regional workshops through training grants. The results have been outstanding. Many more hospitals have ac- cepted the rehabilitation program, many have utilized expansion and improvement grants to expand their facilities and staff, and in a num- ber of selected hospitals affiliated with medical schools, there are new academic and clinical courses on psychiatric rehabilitation. New Work for Blind Persons More than 5,000 blind persons were rehabilitated into employment in 1964 through the public program, only a small increase over the pre- vious year, but a considerable accomplishment in view of the tremen- dous problems that have developed in the placement of blind persons in jobs. Placement of blind persons in routine, repetitive machine opera- tions—once the mainstay of the program—is being largely obviated by automation. Counselors today must be prepared to help blind persons into highly skilled and complex work, now widely available in many industries, but only for those who are well trained, adjusted to their disability, and flexible enough for adaptation. Again, the answers to these problems are being found in research. One illustration of the methods being developed to help blind persons keep pace with the effects of automation is the VRA-grant support given to research at the University of Cincinnati to find ways for blind persons to participate in electronic computer operations, and to a private organization in Pittsburgh for development of techniques in applying such knowledge to actual operations. The language program instituted at Georgetown University a few years ago to teach blind students Russian and German has been an enormous success, and a similar project is being established at Occi- 344 Department of Health, Education, and Welfare, 1964 dental College in California to teach blind students to become linguists in Chinese and Arabic. One of the important sources of employment for blind persons is vending stands, operated in public and private locations under the general supervision of State rehabilitation agencies and the provisions of the Randolph-Sheppard Vending Stand Act of 1936. The size of the vending operation has grown consistently. In 1964 there were 2,442 stands on Federal, public, and private property. They did a gross business of $54 million and returned an average profit of $4,452 to 2,641 operators. Another successful program, for people with low vision, is the optical aids clinics in 20 States. These provide services to scores of persons whose low visual acuity has handicapped them for employ- ment, by fitting magnification devices as a means of increasing their perception. Hearing During the year efforts within the public program and several volun- tary organizations to widen job opportunities for deaf persons were aided by the appearance of electronic and telephonic devices that will improve communication, reduce isolation, and increase opportunities for jobs. One such device, when combined with the telephone, will enable deaf persons to write messages to each other at any distance. The second is a combination of the telephone and television, so that deaf persons can see each other and communicate by signs or lipreading. The VRA has given support to these developments by granting funds for projects that will develop ways to adapt these devices to the needs of the deaf, of whom there are about 250,000 over the nation. To these may be added some 8 million persons who are handicapped by partial hearing or speech difficulties. Some have disorders of the ears, others have defects or loss of the vocal organs, still others have disorders of the central nervous system which impair normal communication. The affected individual faces formidable barriers in his social life and in achieving vocational success. Some barriers can be struck down by medicine and surgery, by various therapies, by hearing aids. Whatever the individual difficulty may be, the VRA is becoming more and more concerned and able to help in the medical and surgical aspects, with the training of special teachers, with research, and with extension and improvement grants to expand facilities for speech and hearing activities. Such facilities are in operation in Wisconsin, Vocational Rehabilitation Administration 345 Georgia, Florida, Tennessee, Alabama, Mississippi, and Indiana, among others, and are increasingly able to offer diagnosis, training, and placement services for many more deaf people. Narcotic Addiction Drug addiction has been a growing problem in the United States for many years, yet from the standpoint of the rehabilitation program there is a great lack of medical and social research upon which to develop guidelines for rehabilitating addicts. They are eligible to apply for the services of State rehabilitation agencies, but the num- ber of referrals has been small and few such persons have been rehabilitated. There are manifest difficulties in this phase of rehabilitation. A new approach is being demonstrated through a grant made to the Vocational Guidance Service of Houston, Tex., for partial support of a halfway house that is providing intensive aftercare services to narcotic addicts released from the Public Health Service Hospital at Fort Worth. This project will offer a combined hospital and post- hospital treatment program of medical, psychiatric, counseling, voca- tional training and placement services, and is the beginning of a new emphasis on rehabilitation of the narcotic addict. Alcoholism and Rehabilitation Alcoholism now ranks as the fourth greatest health problem in the United States, following heart disease, cancer, and mental illness. As a disabling condition it affects some 5 million men and women, of whom about 2 million are employed people. The psychiatric, medi- cal, and social problems involved in rehabilitating alcoholics are tre- mendous and offer such substantial difficulties that less than a thou- sand such persons were rehabilitated in 1964. There are still a great many unknown factors in alcoholism. There is urgent need for research as to the basic causes of excessive drinking in order to assist in the development of appropriate rehabilitation techniques, particularly in the area of improving motivation for return to productive life in the community. There is a similarly great need for intensive training of professional personnel, including those in State rehabilitation agences. The Colorado Vocational Rehabilitation Department is maintain- ing two halfway houses for alcoholics in Denver, one for men and one for women. An encouraging number of the residents of these halfway houses have been able to return to the community and avoid their former habit during the 2-year period that the program has been in 748-869—65 23 346 Department of Health, Education, and Welfare, 1964 existence. Each year a number of counselors from State rehabilita- tion agencies attend training sessions on rehabilitating alcoholics at the Rutgers University Summer School on Alcoholics, and other sessions are held in Colorado, Utah, and Louisiana, under their rehabilitation agencies. In a project at the University of California at Los Angeles, sup- ported by a VRA research grant, the careers of 600 persons who have apparently quit drinking are under examination to determine the personality factors differentiating them from persons who continue to use alcohol. Another project at the same university has under study the personality patterns of ex-prisoners with a history of alcoholism. who have a subsequently clean record of law observance, so that their behavior patterns may be contrasted with those of current prisoners. The third year of a 5-year project at the Salvation Army’s Men’s Social Service of San Francisco has just been completed. The effort there is to demonstrate the effectiveness of an in-residence vocationally oriented program in the rehabilitation of alcoholics. A grant to Temple University’s Diagnostic and Relocation Center is attempting to determine the feasibility of various rehabilitation programs for the treatment of homeless alcoholic men on “skid row.” The Chicago Educational Television Service has been given a planning grant for the development of a series of television films on alcoholism and how to deal with the problem. Another planning grant has been awarded to the North American Association on Alcoholism Programs for a national workshop to develop guidelines designed to bring about a close working relationship between State rehabilitation agency per- sonnel and professional workers in the field of alcoholism. Social Security Disability Applicants The vocational rehabilitation agencies of all but five States are responsible for evaluating the disability and rehabilitation potential of those persons who apply for benefits under the disability provisions of the Social Security Act. This phase of State agency work began in 1955 and, in the relatively few intervening years, has brought increasingly heavy workloads, but excellent results. In 1964, State agencies evaluated about 462,000 of those cases to identify those applicants who seemed to have some prospect for re- turning to work through rehabilitation services. As a result, around 50,000 were considered to have rehabilitation potential in some degree and were accepted into the referral loads of State agencies. A total of 9,600 social security disability applicants were rehabilitated in 1964—about 8 percent of all rehabilitants for the year. Vocational Rehabilitation Administration 347 CHART 7.—DISABLED PERSONS OF AGE 45 OR MORE REHABILITATED 1945-64 Thousands 35 — On 0 1945 1950 1955 1960 1964 There was established in Atlanta, Ga., an experimental project in- volving the State rehabilitation agency, the local Social Security office and the Employment Service. This project utilizes available com- ! munity resources in assisting disability applicants to employment _ through the provision of vocational rehabilitation and placement services. The concurrent efforts of all three agencies are applied in _ the evaluation of disability applicants and in the restoration of these ' individuals to gainful activity. | The District of Columbia rehabilitation agency is conducting a - unique demonstration project which provides for the selection of dis- ability applicants who appear to have employment potential and _ stabilized impairments. Provision of intensive counseling and place- _ ment services may return these persons to employment quickly without _ the need for restorative services or long-term training. Interim reports indicate unusually successful results may be accomplished through _ this project. Preliminary findings of three major research projects suggest that there is a potential among social security disability applicants that _ has not yet been fully realized by the State vocational rehabilitation agencies. Information from these projects (supported by research 348 Department of Health, Education, and Welfare, 1964 grants to Tulane University, the Ohio Rehabilitation Center, and the Sister Kenny Institute) is expected to encourage State vocational — rehabilitation agencies to undertake restoration of more applicants for disability benefits to productive employment. Eleven additional projects that were nearing completion at the close of 1964 are expected to provide valuable data on new techniques for reaching severely disabled applicants for disability benefits. These demonstrations studied the extent to which severely disabled social security beneficiaries, not normally considered as rehabilitation candi- dates, actually could be restored to employment through the provision — of intensive rehabilitation center care supplementing other necessary rehabilitative services. State agencies sponsored nine of the projects and also cooperated with the rehabilitation centers which sponsored the two others. Growing Relationships With Labor Organized labor and the people in the rehabilitation program con- tinued to forge new relationships during 1964. This effort began a few years ago and has since served to make labor more aware of the economic, humanitarian, and sociological benefits to be gained through better understanding of rehabilitation principles and methods. In turn, rehabilitation professionals are acquiring a fuller understanding of organized labor’s problems. The relationships have been enlarged through labor-rehabilitation institutes and seminars across the country, supported by VRA training grants. Twelve of these workshops were conducted in 1964 and more are planned for 1965. Future institutes will place increasing emphasis on the rehabilitation aspects involved in administration of Workmens’ Compensation pro- grams. A National Institute on Rehabilitation and Workmens’ Com- pensation in late 1962 brought together leading authorities in these fields with reference to law, insurance, labor management and govern- ment, and has had great influence on those interested in this phase of rehabilitation. A highly significant research and demonstration grant to the Sidney Hillman Health Center in New York City has been concluded. It was concerned with the incidence of disability among union members and their families, and establishment of a mechanism within a labor health facility for referral of disabled people to appropriate rehabilita- tion resources, particularly those with mental illness. A new and enlarged demonstration program of psychiatric services to members and their families was recently initiated with joint support Pil € Vocational Rehabilitation Administration 349 of VRA and the Public Health Service. Another important VRA- backed research project was being conducted by the AFL-CIO Central Labor Council to find ways to rehabilitate nonunion members and their families. Manpower Development Enactment of the Manpower Development and Training Act brought new obligations to the rehabilitation program, so that handi- capped people can benefit from its provisions. Cooperative arrangements have been made between the Vocational Rehabilitation Administration and the Department of Labor, whereby projects proposed under the legislation may be reviewed from the rehabilitation viewpoint. The legislation is administered by the De- partment of Labor and the Department of Health, Education, and Welfare. Similar relationships are also being developed with the State rehabilitation agencies, toward more complete understanding among all the participants in this activity as they affect disabled people. The New York Division of Vocational Rehabilitation already is providing intensive vocational evaluation for disabled persons being served through these projects. Also in that State, the Human Re- sources Foundation, of Albertson, has undertaken a project for development of new techniques in the training of mentally retarded and other severely disabled persons in commercial and industrial skills, a valuable contribution to the rehabilitation program from this new legislation. Rehabilitation Research Overseas The Vocational Rehabilitation Administration has participated in international rehabilitation research since 1961, in a program involving the United States and nine other countries. The basic legislation for these activities is Public Law 480 (the Agricultural Trade Develop- ment and Assistance Act) which allows the use of currencies accumu- lated in foreign countries from their purchases of U.S. farm commodities for various purposes within those countries, including rehabilitation research. The countries participating are Brazil, Burma, India, Israel, Pakistan, Poland, the Syrian Arab Republic, the United Arab Republic (Egypt), and Yugoslavia. Fifty-seven projects have been approved for operation in those countries. Outstanding among these projects are India’s experimentation into methods of counteracting the effects of leprosy by surgical restoration 350 Department of Health, Education, and Welfare, 1964 and by integration of patients into employment and community life; its demonstration of ways to rehabilitate blind persons into agricul- ture; and its research into restoration of severely burned persons to employability. Israel has many projects. Outstanding among them is one for development of methods for training blind persons in the use of textile machinery. Brazil has developed training methods for prosthetists and orthotists in fitting these devices, and methods of manufacture of prefabricated parts for them, to reduce their costs. Other projects are related to . heart disorders, cerebral palsy, severe burns, and mental retardation. INTERCHANGE OF EXPERTS Under provisions of the International Health Research Act of 1961, the VRA has made 60 awards for the interchange of experts in rehabil- — itation between the United States and the countries participating in international research. The disciplines involved include prosthetics and orthotics, psychology, counseling, plastic surgery, neurosurgery, and physical medicine, among others. This program is administered in VRA through its Division of International Activities. The first exchange visit was made by a group of U.S. specialists in plastic surgery who went to Vellore, India, to study the work among leprosy patients being performed under direction of Dr. Paul Brand. In 2-month rotation, experts from such schools as Harvard, Yale, Johns Hopkins, and the Universities of Pittsburgh, Kansas, Ohio (State), North Carolina, and Pennsylvania, visited the Vellore hospi- tal and brought back to the United States a wealth of information, not only on the treatment of leprosy itself, but on corollary methods of skin grafting and cosmetic restoration, useful in the medical and surgical aspects of rehabilitation in the United States. The inter- change program also has brought many foreign experts to the United States to study its rehabilitation programs, particularly. its organiza- tion and methods, as well as its research in relation to similar projects in their own countries. VISITORS FROM FOREIGN COUNTRIES The Division of International Activities also plans training pro- grams of study and observation of the U.S. rehabilitation program for persons from other countries. They are sent by their own governments and are supported by study grants from the Agency for International Development, the Department of State, or the United Nations and its specialized agencies. — ————— Vocational Rehabilitation Administration 351 Many of the trainees who come here are planning, directing, or operating rehabilitation programs in their own countries, conducting research, or otherwise helping to meet problems of the disabled. This activity has been carried on in VRA since 1947, and through 1964 some 1,500 persons from 80 countries have taken part in it. Training New Workers for Rehabilitation Rehabilitation must encompass not only the vocational needs of the disabled person but the physical, emotional, and social needs as well It follows that services to disabled persons must be given by qualified professionals. In response to a serious shortage of these individuals— rehabilitation counselors, rehabilitation physicians, rehabilitation nurses, therapists, and a number of others, the Vocational Rehabili- tation Administration has supported since 1954 a rehabilitation train- ing program, largely in colleges and universities. CHART 8.—1964 TRAINING FUNDS IN AREAS OF PERSONNEL SHORTAGES Medicine Counseling Speech-Hearing Social Work | Prosthetics Physical Therapy § é Occupational Therapy Psychology Nursing Deafness The training grants program was started in the fall of 1954 with an appropriation of $900,000. In the following year, grants were made for 77 teaching programs, 201 traineeships and 16 short-term con- tinuing education courses. Each year has seen an increase and in 1964, with a $16,930,000 appropriation, 447 teaching programs received support and grants were made for 3,529 traineeships and 15 research fellowships. In addition, support was provided for 147 short-term continuing education courses which reached over 6,000 individuals. 352 Department of Health, Education, and Welfare, 1964 KINDS OF TRAINING GRANTS Long-Term Grants—Grants to educational institutions and rehabilitation agencies for support of basic or advanced profes- sional training. They are of three kinds: (1) Teaching grants, to defray part of the cost of instruction, (2) traineeship grants, to provide tuition and stipends and other costs for students en- rolled in the training program, as selected by the educational in- stitution ; and (3) a combination of both. Short-Term Grants——Training of shorter duration than a semester. They include institutes, workshops, seminars and other training courses. In-Service Grants——Grants to State vocational rehabilitation agencies for staff development programs. Research Fellowships —Awarded for research in rehabilitation for the purpose of producing new knowledge or to assist pro- fessional personnel to prepare for careers in rehabilitation research. Training grants have enabled schools to employ field teachers and clinic supervisors and thus expand their admissions. They have en- abled curricula changes for incorporation of more rehabilitation con- tent, more information about the nature and effects of disability, and the techniques and services that are utilized. From a quantitative standpoint, manpower has been augmented in fields where there were serious shortages. More trained clinicians are working in rehabilitation settings than ever before, and a number of graduates are now on the faculties of participating schools. The fields in which support is currently concentrated are medicine, with special emphasis upon residency training in physical medicine and rehabilitation; counseling; nursing; speech pathology and audiol- ogy; occupational therapy; physical therapy; psychology; recreation ; sociology, dentistry, prosthetics and orthotics; and social work. En- couragement is also given to the development of curricula designed to provide specialized skills and knowledge required by workers for the blind, the deaf, the mentally retarded, and the emotionally disturbed. Training programs that are interdisciplinary in nature, and pilot proj- ects with collaborative practice also are being encouraged. Rehabilitation Medicine Rehabilitation is a concern of many medical specialists, but it is the primary responsibility of specialists in physical medicine and rehabilitation. There is an acute shortage of physicians qualified as specialists in this comparatively new field, and the training grant pro- gram has given emphasis to increasing this number as well as helping Vocational Rehabilitation Administration 353 to insure that all physicans will be knowledgeable about rehabilitation concepts and techniques. Teaching grants to schools of medicine are made to stimulate the inclusion of rehabilitation content in the instruction of all under- graduate students. In 1964, they reached 70 of the 91 approved schools of medicine and osteopathy. This was a noticeable increase from 1956, the first year in which teaching grants were awarded, when only six schools received grants. Grants for undergraduate traineeships include provision for med- ical students to have intensive work experience of 2 or 8 months duration in research or clinical service in rehabilitation. In the first year of this program in 1960, 76 students were awarded such trainee- ships. In 1964, it is estimated that 272 students will have this experience. Since 1955, when only 4 physicians were receiving VRA traineeships for residency study in physical medicine and rehabilitation, the num- ber has grown to 139 in training on June 30, 1964. Just as the rehabilitation process is considered to be the responsibility of many professional fields, so are the medical aspects recognized as involved in several specialties. In addition to the 139 persons specializing in physical medicine and rehabilitation on a full-time basis in 1964 there were 36 physicians enrolled in other residency training programs who were pursuing training in physical medicine and rehabilitation on a part-time basis. Another great need is for educators equipped to give leadership in instruction in physical medicine and rehabilitation. To meet this need for broadly trained academicians, an academic careers program has been established. Grants for this purpose offer opportunities to promising physicians for advance study in rehabilitation topics that will enhance their qualifications for academic posts. Four were in training at the end of the year. Rehabilitation Counseling The field of rehabilitation counseling is primarily concerned with helping a disabled individual to achieve his most productive role. Specific emphasis is placed on the client’s occupational adjustment. Rehabilitation counselors are employed in State vocational rehabilita- tion agencies, rehabilitation centers, hospital rehabilitation programs, the public employment service, sheltered workshops and in a variety of rehabilitation programs in public welfare or public health agencies. They work in a close team relationship with physicians, social work- ers, and other professional personnel serving disabled persons. In many agencies, the counselor carries responsibility for employer edu- > | ‘ 354 Department of Health, Education, and Welfare, 1964 cation and community publicity programs designed to attain a greater acceptance of handicapped persons as qualified job applicants. In State vocational rehabilitation agencies, the counselors are responsible for evaluating the vocational potential of disabled individuals, ar- ranging for medical care, training, and other needed rehabilitation services, and placement in a suitable job. Estimates of the number of graduates of rehabilitation counselor training programs needed annually for replacements or to fill new positions in expanding programs have increased from 600 to a mini- mum of 800, and 1,200 is considered a more comfortable margin. University training programs in rehabilitation counseling are cur- rently graduating many less than these requirements. Because of the urgent need, especially in the State vocational rehabilitation agencies, a large proportion of the training grant funds, second only to medicine, is used for the support of counselor training. In fiscal year 1964, | such teaching grants were made to 38 educational institutions, and 775 traineeships were awarded. Of this number, about 360 were grad- uated and ready for employment, since the curriculum is generally 2 years in length. Psychology The psychologist working in the field of rehabilitation helps the disabled client to deal with those practical psychological problems that prevent him from functioning at his highest ability. Psychologists trained to work with the severely disabled are in extremely short supply. Support exists for the training of psychologists in several special- ized areas, with concentrated emphasis on applicability to work with the disabled. In 1964, 12 universities received grants to strengthen the teaching of rehabilitation psychology and 52 students were awarded stipends for doctoral studies in this field. Since 1957, about 55 students have completed graduate training, chiefly at the doctoral level. Psychiatric Internships In 1964, VRA continued its psychiatric intern training program— started in 1963—for counselors employed in State vocational rehabili- tation agencies. The aim is to provide additional training in psychi- atric rehabilitation to experienced counselors so that they might more effectively serve individuals recovering from mental illness. Three university departments of psychiatry associated with comprehensive hospitals have established training units. Since its inception, 38 Vocational Rehabilitation Administration 355 trainees from 22 State agencies have completed the psychiatric in- ternship program. About 38 additional trainees are expected to complete the program in 1965. Speech Pathology and Audiology é ; Training grants in speech pathology and audiology are increasing the number of speech and hearing clinicians qualified to diagnose and treat adults with communicative disorders. Teaching grants are made to assist university training centers to expand their programs and _ modify their curricula to provide more extensive training for work _ with adults since the majority of the previous programs had been oriented toward preparation of students to work in the public school system. Traineeship grants are made to training centers so that students interested in speech and hearing therapy with adults can secure graduate training, and so that experienced clinicians can have advanced training for teaching or research positions. To provide therapy for the 8 to 9 million individuals with impaired speech or hearing, it is estimated that about 20,000 clinicians are needed, which is almost twice the number currently employed. In order to reach and retain this number 1,500 students should complete graduate study each year, Since about 800 students completed graduate study in 1963, just over half the numerical need is being met. In 1964, teaching grants were made to 59 graduate programs with a total of 491 traineeships, a significant increase since the first grants were made in 1958. The number of clinicians providing services to adults in various rehabilitation settings has greatly increased, espe- cially during the past 2 years. It is anticipated that manpower short- ages will continue to decrease as more of the trainees complete their studies and begin employment providing direct services to handi- capped individuals. Since 1958, approximately 1,300 trainees have completed their studies and 90 to 95 percent of them are engaged in full-time clinical, research, or teaching activities. In addition to the training programs continued throughout the year, there were 9 short- term training courses conducted for 278 trainees. Workers for the Deaf Relatively few professional workers in rehabilitation are equipped with enough knowledge about problems of the deaf. Special skills, such as the ability of communicating manually, are most important in providing the necessary services to these individuals. In 1961, VRA inaugurated a specialized training program designed to prepare a small number of persons working with the deaf for positions of leadership. 356 Department of Health, Education, and Welfare, 1964 Twenty trainees have completed this course of study which includes content drawn from several disciplines, and is composed of both class- room instruction and actual field experience in several settings. Dur- ing 1963 and 1964 additional programs were developed. These pro- grams provide orientation of professional workers to the problems of the deaf. Social Work Grants to schools of social work enable them to incorporate rehabil- itation content in their curricula and provide opportunities for selected students to prepare for future employment as social workers on re- habilitation teams, to participate in research in rehabilitation, or to give leadership in community planning for new services. Social workers in nearly all settings deal with disability and must be able to relate it to the individual, his family and the community. Most teaching grants are now being made for establishment or ex- pansion of field instruction units in nontraditional settings including State vocational rehabilitation agencies and institutions for the men- tally retarded. This is an innovation that is meeting with consider- able success in several State agencies. It is estimated that of the 15,000 social workers needed annually at least 1,500 are needed in health and rehabilitation fields. In 1964, teaching grants were made to 42 of the 58 accredited schools of social work, and 45 schools were awarded traineeship grants for a total of 279 trainees. The 45 schools receiving teaching or traineeship grants had a full-time enrollment of about 5,600 as of November 1, 1963. Nursing Grants to schools of nursing have as their objectives the infusion of rehabilitation content into all relevant aspects of graduate nursing curricula and the specialized preparation of selected nurses for teach- ing rehabilitation to graduate and undergraduate nurses. In 1964, | grants were made to 10 graduate schools of nursing, and traineeships were awarded for 62 nurses. Occupational Therapy Grants for the training of occupational therapists assist schools in their efforts to make the curriculum an effective and dynamic pro- fessional education program; to foster the establishment of new schools in medical centers where such a training program is needed to round out the training of medical and related professional groups; and to increase the number of occupational therapists qualified for teaching, research or other leadership positions. Vocational Rehabilitation Administration 357 Each year there are about 500 graduates in occupational therapy. Some 6,800 registered occupational therapists are available in the United States; the estimated need is about 12,000, with approximately 4,000 new personnel required annually. Since 1955 about 1,600 students of occupational therapy have re- ceived financial assistance. The number of traineeships has increases from 52 in 1955 to 385 in 1964. In 1964, 18 of the 83 approved schools of occupational therapy received teaching grants. Physical Therapy The shortage of physical therapists is a matter of grave concern to the development of the total rehabilitation program, for physical therapy is an essential element in the treatment of nearly all kinds of disability. The training grants in physical therapy are directed toward improving and expanding the training programs in approved schools; accelerating the growth of newly established schools in geographical areas needing them; providing opportunities for ad- vanced study by graduate physical therapists; and fostering experi- ments in new methods of training. About 9,000 physical therapists are currently available in the United States. Between 1961 and 1963 the average number of students who were graduated annually by 36 schools was 560. In 1964 it is esti- mated by 42 schools that approximately 1,000 students will be graduated. Since 1958 traineeships have been awarded to 85 experienced physical therapists for graduate study in physical therapy or related sciences, such as anatomy and physiology. Those who have completed their graduate training are now working in teaching, research or adminis- trative positions in the field. During 1964 traineeship grants were made to 41 of the 42 approved schools of physical therapy, and slightly over 400 undergraduate or certificate students received VRA assistance, which now represents the largest scholarship program for this field. Prosthetics and Orthotics Since 1953, over 9,000 rehabilitation personnel including prosthetists, orthotists, physicians, physical and occupational therapists, and reha- bilitation counselors have received specialized training in the fields of prosthetics and orthotics (artificial limbs and braces) in VRA- supported courses at the University of California at Los Angeles, Northwestern University, and New York University. The VRA-spon- sored traineeships have brought teams of medical personnel to these classes where the clinic team approach to rehabilitation, practiced today in all of the major hospitals and specialized rehabilitation cen- ters, had its initial impetus and development through student partici- pation in amputee clinic practice sessions. Trained personnel in prosthetics and orthotics are urgently needed to staff clinic teams and rehabilitation centers throughout the country. There is also a great need to provide training to residents in ortho- pedic surgery and physical medicine during their residency training. Training Workers for the Blind The recently established university courses for mobility instruction of blind persons were continued in 1964, as was the special training program to teach rehabilitation counselors the basic principles and specialized techniques of placing blind persons in competitive employ- ment. The courses for mobility instructors enrolled 28 trainees during 1964. The newly established training of home teachers for the blind en- rolled its first class of eight students, and some were scheduled to receive their degree early in 1965. The demand for the services of these qualified teachers is increasing and applications for admission to the course indicate a growing interest on the part of potential employers as well as on the part of potential students in this new program. In the area of short term courses for services to the blind conducted among State agency personnel in 1964, there was a series on placement of the blind in competitive occupations; on vending stand supervision and operation; on home teaching of the blind; for home teachers and their volunteer assistants; employment of blind persons as telephone switchboard operators; courses in industrial arts for the blind; place- ment of blind in Federal employment; and in-service training of home teachers of the blind. Recreation for the Ill and Disabled Seven schools were awarded grants in 1964 to train recreation spe- cialists and 28 students were enrolled in these programs. The program was initiated in 19638 and the first traineeships were awarded for the academic year 1963-64. Home Economics Objectives of the home economics training program are to provide financial assistance for study at the master’s and doctoral levels; to refine requirements and criteria for selecting home economists for traineeships in rehabilitation; and to develop graduate programs. ~ 358 Department of Health, Education, and Welfare, 1964 d i + Vocational Rehabilitation Administration 359 Since the first grant for graduate traineeships was awarded in 1963, a total of 15 has been given at the master’s and doctoral levels, with 10 of these in 1964. Short-Term Training Courses In 1964 stress was placed upon short-term training of State voca- tional rehabilitation agency personnel in the following areas: ad- vanced counseling techniques, particularly in the area of motivation; supervision of rehabilitation counselors; job placement techniques; and improvement of the services to the blind, deaf, mentally retarded and those recovering from mental illness. Training for personnel who deal with the mentally ill or emotionally disturbed has included courses on rehabilitation and after-care services for patients returning to the community after a stay in a mental hospital; rehabilitation counseling of the alcoholic, and psychological services for the mentally retarded. Training courses in the field of communicative disorders, which were held primarily for speech pathologists, have included post-laryngectomy speech, aural rehabilitation of adults and emotional problems affecting speech development in cleft palate cases. New Training Centers in Mental Retardation In 1964 training centers in mental retardation were established at State universities in North Carolina, Texas, and Wisconsin, and at Columbia. These centers will conduct a series of short-term courses on a year-round basis and develop new teaching materials for this specialized area. They feature a multiplicity of academic, clinical, re- search, vocational and other resources, and were being staffed with full-time faculty of competence in various aspects of rehabilitation of mental retardates. In addition to these centers, grants for support of field instructional units in mental retardation have been made to 16 universities which have basic training programs in social work, rehabilitation counseling, and speech pathology and audiology. These units have a total of 90 trainees. It is anticipated that additional programs will be developed during fiscal 1965. The settings for such units are in residential train- ing schools, public and private schools, sheltered workshops, hospitals, clinics, rehabilitation centers, VRA research and demonstration proj- ects, State vocational rehabilitation agencies, and other programs serving the mentally retarded. 360 Department of Health, Education, and Welfare, 1964 Research and Training Centers Three years ago the Vocational Rehabilitation Administration in- stituted a series of grants to universities having medical schools and other facilities where rehabilitation research and training can be con- ducted under the favorable conditions that are offered in such settings. Unique contributions to modern rehabilitation are coming out of these efforts, for they provide strategically located institutional situations in which people can be trained in virtually every phase of rehabilita- tion, and where rehabilitation research of a high order can be developed. The first research and training centers of this kind were at New York University and the University of Minnesota, followed soon by the University of Washington and Baylor University. Western Re- serve University and Emory University were also getting started in this direction in 1964. The size and importance of the medical schools participating in the program provide a wide spectrum of disabled patients for clinical in- vestigation, and their education facilities offer almost unparalleled opportunities for the training of undergraduate and graduate students in subjects within or allied with rehabilitation of the disabled. Among the disciplines that have been strengthened in the research and training center program are physical therapy, occupational therapy, prosthetics and orthotics, nursing, speech and hearing, psychology, rehabilitation counseling, rehabilitation administration, and special education for handicapped youths. Graduate and post-professional training are also offered in most of these subjects. Activities at the centers often vary. At New York University there is strong emphasis on medical research in the range of disabilities en- countered in the public rehabilitation program. An increase of inter- est in these activities in 1964 almost doubled the volume of research efforts of the preceding year, and greatly widened its scope. At the University of Minnesota—where the program is. conducted jointly with the Sister Kenny Institute—more than 35 clinical investi- gations and research studies were in progress in 1964, and about 40 publications have been issued, bearing on a wide range of medical and paramedical findings as they pertain to rehabilitation. The University of Washington has made available a new research laboratory for three major projects, and its Department of Mechanical Engineering is using the rehabilitation program as a testing ground for students entering the new field of Medical Engineering. A typical example is an undergraduate study of friction and lubrication of the knee joints in rabbits, which can have considerable implication for studies of the human anatomy. A wide variety of medical and scien- Vocational Rehabilitation Administration 361 tific investigations brings to a total of 18 the projects carried on in 1964. Twelve new research projects were begun at Baylor University in 1964 under this program, and 15 others were continued from 1963. These, too, covered a wide range of investigation applicable to the re- habilitation program. A great many of the projects concerned care of patients in the rehabilitation process, including evaluation of car- diac patients, pulmonary cases, and quadriplegics. As an example of the operation of these programs, Baylor’s College of Medicine reported for the first 8 months of 1964 that a total of 167 patients, each spending an average of 35 days as subjects of rehabilita- tion studies, had not only served rehabilitation research but had also received rehabilitation services that benefited them enormously. 748-869.—65——24 362 Department of Health, Education, and Welfare, 1964 Table 1.—Number of referrals and cases, by agency, fiscal year 1964 Referrals During fiscal year Remain-' Not ing at Acceptedjaccepted| end of Total active Joad (re- | Rehabil- ceiving services) During fiscal year Cases Closed from active load Remain itated After rehabil- itation plan in- itiated 4 Before rehabil- itation plan in- itiated 5 399, 852 119, 708 20, 062 Agency! Total United States, totaly- 4-3 513, 371 Alabama.....------ 9,157 Alaska 255 S252 2, 627 Arizona: General___----- 2, 350 Blind eo 119 Arkansas/iet'. 22228 9, 038 California_...-..-. 40, 024 Colorado.....------ 4, 958 Connecticut: General.__-__--_- 2, 747 Blinds 22 =. 182 Delaware: General_.__-_-- 1, 435 Mind s3 ee 56 District of Colum- [of eee ees 4, 548 Florida: General__---_-- 25, 409 Blinds pees 3, 476 Goorgid fenesatsce 26, 806 Guaimowsecsccece- 8 115 Hawaii: General-s.s- 2 1,979 Blind i520. 225-2 8 Idaho: General_..--_.- 2,105 Bind 22 -ee 2 Winois. 3250-2 13, 727 Indiana: General________ 4,009 Bind se2tS.= 165 Towa: General_._-_..- 6, 272 Blind 25.322 215 Kansas: General_..-___- 2, 736 Blindow 352225. 357 Kentucky.....-~..- 12, 927 Louisiana: General...-_-_- 4,939 Blind2 225.222 706 Maine: General. 2, 036 Blind__- 274 Maryland 7, 205 Massachusetts: General________ 12, 672 Blind. 2s =ce22 312 Michigan: General.o-. 222. 10, 060 Bima Sone: 37 Minnesota: General.._-_---- 7, 603 Blind 2esebeet 1,166 Mississippi: General..------ 3, 920 Blind. £555.02 1,139 Missouri: General___----- 8, 880 Blind 2 cscs 855 Montana: General_—c-.--- 2, 040 Blinds:2s523%. 235 Nebraska General._._---.- 1, 986 13) Lbs bias pe eereS 439 for for year3 Services |services 2 179,182 | 171,785 | 162, 504 4, 864 1, 563 2, 730 208 115 204 880 639 831 57 19 43 3, 937 2, 541 2, 560 9,025 | 25, 035 5, 964 2,103 1, 291 1, 564 1,348 477 922 51 46 729 454 252 47 5 4 1, 739 1, 836 973 8,153 | 10,512 6, 744 409 1, 629 1, 438 8, 452 5,884 | 12,470 35 34 46 595 798 586 42 23 21 471 878 756 16 11 1 6, 695 3, 864 3, 168 2,123 922 964 4 49 67 1, 920 1,717 2, 635 79 48 88 988 749 999 87 76 194 4,974 4, 585 38, 368 3, 245 808 886 259 100 347 549 623 864 108 64 102 2,918 2,304 1, 983 3, 299 5, 132 4,241 173 32 107 4,104 1, 965 3, 991 208 80 2,176 3, 233 2,194 26 490 407 2, 006 764 1,150 410 486 243 2, 840 3, 566 2,474 252 325 278 815 637 588 22 179 34 823 425 738 133 162 144 See footnotes at end of table. 10, 884 422 1, 603 192 7, 004 20,171 4) 632 3, 928 226 1, 402 74 688 27 ee Vocational Rehabilitation Administration eC eee Table 1.—Number of referrals and cases, by agency, fiscal year 1964—Con. Referrals During fiscal year Agency! Remain- : Accepted} Not ing at Total for |accepted| end of services for year 3 services 2 Nevada: General____---- 959 194 581 184 | as EE 36 19 10 rf New Hampshire: General________ 641 344 167 130 iit 2 109 37 23 49 New Jersey: General________ 11, 420 4, 542 3,199 3, 679 905 216 296 393 1, 889 587 780 522 231 64 58 109 31, 752 11, 359 10, 525 9, 868 1, 689 805 263 621 13, 346 7, 643 38, 910 1, 793 i 1, 475 617 572 286 North Dakota____- 2, 064 467 504 1, 093 Ohio: General________ 7, 882 3, 676 1, 975 2, 231 33172: oe 741 336 169 236 Oklahoma. -______- 9, 914 8, 548 2, 942 3, 429 Oregon: General_______- 6, 624 1, 624 2, 934 2, 066 1h 3 ts Ma ES ES 263 51 111 101 Pennsylvania: General________ 47, 304 16, 799 13, 982 16, 523 13) bs a Se 4, 235 921 1, 446 1, 868 Puerto Rico_______ 12, 775 2, 712 1, 860 8, 203 Rhode Island: General______-- 5, 502 2, 310 1,155 2, 037 ic i Bes 138 98 12 South Carolina: eneral__..____ 15, 996 5, 108 6, 940 4, 848 LSE dai eat ly 36 168 114 82 South Dakota: General______-- 1, 448 403 330 715 BiG =. 517 49 167 301 Tennessee: General________ 10, 472 3, 791 3, 089 3, 592 GS ae 1,120 341 32 452 Texas: General________ 17, 089 6, 012 5, 998 5, 079 Rnd.) SEP oS 1, 256 429 458 369 Lan Se 1, 930 998 522 410 Vermont: General______.- 1, 614 336 310 968 iiiiits fee 3 15 14 10 Virginia: Menerall: oo. =~ 18, 084 5, 449 7, 683 4, 952 1ST %e P g 930 199 267 464 Virgin Islands_____ 150 44 5 101 Washington: General____..-- 6, 461 1, 504 2, 322 2, 635 wind. === 343 119 102 122 West Virginia_____ 19, 258 6, 129 5, 248 7, 881 Wisconsin: General 4, 037 3, 954 2, 903 Ls eae 104 25 32 Wyoming_.- 214 106 635 Cases During fiscal year Closed from active load 363 end of year 6 Total active load (re- After Before ceiving | Rehabil-| rehabil- | rehabil- services)| itated | itation | itation plan in- | plan in- itiated 4 | itiated 5 387 113 51 25 48 14 3 2 878 215 136 32 101 19 8 8, 720 2, 890 247 370 593 170 19 30 1,001 319 57 39 142 41 5 4 26, 658 7, 641 1,113 1, 675 1, 752 462 35 67 16, 816 6, 214 338 287 , 506 523 17 77 1, 457 374 27 57 8, 731 2, 642 354 672 1, 159 193 56 97 10, 284 2, 258 268 512 3, 274 721 143 270 160 34 10 3 36, 325 11, 103 1, 907 1, 441 1, 708 478 46 101 7, 031 1, 530 87 215 4, 753 1, 501 285 21 280 65 12 29 11, 083 3, 263 223 331 435 118 6 18 1,077 294 31 7 148 32 7 1 8, 357 2, 861 261 229 782 309 14 29 13, 156 4, 268 366 815 906 320 23 30 2, 668 704 151 21 910 186 50 29 40 10 4 1 10, 838 4,175 232 557 380 163 ll 5 93 40 0 0 4,017 1, 045 178 221 301 54 14 16 15, 326 3, 875 134 1, 136 9, 870 2, 627 160 117 263 57 13 19 423 83 8 0 1Jn States with 2 agencies, the State division of vocational rehabilitation is designated as ‘‘general’’ and the agency under the State commission or other agency for the blind is designated as “blind.” 2 Services declined, services not needed, individual not eligible, individual needing services other than vocational rehabilitation, referred to other agencies, migratory shifting of the individual, etc. 3 Eligibility for rehabilitation not yet determined. ; 4 Closed after rehabilitation plan was initiated; received rehabilitation service but never reached the point of employment because of personal factors, illness, aggravated disability, etc. 5 Closed prior to initiation of rehabilitation plan because of indifference of individual, increase in degree of disability, loss of contact, ete. 6 In process of rehabilitation on June 30, 1964. 1 Estimated, 364 Department of Health, Education, and Welfare, 1964 Table 2.—Vocational rehabilitation grants, 1964, State divisions of vocational rehabilitation Extension State or territory Support and im- Total grants provement grants Total = sho. Bem seat e csn cn se san boone aoa eteneres $77, 219, 830 $1, 766, 272 $78, 986, 102 Alb am 6 2naes 2 eset ee ee Sa omaweeereat eames rene 3, 708, 707 49,872 3, 758, 579 168,166 |.-<-..-beseeee 68, 166 609, 134 13, 336 622, 470 2, 882, 220 27, 990 2,910, 210 3, 884, 810 260, 551 4,145, 361 1, 279, 611 29, 279 1, 308, 890 356, 525 31, 898 388, 423 145, 986 15, 000 160, 986 462,113 7, 238 469, 351 2,310, 791 49, 148 2,359, 939 5, 068, 388 62, 950 5, 131, 338 78, 649 |-------------- 73, 649 389, 794 |..------------ 389, 794 270, 327 |---=-----=---- 270, 327 2, 785, 738 155, 520 2, 941, 258 713, 838 |-------------- 713, 838 920, 838 14, 752 935, 590 601, 078 26, 154 627, 232 Kien tuck ya cs: baa 8 eee eee Seca e eee 1, 339, 645 47,320 1, 386, 965 Louisianass.__- 9-3 32-- as 1, 868, 900 |-------------- 1, 868, 900 Maine. 2 s82-0".— & aabe 288,777 |-------------- 288, 777 Maryland = 27 cececcess secs 1, 085, 794 15, 669 1, 051, 463 Massachusetts__-..------------ 1, 391, 099 48, 057 1, 439, 156 Mrichigan®.’ 5... ear. 9s lee ae (5 reso ee 1, 544, 212 111, 648 1, 655, 860 IMinnesotelst Soc eee 2 ee foes See 1, 389, 193 24,124 1, 413, 317 Mississippi. -.cceesto.-2-4-ees 1,157,498 |-------------- 1, 157, 498 MMcissouris2) = ees oa 1, 105, 946 53, 382 1, 159, 328 Montane le cee sies anes , 854 15, 000 386, 854 Nebraska 99). .- 02 eee seas 358, 007 15, 190 373, 197 ING VBUG tote eee oe coe tice oa aa eee = ee een reer 107, 466 1, 500 : New Hampshire tebe! 2. ee 2s ee Seen ae eee 102, 856 |-------------- 102, 856 INOW Jersey. 2 coe leeees 1, 427, 297 81, 945 , 509, New Mexico , 488 15, 661 , 149 New York -2.. tee os 5, 200, 000 204, 267 5, 404, 267 North Carolina 3, 510, 369 |--------.----- 3, 510, 369 North Dakota 398, 323 15, 000 413, 323 QUO. ot ne oe Bie cee ee wo se ee ee coe eee 1, 386, 313 16, 096 1, 402, 409 Oklahoma toeeectt oes 1, 900, 579 37, 586 1, 938, 165 Oregon) bse. Pee 862, 094) | n-seeceees ee 862, 094 Pennsylvania 6, 791, 927 99, 662 6, 891, 589 Muerto WIGO note eek cea s 1,367, 428 }s=--------=—-- 1, 367, 428 Rhode Island 584, 836 10, 500 5, 336 Both Carolitta! ts 2222.1 4e. 5, cae ade oe seca a aap 2,327, 990 |--------~----- 2, 327, 990 South Dakota , 690 12, 000 419, 690 ‘TONNesspesa.—<5-enssee se 1807, 004) a eee eee a 1, 807, 094 HNC OT pe a Miele eae 2 eee, 2, 667, 824 60, 000 2, 727, 824 Witeh? 9 so. 2.. bees 446, 935 15, 000 461, 935 WOPMON Goo cccsntcodetcwabinccucdsuss—sch ugh hss de euasn nae 239, 418 3,417 242, 835 Wir giniah as once = see we ee nen eee a eee ea eee 1,855, 405 |---------<.c= 1, 855, 405 Virgin slands.- 3 ee one geen does eephebnn yer cesta ee ran 46; 198 |= -ceene ono 46,193 ‘Washington. 0-228 6 ..cene eas o nate ea eee oe eer 997, 585 33, 558 1, 031, 143 West Virginia << 9) ee Sees 82st Se oe eee 2, 102, 198 27, 223 2,129, 421 Wisconsitt. ... ..6ob et on coed ke o> cts RS enema an ads cenen= 1, 709, 578 43,779 1, 753, 357 Wyoming -—*. 2°" 02. 20. cess oo oo eee ee ea ae 171, 306 15, 000 186, 306 a _— Vacational Rehabilitation Administration 365 Sanne ce 8 ee eee Table 3.—Vocational rehabilitation grants, 1964, State commissions or agencies for the blind , Extension State or territory Support | andimprove- Total grants ment grants $7, 636, 541 $156, 176 $7, 792, 717 106. 374-19 oa ee. 105, 374 85, 000 7, 975 92, 975 34, 340" (eee eeu 34, 342 G02, 000) | Saas pea 602, 000 (See Cea eR SNS te 71, 487 25252 (| bao eee 25, 527 58, 612 65, 386 197, 657 197, 657 179, 586 179, 586 224, 573 224, 573 106, 880 109, 805 210, 463 210, 463 126, 584 126, 584 226, 785 226, 785 LEB UM La Aa 460, 266 468, 640 Avadomeimeemeeieees eS. 247, 116 247, 116 54, 468 54, 468 96, 950 104, 545 S7 100! | seme oe eee 37, 169 41 405; (ee Ses ee 41, 405 288, 481 9, 900 298, 381 YOR eee eee ee 73, 278 687, 340 28, 163 715, 503 600; 900 [52-235 690, 900 403, 107 11, 254 414, 361 Vai seers 104; 406" see 104, 405 Pennsylvania_------_ 605, 063 60, 928 665, 991 Rhode Island_----_--- 87, 548 3, 750 91, 298 South Carolina. 88;(708: |. 52s eee 88, 798 SU LU GCS Sr a Se 85, 116 3, 000 88, 116 (USES iaS uu. et ee ee 613,840) los -eeec eee 513, 846 319, 878 43, 966 181, 159 183, 838 93, 112 i > oe.” , * 5 ow foe Ye 3 be , cs —a es i . in ait igo) ed £ sh) Teed erd ety byl: erreviiee ae , “s eo meeeerete = percwrtere oterens minnie atc ee + ft ; ye volatleebautio: Sree QO «ret ehelibilideded ls baci’ ae sok pat by - ; x cmairw? BH ate Saint Elizabeths Hospital Saint Exizazerus Hospital, the largest federally operated hospital for the mentally ill, fulfills its statutory mission by means of three major programs: 1. Treatment—This involves the therapeutic, rehabilitative, and protective programs for an average in 1964 of 7,641 patients including residents of the District of Columbia, beneficiaries of the Veterans Administration, beneficiaries of the Public Health Service, mentally ill persons charged with or convicted of crimes in U.S. courts including the courts of the District of Columbia, and certain American citizens and nationals found mentally ill in foreign countries, the Canal Zone, and the Virgin Islands. 2. Training and Education—This program provides multidis- ciplinary clinical training for professional and other personnel engaged or interested in mental health activities. 3. Research—The hospital plans, develops, and carries out coordinated research programs and projects for the purpose of obtaining a better understanding of the causes of mental disorders, and of the factors bearing upon their development, treatment, and possible prevention. A close working relationship is maintained with the National Institute of Mental Health. In making an annual assessment of the programs of a large institu- tion for the treatment of the mentally ill, it is appropriate to include a statement of the principles governing its operation. It is mankind’s current fundamental concepts as they relate to man in general and to the mentally ill in particular that determine how the mentally ill are treated, and what kinds of programs are developed for them. Fundamental concepts, of course, change through time. 367 368 Department of Health, Education, and Welfare, 1964 Since man is the originator, perpetuator, and executioner of ideas, it is not surprising that he has many ideas about himself. One of the most fundamental is that man is important—important as a person and as a species. From this flows the notion that he, as a person, is entitled to certain rights and respect within the bounds prescribed by the society of which he isa part. In a democratic society, it follows, on philosophical grounds, that this social form can survive only so long as certain personal human rights and dignity are recognized and honored. An erosion of personal rights is often an erosion of democ- racy itself. Our current concepts are that mentally ill persons are treatable because their difficulty is based on naturalistic causes of a medical, psychological, and social nature capable of being, if not yet, fully understood. These basic concepts lead to certain corollaries. (a) The diagnosis and treatment of mentally ill persons are medical problems, but there are social, psychological, and often legal issues involved. (b) Every mentally ill person must have easy and prompt access to programs and services appropriate to his particular needs. (c) It should be presumed that a mentally ill person wants treatment in an appropriate community program, including a mental hospital, unless he actively objects. (d) Those persons dealing with the mentally ill, including friends and relatives, the professional and nonprofessional per- sonnel who provide service to them in and out of hospitals, and attorneys and courts involved in any judicial proceeding, are to be presumed honestly concerned with the best interest of the patient. (e) The human dignity and rights of mentally ill persons must be protected and are as important as the need to protect society. These individual rights include protection, not only against wrongful deprivation of liberty, but also against invasion of pri- vacy, and exposure to traumatic situations inimical to the — treatment of the mentally ill. (f) The patient is the most important person ingot in any mental health program. Without the patient or potential future patient there would be no programs for the treatment of the mentally ill nor the promotion of mental health. Not a few per- sons who believe themselves to be genuinely concerned with the improvement of services for the mentally ill tend to forget the patient. It is not uncommon to see people in different organiza- tions contesting between themselves about who shall provide cer- tain services to the mentally ill. Perhaps this is due in part to Saint Elizabeths Hospital 369 the current dedication to specialization with its attendant prob- lems of professional identity. Many organizational and pro- cedural problems might be easier of solution than they now appear to be if those concerned with their solution were really dedicated to the concept that the patient is the reason for their professional or organizational being. Certain administrative and clinical principles should be honored in the organization of a mental hospital and other facets of a compre- hensive mental health program. 1. There should be continuity of service for each patient. One of the most important tools in conducting therapy with many psychiatric patients is the development of a meaningful human relation between therapist and patient. It is self-evident that the maintenance of such a relation is made difficult if there is a con- tinual change of therapists during the treatment. Further, many patients have particular difficulty in establishing human thera- peutic relations because of their iilnesses. To call upon them to shift this relation from one therapist or group of therapists to another several times during the course of treatment complicates rather than facilitates the treatment process. There are rarely valid reasons to transfer a patient from one therapist or group of therapists to another within the hospital setting. 2. Responsibility must be clearly defined. As long as one group of therapists has the opportunity readily to shift patients to other therapists, responsibility for treatment has not been clearly de- fined. This is important clinically, since therapists will often deal differently with a patient whom they can transfer to someone else than they would if they knew they would have to cope with that particular patient’s behavior. 3. Authority must be given commensurate with the responsi- bility assigned. This administrative principle is very often vio- lated in mental health programs. While there is certainly a place for overall medical policy and “higher authority,” it is possible that if there is a general error in this situation today, it is to give too little, rather than enough or too much authority to persons immediately responsible for treatment of a particular patient. 4, Patients and employees tend to respond to the environment and expectations of the place in which they live and work. Many large public hospitals, and private ones for that matter, distribute their patients on a behavioral classification basis. The trouble with this system is that if a patient is placed in a “disturbed ward” either officially or unofficially designated as such; where the modal behavior of the patients on that ward is disturbed; 370 Department of Health, Education, and Welfare, 1964 where disturbed behavior is expected by the employees; it is not surprising that the patient just introduced to that environment may behave in a disturbed fashion. If a patient is not disturbed while living in a “disturbed ward,” he is a deviant in that cul- ture. If, on the other hand, he is placed in a ward where disturbed behavior is not the modal behavior, where it is not expected by the employees and they will thus try to take steps to minimize or prevent such behavior, and where it is poorly tolerated by the other patients; most patients will behave in a much less disturbed fashion. The same can be said for “untidy,” “regressed,” and other types of wards. It is this type of behavioral classification and organization that also leads to the discontinuity of service for a particular patient as he changes from one behavioral classi- fication to another. Perhaps much of this type of behavioral classification was adopted by our larger hospitals as a convenience for employees who were present in woefully insufficient numbers, but in some instances it also seems to call out rather loudly some underlying assumptions about lack of treatability. 5. Manpower should be utilized at its highest level of compe- tence. Utilizing manpower at less than its full capability is not only wasteful in dollars but is damaging to the dignity and integrity of the individual concerned. Using physicians as clerks, or nurses as janitors results in poor treatment, poor clerical work, poor sanitation and an unhappy staff. 6. Progressive personnel should be employed. 'This refers to the importance of recruiting persons, both professional and non- professional, who are devoted to “seeking a way to get a job done” in contrast to those who characteristically point out why “it cannot be done.” 7. Commonly accepted operating assumption should be queried. It is important that assumptions are not accepted as facts simply because they have been used for some time. Certain organiza- tional forms and procedures tend to perpetuate themselves simply because they are time-honored, even though new knowledge has been acquired or new and better operating assumptions could be or have been made that call for their review. Saint Elizabeths Hospital hopes by its service to the mentally ill to demonstrate that it believes in the importance of man; that it has respect for the rights and dignity of the mentally ill; that it believes the mentally ill are treatable; and that it intends to support and administer its programs based on these ideas. Saint Elizabeths Hospital 371 Program Developments In order to improve the continuity of treatment of patients by the same professional staff members, admission services were opened in three additional services during the report year. Seven of the 12 Psychiatric Services now provide such programs. Further, with few exceptions, patients who require readmission are now admitted directly to the Service from which they were released, where they are already acquainted with the personnel, rather than to be admitted, as in the past, to one of the “admitting services.” These changes, made during the latter part of the report year, have substantially reduced the number of instances in which it has been necessary to transfer a patient from one treatment team to another. “Continuity of treatment” is thus fostered. Still another significant change to improve continuity of treatment took place i in the operation of John Howard Pavilion, a maximum security building utilized primarily for the treatment of patients admitted as a result of criminal proceedings. John Howard Annex was opened in one ward of East Side Service in February 1964. The Annex provides limited medium security facilities where selected pa- tients from John Howard Service may be treated by the staff of that Service when maximum security is no longer medically indicated. The Hospital has long needed medium and minimum security facilities as an integral part of the John Howard Service. The Annex represents only an interim measure until such time as the John Howard Service as it now exists can be expanded into a complex which would provide maximum, intermediate, and minimum security facilities necessary for the treatment of patients admitted as a result of criminal proceedings during the entire period of their hospitalization. It is recognized that the acquisition of new facilities will require several years, hence the importance and significance of the temporary measures represented by the creation of the John Howard Annex. The new Physical Medicine and Rehabilitation Building constructed at a cost of approximately $4,389,000 was put in operation during the year. Four wards were opened in August 1963, and the remainder later in the year. The new building provides badly needed physical medicine and rehabilitation resources but in addition has dining facili- ties for approximately 400 patients from adjacent buildings, as well as for those patients living in the Physical Medicine and Rehabilita- tion Building. Up to this time the first group was fed in a distant overcrowded cafeteria, access to which was rather difficult. Subsequent to the opening of the Physical Medicine and Rehabili- tation Building, space was allocated in that building, and equipment 372 Department of Health, Education, and Welfare, 1964 procured for the establishment of a Speech Pathology and Audiology Unit. The most modern audiological evaluation and treatment equip- ment has been procured and installed, and although selected primarily for patient service, it is also of great value for training and research purposes. This unit provides patient service through the evaluation and treatment of patients with communication problems, training services through which students may acquire practical, supervised experience in evaluating and treating such patients, and the means for conducting significant research projects. A valuable byproduct resulting from the establishment of this unit is the elimination of the need for transporting patients to facilities located away from the hos- pital for specialized treatment as in the past. The hospital’s new program in the Youth Center progressed very well in the development of structured activities for mentally ill chil- dren. There are now in the hospital about 60 patients under 18 years of age who merit special consideration because of the possibility of lifelong maladjustment unless there is some modification in their . present course. These young patients do not yet have fixed patterns of behavior, neither have they completed their schooling nor made their vocational choices. Their relationship patterns and personality are still in a state of flux; their sense of values and attitudes are still fluid. Therefore, they need a special program somewhat different from that provided for adult patients. Specifically, they require educational and group activity programs carried out by persons trained to work with emotionally maladjusted children and adolescents. It would be desirable to have a 24-hour-a-day structured program in a residential setting. Since the facilities and staff are lacking for such a program, the hospital must, for the present, content itself with special activities in the Youth Center for these young patients. A hospital improve- ment grant received from the National Institute of Mental Health will assist in the endeavor. The interest of the community in hospital activities is evidenced by the continued increase in the number of hours of service furnished to patients, without compensation, by volunteers. The following tabula- tion reflects a gratifying though somewhat declining rate of increase during the past year: Hours of service Year by volunteers BS | 7, Sena aicee ee Spe eeeee eete__Sea ly a a ee e a Bee 52, 290 LOGS Sa 8 ce ee ee ees ee ee ee 49, 933 NOG 2) Meee Ah ee Sie ee a ee soe eee ee ee ee 40, 058 Saint Elizabeths Hospital 373 The value of volunteer services is not to be measured only in terms of hours. Many, if not most, services furnished by volunteers are of a nature which, for a variety of reasons, the hospital is unable to supply. In recent years as well as in 1964, there has been a marked improve- ment in the hospital’s sanitation. Insect and rodent control has be- come quite sophisticated. Effective cleaning materials are being man- ufactured at considerable savings. Dietary and ward living area inspections have paid off in improved cleanliness and are resulting in active cooperation from personnel and patients alike. Official visitors from many foreign countries and most of the states came to the hospital during the year. These visits pointed up again the potential that exists at the hospital to lead the way in treatment, training and research by serving as a demonstration center. Population Trends The average resident population continued to decline as did admis- sions and discharges from the hospital rolls. Average in hospital Discharges Year population Admissions from rolls | a Cee 6, 412 1, 692 1, 469 eee 2 ee 6, 668 1, 930 1, 559 PN te oS a oe a rear 6, 838 2, 024 1, 648 The number of patients on visit and leave has risen steadily in recent years, increasing from 245 in 1955 to 1,229 in 1964. The median age for resident patients in 1964 was 57 years and the convalescent leave patients, 46 years. Patients on the rolls were about evenly divided between males and females, but there were substantially more dis- charges of male than female patients and also more male admissions than female. Of the 1,692 admissions during 1964, 1,006 were civilly committed from the District of Columbia. Patients admitted as the result of criminal proceedings totaled 391, or about 23 percent of all admissions. (See charts 1 and 2, and tables 1-6). Professional Training and Education During the past year each professional training program has under- gone intensive review with regard to the following: Specific mission, curriculum, and administrative organization; recruitment methods and problems; supply, equipment, and facility needs; consultation and staffing needs; accreditation standards; and techniques for evaluating programs of trainees. The review has produced a number of benefits, a major one being an increasing integration of program activities with the resultant strengthening of programs and simultaneously, the elim- 374 Department of Health, Education, and Welfare, 1964 CHART 1.—AVERAGE NUMBER OF PATIENTS, FISCAL YEARS 1950-64 ination of duplicated effort. Particular attention was devoted to the development of a core curriculum for several professional disciplines, the orientation program for new trainees, methods for centralized assignment, the sharing of training resources, and the development of more efficient methods for processing applications from prospective trainees. A significant development during the year was the authorization, by the Civil Service Commission, of higher stipends for trainees. Although only about 20 percent of the total increase authorized will be paid in fiscal year 1965 because of fund limitations, it is hoped that sufficient funds will be available in 1966 to make stipend payments at the full authorized amount. The increase in stipends should greatly improve the competitive recruitment position of the Hospital, espe- cially with respect to the quality of applicants. This was demon- strated to a limited extent by the fact that even the anticipation of the Saint Elizabeths Hospital 375 CHART 2.—ADMISSIONS AND DISCHARGES, FISCAL YEARS 1950-64 2000 me = - o” 4 3 ‘ a ’ é ’ Ay rm! eh ee eo ennome om fas tun oso e v ’ ; ’ / oh @ ADMISSIONS % o*, s ? os x a a Ss wy ae 1000 rae DISCHARGES FROM ROLLS (EXCLUDING DEATHS) increase has improved recruitment of rotating interns and psychiatric residents. Another significant development in the psychiatric residency pro- gram was the designation at the end of the year, of training officers in five clinical areas. This action was taken to correct a major weakness in the psychiatric residency program caused by the unevenness of clinical supervision of residents in the various hospital units. There is every reason to expect that when this program is in operation in fiscal year 1965, the quality and quantity of the day-to-day clinical work of psychiatric residents will be greatly improved. A cooperative arrangement was inaugurated during the year with the George Washington University as a result of which the senior psychiatric residents will be provided an opportunity to gain essential supervised experience with patients of a type seldom encountered in the normal inpatient setting of St. Elizabeths Hospital. The results of this arrangement have been extremely satisfactory. 376 Department of Health, Education, and Welfare, 1964 PROFESSIONAL TRAINEES, FISCAL YEAR 1964 The tabulation below shows the number of trainees in the various disciplines: Number enrolled during year Physicians’ :-23l2222) ba 3 SAR ee er 45 Psychiatric, residents=4 2a24.22 ee Eee oe eee 29 Affiliate) psychiatric residents 1..°-*-- 22S" __ 6 eee 3 Surgical residents 2-5 ee ee ee ee 34 Radiology residents t2-2--- bi Se ee eee 2 Rotating medical interns..228..22-— ee eee eee tf INUTSOS & 3 = SY a Oe ee 588 Undergraduate + ©. 8a ee 467 Graduate. students 2S)... +... 3 69 Undergraduate collegiate. ™2___ +... 5. ae eee 52 Other =~ 4. sea eee 3, 760 3, 069 3, 046 23 29 640 22 Time since admission Less than 6 months_-_-__-------_ : 613 504 500 4 4 97 8 Gad monthsset: ates sees ois 402 280 278 2 6 108 8 PORT => he eee nee eee 710 476 474 2 10 210 14 SVRBAIS SF hey ee ee 515 381 379 2 5 111 18 Seas yoars:}sa sey - Shiels Ae Pee 830 654 645 9 10 149 17 DEO YY GANS an Mee ee ee 1, 031 852 846 6 10 156 13 1O“1G9fyearss* 24-58 U 2 | Feats 3.3 1,420 1, 257 1, 250 vd 17 139 7 20,yearsiand overic.200 5) ee 2, 000 1, 948 1, 944 4 5 43 4 Median time since admission 8.3 10. 2 10.3 4.8 4.7 2.8 2.8 3, 881 3, 394 3, 378 16 38 414 35 3, 640 2, 958 2, 938 20 29 599 54 9 8 8 0 0 1 0 34 28 27 1 0 5 1 252 194 193 1 2 49 7 781 584 578 6 ff 168 22 1, 169 877 862 15 19 246 27 1,451 1, 156 1,152 4 14 263 18 1, 550 1,376 1,372 4 10 153 11 1,173 1,073 1,071 2 11 88 1 852 814 811 3 4 32 2 250 242 242 0 0 8 0 55 57 57 42 49 46 40 1 Resident patient status should not be confused with the D.C. resident legal category. The former is defined as patients in the hospital plus those on temporary visit. Saint Elizabeths Hospital 383 Table 3.—Movement of patients on the rolls, by sex, time since admission, ethnic group, and age, fiscal year 1964 Sex, time since admission, ethnic group, and age Time from admission to June 30, 1964 } Less than 6 months 6-11 months--_-----_-- fun a oo eal i a Patients Patients | Change on rolls, | Admis- Dis- Deaths | onrolls, | during June 30, sions charges June 30, year 1964 7, 742 1, 692 1, 469 444 7, 621 —221 3, 937 944 910 210 3, 761 —176 3, 805 748 559 234 3, 760 —45 733 849 216 19 613 —120 465 843 380 61 402 —63 688 VAs. 2 =. 2S 418 65 710 +12 D440 )25-t05.=4- 157 33 515 —30 i eee 121 61 830 +26 E007 We. tose 83 66 1, 031 +24 LOL) (eg. 2. 63 52 1, 420 —91 1070 Wee eee sce 31 87 2, 000 +21 4, 035 791 692 253 3, 881 —154 3, 707 901 777 191 3, 640 —67 8 6 4 0 9 +1 33 22 9 0 34 +1 272 195 169 4 252 —20 827 369 377 5 781 —46 1, 264 348 390 12 1, 169 —95 1, 490 251 260 26 1, 451 —39 1, 562 177 167 61 1, 550 —12 1, 182 152 68 106 1,173 —9 839 130 21 133 852 +13 265 42 4 97 250 —15 55 42 40 76 DD) |= aoe See 1 Data for patients on rolls June 30, 1963, represent time from admission to June 30, 1963. Norte.—Ordinarily the number of patients on the rolls at the beginning of the year plus admissions minus discharges and deaths equal the number of patients at the end of the year. However, this is not true for characteristics which change during the year, such as age or time since admission. 384. Department of Health, Education, and Welfare, 1964 Table 4.—Patients on the rolls by status and legal category, June 30, 1964 Resident patients ! Patients On con- | On un- Legal category on rolls, On va- | valescent| author- total In hos- | On tem-| cation leave | ized leave Total pital porary visit MPotalsioscseeesmibes eae 7, 521 6, 352 6, 316 36 67 1, 013 89 Relmbursable.; =.=. een = aoe 6, 735 5, 629 5, 595 34 63 963 80 2). Ci resident 222 sbee=secae 5, 158 4, 391 4, 362 29 46 686 35 DiC, rvolantaryvesses =.= 337 191 191 0 4 138 re D.C. prisoners, total____-_- F 737 626 623 3 4 65 42 For examination -_---__- 49 49 49 0 0 0 0 Mentally incompetent_ 215 202 200 2 2 8 3 Not guilty, insanity__-_- 350 271 270 1 2 45 32 Under sentence-------- 73 72 72 0 0 0 1 Sex psychopath_------- 50 32 32 0 0 12 6 Veterans Administration__-_ 407 341 339 2 5 60 1 U.S. Nationals from abroad_ 54 50 50 0 0 3 1 U.S. Soldiers Home--__----- 33 22 22 0 0 il 0 Tndians: (PHS) t-6--Seteuss 7 7 7 0 0 0 0 rsh 2 eee 2 1 1 0 1 0 0 Nonreimbursable-- ------------ 786 723 721 2 4 50 9 D.C. nonresident_-_-_------ 811 267 266 1 2 33 9 Military and Coast Guard_ 249 246 245 1 0 3 0 Virgin Isiands::-6...-22..53 120 118 118 0 0 2 0 Federal reservation__ J 33 24 24 0 2 7 0 Public Health Serv. ea 13 13 13 0 0 0 0 Canal Zone----_------ 14 14 14 0 0 0 0 Emergency voluntary 10 8 8 0 0 2 0 U.S. prisoners__-_---- 26 25 25 0 0 1 0 Military prisoners 2__-__~--- 0 0 0 0 0 0 0 Other ses t= Se eed 10 8 8 0 0 2 0 Total prisoners..-—.-.--4= 763 651 648 3 4 66 42 1 Resident patient status should not be confused with D.C, resident legal category. The former is defined as patients in the hospital plus those on temporary visit. 2 During fiscal year 1964, the 20 military prisoners were civilly committed as D.C. nonresidents. The military prisoner legal category is now obsolete. a ae Saint Elizabeths Hospital 385 Table 5.—Movement of patients on the rolls by legal category, fiscal year 1964 Additions Removals Patients Patients|Change Legal category on rolls, To |onrolls,} during June 30, Dis- other | June 30,] year 1963 charges | Deaths| legal 1964 cate- gory UE CL ao Bo rrr 7, 742 1, 469 444 583 7, 521 —221 DS TS yoo) ee ae ae 6, 905 1, 044 410 448 6, 735 —170 och) 5, 239 461 347 338 5, 158 —81 DG avewntaryes_. 2 -____. 334 184 17 10 337 +3 D.C. prisoners total_________-- 787 316 10 95 737 —50 For examination--_-___.__- 67 167 2 12 49 —18 Mentally incompetent-____- 243 61 5 71 215 —28 Not guilty, insanity ______- 333 31 2 4 350 +17 Under sentence-_.__-------- 88 49 1 8 —15 Sex psychopath___________- 56 8 0 0 50 —6 Veterans Administration _-___-_- 436 63 27 4 407 —29 U.S. Nationals from abroad _--- 52 3 1 0 54 +2 U.S. Soldiers Home-.--_-..----- 39 12 5 0 33 —6 Indians (PHS) _...-.- ae ae 15 5 3 0 iz —8 Und. 3 0 0 1 2 —1 Nonreimbursable_.-__-.------------ 837 425 34 135 786 —61 D.C. nonresident_-____.-------- 312 279 19 11 311 —1 Military and Coast Guard___.. 259 0 i 3 7 1 249 —10 Velfa MORES Th (a 128 0 0 3 5 0 120 —8 Federal reservation__--__------ 36 40 0 40 2 1 33 —3 Public Health Service_-------- 14 1 0 1 1 0 13 -1 Cer hay. 2 ee 14 0 0 0 0 14 0 Emergency voluntary--__------ 4 121 4 33 0 86 10 +6 Wo. prisonerd, 2225-45... 41 55 10 65 0 15 26 —15 Military prisoners 1____-_-_-_-- 20 0 0 0 0 20 0 —20 Ons te 2) Ee 9 1 2 1 0 1 10 +1 Total prisoners____-..--_---- 848 391 45 381 10 130 763 —85 1 During fiscal year 1964, the 20 military prisoners were civilly committed as D.C. nonresidents. The military prisoner legal category is now obsolete. 748-869—65——26 386 Depariment of Health, Education, and Welfare, 1964 Table 6.—Discharges by status from which discharged and by condition, en- vironment, and employment, fiscal year 1964 From resident patient status 1} From | From | From Condition or type, environment, and Total vaca- | conva- | unau- employment Direct | From | tion |lescent | thor- Total | from tem- leave ized hospital] porary leave visit ————s 40; 3:\ Raa See aeneeee obi iiee, Sb. ee, dl 1, 469 844 812 32 18 520 87 Condition or type Medical discharges. 5=---.=2.22-=---2-bee—c-—+ 780 216 193 23 14 493 57 Condition on discharge: Hegovered ¢.402- e308. ed een oe-ae 36 ll 1 0 1 24 0 Socially recovered___- 493 107 91 16 6 359 21 Improved_-_--------- 228 84 aa 7 6 106 32 Unimproved 23 14 14 0 1 4 4 Administrative discharges 689 628 619 9 4 27 30 Type of discharge: Against medical advice__._..--------- 62 44 43 1 1 1 16 To legal or police authorities___ a 308 305 304 1 1 0 2 To home State or country = 121 112 111 1 1 5 3 ‘To A. hospital... +. 4.-255= 225 eek 38 35 35 0 0 1 2 Expiration of limited stay, court order, for admission to private hos- PALS ObOs e328 s ee 160 132 126 6 1 20 Environment Lives alone.22.0 22 oe m2 157 60 58 2 2 94 il With S090 io. s0.bvpasesede tens 5$-p2eescer 204 78 72 6 3 115 8 With relatives (not spouse)_--..-------------- 347 152 142 10 7 179 9 With others esi 25 sg ws deo oe =e eee nee 77 35 30 5 2 40 0 Th foster-eare Nomot 2. -ss-4aarce---dup5- oo s-5 47 0 0 0 0 47 0 Tn Dis Village 22 4 tesece deepen ate ek 7 0 0 0 0 if; 0 In other home for aged, nursing or convales- Cont homes ee a i ears 13 2 2 0 0 il 0 In inpatient psychiatric institution___-_______ 152 143 142 1 1 3 5 Am penal institution. osenaae saeeenee cecena ke 318 312 311 1 1 2 3 In other institution -.__--__ 16 ll 10 1 1 4 0 Unknown environment 131 51 45 6 1 18 61 Employment PU time cee = eos es oe eee en 193 53 49 4 1 134 5 Part time or intermittent___ 31 5 5 0 0 25 1 Not employed-__..-_--_-__-_- 985 688 670 18 10 266 21 Unknown employment:---_.<-.--.-=.=----.-- 260 98 88 10 7 95 60 1 Resident patient status should not be confused with D.C. resident legal category. The former is de- fined as patients in the hospital plus those on temporary visit. Surplus Property ~ Utilization! THE EVER-GROWING NEED for facilities and properties to meet the requirements of health and educational activities always seems to exceed funds available to acquire such properties and facilities. Through participation in the surplus property utilization program, thousands of health and educational institutions save millions of dollars annually, which would otherwise be spent from current appro- priated funds, both Federal and local, to acquire real and personal properties essential to the conduct of their health and educational activities because they were able to acquire, by donation and convey- ance, Federal surplus personal and real properties. Personal properties, ranging from pencils to computers, nails to demountable buildings, knives and forks to complete hospital operat- ing rooms, are available through this program. During fiscal year 1964, surplus property which cost over $418 million was donated to over 200,000 eligible health and educational institutions through the State agencies for surplus property established in each State. A good portion of this was equipment, such as machine tools, hand tools, earth-moving equipment, heavy construction machinery, and auto- motive equipment, which went to schools to carry out manpower training and vocational programs under federally sponsored contracts. Many colleges engaged in medical training and research activities under contracts with the Public Health Service and National Institutes of Health have utilized various types of surplus properties in con- nection with this work. Each year greater uses are being found in the teaching fields for surplus electronic-type equipment resulting from the abandonment of missile and other research and scientific 1This activity is administered by the Office of Field Administration, Office of the Secretary. 387 388 Department of Health, Education, and Welfare, 1964 projects of our Government, On the open market, this type of equip- ment would bring little cash return to the Governing in comparison to its cost and its value when effectively utilized through donation for health or educational purposes by eligible institutions. This program played a significant part in carrying out the Presi- dent’s crash program of assistance to the economically distressed Ap- palachian area. During a 3-month period, over half a million dollars worth of property (Federal acquisition cost) was channeled into this distressed area. Federal surplus real properties which had an acquisition cost to the Government of over $35 million were conveyed to health and educa- tional institutions during fiscal year 1964. All real property convey- ances contain restrictions requiring their health and educational pro- gram use for a period of 20 years, in most instances. These properties conveyed at fair market value. In 1964, this approximated $20 million, against which is applied a public benefit allowance and discount, ranging from 40 to 100 percent. This discount is earned by the insti- tution over the period of restriction by its use for health or educational purposes or the unearned discount is collected in cash. During 1964, a total of 234 conveyances was made, 20 for educational programs and 33 for health programs. There were 7,688 acres in- volved and 897 buildings. As in the personal property program, many of these properties were used to carry out programs financed, in whole or in part, through Federal contracts and other types of Federal as- sistance. In a number of instances, the acquisition of surplus real properties has enabled a community to go ahead with the actual construction of essential facilities for which they would have not had sufficient funds if it were not for the acquisition of the surplus Federal real properties. Several junior colleges and area vocational education schools have been established through the use of these Federal surplus facilities during the year. Schools and training centers for the men- tally retarded and physically handicapped have been set up in Federal — surplus facilities. To illustrate the diversification of the uses of real properties during 1964, a listing is given below: 30 College campus sites and facilities 23 College and high school agricultural, teaching, experimental, and vocational training 92 Elementary and secondary educational programs . 7 Contract administrative and service facilities for schools and school systems 28 Housing for school or hospital staffs 10 Hospital or clinic programs Surplus Property Utilization 389 OE nett 14 Treatment, rehabilitation, and training centers for mentally retarded and physically handicapped 3 Diagnostic, evaluation, and rehabilitation centers for juvenile . delinquents 14 Public libraries 10 Water and sewer production, distribution, collection, treat- ment, and service facilities 2 Landfill refuse disposal programs 1 State health department animal farm—cancer research CS a Oe rn a re Pry ee ; Der =i of Reet Be ene ; si ae aa eee ae ile hestit 4 ahead Gri aye aE eae Ee S801 A Peer ibarauljitniiteedd pasa? AER? Hh eiset ies mpi sprain wig Oe «> wien! part in nan oie to thp hontastiaall 1 AY Rhee sittin paiony spew des Firse 1 1 . «| eoquactgetibindl spmewadil dic aieetRonk beaoqeib seutet Tham, Ce nce ett NOR fara roe titohnad nigalad (asich oma Wars emiveyad to bew tn @ wate t it wear i204 at) real on of ax tu PaRaSS jade of aaralit allownands 7 i) te 100 feoont beonant 14 aii f : + , Tt be ‘ ae ; Ba! . ¥etv ince wads th program. J Mw) ut oe bun \3 ia the personal prop a W ved to marey cut préograings Gh ’ Ps mits ~ aa other wee 2 o iher o i mdees, tha aoduieition of a ypairt 112 todbled & commesity 6 gO bhesd Se mnitint facilities for whaelitiay woule ay ert Li ( i¢. \oewe apt reas tity oP MISLoUOD of the p ries, Several inhior éollaies end aka ree cRocls have ewe estehhshed Cirongh tie we of theses ial i img tbe sear. Schools and Leino, onatairs § ot oibd and pivscallr hapdicnywed havh beer aoe wept) fection. Tr Muslrate idis direraifient ion oh. + praia wm be ring [Yt4C a Lois jh give healow ; my st CW hen ormeusaltes and facilities Collapranyd high echoes ogrieyliurel, veo a nd woyaticual training : 9 7 Minna stoonidary tcjutational progenins: 7 Creek ott ellretiveand ahaa Jucilition te Shinn spwtetigs ats 148 Howsing for mheot af y heapital ntaita a0 19 Fieepita? oo altohe prigracm a v5 é oe al ro aed. kia’ i? wir: a e ° Can. Os cei Are ae ~ American Printing House for the Blind As THE OFFICIAL schoolbook printery for the blind in the United States, one of the principal functions of the American Printing House for the Blind, in Louisville, Ky., is the provision of special educational books and supplies for the blind schoolchildren throughout the coun- try through the Federal act “To Promote the Education of the Blind.” This act, originally passed in 1879, authorizes an annual appropria- tion to the Printing House for this purpose. Allocations of books and materials are made on a per capita basis. Only those pupils may be registered whose vision comes within the accepted definition of blind- ness as follows: “Central visual acuity of 20/200 or less in the better eye with correcting glasses, or a peripheral field so contracted that the widest diameter of such field subtends an angular distance no greater than 20 degrees.” The Printing House maintains large catalogs of Braille books, Talk- ing Books, recorded tapes, Braille music publications, large-type texts, and tangible apparatus. i} af ARE or he lot sf ukiio? SATII anette a levieniogn hatoreh Sis i at ufiaresl dadeohte COA fi. ‘STi . fefer tf a hate T Tia Taek (1 a6 io) DR in we : Tike. oon yt, tapitor 42 b a cegatl -atlen is ke abide sandal “hiesio kur al sae bed ? A 4 .7¥ £4 a Tovehd jlilw@ace 4 brn Jeuuriey ort seine s' aa Aire qf LEE hrue BAe 4 a anintend bose pelea tach eff to none tion stenbarobun ase) e at Ofiviiie lagi he oa wAlint) proitibrten il arwah 2.0 bre .A,4 aii)-od (eee ¥ i, fis tral re IOs’ 8h tion weot-£ v3 : wt) doses, bae quirtest. old ai yo tient FGI | x intr tni() od to tatblide lash wit nobouhe abiooed Bae laohoR Halo adi va babiverry at wiaic jutee( bs boot notteourht 2 biestindtaicy T a agellan di gatrye iho: ; ied airtéhirte. otanbarea aati TOBE at bariatldras Aitaaes aftT Cabal Tot vioorise af eincwed 2 8 enn BOY 202.3 tenortaY add wil Batifetoon af maton Qain urey wh i CA-RO0L afl .cottembS smdossT Yo soir s wt hein BOE Logdoe: Mabie’ ods ot ; £08 saw tyslliog enti ‘88 doa Yo alec denivan ht adlt “glorniadA deb” to a asoitsniA add Yo nolionvae ad} to ngitO ferview’) ort b sucunes tobe sili) alt ag Hoes ote oa mld} 4 mt z j it . a a ie yor? * 7 aa : Se h i. - Ly ‘ Le ee (as -, ; : oat * ha iP ta i 14 ? : Pe . a4 | Howard University Howarp University, located in the District of Columbia, was chartered by an Act of Congress, dated March 2,1867. The university consists of 10 schools and colleges, offering programs of higher edu- cation on the undergraduate, graduate, and professional levels. Undergraduate students are registered in the college of liberal arts; graduate students seeking the master’s and doctor of philosophy de- grees are registered in the graduate school; professional students are registered in the colleges of medicine, dentistry, pharmacy, fine arts (including the school of music and the departments of art and drama), and the schools of engineering and architecture, social work, law, and religion. (The school of religion receives no support from Federal funds.) The educational program of the university is conducted in keeping with the democratic purposes of land-grant colleges and State uni- versities, with the low tuition fees and living costs which characterize these institutions and with an educational program resting upon and permeated by the content and spirit of a general or liberal education. The university admits students of both sexes, from every race, creed, and national origin, but it accepts and undertakes to discharge a special responsibility for the admission and training of Negro students. ENROLLMENT OF STUDENTS During the school year 1963-64, the university served a total of 10,565 students as follows: 7,643 during the regular academic year and 2,922 in the summer session of 1963. The total net enrollment, excluding all duplicates, was 8,715 distributed in the 10 schools and colleges as follows: liberal arts, 4,928; graduate school, 916; engineer- ing and architecture, 775; fine arts, 587; social work, 177; medicine, 385; dentistry, 632; pharmacy, 165; law, 137; and religion, 63. The 395 396 Department of Health, Education, and Welfare, 1964 enrollment of Negro professional students at Howard continues to be greater than in all the public-supported universities in all the Southern States. GEOGRAPHICAL DISTRIBUTION OF STUDENTS The enrollment of foreign students continues to be significant. During the second semester of the 1963-64 school year, there were 1,476 foreign students constituting 16 percent of the enrollment. ‘The percentage of foreign student enrollment to the total student enroll- ment at Howard was the highest anywhere in the United States. These 1,476 foreign students came from 48 foreign countries, including Canada, Mexico, and Panania; 3 countries in South America; 12 pos- sessions in the West Indies; 11 countries in Africa; 17 countries in Asia and the Pacific Islands; and 7 countries in Europe. In addition, there were students from Puerto Rico and the Virgin Islands. During the course of the school year, there were 7, 216 degree-seeking students from the United States. These students were distributed as follows: New England States, 197; Mideastern States, 3,281; Great Lakes States, 479; Plains States, 77; Southeastern States, 2,788; Southwestern States, 268; Rocky Mountain States, 32; Far Western States, 83; Alaska, 1; and Hawaii, 8. VETERANS The total enrollment of veterans and dependents of deceased vet- erans was 84. Twelve of these students were graduated. ‘The period during which servicemen could enter the service and be eligible for educational benefits from the Veterans’ Administration ended January 25,1954. Of this total enrollment of veterans, 45 are Korean veterans, 6 disabled veterans, and 33 are dependents of deceased veterans. ARMY AND AIR FORCE ROTC Army ROTC.—There were 477 students enrolled in Army ROTC during the 1963-64 school year. Of this number, 231 were in the first year course, 163 in the second year, 42 in the third year, and 26 in the fourth year. Two were holdovers from 1961-62, and 13 were hold- overs from 1962-63. There were 20 students commissioned as reserve officers in the Army during the year. Air Force ROTC.—A total of 652 students was enrolled in Air Force ROTC. Of this number, 286 were in the first year course, 233 second year, 85 in the third year, and 52 in the fourth year. During the year, 24 students were commissioned as reserve officers in the Air Force. THE FACULTY There were 903 teachers serving the university during the school year. Of this number, there were 490 full-time teachers and 413 part- Howard University 397 time teachers. The full-time equivalent of the teaching staff was 598.35. Of this full-time equivalent, 532.43 were teaching in the rank of instructor or above. The university continues, as always, to seek for its faculty the most able persons who are selected on the basis of their competence and character, without regard to race, sex, color, creed, or national origin. It is to be noted, however, that the Howard University faculty has always included the largest group of Negro teachers and scholars at the university level found anywhere in the United States. Many of the most outstanding Negroes in public life have served at Howard University sometime during the course of their careers. Among such persons were the founder and operator of the first blood plasma bank, a Governor of an American possession, an under secretary of the United Nations, and two judges of the United States Court of Appeals. The faculty continues to remain active in making a valuable con- tribution to education and the advancement of knowledge through significant research and scholarly publications. Funds allocated in the university’s budget for support of research in the social sciences and humanities have been especially helpful in the encouragement of research in those areas. GRADUATES During the 1963-64 school year, there were 884 graduates from the 10 schools and colleges. These graduates came from 36 States, the District of Columbia, Puerto Rico, the Virgin Islands, 20 foreign countries, and 6 island possessions of the British, French, and Dutch West Indies. The 884 graduates were distributed among the 10 schools and colleges as follows: Liberal arts, 407; engineering and architecture, 99; fine arts, 45; the graduate school, 77; social work, 53; medicine, 90; dentis- try, 45; dental hygiene, 13; pharmacy, 12; law, 30; and religion, 13. In addition, honorary degrees were conferred upon three persons. From the date of its establishment in 1867, Howard has graduated 23,822 persons. The great majority of these graduates have been Negroes. Throughout its 97-year history, Howard has been a pioneer in providing Negroes with educational opportunities which were either not available or offered in only limited amount elsewhere. Among institutions in which Negro students are in a majority, the university still stands as the only one affording a complex system of under- graduate, graduate, and professional training. The largest number of graduates has entered the field of teaching, especially in the Southern States. In the field of medicine, there have been 3,470 graduates; 2,015 graduates have gone into dentistry and dental hygiene; 1,785 have entered the field of law; 440 have entered 398 Department of Health, Education, and Welfare, 1964 the ministry; 1,196 have gone into the fields of engineering and archi- tecture; and 699 graduates have gone into social work. Numerous graduates of the university have engaged in Government service not only in the United States but also in many countries abroad. VARIED ACTIVITIES OF THE FACULTY AND STAFF Many members of the faculty and staff were engaged in a variety of useful activities both in the United States and abroad. A pro- fessor of architecture participated in an architectural study tour and a tour of the archeological zones in Mexico. An assistant professor of architecture traveled to seven European countries to study new European towns. The head of the department of home economics served as consultant to the Congo Polytechnic Institute. The head of the Department of Romance Languages served as U.S. specialist in linguistics in eight African countries. An assistant professor of psy- chology served as field assessment officer with the Peace Corps in Puerto Rico. An associate professor of psychology participated in research on brain function and behavior at laboratories in the Soviet Union under the United States-U.S.S.R. exchange agreement. The librarian of the School of Religion is compiling a reference book en- titled, “Who’s Who in the Negro Clergy.” The acting head of the De- partment of Art received a fellowship for 3 weeks’ study at The Hague. The supervisor of the Negro collection served as program specialist and acquisitions librarian at the national library in Lagos. The president of the university served as an adviser of the United States Delegation to the 48th Session of the International Labor Organiza- tion, Geneva, Switzerland. SIGNIFICANT PROGRAM DEVELOPMENTS The new curriculum in the College of Medicine was extended through its second year. Additional improvements in teaching in- cluded the use of the team approach in clinical teaching in medicine | and surgery, the continuation of the guest lectureship program, sup- ported by a new grant, and the establishment of a Testing Office to provide professional assistance in the utilization of newer and more efficient testing and other evaluation procedures. The university received a grant from the Ford Foundation and in cooperation with the Department of State established a 4-year pro- gram designed to prepare Negroes and members of other minority groups for careers in foreign affairs. Forty students from 32 colleges began internships in the foreign affairs scholars program in June. The university continues to operate teaching and research programs having the objective of assisting local neighborhood areas in solving certain of their economic, social, and cultural problems. The Youth Howard University 399 Center concentrates on the problems of the young. The continuing education and community development project functions as a facilita- tor or catalytic agent in the development of community resources and in channeling the services of the larger community to one of the most depressed areas in the District of Columbia. The University Neigh- borhood Council is a voluntary association of organizations and indi- viduals who represent the people who live, work, or have interest in a 3-square-mile area around Howard University. THE BUILDING PROGRAM During the 1963-64 school year, the new Physical Education build- ing for men was completed. Construction is well advanced on the new classroom building for the social sciences and humanities. Plans and specifications are in process for a school of social work building and for two proposed new dormitories—one for women students and one for men. oon, ; } , 7 ‘ Bi ema Noms ater: ‘h,§ ad ae ee ee a a a ne . ah tit fadenrais tei dou. 06 let adob ape enin teins neh Yh imiey, witereniis. Lob) lal PBI, Lio boing tes Ppp Ga | tadie Gir tia Wigecipye ok aslaiisie J lows? aeihliar bead ate st atkiesee Ory i* I Mkio ried) Setese ter ore Apagi ny hada dink edo densi Peo? desfnh yp een gabe wa esate bee OO S eerie ct ei cht Loss barnreleraboad it napeolh Weree teh MRR TUM TON & 8 af Hog Teen? P30 Sitar er Hanae Dy. ot hoa Helper eit Ly Dae p Nunpie cart f TAT Be Ret ma, $ ss BOT 2 d ipak. ba pial yy rare bee: idocks Li ii bedd basie ee | +7) nt ie pig ir ; tet 4 bntereats ptOweRed count PLACATE S ore FIL haiaca wal? hs salsa Gitt 2 tate am ee ages fie, Rar Rb. ig AC th hh aide SiN i eee l Uti PeqQQost Fee YREN i. rt Tha arts . here ta " = Yili ‘ ‘ : ay) ‘ HA aE i) Rae F t { ” ' \ tis ' it Pee? 24 iW rT oes, i tht oi Th ree? = ‘ ® Aa lees rit sf \ i S LARP POE neuer £ oo + oe # Lat: 4 ie Far Fouts ematanty. wt 4 age pe l= esta bla tad e) chart dtgien to pasrece Neagseuce agel putupwis oF fi Preis fey® ATOM Uh eer" wii ye, Maps > sudpnts ie a Iytica Tistraie hips teat lip Sender edbadas nholers arégcenn 1a Pha unite: sty cent aie tans pera Lopes rib Pt Mergee ‘< curlay We tik if NTI, PON im Jena ght cra Aiatlablae Detailed Contents THE SECRETARY’S REPORT Page onary Ss INVESTMONT FOR | OMORROW...-.---—------<<<--4---s-ee-7-- 1 TaBLE 1 —Grants to States: Total grants under all Department of Health, Education, and Welfare programs, fiscal year 1964______________.____ 4 SOCIAL SECURITY ADMINISTRATION penn LO) Nips 28 seer oe as fd ost Joe suede eels Sk 5 THE Oup-AGr, SuURvivors, AND DrsaBitiry INSURANCE PROGRAM_-_-_-__- 5 Witte bern eROGRAM .IS) DOIN Gu2sA-ssecka: She Jeotott tf BENEFICIARINS AND BENEFIT AMOUNTS__-___-------/.skb 28 ee bee ee 7 PA MEErveeROVISIONS 252043 b Sactoclet cnaaiet oe oa sachs I-84 9 ine RORICTION: PROVIDED 2. s2.. 2222420. BR eee be ee Pees Sei 10 iNOOMEMAND DISBURSEMENTS .3i2)= clont = Met epee. dlives Lebo. Be 11 PANG. EH PROGRAM _.o 22. = ee = SBOP tee be 12 Oup-AGE AND Survivors INSURANCE BENEFITS______________________- 13 IDISABIITY PLNSURANCH BENEFITS :¢ 522 Soseniesh eee beeitliva-2 tee be 13 AD VIN TSE RENG CHE “PROGRAM. sou steotet Sete 23. dass oe 13 WorKLOADS, MANPOWER, AND RESOURCES__.--.-------.--------+----- 14 Broan oerroouctiviby sents Ses Jane See bee edestalpese-edt $0. Ee 15 Hinplovees evelopment aicssistnsiosie seend If 2113 so 3-eh eds yeebiece 15 IMPLEMENTATION OF EXECUTIVE ORDERS-_--_-___--1------_+---___-_-_- 16 ieee TANNING: 8. oe een eet ey-E 17 Peru MARA TEVEeH SPINS ES. fi Gee Deb aot ey ee Bene EWE ale 17 IMPROVEMENTS IN SERVICE AND MANAGEMENT. ______-_- 17, Pre ATmON SMR MSD AR OH af: een = see: Dies IME 96 ee atl --Y 2 17, Pa OM VELOPMENTS: 3.2/0: 2oa2oeecles A beet Neath See eee as 18 UPS OONOIN Ut, see ese as teats gp Soe e eek eet eee = HY 18 [IMPROPERLY REPORTED HARNINGS Items2. © 22525 _heLLk tte 19 MicroFritm SUBSTITUTE FOR THE Form SS-5 FILe__________________- 20 UMC OMMENICATIONSsscciin -- oe toe eee = OL No. seen 20 PURER Ab ON sen otis 2 eS Net ee TTL Se 20 end Mem NOC TATE eg SenyenS 2 Sa J i SE I BS 21 Improvements in Claims Processing Time---- _-.-----/-1---+-2----+2 21 PPIs eAND PAPE ATG e soo oe colo en eee eee eaingal 2 22 Preah ACL VG Lessee Sea Mee ented) + bog be PE sell werd 22 PGA DLON ADA CULVAITINS Ete eee ee ene eee eee US. weld wets 24 International Social Security Association _______--------+--+-2------4- 25 DERGEe OL HSHARCH OE ROJMCTS. 2. o0 oe ee ee EE ee Sod 25 Pate DMRAL,CREDIT. UNION PROGRAM.2...-2esleu! seteun 26 LEGISLATIVE DEVELOPMENTS DURING THE YEAR._____-__-- 27 Pete AtOND CONSIDERED Wy ocean ne ok oi See Saat k. bebe 27 IPDGISORTION SU NACTHED A itso. 2 yielate Bott. oo 2 pee poget A wit 28 far tea Vin LIMP ROW, BIMURINILS See eee oa a ee See ees 29 HosnitalLusurance.for, the Aged.....5-..-...--_--- =. “Peemuneeeatl 4 29 EYRETCETT SALLE ae ar ee) ee eRe eee Tel) ges rbd 30 401 748-869—65—— 27 402 Department of Health, Education, and Welfare, 1964 Disability Insurances 2° — = Soo ek ea ee eee ee Extension’ of Program Coverage... © 5. 3 pe eae eee Coverage of ‘Tips"as Wages. — ~ 2 sa oe ee SUMMARY AND ‘CONCLUSIONS 22. = 2 ea Tasue 1.—Old-age, survivors, and disability insurance: Number of fami- lies and beneficiaries receiving benefits and average monthly benefit in current-payment status, by family group, end of December 1963 and December 1962. 3-52 ee eae a oe oe a ee TaBLE 2,—Old-age, survivors, and disability insurance: Number and amount of monthly benefits in current-payment status at the end of June 1964 and amount of benefit payments in fiscal year 1964, by State__ TABLE 3.—Old-age, survivors, and disability insurance: Selected data on benefits, employers, workers, and taxable earnings for specified periods, TaBue 4.—Federal credit unions: Assets, liabilities, and capital, Dec. 31, 1962, and Dee: .31,. 1963_...--55 =... 24 20M A TA he eee TaBLE 5.—Federal credit unions: Selected data on operations, as of Dec. 31,-for each-year 1984-63_-=<222+22222.2-CS9f7084 oe Taste 6.—Federal credit unions: Selected data on operations, by asset size-and State,-1963. 25. .2ss. yo ee ae es ei ere a nites 147 Senin ations epee 8 Pe 147 IeeOrAIMeTOPTAIN® 2 ec. oe 4 Ae a eebiosind olen 147 Paetoarie nari. VW OLkers anes + ete oe ee rite 148 Entomology and Sanitation Programs____---------------------------- 148 SremOnarantine:A ctivities 40 Sye= sew ee Ley eH ee en ete 149 PRAT ONMOR EEN DIAN. LLMALTH se eee ae a 149 SESCIGHIEn ACiliLiCd eames Pevns Whee Mlle teg oe alee TE 150 406 Department of Health, Education, and Welfare, 1964 Page Therapeutic'and! Preventive Servicesi 22. 244 eee eee 150 Medical, Record8s+~ 2.2-2see et eee eee ene: tee ee ee 151 Health, Education. 22° 299 Suu Sclyigeet SN AGO” 3S JOR Siete 151 Maternal-and: Child, Health--=.--=-<=< 200) SONY Sods i Be 152 Dental Services 22 ax'e4<- eho kL OY We Oe De pie eee 152 Major Illnesses and Mortality Ratesi2_2 Si O92 1)_Do YS) See 152 Environmental Health™225 201 Seu Yeo8 SDiyO1d SRipnenek OUAe Uae 153 Construction and! Maintenance. sen 609 SUSE of BOS ae 153 Training for Indians-and Alaska Natives. -=-)-J02) 728 19 Sey TL eee 154 Other. Activities - f22.<3454 222) LS ee ee 2 ee 154 MepicaL SERVICES FOR FEDERAL AGENCIES. __.--_.--________-___-_-- 155 United States Coast Guard, Treasury Department____________________- 155 Bureau of Prisons, Department of Justice_.._.__.-2iil)/_2_-L bE 156 The Y ear,in Review... 32 ee ee 156 Program .Highlights#i... <2.) oe 2 eee es ee 157 Bureau of Employees’ Compensation, Department of Labor_____________ 158 Maritime Administration, Department of Commerce___-__-_____-_-____- 159 BUREAU. OF STATE SERVICES... =... epee eee 159 OFFICE OF THE BuREAU Cuter (Community Hmatrn)_________________ 160 DivisIonior “ACCIDENT, PREVENTION....-<4-.-0--.=.. S50 See Ee ee 160 Research ae22=29-S:eceeeee. 2-32. Se ee ee 160 Programs, and, Projects... ---.--.==. = -SateDale phones aes 161 Draining... >.) =-se se ee Ie iene eee 161 Drvyiston sor) CaRonic,Dismasmss. 1. U__2 124) see A eee eee 161 Heart Disease Control Propram_§_......._.__-._.—.. ...._ ee 162 Cancer, Control, Branchsee- 222 _.=. 4. Be a ee 163 Diabetes.and Arthritis Program: -...... _2euewsl’_ ses eh epee eee 164 Neurological and Sensory Disease Service Program____________________ 165 Gerontology..Brancha2 20 CS- ee ee ee ee eee 166 Mental Retardation ‘Program == 220 -s==22t a aeteee FE ates eee 167 Nursing Homes and Related Facilities Branch__________-__--__--_____- 168 COMMUNICABLE -Disnasn, Cantor.) 2 2 28S eee ae 169 Assistance to’ States] =~ S202 2 oo ae ee eee eee 169 Hpidemic Aid's 5._ 5 eet See. SARE De ees ke ed ee 169 Immunization, Program! SS 2a ee eee 170 Aedes Aegypti Eradication Program = =_ 272.252 582_S° 2p ee ee 170 Laboratory Services2= 2 ONE 2 Se ee eee eee 170 Demonstrations®[222 2222". 25 ee A eee eee 171 Training 22 8s Se ee ee ae eee 171 PHS Audiovisual Facility 220 20> 2 ee ee ee s 172 Representative Disease Control Studies____°___+___-_-_22)_ J 3 eee 172 Venereal: Diseases =.=2=ss2¢22 iss 22222 eee er eee ae 172 Tuiberculosiss> 2222 etc eae _ eee Se eee eee 173 Arthropod-Borne Enecephalitis._=.-_- ==. 22. Sepeet ee eae 173 Infectious Hepatitis 2. £220 223-4 2 ee ie ee 174 Rabiesz 2s. 2-28. Se SS ee A ee eee eee 174 Enteric’ Infections =< _2aee) oe. Saas ee eee eee 174 Smallpoxe 222-2 Pease ee tees aise sal ees eee eee eee 175 Vector Control. 2-2... = sk Sees ee eee bee oe 175 Division oF ComMuNITY H@ALTH SERVICES.._-------2+-4-54- 224 --22-2 175 Health Communications....=.... 5-5 ee eee ee 175 Migrant. Health. - 26 62. ~ancunienh ine np den an aanwinn sae Eeeee 176 _ Detailed Contents 407 Page feeceliesithy Administration.-..... 9-2 ee ee 176 DM siete LL eee gl oie eee beeen 176 MeenmGare Administration. ©. = 2 oe ee oe eee 177 PUPLUPUICOMOMICS. | oo 5 ou ee eterecue dd dace ae ee 177 Remmrrimcenesources. ©. 22 ene os sae ee seh eee ae 177 pemmraeNational Lraining Conferences icsua2senese3 ee eee Bae = 178 Pre eoumlerpinice. oo AE eee eer 178 Division oF DENTAL PusLic HEALTH AND RESOURCES_---------------- 178 SeaiacmenOontal Diseases! - (os Sess so oso at eee eee 179 Makmenbental Care Available_} 2. 2s2ss25--seee eel eee 179 pepincmanoher Llealth Agencies. 0220222 fo ooo ssos- ee eke 180 Mesum vanpower Needsi.0_ 2222 2==)4 sc. seveeey Jee Soopers 180 Division or HospiraL AND MEDICAL FACILITIES. __-------+------------ 181 Erne eee foo 2 Te OL SOP A eee set ats one eee ee 181 MGMMPREMMENITNIR ION © <2 2+ ol ses se occ c esac sk eee sees on see ee 181 Appropriations and Construction Program____-.---------------------- 182 meeloritecseuplic Works Program: 2-252 s2as32 2.sse8 ee senses es 182 esearch and Demonstration Activities. .u2 Detailed Contents 409 OFFICE OF EDUCATION Page Boome VI CH TO. ACTION=<+2222se2ss2ec sac! TAT A SROs 235 POW GAt TONAL ASSISTANCE 2-22. {Uf 207! {Osis 08 eee ime 236 NATFONAL DBFENSH EpucaTion Acr..2!o 0. J ie SLO Lee ee es 236 Segetie—stident: Loans! 2-222 oo - eee) Ah Ok Re 237 mitlon LV ——Graduate) Fellowships2t J. 428 2 34-24 Kalin Wi et 237 Title V-B—Counseling and Guidance Training Institutes__.._____-___-- 238 Pitles Vu Language. Developmenticcaseve: od - sabbe ve bee goeae.. © = 238 Manvuagersnd Area ‘Centers,.._52 222-1 -._j_5_ 1 RANE ek 3 fea 238 Modern Foreign Language Fellowships_-......--.---------------- 239 anwuape: Research and Studiess.2. JA J. Sune deo meee a ee cee 239 Modern horeign. Languace, Institites. 2s oe oe ee ok ee 240 Title I1I—Instruction in Science, Mathematics, and Modern Foreign BEART C ene wee! el oe Re ee ee ee ee eee ee tk oe 240 Title V-A—Guidance, Counseling, and Testing____-_.--_-------------- 242 WOCATIONAL AND TECHNICAL HDUCATION._.-------sasseeecl-aeseeueee 243 Perouituralebducation. 2.20... dete se eee hb Seeeee ds gees anne Ch. 244 emacsucenomics Hducation! 2.2222. lo= = esvede coe pew dt Soot « 245 meaner and industrial Hducation .-...s2: f=. ---<-shoeSh af ante Manatee 246 eC MTV OME CALION 2.2 te A We Le Pe. tee teeta 246 ECU MEAE PCED ICTY a wot AE See EE oe a a Cale a oe bee ag le t oe o 247 ert rcaipiintaca tion: Af o Abii) 2 eee) FOR, eA hee ee og 247 Seine ray PMPACTOD ARBAS U0" bh Ni ERS ANS ory ot cate 249 remem yates Stile SN coe es BE ie there te Pots dae 249 louis Lucy EG IES Se eS ee er es ek oe ee ae 249 Rupa piern rocubublic education. se 2224 ee ene kes on a eectieede Bae 250 PeOntaEA NOC OLLNGES = 225422. 5 sm ae Sk cet eee rn estes toed 250 AREA REDEVELOPMENT AND MANPOWER DEVELOPMENT AND TRAINING Ce ean eS Mee sR Gc ae ee ee es By eee 251 Axea Redevelopment Act Training...._.....-._-.---------------é1--- 251 Manpower Development and Training Act___.._________-------------- 252 INOUCRTIONAL PELNVISION FACILITINS!.--...---.2---2--seetSckasse4e 253 RaaneronenGnn ABSISTANCD.5-+.—<) Mee Se eo eee eee. eee 307 New) CouRTSINTEREPRETATIONSS) 2) 22a eee eee 308 CHANGES INUTHE LAW “AND REGULATIONS. 0 = -8 one sao eee 311 Repulations - 7 -tti.ter lees et eee ee Re ee eee 312 SCIENTIFIC} INVESTIGATIONS = 2-2 - ooo ee eee eee eee ee eee 318 HNFORCEMENT STATISTICS O82 SESS SS 324 TaBLE 1.—Actions on foods during the fiscal year 1964____------------ 288 TasLE 2,—Number of samples on which criminal prosecutions and seizures were based and number of court actions instituted during fiscal year 19642 Eee Se, be ee ern e, eee ere 325 TABLE 3.—Import samples collected, examination made, and lots detained during:-the fiscal ‘year’ 1964.2222.55s-2 20 oe Se ss. See eee 325 Cuart 1.—Retail sales of drugs in the United States, calendar years 1954-68 coc ete oe en ae ne one ne ee ee ee eee 272 Detailed Contents 411 Page CuHArt 2.—Retail sales of food in the United States, calendar years PO eee SS ee ee mee es 274 Cuart 3.—Retail sales of cosmetics in the United States, calendar years PAGS! UE. a aS ee a A A ae aN a Alig Ne ie aie aie ie 275 Cuart 4.—Budgeted positions for food and drug enforcement operations (excluding fee-supported certification services), fiscal years 1955-65__-- 277 VOCATIONAL REHABILITATION ADMINISTRATION Srna ENS E ES caer 9s 2 ss: >_< ee EO ee ee 329 IN WU ONe EES JAR Smet 0h Ieee! Ty) Nohgee Sie t Ste te 8 329 EFrrect oF DISABILITY WITHIN THE FAMILY_.__...._--.--.---------- 331 RUBABILITATION VS. PUBLIC ASSISTANCE. . Ue -o J S2m el ete 332 SGRNONIN Ge ViInITARY -REJEOTHES. 9200 vir o. Sonos ainiats bob ef 334 MeCPANSTONEAND, US, OF FACILITINS..._._.:......--22-2--seoen------- 330 PENDAMRO Re UH OE ROGRAM 2... 2-2 . eee ee ee 355 Winsor THe DMAn ee Se eee eo Oe oye: 355 TAD VORK =. Sot comets Leow. _otrenliee tambo: sonersto5sk 5 356 eR REN Cia. at. BOS eek Leal wpe edna Sie wae deel boo 4 356 MEeurArTiONATLHERAPY Aes soolenict« Pbyin tie. wensles Bdew sets sak 2 356 J oepetscve Mit, Yl NRO yes 2S OS Cee ie See hr See eee eee eee 357 Pret tOAm AND AORTHOTICS = = aa oe a 357 [RP sINING. WORKERS APOR) THN? BLIND..235.4. 0-228. 5.-022085_ 55-2285. 358 MOCRHATION FOR THE ILL AND DISABLED.......--..--.----.----=---- 358 UO MEE EH CON OMICS ear roto 2 oo 4 nr ee ee I _ 358 412 Department of Health, Education, and Welfare, 1964 Page New Training Centers In Mentat RETARDATION_._.-~-_----------- 359 RESHARCH MAND (TRAINING CONTERS..c 4 o-o. ee e e 360 TaBLE 1.—Number of referrals and cases, by agency, fiscal year 1964____ 362 TaBLE 2.—Vocational rehabilitation grants, 1964, State divisions of vocauional rehabilitation... 6 acs ss eee eee eee. ee 364 TaBLE 3.—Vocational rehabilitation grants, 1964, State commissions or agencies for the blind 2.4 obec wee eee oc eae ee eee 365 Cart 1.—Rehabilitations by years. <2---2 s--2_--=s2214_-CL aang ee 328 Cuart 2.—Principal causes of disability among 1964 rehabilitants_______ 330 Cuarr 3.—Major occupations of persons rehabilitated in 1964_________- 331 Cuart 4.—Sources of referrals among 1964 rebabilitants__.__...._-__-- 3398 Cuart 5.—Funds for State rehabilitation programs_____._______-_-_---- 337 Cuarr 6.—Federal funds expended for research and training in vocational rehabilitation... == sapyeee"s weet See ee eee eee eee 339 Cuart 7.—Disabled persons of age 45 or more rehabilitated 1945-64_____ 347 Cuart 8.—1964 training funds in areas of personnel shortages________-- 351 SAINT ELIZABETHS HOSPITAL PROGRAM, DHVEUOPMENTS©.--0 elec oe Sos ee ec eee aes ae Ses 371 POPULATION: DREN DSieee tee tee ee See ee 2 re 373 PROFESSIONAL TRAINING AND EDUCATION_.----------------------_-22- 373 Professional; Trainees;,fiscalltyear 19642222. - 2. Se eee 376 RESHARCH Staewress ooo ee co Re ee 376 ‘Behavioral :Studies cee Se a ee er see Bee 376 Clinical:Studies: s252 2 ese Pee a ROT AE OA eee 377 SPHCIAIS STUDIES sats eee eee EER RARE eee 378 STAFFING ANDAPINANCINGS$ oes oo are UE lee AAT ee eee 380 BUILDINGSZAND "HA CILITINSS {so et en ee 381 TABLE 1,—Patients, admissions, and discharges, fiscal years 1935-64---. 381 TABLE 2.—Patients on the rolls, by status and by sex, time since admission, ethnic'sroup, and age, June's0.1964: 22-22 ee Sone en ee 382 TABLE 3.— Movement of patients on the rolls, by sex, time since admission, ethnic proup; and age; fiscal years! 9642) 2 eee ee se ne ek ee 383 TABLE 4.—Patients on the rolls by status and legal category, June 30,1964. 384 Tas iE 5.—Movement of patients on the rolls by legal category, fiscal year 1D G4 ee ee mn aa ees eR oe Ee Sy Se 385 TasiE 6.—Discharges by status from which discharged and by condition, environment, and employment, fiscal year 1964____-----__---_-------- 386 Cuart 1.—Average number of patients, fiscal years 1950-64__-___--__-- 374 Cuart 2.—Admissions and discharges, fiscal years 1950-64_---_-------- 375 Cuart 3.—Time until release, all civil admissions, fiscal year 1962__------ 379 SURPLUS PROPERTY UTILIZATION PROGRAM ‘ACTIVITINELS 2. seen. Sete - £ ee ee te. Pe eee Cee 387 Detailed Contents 413 AMERICAN PRINTING HOUSE FOR THE BLIND Page SERVICES TO SCHOOLS AND CLASSES FOR THE BLIND__------------------ 391 GALLAUDET COLLEGE eRe OHEMCRS: ACTIVITIES... canc-accccocanaoesuaaccdsesa-ccsce- 393 HOWARD UNIVERSITY POO UOC LG 8 == So ee ee eee See 395 mooerapnical Distribution of Students._....2.-.--..2.-0._-2 2... ..--- 396 FESS. os lll Soa RRS Soe Le a oO alt eae ae ET a a 396 Pree virmOrce. ly Od Gu c £2 so ccu oo eee ae eee ria te 396 oe UY iF Ilyi. dae a nenelan See pipe ete” le oi es Ae 9h 396 RTI Os Bed 2 ee ene Ae ee te he 397 Mareurxcuvities of the Faculty and Staff_...-.-..--..-..--.....=---.<- 398 Pranincant program Dévelopments___-.....3~.-.=-.22s-<...--..-.---. 398 PCH PMECOOTAM 2 8 42S Se ee Man Sue eee ooo Gaeb ee ese 399 U.S, GOVERNMENT PRINTING OFFICE:1965 ’ i ‘ 7 W =n" ' rf 7 ‘ ll «y 4 ‘LA é 6 4 4 of. ; d x «} TO ONLY VAD To “u 4 argue 4.9 = a ~) ~~ a eo ee » * $ r y P é _ a . aya -ieeunie ier of Ty re , « ALI. 4 \ ] ; ” ; cath at me Lal ave BSonse hiOS ‘THU TA SUI Osh YOR ie inaticie to Sain AY : a Vea has aes