U.S. Department of Health, Education, and Welfare Annual Report 1968 [U.S. Department of Health, Education, and Welfare Annual Report 1968] [From the U.S. Government Publishing Office, www.gpo.gov]  1968 U.S. Department of Health, Education, and Welfare r^/ / \ \- 1 I z / A Z14UX ( i >' I f I 0 Ml— h I I Z r\ m) ki »a 311234 DATE DUE n _ C- 93472-/96y/b / DISCRIMINATION PROHIBITED—Title VI of the Civil Rights Act of 1964 states: “No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.” Therefore, all programs and activities receiving financial assistance from the Department of Health, Education, and Welfare must be operated in compliance with this law. For sale by the Superintendent of Documents, U.S. Government Printing Office Washington, D.C. 20402 - Price $1.75 (paperbound.) THE SECRETARY OF H EALTH, EDUC ATIO N, AN D WELFARE WASHINGTON, D. C. 20201 January 14, 1969 Dear Mr. President: I transmit herewith, in accordance with law, the Annual Report of the Department of Health, Education, and Welfare for the fiscal year ending June 30, 1968. The Report describes the major programs and activities of the Department and outlines some of the major recent accomplishments. It also touches on some of the important challenges which lie ahead. With this report I complete 34 years of close association with the Department and its predecessor agencies. I have tried to summarize my experiences and observations in the initial section of the Report. I wish to acknowledge the strong support you have given to the work of the Department and the leadership you have shown in expanding the capacity of the Department to assist in improving the health, education, social security, and welfare of the American people. There is much we have done in the last eight years; there is much yet to be done. I have appreciated the honor you bestowed upon me in making it possible to have the responsibility of directing the work of this great Department this last year. Sincerely, Secretary The President The White House iii 311234 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE As of September 1, 1968 Wilbub J. Cohen, Secretary James H. McCbocklin, Under Secretary OFFICE OF THE SECRETARY Dean W. Coston_____________ Ralph K. Huitt------------- Samuel Halperin-------- John T. Grupenhoff_____ Joseph Ventura--------- Lynn M. Bartlett___________ Joseph G. Colmen------- Philip H. DesMarais____ Shelton B. Granger----- Ralph C. M. Flynt------ Philip R. Lee, M.D--------- William H. Stewart, M.D. George A. Silver, M.D-- Leon Jacobs____________ Katherine B. Oettinger._ Richard M. Magraw, M.D— James H. Cavanaugh_____ Leo J. Gehrig, M.D_____ Alice M. Rivlin____________ John Brandl____________ (vacant) Mancur L. Olson, Jr---- C. W. Bateman----------- Executive Assistant to the Secretary. Assistant Secretary for Legislation. Deputy Assistant Secretary for Legislation. Deputy Assistant Secretary for Legislative Services. Congressional Liaison Officer. Assistant Secretary for Education. Deputy Assistant Secretary for Education. Deputy Assistant Secretary for Special Educational Services. Deputy Assistant Secretary for International Affairs. Deputy Assistant Secretary for International Education. Assistant Secretary for Health and Scientific Affairs. Surgeon General (Public Health Service). Deputy Assistant Secretary for Health and Medical Care. Deputy Assistant Secretary for Science. Deputy Assistant Secretary for Family Planning and Population. Deputy Assistant Secretary for Health Manpower. Director, Office of Planning and Program Coordination. Director, Office of International Health. Assistant Secretary for Planning and Evaluation. Deputy Assistant Secretary (Program Analysis—Education). Deputy Assistant Secretary (Systems and Program Analysis—Health). Deputy Assistant Secretary for Social Indicators. Deputy Assistant Secretary (Income Maintenance and Social Services). iv James F. Kelly------------- James B. Cardwell------ John R. Croxall________ Alanson W. Willcox_________ St. John Barrett_______ Edward C. Sylvester, Jr____ Alvin L. Schorr________ (vacant) (vacant) James P. Alexander_____ Ruby G. Martin_________ Edmund Baxter__________ Donald F. Simpson__________ John D. R. Cole________ (vacant) William H. Mitchell____ Sol Elson______________ Irving Goldberg_____________ Fritz P. Witti_____________ Assistant Secretary, Comptroller. Deputy Assistant Secretary, Budget. Deputy Assistant Secretary, Finance. General Counsel. Deputy General Counsel. Assistant Secretary for Community and Field Services. Deputy Assistant Secretary. Deputy Assistant Secretary (Community Development). Deputy Assistant Secretary for Youth. Director, Center for Community Planning. Director, Office for Civil Rights. Director, Office of Field Coordination. Assistant Secretary for Administration. Deputy Assistant Secretary for Administration. Deputy Assistant Secretary for Personnel and Training. Deputy Assistant Secretary for Management Systems. Director, Office of Surplus Property Utilization. Acting Assistant to the Secretary for Public Affairs. Acting Director of Public Information. OPERATING AGENCIES SOCIAL SECURITY ADMINISTRATION Robert M. Ball____________ Arthur E. Hess____________ Thomas C. Parrott_________ Robert J. Myers___________ Jack S. Futterman_________ Melvtn Blumenthal_________ Harold P. Packer__________ Russell R. Talbert________ Alvin M. David____________ Ida C. Merriam____________ William E. Hanna, Jr_____ Bernard Popick____________ James W. Murray___________ J. Deane Gannon___________ Thomas M. Tierney_________ James H. Nease____________ Hugh F. McKenna__________ Commissioner of Social Security. Deputy Commissioner. Assistant Commissioner (Field). Chief Actuary, Office of the Actuary. Assistant Commissioner for Administration. Assistant General Counsel, Office of the General Counsel (Health Insurance Division). Assistant General Counsel (Old Age and Survivors Insurance Division). Assistant Commissioner for Public Affairs, Office of Information. Assistant Commissioner for Program Evaluation and Planning. Assistant Commissioner for Research and Statistics. Director, Bureau of Data Processing & Accounts. Director, Bureau of Disability Insurance. Director, Bureau of District Office Operations. Director, Bureau of Federal Credit Unions. Director, Bureau of Health Insurance. Director, Bureau of Hearings and Appeals. Director, Bureau of Retirement Survivors Insurance. v PUBLIC HEALTH SERVICE HEALTH SERVICE AND MENTAL HEALTH ADMINISTRATION Irving J. Lewis Acting Administrator. Irving J. Lewis Deputy Administrator. Alan W. Donaldson Associate Administrator. Paul Q. Peterson, M.D Associate Administrator for Direct Health Programs. John H. Kelso Assistant Administrator for Management. Karl D. Yordy Assistant Administrator for Program Planning and Evaluation. J. Jefferson Bennett Assistant Administrator for Legislation. Edward J. McVeigh Assistant Administrator for Information. Paul J. Sanazaro, M.D Director, National Center for Health Services Research and Development. Theodore D. Woolsey Director, National Center for Health Statistics. David J. Sencer, M.D Director, National Communicable Disease Center. Stanley F. Yolles, M.D Director, National Institute of Mental Health. Harald M. Graning, M.D Director, Health Facilities Planning and Construction Service. John W. Cashman, M.D Acting Director, Community Health Service. Stanley W. Olson, M.D Director, Regional Medical Programs Service. Erwin S. Rabeau, M.D Director, Indian Health Service. Robert van Hoek, M.D Director, Federal Health Programs Service. CONSUMER PROTECTION AND ENVIRONMENTAL HEALTH SERVICE Charles C. Johnson, Jr Administrator. John J. Hanlon, M.D Deputy Administrator. Albert H. Stevenson Associate Administrator. E. R. Lannon Assistant Administrator for Administration. Jerrold Michael Assistant Administrator for Program Development. Joseph Lieberman Assistant Administrator for Research and Development. Thomas Williams Director Office of Public Affairs. Chris A. Hansen Commissioner, Environmental Control Administration. H. L. Ley, Jr., M.D Commissioner of Food and Drugs. John T. Middleton Commissioner, National Air Pollution Control Administration. NATIONAL INSTITUTES OF HEALTH Robert Q. Marston, M.D Director, National Institutes of Health. John F. Sherman Deputy Director, National Institutes of Health. Robert W. Berliner, M.D Director of Laboratories and Clinics. Ronald W. Lamont- Havers, M.D Associate Director for Extramural Programs. Jack Maser, M.D Associate Director for Clinical Care Administration. vi Richard L. Seggel----- Clifford F. Johnson___ Thomas J. Kennedy, Jr., M.D_________________ Leonard D. Fenninger, M.D— Frederick K. Erickson__ Viron L. Diefenbach, D.D.S_______________ Raymond F. Dixon______ Miss Jessie M. Scott— Frank W. McKee, M.D_ Martin M. Cummings, M.D_________________ James Lieberman, D.V.M Kenneth M. Endicott, M.D— Theodore Cooper, M.D------- Dorland J. Davis, M.D------ G. Donald Whedon, M.D------ Gerald D. LaVeck, M.D------ Seymour J. Krestiover, D.D.S— Frederick L. Stone--------- Edward F. MacNichol, Jr---- Jack Masur, M.D------------ Roderick Murray, M.D------- Arnold W. Pratt, M.D------- Paul Kotin, M.D------------ Thomas J. Kennedy, Jr., M.D— Eugene A. Confrey---------- William B. DeWitt---------- Milo D. Leavitt, Jr., M.D-- SOCIAL AND Mary E. Switzer------------ Joseph H. Meyers----------- Joe B. Parks_______________ James F. Garrett___________ Samuel E. Martz------------ Director, Office of Administrative Management, and Executive Officer. Director, Office of Information. Director, Office of Program Planning and Evaluation. Director, Bureau of Health Manpower. Acting Director, Division of Allied Health Manpower. Director, Division of Dental Health. Director, Division of Health Manpower Educational Services. Director, Division of Nursing. Director, Division of Physician Manpower. Director, National Library of Medicine. Director, National Medical Audiovisual Center. Director, National Cancer Institute. Director, National Heart Institute. Director, National Institute of Allergy and Infectious Diseases. Director, National Institute of Arthritis and Metabolic Diseases. Director, National Institute of Child Health and Human Development. Director, National Institute of Dental Research. Director, National Institute of General Medical Sciences. Director, National Institute of Neurological Diseases and Blindness. Director, Clinical Center. Director, Division of Biologies Standards. Director, Division of Computer Research and Technology- Director, Division of Environmental Health Sciences. Director, Division of Research Facilities and Resources. Director, Division of Research Grants. Acting Director, Division of Research Services. Director, Fogarty International Center for Advanced Study in the Health Sciences. REHABILITATION SERVICE Administrator. Deputy Administrator. Associate Administrator. Assistant Administrator for Research, Demonstrations, and Training. Assistant Administrator for Program Planning and Evaluation. vii Fred H. Steininger--------- Paul W. Pyle, Jr___________ Emanuel M. Silverman_______ Philip A. Holman___________ Joseph H. Meyers___________ Stephen P. Simonds_________ Francis L. Land, M.D_______ Joseph V. Hunt_____________ P. Frederick DelliQuadri___ William D. Bechill_________ Charles E. Hawkins_________ Robert Mugge_______________ Margaret A. Emery__________ Assistant Administrator for Federal-State Relations. Acting Assistant Administrator for Field Operations. Assistant Administrator for Administration. Assistant Administrator for Public Affairs. Acting Director, Juvenile Delinquency and 'Youth Development. Commissioner, Assistance Payments Administration. Commissioner, Medical Services Administration. Commissioner, Rehabilitation Services Administration. Chief, Children’s Bureau. Commissioner, Administration on Aging. Special Assistant to the Administrator for Legislative Affairs. Acting Director, National Center for Social Statistics. Policy Coordinator. OFFICE OF EDUCATION Harold Howe II____________ J. Graham Sullivan________ Wayne O. Reed_____________ James A. Turman___________ Grant Venn________________ B. Alden Lillywhite_______ Preston Valien____________ Norman J. Boyan___________ James J. Gallagher________ Don Davies________________ Dorothy M. Gilford________ Regina Goff_______________ Joseph Froomkin___________ Albert L. Alford__________ Leroy V. Goodman__________ Bernard Sisco_____________ Walter E. Mylecraine______ Robert C. Leestma_________ Commissioner of Education. Deputy Commissioner of Education. Associate Commissioner for Federal-State Relations. Associate Commissioner for Field Services. Associate Commissioner for Adult, Vocational, and Library Programs. Acting Associate Commissioner for Elementary and Secondary Education. Acting Associate Commissioner for Higher Education. Acting Associate Commissioner for Research. Associate Commissioner for Education for the Handicapped. Associate Commissioner for Educational Personnel Development. Assistant Commissioner for Educational Statistics. Assistant Commissioner for Programs for the Disadvantaged. Assistant Commissioner for Program Planning and Evaluation. Assistant Commissioner for Legislation. Assistant Commissioner for Public Inf or mation. Assistant Commissioner for Administration. Assistant Commissioner for Construction Service. Assistant Commissioner for International Studies. viii FEDERALLY AIDED CORPORATIONS Leonard M. Elstad_______________ President, Gallaudet College. Finis Davis_____________________ Superintendent, American Printing House for the Blind. James M. Nabrit, Jr_____________ President, Howard University. REGIONAL OFFICES REGION I, BOSTON, MASS. Walter W. Mode_______________________________ Regional Director. REGION II, NEW YORK, N.Y. Mrs. Bernice L. Bernstein____________________ Regional Director. REGION III, CHARLOTTESVILLE, VA. Bernard V. McCusty___________________________ Regional Director. REGION IV, ATLANTA, GA. William J. Page, Jr__________________________ Regional Director. REGION V, CHICAGO, ILL. James G. Brawley_____________________________ Regional Director. REGION VI, KANSAS CITY, MO. James W. Doran_______________________________ Regional Director. REGION VII, DALLAS, TEX. James H. Bond________________________________ Regional Director. REGION VIII, DENVER, COLO. William T. Van Orman_________________________ Regional Director. REGION IX, SAN FRANCISCO, CALIF Charles H. Shreve____________________________ Regional Director. ix U.S.DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Regional Boundaries and Offices —. j \ NORTH DAKOTA \ / -----.. / ’» \ MINNESOTA 1 V I \ । Zr/V / I \ ----------I f WISCONSIN \ / I . 'I J I • . -- SOUTH DAKOTA 11 ^7/1 11 IM.^A I I X«OMI^------ | I / I ~ I I I 7____________\ I \ A / I i I / MISS. ! ala. \ _______!______ t ~ I / | Allan’0 X* J S~V xX r—r~-----1 Uli I ) ) IV ( PUERTO Rico. \ \ ^—■ LJ \ VII \ / j -A U VIRGIN ISLANDS \ X. '''» '• Z——■ I faSeTDAX...-- \ •— ■ \ k j LOUI5IANA ~ \ ichorage \ \ X \ ro ~ \ f \ \ / & \ / \ I Honolulu X \ / x / ALASKA HAWAII V> __________________] ____________ Contents J’age The Secretary’s Introduction................................. 1 Staff' Offices Assistant Secretary for Legislation......................... 45 General Counsel............................................. 49 Assistant Secretary for Program Planning and Evaluation. . 53 Assistant Secretary, Comptroller............................ 54 Assistant Secretary for Administration...................... 59 Assistant Secretary for Community and Field Services. ... 66 Assistant Secretary for Health and Scientific Affairs.... 73 Assistant Secretary for Education........................... 78 Office of Public Information................................ 88 Operating Agencies Social Security Administration.............................. 91 Office of Education........................................ 123 Social and Rehabilitation Service.......................... 179 Public Health Service...................................... 257 Health Services and Mental Health Administration....... 259 Consumer Protection and Environmental Health Service. . 291 National Institutes of Health............................ 349 Federally Aided Corporations Howard University.......................................... 405 Gallaudet College........................................ 407 American Printing House for the Blind...................... 409 A detailed listing of the contents of this report, by topic headings, appears on pages 409-418, xj DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE SECRETARY U nder Secretary_ OFFICE OF “ PUBLIC INFORMATION Il । II ASSISTANT ASSISTANT SECRETARY acciqtont ASSISTANT ASSISTANT ASSISTANT ASSISTANT secretary (Health and SECRETARY GENERAL SECRETARY SECRETARY, SECRETARY Scientific Affairs) (Planning and COUNSEL FOR COMPTROLLER (Education) (Community and ----------- (Legislation) Evaluation) ADMINISTRATION Field Services) Surgeon General evaluation; Public Health Service ____ ________________ __________------------------ ------------- --------1---- ------------- I---J—— r-----------q j-amerIcanT I-■L_1 [“■L_T PRINTING GALLAUDET HOWARD i HOUSE COLLEGE UNIVERSITY [for the BLIND] _ puBUC HEALTH SERV|CE ____________________________________________________ ____________________ I ,, I ,, o_________________________ _________I_____ _______1------ -------1----- CONSUMER HEALTH SERVICES NATIONAL SOCIAL AND SOCIAL OFFICE OF ENVIRONMENTAL & MENTAL HEALTH INSTITUTES OF REHABILITATION S^^TY EDUCATION HEALTH SERVICE ADMINISTRATION HEALTH SERVICE ADMINISTRATION [__2__J REGIONAL OFFICES xii The Secretary’s Introduction Wilbur J. Cohen, the author of this Introduction, was Secretary of Health, Education, and Welfare, during the period covered by this Annual Report. He has been succeeded by Robert H. Finch. Mr. Finch was nominated by President Nixon on January 20, 1969, confirmed by the Senate on January 21, and sworn in on January 22. The Stewardship The Secretary of Health, Education, and Welfare holds a demanding, versatile, important, exciting and intensely human job. His is a splendidly rich and gratifying stewardship. He is the only national official paid by all the people whose full-time job is to guard and strengthen the people’s health, education, and social opportunities. His Department handles the major portion of Federal grants-in-aid funds for social programs. He administers the largest insurance program in the world. So the shape, direction and style of Department programs in many ways set the course for State, local and nongovernmental agencies. The health, education, and welfare of the American people has become big—and urgent—business. As our Nation grows and expands, every sign points to its becoming a still bigger and more urgent business. In 1968 about $163 billion, or roughly 20 percent of our Nation’s entire gross national product, went for health, education, and social services. These were not, of course, all Federal dollars, but a mix of State, local, Federal, and private funds. The Secretary of Health, Education, and Welfare is not charged with responsibility for all these funds and for the programs they make possible. Far from it— HEW expenditures represent somewhat less than a quarter of our total national social effort in these fields. A large and growing population, and ever more complex social forces will—and should—combine to make this figure go up in the coming decade. The Secretary is necessarily concerned with large, sensitive issues of public policy. The Constitution gives major policy responsibility to the President and to the Congress. The Congress is the Board of 1 2 Department of Health, Education, and Welfare, 1968 Directors of the Health, Education, and Welfare Corporation; the President is Chairman of the Board; the Secretary of Health, Education, and Welfare is the Executive Officer. Congress takes action by enacting laws. New needs constantly demand new laws; old laws constantly require repeal or change; programs demand efficient, imaginative, and dynamic administration. To achieve such administration, the Secretary of Health, Education, and Welfare must review and approve budgets, allocations, priorities. He must approve and issue innumerable reports and recommendations on topics ranging from prescription drugs to smoking, from the desegregation of schools to the payments made to people in need. What’s more, the Secretary must listen, must talk, and must consult about emerging national needs—with the President and with other Cabinet members, with the Director of the Budget, Civil Service Commission Chairman and members of Congress of both political parties. He must necessarily argue for increased appropriations because no budget is ever adequate to meet all the health, education, and welfare needs of a great and growing Nation. Many men and women, many young people concerned with social problems, bring him their views. For him, they are a valuable source of fresh approaches to existing problems, and a way of identifying emerging ones. His door and his mind must never be closed to new ideas, new priorities, new approaches. As head of the Department which accounts for the largest part of the domestic budget, the HEW Secretary is one of the Nation’s chief communicators. He must tell his fellow Americans about everyday health, education, and welfare problems—how to halt danger to their health—or how to improve their children’s schooling—or how to restrain rising medical costs. They don’t always listen, but they must have the chance to have the facts the Government obtains through their taxes. So the Secretary must be able to read and digest innumerable reports, memos, newspapers, and magazines; testify repeatedly before Congressional committees; answer all kinds of questions in letters, testimony and press conferences; propose new solutions to problems that have been with us since Biblical times; and in general report to the American people he serves on his stewardship. No one can fill this stewardship according to a public administration text. The Secretary must see and react to physicians, scientists, and other men and women rendering brilliant service to mankind. He also sees and reacts to the narrow jealousies of professional groups as they vent their parochial views on large and important issues. He watches the efforts of Congress as it works hard to meet national needs. He also The Secretary’s Introduction 3 watches Congressional conflicts or misunderstandings which may delay action on programs and money affecting the very lifeblood of his Department—and of all Americans. He must be deeply concerned with the pages of statistics he receives regularly, reflecting gaps in the Nation’s medical care, education, social security, and welfare. He must be just as deeply concerned with the handwritten letter on lined paper from the sick man, the student or teacher, the retired widow, and the mother with six children on welfare. They write him when they do not receive help elsewhere. Urgent telephone calls and letters from Governors and Mayors, and business and labor leaders, give the Secretary their needs and views. At the same time he hears each day from a husband who wants to know how to pay for his wife’s medical bill, from a mother whose child has been in a dispute with school authorities, and from parents and husbands or wives who, in a last effort to save their lives, want their loved ones to enter the Clinical Center at Bethesda. Sometimes these calls come to him in the middle of the night; his telephone never stops ringing. The clock ticks fast in the United States—and at the Department of Health, Education, and Welfare. Every day almost 10,000 babies are born, over 10,000 young persons turn 21, and over 4,000 men and women cross the mysterious line labeled “aged 65.” There are over 5,000 marriages and about 1,500 divorces. And each month the mail brings a social security check to over 24 million people and a welfare payment to 8,500,000 persons. On an average day over 5,000 die, including over 200 infants. Almost 9 million persons are sick or disabled—2 million of them confined to hospitals or nursing homes. On an average weekday some 57 million boys and girls go to class in schools or colleges. Every one of these people and every one of these events is of concern to the Secretary of Health, Education, and Welfare. There have been seven Secretaries of Health, Education, and Welfare. I have served the shortest period—less than 1 year. But I have watched, and studied, and participated in the programs of this Department and its predecessor agencies for over 34 years. When T first reported for duty in 1934,1 was paid $1,540 a year. I have worked under five Presidents—Roosevelt, Truman, Eisenhower, Kennedy, and Johnson—with different programs and different styles, or ways, of achieving these programs. This report, then, attempts to distill and bring together some of the results of this experience, some of the conclusions reached and recommendations arrived at. It is submitted with humility, and with full respect for the complexities and demands of public office in a demo 4 Department of Health, Education, and Welfare, 1968 cratic society. It is submitted in partial repayment of the opportunity to have learned, and to have participated in the leadership of this society. Is HEW Manageable? In the early days of the Republic, the settlers hungered for the great freedoms—to speak, to think, to write as they pleased. This brought about a society unmatched in ability to learn, and to earn. Today, we strive to add to individual freedom by creating fuller opportunities in which it can be exercised. The mission of this Department is the creation of these fuller opportunities for individual Americans. This mission calls for a unified approach to the problems of individuals, individual families, and individual neighborhoods. You cannot consider a child’s health apart from his education, you cannot further a family’s welfare apart from its health—or education. Fragmenting the Department would only fragment its capability to deal with whole human problems. Most of the vastly expanded health, educational and welfare services that are now provided by government—Federal, State, and local—are designed to supplement and to strengthen the family. Government now provides the education services that each family once provided for itself—and government provides infinitely richer and better education. Government provides a wide variety of health services—health education, health research, the elimination of pollution, the construction of hospitals, the administration of Medicare—and thus greatly adds to what each family can buy for itself. And government provides that security of income—either through social security or public assistance—that assures the welfare of the family. The family is the basis of American society and its well-being is the central objective of government social programs. Still, from time to time, outstanding leaders in Congress or the different professions tell us that the Department of Health, Education, and Welfare is unmanageable and should be broken up. Broken up how ? A separate, cabinet Department of Education has its ardent advocates. So does a cabinet Department of Health, a Department of Human Conservation, and a Department of Consumer Protection. I do not share the view that the Department should be broken up. Those who would split HEW into separate parts feel their field of interest—education or health—is so vital to the national interest that it deserves more visibility and prestige. They want to have a voice in the highest councils of government. But if cabinet offices of narrower The Secretary’s Introduction 5 compass were created, each with its separate constituencies, the President would have to do work now performed by the HEW Secretary—balancing priorities, weighing alternatives, and making decisions about various programs for people. This would add burdens to an already overburdened Presidency. If more cabinet offices were set up, the President would have more top officials reporting to him, and would have to add more staff in the White House to deal with them and coordinate their views and problems. Anonymous staff in the President’s office or the Bureau of the Budget—no matter how able or how experienced—should not be, and cannot be, responsible to the Congress and the public for major policy decisions. So it might eventually become necessary to elect an Executive Vice President to work directly with Cabinet members and other high-ranking officials in the administration of domestic programs. Those who argue for a Departmental umbrella covering more, not less, territory, stress that HEW’s interests range far and wide. I think suggestions for a Department of Human Conservation—or something like it—are valid and should be carefully considered. The Department of Health, Education, and Welfare—often referred to as the Department of the People—should in any case operate in a larger orbit of total concern for human needs. We must beware of endless quests for different, cleaner separations and neater classifications for the formidable problems of human welfare. The trouble is that such problems do not yield to easy compartmentalization. They won’t go away just because you put them in a separate box on a new organization chart. Like executive departments and agencies, Congressional committees find it harder and harder to maintain jurisdictional niceties when they are considering health and welfare legislation. Sc pe, Size, Diversity To support the view that the Department of Health, Education, and Welfare is unmanageable, one would have to argue that the General Motors Corporation is unmanageable, or that the Governors of New York and California cannot possibly manage their States. The operations of the Department of Health, Education, and Welfare compare favorably with those of any large enterprise, public or private. Social security is administered as efficiently as any private insurance company. The National Institutes of Health fund difficult research as efficiently as any business or university. And the Rehabilitation Services Administration has a return of $35 for every $1 it spends on a rehabilitated person. 328-184—69----2 6 Department of Health, Education, and Welfare, 1968 It is not the size or number of products of an institution which makes it manageable or unmanageable. It is the lack of common purpose. It is the lack of competent staff. It is the lack of intelligent, able leadership. It is the lack of flexibility. It is the lack of a constant flow of new ideas and people willing to change, to experiment, to try new ways. The Department of Health, Education, and Welfare has a unifying purpose, and has a cohesive concept pulling its several parts toward a common end—improving the quality of life for all Americans, increasing their options and so their freedom. The Department has able and dedicated staff: including a Nobel Prize-winning geneticist; a half-dozen Rockefeller Public Service Award winners; and innumerable winners of other national awards. There is no doubt that as their programs grow, HEW’s personnel can handle increased responsibilities. I do not believe there is any substantial merit in the argument that the scope, size, or diversity of the Department make it unmanageable. But the Secretary and his staff need additional help to lead and manage HEW effectively. I recommend: • That the Secretary of Health, Education, and Welfare be selected by the President from among men and women who do not intend to seek other elective public office or judicial appointment. The decision-making responsibility for health, education, and welfare (including such matters as civil rights) is so important that it should not be based even in part upon possible impact on the Secretary’s political future. • That the Secretary of Health, Education, and Welfare not be a professional specialist in one of the fields of the Department’s work. He should be a well-informed generalist who does not lean toward any individual specialty or group. • That the Secretary have enough staff assistants so that he can realistically carry out his important responsibilities. The Secretary’s capability was much improved with the addition of three Assistant Secretaries in 1965. But the Department’s top management is still inadequate. The Department needs: —Three Under Secretaries to deal with substantive program matters in health, in education and in social opportunities. —A new Under Secretary for Management, skilled in managing large enterprise, who should be a permanent career official. He would give the Department continuing managerial competence through political transitions. The present position of Under Secretary should be retained to provide the Secretary with a top level assistant and to aid him in handling policy matters. The Secretary’s Introduction 7 —Two more Assistant Secretaries: one for Public Affairs; another for International Programs. • That the Congress substantially increase the salary scale for senior personnel if the Department is to attract and retain qualified and able scientists, physicians, actuaries and administrators. Since these men and women can get much higher incomes outside of government (often for jobs with much less responsibility), the Department cannot compete fairly for them in the economic marketplace. This is an urgent need. The Need for Flexibility The Secretary must be able to organize and run his own shop. Every Secretary faces pressure from organized groups outside the Federal establishment. If there is a special unit in the Department which deals with its concerns, that pressure group usually wants to raise the unit up the status ladder, to report directly to the Secretary or an Assistant Secretary. Children’s groups want the Children’s Bureau reporting to the Secretary, and senior citizens want the same for the Administration on Aging. Mental health advocates have urged that the Secretary move the National Institute of Mental Health out of the Health Services and Mental Health Administration, to report directly to the Assistant Secretary for Health and Scientific Affairs. This internal competition is based on the notion that the more “visible” a unit, the more money it will get from Congress, and the more time and attention it will get from the Secretary. All these proposals have merit within their individual narrow domains. But no group of professionals, or advocates of any one program—no matter how worthy—should be able to freeze HEW’s structure. If he is to do his job, the Secretary must be able to organize the whole Department so it can work in coordinated, effective and balanced ways, in the entire public interest. After all, the Secretary’s decisions are subject to review and revision by the President, the courts, and various committees of both Houses of Congress—legislative, investigative, and appropriations. They are also subject to scrutiny by the press. Public policy should not be determined by a bureaucratic pecking order. Priorities should be set by the Secretary, the President, and the Congress in terms of national needs. Substituting administrative rigidity for flexibility hampers the Department’s ability to deal with changing situations as they arise. Just as the Secretary should not have his organizational hands tied by outside pressure groups, so he must not be tied lock, stock, and barrel by the legislative branch. Over 200 specific limitations and di 8 Department of Health, Education, and Welfare, 1968 rections on spending in the HEW appropriation act this year limit his discretion. Many more such directions in committee reports and legislative history of debates limit it further. Some directions specifically concern minor details, other broadly delegate policy decisions. Congress must always have the last say. Realistically, the Executive Branch of Government must share with the Legislative Branch the broad responsibility for directing programs. But the very least that Congress could do to make this sharing process work is to give the Secretary needed flexibility to meet changed circumstances, emergencies, or new priorities. What’s more, the Secretary himself must not have his hands tied by his own bureaucracy. He must be able to continue strengthening the Department’s regional offices—out where the people are. The nine regional HEW directors serve as his personal representatives in the communities where Americans live, and where their problems proliferate. Regional offices should have more authority and more responsibility for decision making, more power to earmark funds, and to make certain grants and contracts for vital projects. Our best men in Washington should take pride in accepting assignments in the field. A field command is regarded as an asset to the career of any army officer, and a post abroad is an asset to any diplomat. So work in the field should be the mark of a well-rounded HEW employee. Therefore, I recommend: • That the Secretary have authority to organize and reorganize the Department internally from time to time. In doing so, he would aim for efficiency, economy and efficacy. He should not be stymied by organizational entities required by existing laws— the 1912 laws relating to the Children’s Bureau, for instance, or the 1965 law relating to the Administration on Aging. • The return of the Elementary and Secondary Education program to regional decentralization, and more regional staff of all kinds so that the regional offices can wmrk closely with city and State officials, empowered to help them strengthen grassroots government. • Legislation which would authorize the Secretary to use up to $25 million of unexpended appropriations under existing laws to meet needs which are not specifically provided for in the Appropriations Act, and which arise from emergencies, or changing circumstances. Instead of 200 appropriation items, there should be no more than 100 groupings—leaving both the Congress its proper role in money matters and more flexibility for the Secretary. The Secretary’s Introduction 9 Relations With the Office of Economic Opportunity The Office of Economic Opportunity has pioneered with a number of bold and important antipoverty programs. Now good management and efficient administration demand that those poverty programs that have been tested and proven should be tied in more closely with ongoing programs in the Cabinet Departments. This is the only way they can enter into and affect our systems of government. As administrator of the Nation’s largest antipoverty programs, the Department of Health, Education, and Welfare will naturally fall heir to many OEO programs. Therefore, I recommend: • That Head Start be administered along with the day care programs administered by the Children’s Bureau; that the Neighborhood Health Services and family planning services be administered along with the health activities in HEW; and that OEO programs for senior citizens be put in HEW’s Administration on Aging. • That OEO remain as an overall unit watching and reporting on all programs affecting the poor, starting new programs and initiating new approaches: it should get out of the day-to-day business of running large-scale programs. Model Cities The Model Cities program, administered by the Department of Housing and Urban Development, has become an important and effective part of our antipoverty efforts. Under it neighborhood residents have joined with city officials in planning to improve their destinies. State, regional, and national officials have helped. In Washington, a genuine and strong Model Cities interdepartmental effort is underway. This effort should be strengthened. The Model Cities program offers great promise for progress in our inner cities. Minor Thoughts About Major Relationships No report of this size and nature could possibly cover all HEW’s managerial problems. Just as the Department does not cause all of these problems, so they are not all within its ability to resolve. Some of the kinks in the HEW-Congressional relationship could be ironed out by reorganization of the Congress itself—no mean task. Expansion and improvement of Congressional committee staff, for instance, could improve HEW programs. Many shorthanded Committees allow members and staff to charge their official travel to the Department’s budget. The Congress should 10 Department of Health, Education, and Welfare, 1968 avoid this practice, which may result in troublesome obligations. Congressional committees should have sufficient travel funds and should observe normal accounting practices. The Congressional practice of announcing the release of Department grants to the public usually works out reasonably well. Occasionally, a senior member, or an important Committee member with special influence, gets a jump—or “scoop”—on his colleagues. This may simply annoy his colleagues. Or in the case of politically evenly divided State delegations, or future rivals for political office, it may result in disputes which the Department cannot handle to the satisfaction of all concerned. Members of Congress who vote Federal funds should be able to get some of the credit for those projects they make possible. Sole credit should not go to those of our fellow citizens who are always wailing about Federal expenditures and supposed Federal waste, but support strongly the Federal appropriations and expenditures which help their narrow constituency, their favorite interest group, or their special purpose program. Therefore, I recommend: • That the announcement of every construction grant and every project financed even in part by Federal funds should show the public conspicuously that this is so; and that when the project is underway the public continue to be informed that it is operating because of Federal financing. HEW cannot move to strengthen the hands of its masters in the Congress. But it can and must move to strengthen hands in State and local government, if it is to meet rising expectations and demands for social services. That State and local governments throughout the country vary widely is a truism. That they are often weak is a harsh but fair generalization. City after city finds that, because it is completely dependent on the property tax as a source of revenue, it has not the funds to pay for its children’s schooling, or to meet its welfare bill. State and city governments have not historically been able to attract and hold enough highly qualified people. The administration of health and welfare programs by many State departments in many States makes for fragmented service delivery. The grants-in-aid mechanism has given the Department a tool to use in working toward solutions to national problems, while maintaining a valuable dispersion of national power. But only solid capable State and local government can assure the gains made by the HEW programs of the past years. Without city and State organizations capable of guiding social planning operations, HEW programs will fail, Therefore, I recommend; The Secretary’s Introduction 11 • That new forms of financing be developed to free local communities from their reliance on the outmoded, inefficient and unproductive property tax. The property tax should be reduced and eventually eliminated as a basis for financing education and local government services. • That HEW—working through its regional offices—give cities more help in breaking down artificial barriers to dealing with air and water pollution, or waste disposal, on a regional basis. • That HEW build on a constructive practice already begun: helping State and local government recruit and keep highly qualified staff. • That State agencies be reorganized to group their activities in a more rational and coordinated way, with special consideration to a single State health and welfare agency, such as those in Wisconsin, Utah, and California. • Modernization of State and local civil service laws to provide more flexible procedures for selecting able people and to assure greater opportunities for poor and disadvantaged men and women. • The revision and strengthening of the State merit personnel standards established by Congress in 1939 in the Social Security Act, in the light of recent experience and new needs. Further consideration should be given to the recommendations in the Report of the Secretary’s Advisory Committee on Merit System Standards, which reported in January 1969, to the Secretary: employment opportunities for culturally, economically, educationally and physically disadvantaged people should be expanded in State and local programs; educational requirements should be reviewed and revised to permit State and local agencies to employ creative and innovative men and women. The Last Health Hurdles In the past 2 or 3 years our Nation has emerged from a necessary— a pioneering—period of concentration on medical research. Looking up, bemused, from our microscopes, we have found great numbers of eager, waiting patients. As a Nation, we have realized that medical research is a first step only, and gone on to apply ourselves to the difficult task of delivering the results of that research to people. We have realized, too, that good medical care depends not only on scientific knowledge, but on trained men and women, up-to-date hospitals and clinics, sound planning and organization, and proper financing. 12 Department of Health, Education, and Welfare, 1968 Every one of these elements has been strengthened, and we have arrived at the point where large numbers of Americans can indeed get good health care. Yet the HEW Secretary spends a great portion of his time pondering and dealing with the complexities of modern health problems, technological, social and economic: the more people there are, the longer people live, the more income they earn, and the more they know about the astounding possibilities medicine offers, the greater their demand for high quality health care. They will not be satisfied with run-of-the-mill care when society can produce the best. The woman with a kidney disease who watches someone else being treated with an artificial kidney on her television screen will not face death without recourse, nor will her family. The man who reads about heart surgery over his morning coffee will not deny it to his child because he can’t afford it. He feels the best health care is not a luxury, but a right. As demand for such “best” health care rises, so does the pressure on our understaffed hospitals and clinics, on our doctors and nurses. Trained health workers are in short supply. Medical costs spiral. The Nation invests more than $50 billion—6 percent of its gross national product—on health each year, but it doesn’t get a high enough return. What’s more, only an infinitesimal fraction of this investment goes toward improving the way our whole system of health care works. It will not be easy to leap such health hurdles; we may have to climb over them slowly. Current needs point in separate, but overlapping directions. While sustaining and increasing efforts in basic medical and biological research, we must improve methods of delivering and paying for health care. And while we perfect essential programs for the elderly, we must emphasize the neglected needs of children—in health care as in other fields. We must take every possible step to hold down health care costs, including enlarging incentives for efficiency. We must remove obstacles to the efficient use of health resources. Medicare—Medicaid Medicare has lifted a crushing financial burden from the backs of older people and their families. No longer do our older men and women have to delay vital medical attention; no longer do families have to pauperize themselves to get it. Without interfering with the doctorpatient relationship, without burdensome administrative machinery, Medicare is working well and helping to raise the quality of all health care. For this Secretary, who argued its case so long, the proven success of Medicare has been a source of great personal satisfaction. I recommend: The Secretary’s Introduction 13 • That Medicare now be extended to totally disabled people, no matter what their age. The disabled are faced with the same problems as the aged: heavy medical expenses at a time when their income and earning power are very low. Permanently and totally disabled social security beneficiaries can be included in the Medicare program on a sound basis. • That the doctor bill part of Medicare be put on the same social insurance prepayment basis as the hospital part. This would make it unnecessary for older and disabled men and women to pay $4 a month for medical insurance out of their retirement incomes. • That at least part of the cost of prescription drugs, which can be unusually heavy for an older or disabled person, be covered under Medicare. • That a reasonable cost range for all drugs should be used in all federally supported programs. The crushing burden of sickness falls most heavily on the poor, who can least afford it, and who suffer it more frequently and more severely than other groups. Poverty helps cause ill health; ill health helps cause poverty. Medicaid, which became law in 1965, has made a start at helping to break the cycle of poverty and ill health among 8 million Americans. It has also opened our eyes to the terrible need for health care among the poor. We must not precipitately restrict the program because the costs have been more than were estimated. There have been a number of problems in the administration of the Medicaid program. To ascertain their scope and implications I arranged for public hearings to be held in nine major cities on the Medicaid program. I have transmitted the record of these hearings to the Congress. I urge that they be studied carefully before taking action. Based on my review of these hearings I recommend: • That Medicaid be amended to increase its coverage substantially, so that all who need, but cannot afford, decent health care may have it. • That the recommendations of the National Advisory Committee on Medical Assistance for the revision of Medicaid be followed to tighten up the program, moderate increased costs, and prevent lax operation in some States. • That health insurance coverage be expanded to reduce the need for Medicaid. The Cost of Illness Most Americans carry some form of voluntary insurance, covering at least a part of hospital care. Medicare has substantially increased 14 Department of Health, Education, and Welfare, 1968 this coverage, Medicaid has helped the indigent. Still, long run serious illness, with all its high—and rapidly rising—costs, can spell economic disaster for the millions of persons who are not covered, and for those who are inadequately covered. All American families should be free from fear of such disaster. They should be financially protected against catastrophic illness, and should be able to afford revolutionary and expensive treatments. The economic risks of illness should be spread further through comprehensive insurance protection. One way in which this could be achieved is through comprehensive health insurance legislation covering all persons who work and their families. Employers and employees would be required to contribute to such comprehensive insurance protection. If the Nation decided to take a Federal-State approach to this problem, the Federal Government could levy a national payroll tax, against which a State would receive a 90 percent offset if it had an approved State health insurance plan. The Federal Government would establish standards for such State plans. Unemployed and nonemployed men and women would be covered with Federal aid. American families should not have to pay exorbitant prices for comprehensive protection. The Nation could save additional amounts if those for whom hospital treatment is not mandatory were treated at home, or in nursing homes, or through periodic visits to their doctors’ offices. It has been estimated that if the average cost of general hospitals could be brought down by only 10 percent, savings would total almost $1 billion each year—and $3 billion by 1975. In order to find ways to reduce unnecessary medical costs, I have appointed an Advisory Council on Health Protection and Disease Prevention. This Council will study the problem of preventing disease and disability, and make recommendations to the Secretary. This should be an important step in conserving scarce resources preventing the unnecessary utilization of medical services. The Social Security Amendments of 1967 provide for experiments to assure the fiscal health of the hospital system and at the same time to give purchasers of services full value for their dollars. The Amendments of 1967 provide for experiments with “incentives for economy while maintaining or improving quality in the provision of health services” in connection with reimbursement under such programs as Medicare. Most hospitals and hospital groups are eligible to submit proposals for incentive reimbursement experimental plans. Therefore, I recommend: • That a Commission on Health Care Insurance, consisting of distinguished representatives of the consuming public, the health The Secretary's Introduction 15 professions, and insurance carriers be appointed to recommend the precise form of comprehensive protection against the economic burdens of catastrophic illness which would result in all persons being covered on an economical and efficient basis. • That while this Commission is completing its study, most of the available private, as well as public, insurance coverage be broadened to provide coverage for a full range of preventive, ambulatory, and diagnostic care; and to cover such health problems as alcoholism or mental illness. If public and private third party payers fully covered preventive and diagnostic services (like outpatient services), patients would use less costly health resources outside of hospitals more and the long-run costs of Medicaid would be reduced. • That hospital incentives to reward efficiency without compromising medical care be rapidly expanded. Once effective means of controlling hospital costs have been demonstrated, they could be extended in Medicare, Medicaid, and Maternal and Child Health Programs. Successful businesses must provide high quality services at the lowest reasonable costs. We should help our hospitals do the same. • That physicians and hospitals should voluntarily restrain price increases in order to avoid restrictive controls. Kiddicare; Family Planning In the next 10 years, the Nation must place as much emphasis on the health needs of its children as it put in the last decade on the needs of its older people. Thousands of women in low-income groups do not now have adequate access to comprehensive health services. Tragic results include great numbers of unwanted children—of mentally retarded children—of children with avoidable physical and emotional defects. Competent pre-natal care and competent health care during the earliest part of life can mean the prevention and control of many crippling handicaps. So the case for fuller child health opportunities does not rest alone on present comfort, or hardship, or even damage to the human spirit. It rests on possible irreparable physical damage to the brain and body. I recommend: • That comprehensive pre-natal care be extended to all women of low-income families, so that, as far as possible, all children be born well. ® That family planning be included as a part of comprehensive health care to these women so that every child is born a wanted child. Family planning should no longer be the quiet privilege of 16 Department of Health, Education, and Welfare, 1968 the well-to-do. It must be an integral part of our efforts to reduce poverty, raise educational levels and so give people great freedom of choice. Out of about 5 million medically indigent women who want family planning services, only 500,000 now receive such services. About 450,000 large families would no longer be poor if they had only three children to support. • That medical care for all children in low-income families be provided during the first year of life, placing special emphasis on nutrition, on the prevention or early correction of crippling disabilities and on dental care. Once this program—which we call “Kiddicare”—is established, that it be stretched over a five-year period, so that the children covered would be assured of medical care until they reach the age of six. • That the health activities of the Children’s Bureau and the Medicaid program be transferred to the Public Health Service and coordinated with the Neighborhood Health Centers and Family Planning programs to assure unified delivery and financing of medical services. Nutrition and Health It is intolerable that there is even one hungry child in America. We have the ability to wipe out hunger and malnutrition, but we have not yet demonstrated the will. We are only beginning to discover how widespread malnutrition is among the poor, the aged, the sick, and the young. But we know enough to say forthrightly that there is malnutrition in the United States, and that it is highly correlated with poverty. We know that food assistance programs do not reach some 14 million of the 22 million poor, and that even when communities have such programs, local administrative barriers often prevent food and funds from reaching those who need them most. Poverty is the basic, underlying cause of hunger; the changes I have recommended in the social security and welfare systems would go far toward alleviating it. But we need to go beyond this, and even beyond the nutrition problems of the poor. We need to know a great deal more about general relationships between nutrition and health, and the broadest considerations of human development. Responsibility for nutrition activities has been fragmented throughout the government: within the Department of Health, Education, and Welfare, within the Executive Branch of the Federal Government, and within the Congress. Within the Department, I have directed the establishment of a new intradepartmental committee tc coordinate at least HEW’s nutrition programs. The Secretary’s Introduction 17 In 1946, the Nation adopted a new goal: The creation of maximum possible employment. It is now time to establish the elimination of malnutrition as a national goal. To further that end, I recommend: • That the Congress enact legislation declaring the eradication of malnutrition to be a national responsibility, and giving appropriate officials in the Executive Branch the authority and responsibility to carry out this mandate. • The creation of a Federal Interagency Nutrition Council, headed by the Secretary of Health, Education, and Welfare, to outline national policies in all areas of nutrition and to coordinate the activities of the individual departments and agencies. • The creation of the Human Nutrition Administration within the Department of Health, Education, and Welfare, with responsibility for research and evaluation, and expanded and revised food stamp and food distribution programs, including school feeding and other relevant medical-nutrition programs. • That this new Human Nutrition Administration distribute food stamps on a nationwide basis, with eligibility based upon family income determined by the Social Security Administration’s national poverty standards, rather than local welfare standards. Mental Health and Mental Retardation The record of the past years in dealing with the tragedy of mental illness is one of great achievement and great promise. Measured in terms of dollars, we are investing about $367 million this year in the field of mental health as compared to $68 million ten years ago. Measured in terms of accomplishments, we can look to a record of expansion in research, the training of skilled manpower, and the development of a new approach to treatment through community mental health centers. I recommend: • That we accelerate our research effort to provide better understanding of mental illness, how it can be prevented and treated. • That we redouble our efforts to provide the trained personnel needed in the fight against mental illness. • That we seek to reach the goal of 500 community mental health centers in operation by 1972. • That we explore methods of providing expert examination of school age children to discover those who may fall victim to mental or emotional illness, so that they can receive needed counseling and treatment at the earliest possible time. • That HEW encourage industry to intensify its efforts to hire mentally retarded as well as other handicapped men and women; 18 Department of Health, Education, and Welfare, 1968 that it encourage its fellow government agencies to adopt similar employment policies. The Way Services Are Delivered Comprehensive group practice—particularly group practice with prepayment—has proven to be an efficient way of delivering health care. In such plans groups of physicians, working together within the framework of our private health system, can see up to one-fifth more patients, and these patients can get individual care of high quality for 20- to 30-percent less cost. As the President’s Advisory Commission on Health Manpower has pointed out, such organizations reduce the use of our overtaxed hospitals and make more efficient use of health personnel. Other new organizations and reorganization of health services have shown that they can promote good medical care at low prices. “New Careers” programs—training men and women who haven’t had enough education or other advantages, for health occupations—offer great promise. In such programs, the poor skillfully fill needed jobs, benefiting themselves and our whole society. Neighborhood health centers offer a full range of services right in the communities where people live. Some of the hospital outpatient departments now serving as “family doctors” to our inner cities are pioneering in offering comprehensive family-centered care instead of impersonal, episodic, emergency treatment. Whole communities, under the national Partnership for Health program, have intensified their health service planning. They are beginning to answer questions like, how many hospital and nursing home beds they need—or what steps they must take to clean their water supplies—or what rural health needs have priority, far better than Washington officials could. Therefore, I recommend: • That financial incentives be offered to encourage the development of prepaid group practice groups, expanded community hospital outpatient services, and other plans offering promise of greater efficiency, more comprehensive service and the like; and that the reimbursement policies of public and private insurers reflect the increased efficiencies of such providers. • That overly restrictive State laws now impeding the use of new kinds of health manpower be substantially revised so we can properly use the talents of technicians and aides in medicine, dentistry, nursing, and pharmacy. • That Federal help be focused on our big cities’ urgent need for construction and rehabilitation of medical facilities, whether they The Secretary’s Introduction 19 be built as central complexes or in the neighborhoods; and that comprehensive State planning be required as a condition for Federal aid, with priority given a full range of inpatient, outpatient and extended care services serving large numbers of people. • That the programs to combat alcoholism be intensified and expanded. Cigarettes and Health Five years after the American people received their first official warning on smoking and health, cigarette consumption in the United States had dropped by over 1 billion cigarettes in 1968. Though we number 2 million more adults, we have increased evidence that more and more adults are giving up smoking and fewer teenagers are taking it up. Still, smoking, a grave problem in 1964, is graver today. To some extent it can be said that cigarette smoking has canceled many of the health gains made in recent years. Deaths and diseases associated with cigarette smoking continue to rise. In 1964 there were nearly 46,000 deaths from lung cancer; this year there will be over 59,000. Five years ago emphysema and chronic bronchitis killed 20,000 Americans; twice that number will die this year of these respiratory diseases. Cigarette smoking contributes to coronary heart disease: in 1964 there were 545,000 deaths from this disease; in 1969 the number is expected to be 590,000. What’s more, the Nation’s workers who smoke cigarettes spend over a third more time away from the job because of illness than those who do not smoke. Three main obstacles bar our way to reducing the number of persons now smoking, encouraging young people not to start, and urging those who continue the habit to use less hazardous cigarettes and less hazardous ways of smoking: One is economic, involving public revenues, agricultural income, and industrial profits. A second is social acceptability of cigarette smoking and its near-addictive hold on many people. A third is the posture of those who insist that the health hazards of cigarette smoking have not been proved, despite the evidence. Public education, news coverage of smoking and health developments, antismoking messages on radio and television, increased concern and activity by health professionals, and health education in schools—all these reduce cigarette smoking. But although the Public Health Service has a total annual budget of $2.8 billion, only about $2 million goes for cigarette smoking behavioral research and education. 20 Department of Health, Education, and Welfare, 1968 Last July, 1 submitted to Congress a report on the Health Consequences of Smoking, as required by the Federal Cigarette Labeling and Advertising Act of 1965. The report confirmed or strengthened the conclusions of two previous reports published by the Department in 1964 and in 1967. With the 1968 report, I sent four recommendations to strengthen the Department’s program. These are included in the following recommendations I now submit: • That the warning statement required by the Federal Cigarette Labeling and Advertising Act be strengthened, as recommended in 1967 by the Federal Trade Commission, to become: “ ‘Warning’ Cigarette Smoking Is Dangerous to Health and May Cause Death from Cancer and Other Diseases.” This warning should be moved from the side of the package to the front and the back of the package, and the text should be clearly legible, and should be required to accompany all cigarette advertisements, including those on television, radio, and in the press. • That levels of tar and nicotine in cigarette smoke be published on cigarette packages, on cigarette vending machines, and in all advertisements. Authorization should be given to add other harmful agents to this listing. • That formal liaison between the government and the tobacco industry, begun by the HEW Secretary in 1968, be supported. It is essential to strengthen such cooperation to deal with the smoking and health problem. • That increased appropriations be made to support research, both basic and behavioral. We must learn more about what elements in tobacco cause harmful effects on human health and how; we must at the same time learn more about why people smoke, how those who want help may be helped to resist the habit, and we must work toward the discovery of a nonhazardous cigarette. • That increased appropriations be made to broaden and expand programs of public information and education. Special efforts are needed to take advantage of improved methods of teaching children about the effects of smoking. The Department should support the training of classroom teachers and the preparation of teaching materials to accomplish this. • That Federal taxes on cigarettes be substantially increased and made uniform throughout the Nation. When the national economy suffers excess illness, disability, work loss and premature death among cigarette smokers, surely a greater use of Federal taxing authority is justified, to help finance necessary research and educational programs. The Secretary’s Introduction 21 Intensified Research on Service Delivery In every health program we undertake, we should intensify research on the delivery of services. It is useless to learn the results of cigarette smoking, or to find a new vaccine or surgical technique, if people can’t learn about and use them. Research discoveries in the laboratory, until they are applied, save mice, not men. A Nation which can invent machines to keep a man alive can invent ways of getting man and machine together—and keeping them together as long as necessary. A Nation which knows how to treat alcoholics, or narcotic addicts, can devise ways of getting that treatment to those who need it. A Nation on its way to the moon can overcome the barriers to good health care suffered by the women who must, to get a doctor, walk five to ten blocks to the nearest bus line— then change buses and pay two or three fares to get to the hospital— then sit for hours in a clinic waiting (and sometimes forego a day’s pay). Failure to deliver services resulting in isolation, the absence of hospitals and clinics—impersonal scattered services, ignorance and lack of understanding of preventive measures, of symptoms and available treatments—misuse and underuse of our resources—and above all high costs—these are the health hurdles before us now. Schooling: the Great Steps Forward In education, as in health, we have taken great steps forward in the last years. In education, as in health, we need to move forward faster still, emphasizing the needs of the young. They are, after all, our Nation’s future. About one of every three of us is a student, a teacher, or educational administrator. And 6 percent of our income goes to formal education. The fact that we are now truly an educational society is reflected at HEW. The more than 75 laws enacted in the past 8 years have touched the lives of millions and changed the face of the Department. The Office of Education, which for almost a hundred years was primarily a statistics-gathering organization, is now a bustling agency administering funds that are giving millions of our children fuller opportunities : special help for poor boys and girls; books and other educational materials; grants, loans, and work-study help for young men and women who want to go beyond high school; aid for more than half our colleges and universities; and research grants that have improved the whole process of education. Most importantly, after a century of debate, the fears and bugaboos about Federal control and all the rest 328—184—69----3 22 Department of Health, Education, and Welfare, 1968 have proved groundless; the issues have been clarified and the facts straightened out. The Federal role in education has been established. We have made a good beginning. Still, we are barely keeping pace with our Nation’s rapidly growing and constantly changing education needs. No one can afford to stop learning in a society where, by 1975, some three-fourths of our labor force will be producing goods and services that did not exist ten years before. Future generations need as early a start as possible. And the followthrough should be a lifetime pursuit. The Nation must make a greater investment in education at all levels. We must close whatever gaps we suffer. Strengthening Federal Support Without an increase in our overall investment in education, we cannot assure each child that the goal of his education depends on ability, not geography, or his family’s financial capacity. We must narrow the range of per-student expenditures among the States, and within the States. We must share the cost of educating poor and handicapped children. We must mobilize our research and development resources so that we can improve the whole range of educational activities. And, to get the most for our dollars, we must streamline and coordinate our programs through efficient administration, effective performance and evaluation. Therefore, I recommend: • That the property tax—the chief source of revenue for the schools—be modified, supplemented by other sources of revenue, and eventually eliminated. • That within the next 4 years today’s Federal share of 8 percent of elementary and secondary school expenditures be sharply increased year by year, from $1.5 billion to the full authorization of $3.5 billion annually. • That, to assure that all funds for education are well spent, we encourage and support the national assessment of the state of learning in the United States, already authorized by Congress, for a 5-year period. • That legislation be enacted to place all income to the United States from leases and royalties from shale oil and other minerals in a trust fund, and the proceeds be used for the support of education in accordance with our Nation’s education laws. A Real Headstart A growing body of knowledge tells us that very, very young children can be stimulated to learn far more than has been expected in the The Secretary’s Introduction 23 past, and that learning really does begin at birth. One scientist believes that by beginning at the earliest possible stage in the child’s development, we could perhaps stretch the IQ of future generations by as much as 30 points. All children need attention, time, and money spent on them before they reach the age of 6. Yet the children who most need to have their minds stretched and their environments enhanced—including two-thirds of the 2 million poor children between the ages of 3 and 5—lack such opportunity. Therefore, I recommend: • The extension of Head Start for low-income children, for all handicapped children, and ultimately for all children who could benefit, urban and rural—first for 5-year-olds, then for 4-year-olds, then for 3-year-olds. • Effective followup for preschool programs, incentives to attract highly qualified teachers to work with disadvantaged children, and use of advanced educational equipment and of individual tutoring. • New school construction and operating fund programs to improve the quality of education. • Schools which serve as vital centers of community activity; school systems which strengthen community ties with the schools and encourage real parental participation. Day-Round, Year-Round Schools We have a tremendous investment in school plants in the United States; we should put it to better use. One of the greatest wastes we suffer is the school that opens at 8 :30 a.m., closes at 3:30 pan., and shuts for 3 months in the summer. Today’s slum school especially is often only a building where children are kept for so many hours a day. If it expanded in hours, and community service, it could become something much more: a neighborhood “capital”, a source of pride and a symbol of individual and communal achievement. Schools in both slum and suburb should be kept open afternoons, evenings, and all year long. But 12 months of the same old thing will not do: the school should become a place for young and old to go for useful education covering a wide range of programs—vocational training, work experience, advanced courses, cultural activities, community service, and remedial training of all kinds. Therefore, I recommend : • Federal support to help school systems seeking to convert to fulltime education, starting with schools for disadvantaged children. 24 Department of Health, Education, and Welfare, 1968 The Many Aspects of Education Our educational institutions—like our citizens—should develop their individualities and keep these individualities. There must be many different kinds of such institutions—each of them as good as possible, in its own way. The student who wants to learn to work with his hands as a draftsman, for instance, should have that chance, just as the Shakespeare scholar has his. The landmark Vocational Education Amendments of 1968 give us the tools to increase opportunities for vocational education. They point the way to new bonds among government, school systems and private industry. In this new partnership, opportunity is joined to educational experience through cooperative, part-time work-study, and both lead to specific jobs. Once a student finishes high school, he should continue to have a varied choice of learning styles. Yet, we are far from the goal of giving different sorts of educational opportunities beyond high school to all young people who deserve such opportunities and can benefit from them. We have made progress. The growth of junior colleges over the past decade has been phenomenal—with schools opening at the rate of about one a week. They have already proven their potential. But we must make sure that no economic or racial barrier stands in the way of talented students who want to go beyond high school— whatever the direction. What’s more, new sorts of jobs and new kinds of careers constantly demand that schools and colleges foster the art of learning in the broadest sense, and provide training outside the formal educational structure. More and more pupils need the kind of broadly based general education that helps them adapt to lifetime changes. Not only must they have a sound basic education, but they need opportunities for continuous learning while they are at school and college, and throughout their lives. This means their schooling must reach into the community—and into the world of culture, art, and government as well. We have more than 8 million vocational education students in the country today. What is more, businesses and industries show increasing interest in training and retraining programs. Nearly 2 million people are now involved in vocational, technical and professional training outside the formal educational establishment. Many more are enrolled in correspondence courses. Television’s educational courses reach still others. But the potential has barely been tapped. Therefore, I recommend: The Secretary's Introduction 25 • That we triple the number and dramatically improve the quality of opportunities in vocational education under the new Vocational Education legislation. • That we develop a whole series of continuing education programs—through vocational and technical schools, junior colleges and universities-—educational television, community schools— and any other possible resource. Higher Education The 1960’s have seen an unprecedented increase in the Federal commitment to higher education—from $2.5 billion in 1963 to almost $6 billion in 1968. Clearly, America’s colleges and universities owe their growth and vitality in large measure to such great laws as the Higher Education Facilities Act of 1963 and the Higher Education Act of 1965. In enacting the Higher Education Amendments of 1968 the Congress took another major step in the strengthening of higher education. But with all this progress, inability to pay, rather than inability to learn, still prevents many talented students from entering and completing college. Students with the same achievement levels, but with different family incomes, even attend college in strikingly different ways. Moreover, many question the future financial health of higher education. They especially doubt its ability to take on large numbers of additional students and to pay for high-quality graduate education. The Nation has a valuable resource in its specialists with graduate degrees, and in the research they make possible. States and individuals cannot afford to nurture this costly resource alone. The time has come for a bold new commitment to higher education, a commitment with two major thrusts: To promote equality of opportunity by ensuring that all able students can afford to go on to postsecondary education, and that institutions are able to accommodate them; and to strengthen graduate education and research by supporting graduate students and helping institutions develop a limited number of centers of excellence for graduate teaching and research. Student aid should be our chief concern. Aid for students who need it most, or who would not otherwise go to college, should have our first priority. Still, institutional aid enhances the education of each individual student, and equality of opportunity in higher education is an empty goal unless colleges and universities have the resources for high-quality education. Part of these resources must come from tuition and fees, part from State and local governments, part from private giving; but without increased Federal help, these resources will not be sufficient. 26 Department of Health, Education, and Welfare, 1968 The Federal Government must also directly help the institutions meet the financial burden of serving many more students. Therefore, I recommend: • The expansion of Federal student aid programs, such as educational opportunity grants and college work-study until the number of federally aided students reaches about 3 million by 1976— instead of the present 1% million—with Federal aid available to the majority of students now at college from families with incomes under $9,000 a year, and to the thousands of potential college students from such families. • Cost-of-education allowances paid to every institution which enrolls a federally aided student (undergraduate and graduate). • A variety of aid for graduate education and research to strengthen graduate research and increase the number of centers of excellence. • Consolidation of Federal aid programs for higher education construction and equipment, to give colleges and universities more flexibility to use Federal funds in accordance with their own plans and priorities. New and expanding institutions, and those which must replace deteriorating plants and equipment, need help for the capital cost of institutional expansion. • Congressional examination of all kinds of institutional grants, to learn more about the impact of formula aid on the quality of higher education, on the balance between public and private colleges, and on the maintenance and growth of support by State and local governments. Family Life and Sex Education Americans depend on their families for warmth, security and sustenance. The family shapes its children, directs their talents and encourages them as they define their values. Society cannot control the family, or teach people how to raise families successfully and lead successful family lives. It can, however, try to teach what we know of successful family life and sex education. In August 1966, at my suggestion, the Office of Education issued a policy statement supporting the inclusion of important, long-neglected family life and sex education courses in elementary and secondary school curricula. Many school districts around the country have begun to include such courses as a regular part of children’s education from kindergarten through high school. Often such courses become centers of a stormy political issue. Even highly emotional political controversies prove useful when they excite open and public discussion of a significant—and too often The Secretary’s Introduction 27 taboo—subject. Expanded programs of family life and sex education will contribute to the stability of families, to the reduction of venereal disease and illegitimacy, and to the fuller appreciation of human life. Therefore, I have broadened the responsibilities of the Department’s Committee on Population and Family Planning to include consideration of sex education and improved and strengthened family life. Student Unrest The numerous, often violent, disturbances on our college and university campuses have worried and upset the Nation. Reflecting this disenchantment with young dissidents, the 90th Congress enacted certain legislation aimed at denying students who participate in violent and disruptive demonstrations the benefits of federally financed grants, loans, and fellowships. Surely the student activities at which such legislation is directed are destructive and self-defeating; I cannot condone them. Whatever the need for reform in our academic life, physical harassment, obstruction, and vandalism cannot be used as acceptable means of dramatizing it. Nonetheless, I am deeply concerned about the practical effect of the student unrest provisions. In the first place, they present the colleges and universities which must enforce them with a confusing set of conflicting and overlapping regulations. For example, section 504 of the Higher Education Amendments of 1968 and section 411 of the 1969 Appropriation Act both turn on the conviction of an individual student of a crime. However, in each section, the nature of the crime, the identity of the convicting court, the procedural incidents, and the consequences of a finding against the student are defined differently. Moreover, these provisions may have grave consequences for the education programs administered by the Department of Health, Education, and Welfare. They involve the Federal Government in the maintenance of campus discipline—usually and properly a college and university function. By imposing rigid Federal standards, they may restrict the ability of college and university administrators to deal with disruptive students on the basis of each individual, particular situation. And, by making the consequences of a student’s participation in a demonstration turn ultimately on the size of his pocketbook rather than on the strict nature of his conduct, the unrest provisions discriminate on economic grounds. All in all, then, they may do more to exacerbate campus tensions than to ease them, and do more to hamper than to help official capacity to deal with these tensions. Therefore, I recommend: 28 Department of Health, Education, and Welfare, 1968 • That the public interest would be better served if Congress followed the Senate proposal, vesting in the college or university full discretion for determining how a student’s misconduct should affect his eligibility for Federal assistance. • That, in any event, Congress correct the present conflicting and overlapping nature of the laws in this area by eliminating the restriction now imposed by section 411 of the 1969 Appropriation Act. Selective Service and National Manpower Policy Descriptions of the American draft system range all the way from pure praise to simple acceptance to “Kafkaesque in its inscrutable arbitrariness.” Whatever the truth, the continued education and training of the graduate and professional manpower required by the national interest warrant the review and modification of the Military Selective Act of 1967 (Public Law 90-40). Men of military service age deserve more equitable treatment from their country. A random selection system within the ago groups eligible for service may be the long range solution. Any single deferment, regardless of age or educational level, should be based upon the ultimate national interest and security. Pending congressional action on Public Law 90-40, the selective service procedure should be modified so that young men and women eligible for service suffer a minimum of uncertainty. Therefore, I recommend: • That a prime age group (age 19) be designated as the first to be inducted into the service, and that those who are now past age 19 (but not yet 26) and who are not entitled to deferment, be treated for this purpose as if they were 19 (be placed in the 19-year-old pool). • Since all fields of higher education are, or may be, of equally critical importance to the balanced development of the Nation, that no higher education field or discipline be considered more important or critical for selective service deferment purposes than any other. Assuring a Decent Livelihood Our American society firmly believes that an able-bodied man should pull himself up by his own bootstraps. It is only gradually coming to grips with the fact that he can’t pull himself up by his bootstraps if he hasn’t any boots. The Secretary’s Introduction 29 It has been shocked to realize that the man criticized for quitting his job had to do so to take care of motherless children or that children fall asleep in class because they have been kept up all night in crowded rooms, or that they cannot achieve good marks because they are hungry and undernourished. As a Nation, we are facing the reality first confronted in the 193O’s: No child, no man can thrive on an empty stomach; the key to opportunity is a decent income earned with dignity. But we have not gone as far in assuring this income as have most of our fellow democracies. It is an ugly paradox that this is true in our wealthy country, with its vigorous capacity for growth and for change. It is a paradox that some suffer hunger in the midst of surplus, that rat-haunted slums exist near comfortable suburbs, that there is a lack of steady, decent jobs in a period of high employment; that when most Americans enjoy an extraordinarily high standard of living, we still have some 22 million human beings living in poverty. Social Security For the first time since the world began, we, as a Nation, have the capacity to end poverty. The most formidable weapon in our arsenal is one most Americans have not usually thought of as an antipoverty program—Social Security. The Social Security and Unemployment Insurance Systems moderate the loss in earnings due to retirement, death, disability, and temporary unemployment. They offer American workers and their families basic, necessary protection. For instance, social security is the main source of continuing income for retired people—many would be destitute without it. Social security benefits keep 10 million people above the poverty level. Without these benefits, they would have to depend on relatives who often could not readily afford such support, or they would have to go on relief rolls. Without these benefits, nineteen out of twenty beneficiaries would not achieve even a moderate living standard. Over 24 million American men and women are receiving old-age, survivors, or disability insurance checks totaling $2 billion each month. Still, the social security recipient keeps body and soul together on an average of $100 a month. And the minimum benefits are now only $55 for a single person and $82.50 for a couple. Whenever suggestions are made concerning increasing social security benefits, inevitable but proper questions arise: Can we afford it? Should the cost be borne by payroll contributions ? In considering these important questions, we should remember that the employer’s net social insurance contribution rate today is lower 30 Department of Health, Education, and Welfare, 1968 than it was expected to be when the social security program was enacted in 1935. I have transmitted to the Chairman of the House Committee on Ways and Means, and to the Senate Committee on Finance, a report on this matter, which in my opinion justifies additional payroll contributions for further improvements in the program. I recommend: • That social security benefits be raised substantially to a $100 per month minimum for an individual and $150 for a couple over the next several years. This would have a dramatic effect—lifting 4.4 million people out of poverty. The first step toward this goal would be a 10 percent general boost and a jump from $55 to $80 minimum for an individual and from $82.50 to $120 for a couple. This first step alone would move 1.2 million persons out of poverty. Taking 150,000 aged men and women off the welfare rolls and greatly reducing the number of needy crippled, disabled and blind; at an annual savings in local, State and Federal funds of $255 million. States would then be freer to concentrate their helping efforts on the families most in need of preventive and— where it is too late—rehabilitative services. • That the maximum earnings base on which social security benefits are computed (now $7,800 a year) be completely eliminated in determining the employer’s contribution. • That the maximum earnings base for determining the employee’s contributions and benefits be increased by steps to $15,000 a year so that the social security system will cover about the same proportion of wages as it did in 1939. • Consideration be given to changing the ratio of employer-employee contribution, from a 50-50 basis to two-thirds from the employer and one-third from the employee. This step would recognize the fact that the employer can deduct his contributions as a business expense in computing his tax, while the employee must pay an income tax on his deduction. • That the Congress consider refunding part of all of the payroll tax paid by those below the poverty level out of general Federal revenues. • That the level of unemployment insurance be raised substantially, that Federal standards be set for it, and remaining gaps in coverage be closed; that workmen’s compensation benefits be improved for those who cannot work because of disabilities suffered on the job- • That the Congress enact legislation providing for payment of social security benefits to persons at age 60 on an actuarially reduced basis in either of two cases: if at any time unemployment The Secretary’s Introduction 31 for the United States should exceed 41£ percent for any four consecutive months, or if the Council of Economic Advisers advises the President that unemployment is likely to exceed 5 percent for three consecutive months. • That the retirement test on which there is no loss of income be increased from $1,680 a year to $1,800, and that this amount be automatically increased in the future in relation to increased earnings. The Right to Welfare Nobody likes our present system of public welfare. Those who get it say it demeans them. Those who administer it feel strangled by its paperwork—especially its eligibility forms. Those taxpayers who pay for it worry rightfully about its $8 billion cost. Here at the Department of Health, Education, and Welfare—the Federal agency charged with the administration of the public assistance system—we are committed to its change and improvement. This Secretary, who has worked toward this for 34 years, would also like to end the dole. But how? Most people turn to public welfare in despair—not greed—and as a last resort. Although 22 million Americans are poor, only 9 million of them receive relief, millions less than might qualify. The great majority—or about 7 million—of our public welfare recipients are either very old (2 million) or very young (4.2 million) or blind (85,000) or permanently and totally disabled (700,000). Unskilled, hampered by a lack of education, families travel to our great cities because they dream of opportunity, not handouts. Once on relief, they usually hunger to get off and into decent self-respecting Jives, the kind most Americans take for granted. It’s no wonder. The average monthly welfare check for an aged man or woman is $70.25, for a family with 3 children, $162 (or $39.50 per person). As in any category system of relief, the recipient can starve unaided if he does not qualify under specific labels of dependency. And because States match Federal welfare funds in different amounts, there are gross discrepancies in welfare payments. In Mississippi, a needy mother of 3 gets an average of $35 a month ($8.45 per person), in New York, $282.35 (or $71.75 per person). There are also great discrepancies in rules and regulations. The number and style of investigators approving or disapproving the welfare client varies. But too many States are still entangled in a quest for the “worthy poor.” If six people witness a murder, the alleged murderer can enter a court of law, raise his right hand, swear to his innocence and rate a lawyer. He is innocent until he is proven guilty. But an ill-clothed welfare mother of an undernourished 5-year-old is 32 Department of Health, Education, and W el fare, 1968 often treated as guilty of some infraction of existing rules until she is proven innocent. Beset by complex problems, bewildered by intricate forms, she presents herself at the public assistance headquarters. The welfare worker almost always has to spend so many hours checking her statements about income, or property, or relationships, or residency, that there is little time left to help set the family on the road to independence by unravelling the personal and family difficulties which beset so many. All of this has now begun to change. Long ago, the Social Security Act, by demanding a few basic ground rules, set in motion a process which over recent years has effected a quiet revolution in the rights of the poor. The legal framework required of public assistance plans has been strengthened by Congress. The doors of the courts have been opened to demands that these programs meet constitutional standards of equity and rationality, both in substance and in procedure. The emergence of the legal services programs for the poor has made possible challenges to a host of questionable practices. Today there is a growing recognition of the legal right to the receipt of public assistance, a legal right to insist that it be fairly designed and fairly administered—and a legal right to invoke the Constitution to assure the fairness of the system. What lies ahead is the task of applying these rights, point by point, so that the poor may come to stand truly equal before the law. The Fourteenth Amendment to the Constitution applies to the poor and the disadvantaged as well as to other citizens of the United States. Constitutional decision is the responsibility of the courts, but the Secretary of HEW also has major responsibilities for the fair and proper administration of public assistance. An End to the Dole Most Americans are compassionate, they are pragmatic; they accept the fact that they cannot let over 4 million children starve. They do not so easily accept the fact that there are 1.4 million adults—mostly parents—taking care of these children on the relief rolls—or understand the complex social forces that put them there. All are agreed that we should take a good hard look at our public welfare system, and work toward its reform. My first recommended step in such an effort—raising the minimum social security benefit— would take 150,000 needy aged men and women off the welfare rolls. We must also turn our attention to the world of work and work opportunities, to the problejns of welfare administration, and improved services. The Secretary’s Introduction 33 A major study, carried out in 1966 by Dr. Lawrence Podell of the City University of New York, shows what many of us suspected—that most welfare mothers want to work. Seven in 10 mothers interviewed preferred to work for pay rather than stay at home; two-thirds planned to work in the future (the fact that one in six never went beyond fourth grade and another one in six never graduated from high school indicates the level of job they could hope for). We must concentrate on better training and better jobs for welfare recipients. We must also achieve such training and such jobs for the one-third of the poor who belong to families whose heads hold full-time year-round jobs. Wives and children share in any higher earnings achieved by under-employed and unemployed men. If we could lift these families above the poverty level, we could concentrate more effectively on smaller numbers of hard-core poor who are left—on and off the welfare rolls. Therefore, I recommend: • A greatly expanded program of work incentives, and opportunities for productive and self-supporting work (jobs—job training—and the development of New Careers possibilities). • The establishment of a national Federal welfare payment, administered according to national standards, to be available to individuals in need in all the States. The Federal courts have pointed the way to this reform in several States by declaring welfare residency laws illegal. If the Federal Government picked up the check, welfare payments and policy among the States would be equalized. And the budget burden of our great cities would be eased, leaving them freer to use their funds for constructive social services—schooling—recreation—and all the rest. Such a system would include financial incentives for men and women to seek employment, adequate day care for the children of working mothers, an effective job training program, legal protection, visiting nurse and family planning services. • Cutting down wasted professional time by using a simplified Eligibility Application Form, instead of a detailed investigation to determine the eligibility of public assistance recipients. This has been tried with some success in New York and California, and would, of course, require scrupulous sample checking. Each of us who pays an income tax is asked to declare our income; and each of us knows that his declaration is reviewed and may be questioned. Each of us knows that if he is found guilty of fraud he will be punished; the same would be true in public welfare. The public sympathizes with the plight of the aged, the blind, and disabled. We should start our new policy with them. The funds 34 Department of Health, Education, and Welfare, 1968 saved could well be used for constructive, rehabilitative social services. Consumer Protection A family’s standard of living can be raised not only by increasing its resources, but also by assuring that it uses them wisely. The poor and the aged are susceptible targets for consumer fraud. The woman on welfare who knows how to avoid being shortchanged at the supermarket is that much ahead. So is the man who knows how to ask fair treatment from his landlord, whatever his income. For many years consumer problems were pushed aside, and consumer protection programs relegated to a minor, insignificant place. After all, consumer interests were fragmented, and opposition to them well organized and well financed. Now the leadership of some dedicated members of Congress and the increased attention devoted to consumer problems by the national news media have changed the picture. New laws protect us against a wide variety of dangerous products and unfair practices—from infant blankets to automobiles, from unwholesome food to consumer credit. Within the Department of Health, Education, and Welfare we have taken a number of steps to focus attention on consumer protection, and to provide more and better information to consumers. I recommend, in addition, that HEW: • Authorize a central or agency publication to give consumers information about consumer choices developed through government-sponsored, taxpayer-paid research. • Offer Federal financial aid to States to improve their consumer service programs. • Provide for the coverage of certain prescription drugs under the Medicare program. ® Authorize payments for drugs under Medicare and Medicaid at reasonable prices normally paid by drug dispensing establishments—like pharmacies or hospital clinics. • Publish and disseminate an up-to-date U.S. Drug Compendium of prescription drugs, listed by their generic name with pertinent information on each drug. • Require that all prescription drugs in tablet or capsule form bear an identification which would reveal the manufacturer and identify the drug; the manufacturer’s name and the generic or established name should also appear on the label of prescription drug containers. The Secretary’s Introduction 35 Federal Credit Unions Federal Credit Unions have come to be an important part of consumer protection as a method of saving for more than 10 million wage earners. Assets of the 12,600 credit unions now stand at about $6.6 billion. I have been a member of credit unions since 1936, and I know what they can mean to struggling young families. Though the members of the credit unions are generally working people of modest means, who can ill afford to lose their savings (which average only $562), the Federal Credit Unions remain the only federally-chartered savings institution without deposit insurance. Therefore, I recommend that: • Federal Deposit Insurance protection be provided to credit union members, similar to the protection of deposits in banks. The fact that liquidations have been infrequent—combined with the Credit Unions’ excellent record—would keep such insurance costs to a minimum. Income Maintenance The goal for the years ahead is to weave a net—through employment efforts, our social insurance system, a reformed public assistance program, and intensified consumer protection—through which no American may fall. But even with the best of intentions, the most skilled craftsmen, and the strongest thread, it will take time to make a foolproof web—one without a single flaw. The recommendations of the President’s Commission on Income Maintenance, which is examining all practical alternative income maintenance systems, should be very helpful. HEW’s goal should be to assure a decent minimum for every American individual and every American family. Such an income maintenance system should have built-in incentives, encouraging every able-bodied man and woman to contribute as fully as possible to our economy, as well as to share in its benefits. To Better the Quality of American Life: Paying the HEW Bill To reach great goals, we must make great choices. As a Nation, we must decide what kind—what quality of life—we want to accomplish for our people. And we must set priorities, so that we have the 36 Department of Health, Education, and Welfare, 1968 means to move toward greater health and education and social opportunities. This we can do. We need only the will to do it. Our gross national product increased by more than half between 1960 and 1968. The vitality of the economy, and our capacity to harness its power for stable, steady growth, have proven formidable. If our Nation continues its present course, total production will increase an average of $40 to $50 billion each year, and grow larger as time passes. The same is true of Federal revenues. Given no change in tax rates, they will increase by more than $15 billion a year. Can We Afford Improved Health, Education, and Welfare? Our gross national product for 1969 is estimated to be $920 billion and will undoubtedly exceed $1 trillion in 1971. At this rate of growth, the gross national product should reach $1,300 billion by 1976 and exceed $1,500 billion by 1980. There is absolutely no question that we have the resources to improve our health, education, and welfare if we commit ourselves to making the proper priorities in our tax system and other programs. In 1960, our gross national product was slightly less than $500 billion and we spent, in the United States, $79 billion for all health, education, and welfare activities, public and private. This amounted to 16 percent of the gross national product. By 1963, our gross national product had increased $80 billion to $575 billion; our health, education, and welfare expenditures to $100 billion; and the proportion of these expenditures to gross national product to 17.4 percent. By 1968, the GNP had increased nearly another $50 billion to $822 billion; health, education, and welfare expenditures to $163 billion; and the proportion of such expenses rose to 19.8 percent. These trends unmistakably indicate that during the next 8 years, as our gross national product rises, so the proportion of the gross national product invested in health, education, and welfare can and will rise. With a GNP of $1,300 billion in 1976, the proportion invested in health, education, and welfare could rise to 25 percent, making possible $325 billion to be invested in health, education, and welfare compared to $163 billion in 1968—a doubling in the 8-year period. This would enable us to be investing by that time about $50 billion more in health, $60 billion more in education, and $55 billion more in social security and welfare. And we could do that simply by more equitable sharing of a bigger pie. The Secretary’s Introduction 37 A Nation which, spends more than $8 billion for tobacco and $11 billion for alcohol, a Nation in which 12 million people own pleasure boats, can surely use its increased revenues for human beings. A Nation in which 79 percent of the households own one car, and one quarter of the households own two or more cars, can afford to improve the quality of life of its least fortunate citizens. But it has to want to pay the price. Paying the HEW Bill The taxes we pay are simply the price of Government services and commodities. Tax collection is the mechanism through which consumers—or the general public—pay the price. Americans rightfully want to pay reasonable prices. No one wants to pay too much for a car, or a loaf of bread, or drugs. No one wants to find he’s bought meat so tough he can’t eat it, or that a house exactly like his could have been purchased for less money. By and large, Americans have received good value for their health, education, and welfare tax dollars. Look at the substantial dramatic gains of the past years: We have strengthened our chances for the blessing of good health— dramatically lowering infant mortality rates, for instance, and have begun a new life-giving community approach to mental health and illness. We have overcome the Federal aid to education barriers, and millions of school children have benefited—through books, new imaginative ways of learning, and help toward college education. We have improved the quality of education and enhanced equal opportunity, decreased the number of high school drop-outs, rehabilitated the handicapped and those on welfare rolls, enacted Medicare and other improvements in social security, and brought about a significant drop in the number of Americans living in poverty. This is the story of the past years. Many people have asked each recent HEW Secretary, when we have moved forward so rapidly, why must we pay the price for more social services. The answer is two-fold. First, the needs are still great. They are especially great for our least fortunate families. A Nation which still has 22 million poor, living in a world of bad health, housing and food, with little clothing, and a hopeless, depressing environment, cannot sit back and rest on its laurels. Second, the better the quality of life for most of us, the more those ask who have not achieved such a life. They watch television, they read the popular magazines. They want the best for themselves and their children. HEW programs are designed to help them achieve it.. 328-184—69- 38 Department of Health, Education, and Welfare, 1968 Increased social services will have to be financed through taxation, as they have been in the past. And, as in the past, increased health, education, and welfare expenditures will add to the stability of the economy, its toughness, its strength, and its potential for growth. The more educated Americans, the more Americans in good health, the more trained and able to work, the greater our national muscle. We must invest more in the health, education, and welfare of our children. I have recommended increased education and health services for children. I also recommend: • That the appropriations and authorization for child welfare services (foster care, adoption, care of abused children and all the rest) be increased, in order that all children and families in the Nation will have a better chance to lead lives of productivity and fulfillment. Tools for Policymaking So big have become our institutions, public and private, so complicated our enterprise, that meeting our health, education and welfare needs will take even more than determination and even more than willingness to pay. We must shape more effective tools for policymaking. As organizations grow, the time needed to implement decisions gets longer. We are increasingly required to make very important and very expensive long-range decisions which, while not irreversible, are very hard to change. If we are not careful, inaction—or doing nothing—will become our chief strategic device, our policy tool. We dare not let this happen in urgent areas of social planning. Health, education and welfare problems, and related problems in housing or transportation, demand broad and active planning. But we do not have the necessary information to make carefully reasoned policy choices and form sensible plans. We agree, for example, that we want to eliminate poverty. But how—specifically ? Many ideas compete in the theoretical marketplace: guaranteed income, negative income tax, family allowances, wage supplements. The trouble is that we lack some of the most crucial information about such programs, and their effect on individual lives. If the American people are to decide between alternatives, they must have more facts. What effect would a children’s allowance have on family size? How would wage earners react to various kinds of negative income tax proposals ? Again, we agree that we must do something about the quality of life in our major urban centers. Again, how—specifically? Again we don’t The Secretary’s Introduction 39 have enough information or even refined enough ways of measuring the consequences of urban living upon the very young, the elderly, or upon their health and education. Therefore, I recommend: • That the Federal Government undertake a substantially enlarged statistical program—gathering and disseminating information necessary for sound social planning from and to States, local governments and other interested organizations. This would include information on the effectiveness of family planning and other health programs, an ongoing national assessment of educational achievement, comparative facts on the effectiveness of delivering health care, job training and preschool education. • That the President or the Department of Health, Education, and Welfare each year issue a social report, as the Council of Economic Advisers issues an economic report, measuring the quality of our society for the President, the Congress and the public. The Budget As we cut a larger and larger piece of the national pie for social goods and services, we must improve our chief policymaking tool— the budget. Budget timing and process now impose almost impossible burdens on Department and agency staffs, creating difficult problems for program administration, and impairing the quality of decisionmaking. In recent years Congress has acted on the HEW budget only after the fiscal year has begun on July 1. This means that one year’s HEW budget planning must begin before the previous year’s budget has been finally acted upon. Senior Department officials spend enormous amounts of time and energy working on two separate budget years at once. This has become the pattern. It is not a sensible one. Therefore, I recommend: • That the budget be put on a calendar year basis, so there is enough time for Congress to study and act on important HEW matters. The President would present his budget proposals in January of each year and the new appropriations would be available on Jan-uary of the following year. Everyone involved would have more time to do a better job; the results would be much improved. • That Congress fund programs well in advance of the time they go into effect, especially if they involve school districts, universities, States, or municipalities (which must prepare their own budgets anywhere from 6 to 18 months before the budget year of the Federal Government.) 40 Department of Health, Education, and Welfare, 1968 • That Congress take a vacation in the month of August, not only to enable its members to have a vacation, but to give key congressional and executive staff an opportunity for much-needed rest. No private industry would operate on the present timetable, which is wearing out the senior people in the executive departments and on congressional staffs. A brief pause in the legislative year would improve the Congress’ ability to complete its work, and it probably also would do a great deal, in the long run, to improve the quality of legislation. Civil Rights Better schools, more hospitals, higher income—all such changes mean little unless they are equally available to all Americans. That is why the Civil Rights legislation of the 1960’s stands as one of the most significant measures taken to improve the quality of life in the United States. HEW now shares major responsibility for the enforcement of such laws, based on the concept that all Americans should enjoy services and benefits made possible by their Federal tax dollars, without regard to race, color or national origin. Though this proposition seems eminently fair, it is nevertheless a fairly recent concept in the administration of Federal grant programs. Title VI of the 1964 Civil Rights Act specifically and unequivocally prohibits racial discrimination of every kind in federally assisted programs. It also requires Executive agencies to end Federal support of any program in which discrimination is practiced. The 1964 Civil Rights Act has had a great impact on the desegregation of hospitals, nursing homes, elementary and secondary schools, colleges and universities. HEW’s efforts to enforce such principles in its administration of Medicare, which have been almost 100 percent successful, is one of the great untold stories of the past years. Quietly, steadily, the country’s hospitals have been desegregated, more patients are treated equally, and more doctors are admitted to staff privileges. The pattern of discrimination has been broken. Considerations of good health can now take precedence over those of race. In education the record shows steady, albeit slow, progress in desegregation. This; thrust has been expanded to all educational agencies in the Nation. The record shows the significant change that has taken place in compliance of school districts organized on a dual, racially-segregated basis. In 1963, before the enactment of the Civil Rights Act, only 1.17 percent of Negro students in the 11 deep Southern States were attending school with whites; in September 1967 this percentage had The Secretary’s Introduction 41 increased to 13.9 percent. Nearly all school districts with white and Negro teachers have begun the process of faculty desegregation. Amendments to the Elementary and Secondary Education Act enacted in 1967 spread the effects of Civil Rights measures by requiring that HEW’s compliance program “be uniformly applied and enforced throughout the 50 States.” Subsequently the Department began to study the distribution of minority students and faculty, Spanish-sur-named, Oriental, and Indian, as well as Negro, from northern and western school districts. More than 30 preliminary reviews and five full reviews of school systems have taken place. Preliminary review shows that civil rights problems are nationwide and concern all minority groups. In a very real sense, the Nation is at a turning point in its efforts to bring alive the principles of equality and justice. I recommend: • Title VI of the Civil Rights Act continue to be not a panacea, but an indispensable ingredient in the total Federal approach to equal educational opportunity. • Legislation to provide Federal financial aid to school districts which have an approved plan of desegregation for school construction, teachers’ salaries and other needed services where such school districts demonstrate a fiscal incapacity to carry out such plans. • The civil rights program in the Department of Health, Education, and Welfare be administered by a Deputy Under Secretary with responsibility for compliance, technical assistance, and education. Improving the Quality of the Environment On Christmas Day, 1968, three Americans circling the moon transmitted photographs to Earth which more forcefully than any other event in history emphasized the fragile and destructible nature of our environment. We know far better now than ever before how thin and precious is the veil of atmosphere, how rare and wondrous are the oceans and rivers, how incredibly complex and delicate is the balance which permits the existence of life on Earth. Today this Earth of ours faces a major environmental crisis. Urbanization, the increase of population, fantastic advances in technology, and the mistakes of the past have brought biological, radiological and chemical contamination of land, air, food and water; crowding; noise; destruction of natural resources; and many other threats to human health and well-being. We cannot have it all one way or the other. The human race cannot prosper unless it makes use of the 42 Department of Health, Education, and Welfare, 1968 riches of the Earth. But man cannot survive if he turns these resources against himself in the form of pollution, contamination, and hazardous living conditions. Such problems cannot be solved piecemeal. They require continuous, coordinated study and action. To this end a new organization, the Consumer Protection and Environmental Health Service, was set up last July within the Department of Health, Education, and Welfare. As the one agency in the Federal Government approaching all the complex environmental problems from the viewpoint of human health, safety and welfare, HEW should provide a central focus for the Nation’s environmental efforts. Throughout the environment, the forces of change far outnumber those aimed at understanding the significance of change. Our vast and growing capability in the fields of science and engineering has enabled us to push on, all too often without knowing where we are going and what we are doing—to our world, and to ourselves. As a first major step toward this essential knowledge, I have directed the establishment of the National Institute of Environmental Health Sciences among the nine National Institutes of Health. This new institute is a further commitment on the part of the Department of Health, Education, and Welfare, and of the Federal Government, to the principle that human well-being and health must not suffer because of man-made environmental changes. We must continue and expand our environmental control efforts. Therefore, I recommend: ® Expansion of our efforts to reduce air and water pollution—two of the greatest threats to man’s health and economy. • Application of all of our knowledge to reduce accidental deaths and injuries, and expansion of occupational health programs. • Elimination of the food contamination which causes food-borne disease. • Elimination of substandard and unsafe drinking water supplies. ® Protection of the American people from exposure to all harmful radiation. • An increase in our efforts to control community noise. • Expansion and improvement of solid wastes management. • Increase in our efforts to reduce home and neighborhood environmental health problems, including a drastic reduction of the number of rats in the United States. • Expansion of research and evaluation of the effects of environmental stresses on the individual. The Secretary’s Introduction 43 Cooperation With the Private Sector The private sector in 1968 was responsible for $52 billion of the $163 billion invested in the Nation’s health, education, and welfare. The amount spent by the private sector grew from $35 billion, in 1933, and will continue to grow with the years. There is ample room in our society for a substantial and creative role for the private sector. Business enterprise can help train young people, including the disadvantaged, for New Careers. They can help perform nutrition research, to solve the terrible problems of hunger and malnutrition. The television and communications industry can forge direct lines between patient and doctor. New learning machines can bring about great changes in curriculum and bring more knowledge for more children. A nonhazardous cigarette might emerge from industry-government cooperation. Such cooperation could also result in the development of technological ways to control air and water pollution. Business and government are not enemies. They should and could be effective partners in a wide range of constructive activities which would mean better health, education, and welfare for all Americans. The Need To Choose Eight years ago, when I returned to HEW from university life, there were about 100 programs in the Department. Today we administer more than 250 programs. Statistics, of course, are significant only as they affect human beings. Statistical changes at HEW have touched, changed, and improved the personal lives of millions. They now spell hope and opportunity in the most profound sense of those over-used words. But we cannot afford simply to continue what we’re doing. We cannot afford to stand still. When our population is increasing so dramatically and the complexity of our problems is intensifying, standing still is going backwards. We have built up the momentum; we must go forward. To do so we must be willing to pay the bill. We must continue to improve the administration of present programs, of course. But in this world you cannot get something for nothing. We must choose what we want to do in health, in education, and in social opportunity, and find sensible, convenient and equitable ways to pay for it. Here at HEW, we have progressed far toward the achievement of the Republic’s oldest, fondest dream: making a better society on this earth than has ever been made before. We have increased the individual American’s real freedom. We have done so by giving him 44 Department of Health, Education, and Welfare, 1968 greater options. Social Security and Medicare give parents, grandparents and children the freedom to choose different paths. They have more choice as to what to do with their money and their talents. No longer does a family have to give up a youngster’s college education to pay a grandparent’s medical bills. Education programs give young and old alike the equipment to choose between careers. (After all, the illiterate man has no real freedom to choose what he wants to do.) The development of an effective measles vaccine prevents the crippling of thousands of children and lifts a burden from parental shoulders. Rehabilitation programs make work possible, life bearable; and return the investment made in them many times in earnings and taxes. It is my hope that the United States will use its vast resources to abolish poverty, improve the health and education of all our people, and to achieve an adequate system of social security. It is my hope that those who do the Department of Health, Education, and Welfare’s work will never lose sight of their goals, and will press forward to create better programs for all Americans. Office of the Secretary Legislation In both the number of bills enacted and in their quality and potential implications, the legislative responsibilities of the Department of Health, Education, and Welfare significantly expanded in fiscal year 1968. All of the 15 new laws helped to enhance the quality of American life. Many helped increase and equalize opportunities for American citizens and strengthen partnerships with State and local agencies. The new laws were: Education ELEMENTARY AND SECONDARY EDUCATION AMENDMENTS OF 1967 (PURLIC LAW 90-247) Strengthened and improved programs of assistance for education by permitting funds to be used for the education of Indian children and children in overseas dependents’ schools of the Department of Defense. It also amended the National Teacher Corps program, provided assistance for comprehensive educational planning, improved programs of education for the handicapped, and strengthened assistance to schools in federally impacted areas and in major disaster areas. EDUCATION PROFESSIONS DEVELOPMENT ACT OF 1967 (PURLIC LAW 90-35) Was enacted to coordinate, broaden, and strengthen programs for the training and improvement of the qualifications of education professionals. Signed June 29, 1967, this act took effect in fiscal year 1968.) PURLIC RROADCASTING ACT OF 1967 (PURLIC LAW 90-129) Authorized Federal grants to assist educational radio and television broadcasting and established a nonprofit, nongovernmental corporation to channel private financial assistance to educational radio and TV. PURLIC BROADCASTING ACT, EXTENSION OF AUTHORIZATION (PUBLIC LAW 90-294) Transferred first-year authorization from fiscal year 1968 to 1969. (Also see Public Law 90-129, above.) 45 46 Department of Health, Education, and Welfare, 1968 LIBRARY SERVICES AND CONSTRUCTION ACT AMENDMENTS OF 1967 (PUBLIC LAW 90-154) Clarified the intent of Congress with respect to interlibrary cooperation and specialized State library services. These programs are now 100-percent federally funded during the first year of operation. Also, essential flexibility was given to State and local administration of the program by permitting the acquisition of existing buildings for use as public libraries, in addition to construction. COLLEGE WORK-STUDY AMENDMENTS (PUBLIC LAW 90-82) Amended the college work-study program to allow students to work up to 15 hours per week on an average basis over the term of each semester, and provided for a limit of 85-percent Federal funding in the fourth year of the program and 80 percent in the fifth year. Health PARTNERSHIP FOR HEALTH AMENDMENTS OF 1967 (PUBLIC LAW 90-174) Extended the program of comprehensive health planning and services assistance to the States, authorized a program of grants and contracts aimed at developing improved health services techniques, and established a Federal program of regulation of clinical laboratories. It authorized the use of funds for rat control programs, the use of PUS hospitals for local disaster preparedness planning and emergency health problems, and funds for program evaluation. MENTAL HEALTH AMENDMENTS OF 1967 (PUBLIC LAW 90-31) Extended the authority for grants for construction and initial staffing of community mental health centers through fiscal year 1970. It also extended the program to include funds for acquisition or renovation of existing buddings. (Signed June 24, 1967, this act took effect in fiscal year 1968.) MENTAL RETARDATION AMENDMENTS OF 1967 (PUBLIC LAW 90-170) Increased the construction of new facilities for research and direct services in the area of mental retardation. It extended an existing program for training teachers of the handicapped and initiated a new program for training teachers in physical education and recreation for the handicapped. AIR QUALITY ACT OF 1967 (PUBLIC LAW 90-148) Expanded and improved the research and development program for air pollution control, provided for planning and control programs on a regional basis, required standard-setting and enforcement by the Office of the Secretary 47 States, and permitted strong Federal action if States do not act. It established a Presidential Air Quality Advisory Board, required registration of fuel additives, provided for a study of national emission standards and of jet aircraft emissions, and required comprehensive cost studies. VOCATIONAL REHABILITATION AMENDMENTS OF 1967 (PUBLIC LAW 90-99) Set up a National Center for Deaf-Blind Youth and Adults, authorized a system of project grants to handicapped migratory workers, and continued increased allotments to the States through 1970. It also authorized a final year of Federal support of statewide planning in rehabilitation, abolished residence requirements, and designated the District of Columbia as a special jurisdiction. OLDER AMERICANS ACT AMENDMENTS OF 1967 (PUBLIC LAW 90-42) Extended the Older Americans Act through June 30, 1972, and authorized appropriations to operate the research, demonstration, training and formula grant programs of the Administration on Aging. VOCATIONAL REHABILITATION AMENDMENTS OF 1968 (PUBLIC LAW 90-391) Extended appropriations through 1971 for grants to the States for vocational rehabilitation services and for innovation projects to develop new methods of providing and expanding services to people with severe disabilities. The act also renewed the authority to continue grant support for special projects in research, demonstrations, expansion, and training of rehabilitation personnel, including regional research and training centers. Special project emphasis now will include those projects directed at the rehabilitation of the mentally retarded. (The Congress cleared ths act June 24, and the President signed it July 7, 1968.) JUVENILE DELINQUENCY PREVENTION AND CONTROL ACT OF 1968 (PUBLIC LAW 90-448) Was designed to assist courts, correctional systems, community agencies, and primary and secondary school systems in the prevention, treatment, and control of juvenile delinquency. Funds were authorized to support research and training efforts, and to provide assistance for the diagnosis, treatment, and rehabilitation of youths who are delinquent or in danger of becoming delinquent. (This act was ready for Senate action at the end of fiscal year 1968. The act was cleared July 18, and the President signed it July 31,1968.) 48 Department of Health, Education, and Welfare, 1968 Social Security SOCIAL SECURITY AMENDMENTS OF 1967 (PUBLIC LAW 90-248) Provided a 13-percent, across-the-board increase in benefits, with a minimum monthly benefit of $55, and increased the special benefits for those aged 72 and over to $40 a month. The amount of permissible outside earnings was increased for disabled widows. The act also provided for work incentives for public welfare recipients, increased authorizations for child welfare programs, demonstration projects, and support of social work manpower and training, and provided for expansion and improvement of child health programs. MEDICARE ENROLLMENT EXTENSION (PUBLIC LAW 90-97) The first general enrollment period for participation under part B of title XVIII (the supplementary Medicare program) was extended from December 31,1967, to March 31,1968. SOCIAL SECURITY/PUBLIC WELFARE EXTENSIONS (SEC. 2 OF PUBLIC LAW 90-36) Extended for 1 year, through June 30,1968, the programs of assistance to repatriated Americans and children of unemployed fathers; extended authorizations under section 1115 of the Social Security Act (experimental, pilot, or demonstration projects); extended for 1 year, through June 1968, authorizations under sections 135(e), 155(b), and 202(e) of the Public Welfare Amendments of 1962. (Signed June 29, 1967, this act took effect in fiscal year 1968.) Consumer Protection CLINICAL LABORATORIES IMPROVEMENT ACT OF 1967 (SEC. 5 OF PARTNERSHIP FOR HEALTH AMENDMENTS OF 1967, PUBLIC LAW 90-174) Authorized the Secretary of HEW to establish minimum performance standards for all clinical laboratories engaged in interstate commerce and permits the Secretary to bring court action against any licensed laboratory that represents an imminent danger to public health. FEDERAL CREDIT UNION ACT AMENDMENTS OF 1968 (PUBLIC LAW 90-375) Increased maturity of secured loans, increased limit on unsecured loans, continued Project Moneywise for residents of low-income areas, and updated procedures of Federal credit unions. (The Congress cleared this act June 24, and the President signed it July 5, 1968.) Office of the Secretary 49 General Counsel The Office of the General Counsel furnishes legal advice to the Office of the Secretary and to all component bureaus and agencies of HEW. It also represents the Department in administrative proceedings and assists, and in some cases participates with, the Department of Justice in representing the Secretary and other HEW officials in actions in the courts. The most significant legal developments during the fiscal year were in the areas of education, civil rights, consumer protection, and public welfare. Most of these areas were involved in the Secretary’s responses to the Poor People’s Campaign, and the Office of the General Counsel took the responsibility for delineating the extent of the Secretary’s authority to meet those demands which he felt to be justified. Education In education the principal legal issues revolved around the provisions in the Elementary and Secondary Education Act and in the Higher Education Act requiring or permitting Federal assistance for school facilities and programs in church-related schools or for students in such schools. The constitutionality of these statutory provisions had been the subject of much public and Congressional debate but had not previously been considered by the Federal courts because of earlier decisions of the Supreme Court apparently precluding a taxpayer from raising the question by legal action. However, on June 10, 1968, the Supreme Court held in Flast v. Cohen that a Federal taxpayer had sufficient interest in the spending of tax dollars in ways alleged to violate the First Amendment, to enable him to challenge the constitutionality of the Elementary and Secondary Education Act. At the close of the year the case was still pending in the Federal district court to which it had been returned for a decision on the merits of the First Amendment issue. The decision of the Supreme Court allowing such suits has generated the filing of further cases against the Secretary which will resolve the constitutionality of the various educational aid provisions. Civil Rights In the civil rights area the General Counsel handled 73 hearings under title VI of the Civil Rights Act of 1964 to terminate Federal financial assistance to school districts and other local agencies that were discriminating on the basis of race. During the year orders of termi 50 Department of Health, Education, and Welfare, 1968 nation became effective as to 63 school districts, three hospitals, and one institution of higher education. A suit attacking the regulation under which the Department has been enforcing title VI was successfully defended in the case of Gardner v. Alabama. The most significant legal development came from the decisions of the Supreme Court in Green v. County School Board of New Kent County, and Raney v. Board of Education, that freedom-of-choice plans of school desegregation must actually work to break down the dual racial system in order to meet constitutional requirements, and that if other methods are available which will more speedily achieve this object, such methods must be used in lieu of free choice. This decision confirmed the view of Brown v. Board of Education which this Department had taken in enforcing title VI of the Civil Rights Act. Consumer Protection and Environmental Health There were a number of significant legal developments in the area of consumer protection and environmental health. In a case under the “new drug” and antibiotic drug provisions of the Federal Food, Drug, and Cosmetic Act, it was held by a Court of Appeals that a new mechanism for ligating severed blood vessels during surgery was a “new drug” within the meaning of the statute and hence subject to the requirements of advance proof of safety and effectiveness. Another major area of legal activity to protect the consumer involved implementation of the drug efficacy study being carried out by the Food and Drug Administration to reevaluate all drugs approved between 1938 and 1962. Legal steps were taken by FDA as necessary to require labeling changes or reformulation for some drugs, and to require removal from the market of others found to be ineffective. As the year ended, our attorneys were also engaged in a very complicated and protracted administrative hearing to improve the labeling of foods for special dietary uses (mainly vitamin and mineral supplements) and to standardize some foods for special dietary use. Social Security The volume of social security litigation arising from the denial of claims for benefits continues at the level of approximately a thousand cases annually. The hoped-for reduction in volume resulting from the revised definition of “disability” in the 1967 amendments had thus far failed to materialize. The 1967 amendment barring the payment of social security benefits to persons outside the United States who are not U.S. citizens in the absence of reciprocal provisions by their countries of citizenship, Office of the Secretary 51 has been eased considerably by the negotiation of arrangements with eight foreign countries enabling them to meet the conditions in the Social Security Act. Approximately 9,000 American citizens benefited by these arrangements. Public Welfare In the field of public welfare the major legal developments of 1968 can be understood only in their historical context. The year witnessed an emerging recognition that public assistance and other noncontributory benefits, gratuitous though they are, carry with them substantial legal rights. In part these rights are creatures of the statutes establishing the programs, but in part they reflect dictates of the Constitution that come into play once a program is established. A claim that legal rights might attach to the receipt of noncontributory public benefactions would have startled most judges and most legislators when the Social Security Act was passed in 1935. Except that some State constitutions guaranteed free public schooling, there was little in either the law reports or the statute books to give color to such a claim. Courts had been chary of according to the beneficiaries of gratuities even the most basic of constitutional rights, due process and the equal protection of the laws. Congress, at the very time it was writing a few assurances of equity into its original public assistance grants, could still describe assistance as “public charity” and could still condone plans to aid only the “deserving” poor. The then-prevalent concept of public beneficence was that of a governmental function cast in the image of private philanthropy, with much the same freedom to indulge in paternalistic selectivity. Yet the Social Security Act, by demanding a few basic ground rules, set in motion a process which has gradually undermined this concept of the public almoner. State plans were required from the outset to be Statewide, to abandon local settlement rules, to provide fair hearings to disappointed applicants, and to furnish all assistance in the form of cash. Later amendments to the Act furthered the process as they strengthened the legal framework required of State plans. Prompt payment of assistance to all eligible persons was required by Federal law, as was appropriate consideration of income and resources, while administrative actions looking to equitable treatment of beneficiaries and forbidding “unsuitable home” exclusions were accepted by Congress. Meanwhile, a gradual change took place in the climate of opinion, in the perhaps unconscious premises of popular thinking, toward the status of the disadvantaged in our society. Finally, developments in related areas of the law opened the doors of the courts to 52 Department of Health, Education, and Welfare, 1968 demands that public benefit programs meet constitutional standards of equity and rationality, both in substance and in procedure. As the poor become better organized and more articulate, as they become able to enlist skilled legal advocacy in their cause, as the courts begin to give ear to their grievances, as the Poor People’s Campaign dramatized their needs, their standing to assert their rights has achieved an unprecedented measure of acceptance not only by the judiciary but by administrators and the public as well. New though recognition of these rights may be, the legal principles underlying them have been long in the making. Unlike assistance, sometimes in explicit contrast to assistance, social insurance benefits have been described from the outset as being “payable as a matter of right.” Yet assistance, equally with insurance, rests on statutes or regulations which direct that it be paid to all eligible persons, and which, equally with insurance, create a right to its benefits. Because of its contributory nature insurance carries a long-range commitment, as assistance does not, to maintain the rights to payment into the indefinite future,1 but the right to receive assistance today is not lessened by the chance that some wholly new system will be substituted for it tomorrow. These several forces, working in conjunction over the last generation, set the stage for the recent burst of litigation which has already defined some of the basic rights of persons claiming public assistance, and promises to define a great many other rights. The “man-in-the-house” rule, depriving children of assistance because of the misdeeds of their parents, has been outlawed by the Supreme Court, and the validity of State durational residence requirements, struck down by lower courts, has been twice argued on appeal to the Supreme Court but at the time of writing remains undecided. Federal district courts have invalidated Maryland’s maximum on payments to large families and Georgia’s “employable mother” rule; two courts have disagreed on the procedural requisites, under the due process clause, for the termination of assistance; attacks on work requirements and lien provisions have been rejected. A host of other issues are before the courts or soon will be. Plainly, the poor are in process of achieving equality before the law. Already it 1 Although not actually contractual in nature, the insurance system has been described as “vested with the aura of a contract.” (“Security, Work and Relief Policies,” H.R. Doc. 128, Pt. 3, 78th Cong., 1st Sess., p. 523.) There are of course other important differences between insurance and assistance: Insurance rights have been earned by work in covered employment and have been paid for in part; indigence is not a condition of eligibility in insurance as it is in assistance ; benefit amounts are determined in quite different ways. These differences contribute largely to the popularity of insurance as compared to assistance, but they are not relevant to the existence, under present law, of a legal right to the receipt of payments by persons who meet the conditions of eligibility stated in the various programs. Office of the Secretary 53 can be asserted, as the Secretary has put it, that there is a “legal right to the receipt of public assistance, a legal right to insist that it be fairly designed and fairly administered—and a legal right to invoke the Constitution to assure the fairness of the system.” Program Planning and Evaluation HEW refined its system for support of planning and analysis of the Department’s programs. This system groups resource allocations and program results by major purposes, activity, and beneficiary groups. Automation of the system allows information to be provided by organization, appropriation, mode of financing, legislative situation, and the nature of the recipient to whom funds are distributed. This system is being integrated into the total Department planning, evaluation, and budgeting process, and will be further expanded and refined during fiscal year 1969. Using the inputs of an automated information system and numerous analytical studies, a planning process is being developed that will allow decisionmakers at various levels to make more informed decisions about the allocation of Department’s resources. Further efforts to perfect this process are planned for fiscal year 1969. The continual process of sharpening objectives and updating and revising the agency plans is carried on under the direction of the Office of the Secretary. The 1966-67 edition of Health, Education, and 'Welfare Trends was published in June 1968. Trends presents annual historical statistical series of national data on program operations and current social, demographic, and economic developments affecting future directions in health, education, and welfare. Part I of Trends is designed to further national understanding of the interlocking developments in health, education, and related fields. It furnishes long-term perspective on the shifting patterns of change by presenting annual data for several past decades and selected projections to the 1980’s. State Data and State Rankings in Health, Education, and Welfare, issued as part 2 of Trends, shows variations from State to State by selected subjects for the latest year for which State data are available. Part 2, by disaggregating the national statistics, reveals to some degree State variations in assets and in the range of response to problems and deficiencies in health, education, and welfare fields. The President directed the Secretary of Health, Education, and Welfare to establish the capacity to develop social statistics and indicators to supplement those already issued by the Council of Economic Advisers and the Bureau of Labor Statistics. Useful social indicators 328-184—69----5 54 Department of Health, Education, and Welfare, 1968 could not be developed without first developing basic new concepts and definitions, and this task was the principal concern during fiscal year 1968. Comptroller The Assistant Secretary, Comptroller, is the principal adviser to the Secretary in the financial management of the Department. His office is responsible for establishing basic Department financial management policy, including budget planning and administration, fiscal policy and procedure, operations analysis, grants administration policy, Department-wide audit, payroll services, and data processing services. Appropriations and outlays, fiscal year 1968 Appropriations Outlays Health agencies---------------------------------------------------- $2,927,877,000 Office of Education________________________________________________ 3,982,780,000 Social and Rehabilitation Service__________________________________ 5,968,692,000 Social Security Administration_____________________________________ 1,384,659,000 Payments to trust funds from general funds______________________________________ Disbursements from trust funds__________________________________________________ Bureau of Federal Credit Unions_________________________________________________ Special institutions-.............................................. 35, 540,000 Office of the Secretary.___________________________________________ 37,297,000 $2,396,180,000 3,619,266,000 5,969,998,000 (1,011,631,000) 28,537,581,000 134,000 30,376,000 22,226,000 Total------------------------------------------------------------ 14,336,845,000 40,575,761,000 Finance LETTER OF CREDIT OPERATIONS The agencies of the Department, under leadership of the Office of the Assistant Secretary, Comptroller, undertook a critical examination of HEW’s letter-of-credit operations. A task force, with representation from the several agencies, developed comprehensive letter-of-credit guidelines and instructions for use by all grantees and other recipient organizations that obtain financing of HEW programs through letters of credit. The nationwide review of letter-of-credit operations, made by the HEW Audit Agency at 177 State agencies and selected local agencies, showed clearly that most State and local agencies could significantly improve their management of Federal cash and reduce cash balances. The Department’s agencies, therefore, greatly increased their efforts to minimize these cash balances and improve management of the letter-of-credit system. These efforts were reflected by net reductions in cash balances of recipient organizations of about $63 million during fiscal year 1968. Office of the Secretary 55 OTHER FINANCING OPERATIONS The National Institutes of Health converted from an automatic quarterly advance system for about 1,500 grantees to a monthly grantee cash request system. The quarterly advance system disbursed an estimated $53 million in excess of grantees’ current needs. NEW COMPUTER SYSTEM The Office of the Secretary is replacing its computers with a “third generation” model which will greatly decrease problem-to-solution time. The new system will facilitate the creation of large, randomly accessible data bases. Through use of random access storage devices and programing tools new to the Office of the Secretary, users will be able to communicate directly with the new computer through a wide variety of input and output devices. The system will be expandable to accommodate a 5-year projected workload. IMPROVED PAYROLL SYSTEM In response both to audit reports and to our own requirements for system improvements, the Office of the Secretary is designing and implementing an improved payroll system to be installed on the new computer hardware system. The improved system will provide greater accessibility to data and will improve ability to make payroll reports and to answer payroll data questions. ACCOUNTING SYSTEMS DEVELOPMENT AND APPROVAL During the past year effort has been on development and formal submission of accounting systems to the Comptroller General as a three-phase operation. The first phase covered design of the “umbrella” system and writing of policies and standards. The second phase involves submission of the detailed plan and description of the subsystems. The third phase comprises the implementation of the agency subsystems. Agency subsystem development and implementation is progressing. • The Social and Rehabilitation Service accounting subsystem was formally submitted to the Comptroller General on June 13, 1968. This system has been designed to provide management with timely financial data which will assist in the planning, control measurement, and evaluation of SRS operations. Progressive implementation of this system will begin in July 1968, with final implementation expected by July 1969. • The Social Security Administration accounting subsystem, now in operation, was formally submitted to the Comptroller General in July 1968. This subsystem is EAM oriented, but conversion of the EAM process to computer operation is anticipated. 56 Department of Health, Education, and Welfare, 1968 • The Office of Education accounting subsystem was formally submitted to the Comptroller General in July 1968. This complex and diversified system incorporates the principles and standards of the “umbrella” system and is computerized. ® The centralized ADP payroll subsystem was submitted to the Comptroller General for approval in November 1967. This subsystem, however, is undergoing redesign and the General Accounting Office has deferred review until after the modified system goes into effect. ACCRUAL ACCOUNTING To comply with the Bureau of the Budget Bulletin 68-10, April 26, 1968, and to assist in the implementation of accrual accounting policies as defined in the HEW “umbrella” accounting system, the Department conducted a review of the financial processing of grants. The purpose of this review was to provide a basis for determination of accrued expenditures at June 30, 1968 and at the end of each subsequent month. It constituted the main effort in a Department-wide survey preparatory to the development of accrual accounting instructions (now available in draft form for use throughout HEW), and was made by the consulting firm of Lindsley H. Noble & Associates and Department financial staffs. The contemplated accrual procedures substitute statistical measures for direct individual reporting by numerous grantees and contractors. The use of statistics is necessary to provide data on a timely basis and to accommodate the large number of grants and contracts. The use of accrued expenditures is expected to help in expressing actual program costs in grant areas where there is a large amount of unpaid liabilities at monthend. It also will in some cases provide more flexible fund usage and will allow performance-cost evaluation in the interest of improved management. Grants Administration Through its formation of the Division of Grants Administration Policy, the Department took a significant step toward strengthening grantee institutions and improving Department grant management methods. The Division published a grants manual which provides guidance for the Department’s agencies in their administration of grant programs, thus reducing the unnecessary variations among programs with which grantees had earlier been faced. The effective operation of a Public Advisory Committee, comprised primarily of representation of the grantee community, has also been established. Meeting quarterly, the Committee advises the Secretary on Office of the Secretary 57 significant issues of grant administration affecting the grantee community. It also provides a basis for early consideration of significant new or revised Department policies. Another committee has also been established which regularly brings together in a common forum all major programs for continued review and evaluation of Department grant administration methods. A number of major improvements in grants administration policy have resulted : Unified reimbursement policies of student support programs, with a Public Advisory Committee established to regularly review the adequacy of the levels of stipend support; improved administration of construction grant programs through the unifying of forms and review procedures; and greatly simplified reporting of grant expenditures. In its establishment of indirect cost rates for grants and contracts awarded by the Department, and in the development of related cost policies, this Division has during the past year brought this function to a current status and now provides a major financial advisory resource for the grantee community. The “Grants Administration Report,” a new publication of the Division, provides in-depth analyses and considerations of the issues relating to grant policies. Audit Agency The Audit Agency, established in 1965, audits all Department programs and activities, including those conducted by and through its various grantees and contractors. The audit workload thus represents more than 1,400 Department installations, 545 State agencies, 20,000 school districts and other local units of government, 4,000 universities and other private organizations, 150 health insurance intermediaries, and 10,000 hospitals and extended care facilities. The sheer magnitude of this workload, coupled with the need for timely audit service, requires necessary coverage with a minimum effort. Some of the techniques used by the Audit Agency to provide this service are: Total Audit Concept Many of the Department’s programs are administered through organizations that often receive grants and/or contracts from more than one of the Department’s operating agencies. Our auditors perform a concurrent audit of all such activities at the institution, thereby permitting an evaluation of total management operations as they affect Department funds. In this manner, audits are accomplished more efficiently with fewer visits and less disruption of the activities of the organization being audited. 58 Department of Health, Education, and Welfare, 1968 Cross-Servicing Arrangements Many organizations participating in the Department’s programs also participate in programs administered by other Federal agencies. We coordinate with these agencies to establish a system of audit cognizance whereby the Federal agency having cognizance (usually determined by the volume of program dollars involved) extends its audits to meet the audit needs of all Federal agencies involved. Utilization of Outside Auditors For many organizations, participation in the Department’s programs is but a part of their overall activities. Whenever possible, internal reviews of such organizations’ operations by their own audit staffs or their public accounting firms are being utilized by our auditors. We are continually encouraging these organizations to have their internal reviews performed so that they will meet HEW audit requirements as well. This technique, in addition to minimizing the impact of a growing audit workload, has the added advantage of strengthening the management capabilities of the grantee organizations participating in the administration of the Department’s programs. Examples: • Audits of Medicare program.^—We developed a plan which relies on public accounting firms for audits of intermediaries and providers. Generally, the hospital extends the engagement of its own accounting firm to conduct the Medicare audit. The intermediary, with its own staff or separate independent firm, evaluates these audits through review and test checks. The Audit Agency audits the intermediary and evaluates its conduct of this audit approach. • Audits of colleges and universities.—We developed and distributed to educational institutions audit programs for the work-study and NDEA student loan programs. We are continually urging educational institutions to extend the audit engagement of their accountants to cover these two programs. To date, a total of 1,084 institutions have agreed to participate in this approach. o Audits of State and local agencies.—We are continually working with States and intergovernmental organizations with a view toward increased utilization of work performed by State audit staffs. During fiscal year 1968, meetings and training sessions were held with State audit groups to explain the Department’s audit needs and demonstrate Audit Agency techniques. We initiated 14 demonstration projects on Federal-State audit partnership designed to assist State audit organizations to strengthen and expand their audit capabilities. Office of the Secretary 59 Administration The Department continued to give high priority to modernizing its administrative machinery, revitalizing its organizational structure, improving its operating relationships with its State and local partners, and strengthening its capacity to offer employees and potential employees maximum opportunity for growth and development. Two major organizational changes which occurred in the spring and summer related to health and social welfare functions respectively. The health functions of the Department were completely reorganized. The Assistant Secretary for Health and Scientific Affairs was placed in charge of the new Public Health Service and the Surgeon General was made his principal deputy. Together they provide policy and professional guidance for all Department health functions, including the Medicare and Medicaid programs and the Children’s Bureau health functions. A new concept for social and rehabilitation services was developed designed to join under single leadership both the income support programs for needy Americans and the social service and rehabilitation programs that many families and individuals need. This concept was implemented through the establishment of the Social and Rehabilitation Service, joining in one organization the former Welfare Administration, Vocational Rehabilitation Administration and the Administration on Aging. The new agency achieves greater unity of purpose and an integrated approach to social and rehabilitation programs. Personnel Administration In the field of personnel administration, fiscal year 1968 was marked by change, innovation, and the improvement and expansion of existing personnel programs in response to the rapidly growing responsibilities of the Department. A significant element of change was the reorganization of the Department’s health and health-related programs, which included elevating program management to the departmental level, and abolishing the former Office of the Surgeon General, Public Health Service. Through the realignment of resources permitted by these actions, personnel administration within the Office of the Secretary and in the new health administrations was substantially strengthened at no overall increase in staff. Finishing its second year, the Department’s career development program was significantly advanced. At the close of the year, 21 career service boards, covering approximately 60 percent of the Department’s total employment, had been established; and 15 of these boards had presented plans for the improvement of personnel management 60 Department of Health, Education, and Welfare, 1968 in their respective occupational areas to the HEW Career Development Council. In the area of employment of minority group members, the year’s efforts were highlighted by an intensive recruiting campaign in the West and Southwest to increase the employment of Mexican-Americans. In spite of such problems as linguistic difficulties and the lack of adequate recruitment materials for such an effort, placements were made from the trainee to the professional level. In the youth and summer employment programs the Department exceeded YOC program quotas by more than 50 percent, and the number of special administrative interns doubled over the previous year. A continuing evaluation and supervisory indoctrination program was also initiated. Over 72,000 HEW employees received formal training during the year, as compared with 38,000 for the previous year. Most of the increase was attributed to new and expanded in-service training programs, particularly in the areas of orientation, clerical, and supervisory training. Eight HEW employees received the highest national recognition: the President’s Award (Arthur Hess, SSA); the Rockefeller Public Service Award (Secretary Wilbur J. Cohen) ; the Arthur S. Flemming Award (Dr. Frank J. Rauscher, NTH); the National Civil Service League Award (Dr. Alexander Langmuir, NCDC, and James F. Kelly, OS); Ten Outstanding Young Men Award (Dr. Paul Park-man, NIH); the Federal Woman’s Award (Ruby Martin, OS); and the Young Federal Lawyer’s Award (Paul Merilin, OGC). There were 20 distinguished service awards compared with 16 in 1967; 201 superior service awards, compared with 96 in 1967; 1,158 employee suggestions adopted, compared with 965 in 1967; and 1,676 cash performance awards, compared with 1,250 in 1967. Two new awards, the HEW Award for Distinguished Public Service and the HEW Achievement Award, were established during the year. The number of unions accorded exclusive recognition increased from 77 in fiscal year 1967 to 120 in fiscal year 1968. The number of collective bargaining agreements increased from 32 to 68, and formal recognition from 44 to 65. There was also a larger number of complaints and arbitration actions. At the close of the year primary attention was being directed to more effective management of this rapidly expanding program. By way of reinforcing all aspects of personnel administration, continuing and expanded efforts were directed to employee information and communication programs. The HEW Forums, inaugurated in 1967, presented 16 lectures by Department officials. Forum papers Office of the Secretary 61 for the series were published and distributed to Department employees. The HEW Employee Forum, instituted and led by the Secretary, presents issues and topics of major interest and concern to employees of the Department, and permits these employees to engage in direct dialog with key HEW officials. The HEW Film Forum screened films for Department employees on subjects related to the mission of the Department such as the human environment, mental health, race in America, education, and poverty and health. The Career Development News, a monthly publication, was initiated to inform employees, supervisors, and managers on career development policies, programs, and activities of significance to the fulfillment of their responsibilities and the advancement of their careers. Underlining the need for continuous improvement of all aspects of personnel administration is the steady increase in overall employment and the need for new skills and abilities to meet changing program requirements throughout the Department. The number of paid employees increased from 105,596 in June 1967 to 117,113 in June 1968. The Social Security Administration accounted for approximately 62 percent of this increase, in response to the huge workload expansion generated by the health insurance program and statutory changes in the social security system. The second largest center of growth, 27 percent of the total increase, was in the Department’s health programs. Equal Employment Opportunity The Secretary transferred the equal employment opportunity program, formerly a responsibility of the Special Assistant to the Secretary for Civil Rights, to the Office of the Assistant Secretary for Administration. In HEW, this staff was charged with the responsibility to provide equal opportunity in employment for all qualified persons; to prohibit discrimination in employment because of race, color, religion, sex, or national origin; to establish and maintain a positive program of equal employment opportunity for all civilian employees and applicants for employment; to provide for the prompt, fair, and impartial consideration of all complaints of employment discrimination based on race, color, religion, sex, or national origin; and to promote the full realization of equal employment opportunity through programs affecting employability, such as employee housing opportunities, and selection and acquisition of buildings or space. 62 Department of Health, Education, and Welfare, 1968 The equal employment opportunity staff also serves as a focal point for the coordination and development of programs and projects concerning minority group activities in HEW, and represents the Department on EEO matters. Management Systems Under the coordination of a newly established Department regulations officer, new regulations development procedures were developed to insure that concerned staff officials participate in the resolution of policy issues before formal regulations are drafted, and to get regulations review, as appropriate, by heads of State and local government. A program was initiated to standardize commonly used data elements in Department data processing systems such as organization components of the Department, firms with which the Department does business and geographic areas. Completion of a study of program relationships between the Food and Drug Administration and the Public Health Service provided background for the establishment of the Consumer Protection and Environmental Health Service. Improvement in the management of our programs resulted from review of Federal grant-in-aid processing time. The President, concerned that many agencies were taking much too long to process grant-in-aid project applications filed by State and local governments, directed the Secretaries of Housing and Urban Development, Labor, and Health, Education, and Welfare, and the Director of the Office of Economic Opportunity, to join in finding ways to reduce, by at least 50 percent, the time it takes to process applications for Federal assistance in four major areas of intergovernmental cooperation: model cities, neighborhood centers, manpower development, and water and sewer facilities. An internal HEW committee was established, under the direction of the Assistant Secretary for Administration, to review HEW grant programs which might become components of multipurpose projects and to determine where and how reductions in processing time could be made to meet the President’s goals. Programs examined were those judged to be critical, based on such factors as dollar size, relation to important urban problems, and the nature of and time involved in the existing application process. Against these and related criteria, the committee identified 18 HEW grant programs in the four major areas where reductions in processing time could be achieved. New procedures were established for these HEW programs which would reduce average processing time by 51 percent. These results were included in the Interagency Report to the President, Reducing Federal Grant-In-Aid Office of the Secretary 63 Processing Time (Sept. 30, 1967). The procedures established became effective on December 31,1967. The Final Report of the Joint Administrative Task Force, Reducing Federal Grant-In-Aid Processing Time (March 1968), identified eight additional critical programs for which reduced processing times averaging better than 50 percent were established. Procedures for achieving reductions in these eight programs were effective March 31,1968. General Services Among the improvements in general services successfully completed were: Consolidation of Department-wide magnetic tape procurement, the joint use of a single teletype network by all HEW operating agencies and the regional offices, the introduction of new accounting criteria for personal property, elimination of unnecessary communications equipment, and redistribution of personal property. Surplus Property Utilization Personal property, surplus to the needs of the Federal Government, with an original acquisition cost of $309.8 million, was allocated for distribution to health, educational, and civil defense donees in fiscal year 1968. Most of the slight increase over the previous fiscal year was attributable to the release by the military of relatively high-cost property such as computers and aircraft. The availability of the so-called common-use items could not meet the demand of eligible donees. For example, during fiscal year 1968, 29 aircraft, which originally cost $1,478 million, varying from Piper Cub to C-45 Beechcraft, were donated to institutions to carry out pilot, airframe, powerplant, and instrument training programs. Two major vessels, with a combined acquisition cost of $1,131 million, were donated for oceanographic, marine, and biology research, and other educational purposes. Seventeen computers of varying types, with an acquisition cost of approximately $4.9 million, were donated to 16 institutions of higher learning. In October 1967, as a result of an on-site review of DOD European depots by committee staff members, the House Committee on Government Operations recommended that this Department, General Services Administration, and the Department of Defense jointly study the possibilities of bringing back to this country Federal excess personal properties located outside of the country. Acting upon this recommendation, the three agencies developed a procedure for screening, requesting, and returning to this country for Federal reutilization and for donation, reportable-type overseas DOD properties in selected 64 Department of Health, Education, and Welfare, 1968 condition classifications. This procedure was put into effect on July 1, 1968, on a 1-year experimental basis with respect to property located in Germany. For the third consecutive year the acquisition cost of surplus real property conveyed for health and educational purposes, including research, exceeded that of the previous fiscal year. Real and related personal property, with an original acquisition cost of $114 million, was transferred to eligible health and educational institutions in fiscal year 1968. This was an increase of $19.9 million over fiscal year 1967, and was the peak of the activity since the program’s inception. This increase is attributed to the increased number of obsolete military installations conveyed, as well as several similar properties of the Veteran’s Administration. An example of an obsolete military installation is the former Walker Air Force Base, Roswell, N. Mex.: 234 acres and 76 buildings, which had an acquisition cost of $10 million, were transferred to Eastern New Mexico University for use as a branch campus, offering a 2-year standard academic college program. The university will also specialize in vocational technical fields suitable to the needs of the area. Another portion of the facility was conveyed to the Roswell Independent School District for elementary school use. A third conveyance of land and the former base hospital was made to the New Mexico State Department of Hospitals and Institutions for hospital purposes. Another example of a major facility conveyance is in the State of Nevada where portions of Stead Air Force Base, totaling 424.57 acres of land, 51 buildings, and related personalty, with an acquisition cost of $11.7 million, were conveyed for health and educational purposes: 327.88 acres of land, 48 buildings, and related personalty were transferred to the University of Nevada; the sewer system, including treatment plant, mains, and 79.52 acres of land, to the city of Reno; and 17.07 acres of land to Washoe County School District. The district has now constructed an elementary school on the site. Not all of the real property transferred has been of this magnitude. A number of old post offices are continuing to serve their communities as public libraries, and buildings from reclamation projects are serving as teachers’ residences. The following illustrates the diversified purposes for which 161 parcels of surplus real and related personal property were conveyed during the 1968 fiscal year: College campus sites and facilities___________________________________________ 19 College and high school agricultural, teaching, experimental, and vocational training ___________________________________________________________________ 27 Elementary and secondary educational programs____________________________ 64 Central administrative and service facilities for schools and school systems 6 Office of the Secretary 65 Housing for school or hospital staffs_______________________________________ 10 Hospital and clinic programs________________________________________________ 3 Treatment, rehabilitation, and training centers for the mentally retarded and physically handicapped__________________________________________________ 3 Public libraries_____________________________________________________________ 10 Water and sewer production treatment and service facilities_________________ 10 Land fill refuse disposal programs_____________________________________________ 1 Research _____________________________________________________________________ 5 Juvenile rehabilitation and training centers___________________________________ 3 State Merit Systems A major emphasis of the Office of State Merit Systems during fiscal year 1968 was a combined effort with the Federal program agencies to stimulate and assist the States to provide increasing opportunities for the disadvantaged in public employment. The Office focused attention on the means whereby socially desirable objectives can be attained within the framework of merit principles. To review the Federal-State cooperative personnel program in the light of current manpower and social policies and operating needs, the Secretary appointed an Advisory Committee on Merit System Standards. The Committee is charged with making general policy recommendations on personnel standards applicable to State and local agencies, and proposals for optional effectiveness in the program. In line with tentative conclusions of the Committee, the Office of State Merit Systems sent forth to State personnel directors certain modifications in merit system practices which States should adopt in order to meet current program objectives. These suggested modifications stress the restructuring of jobs to provide career opportunities for disadvantaged persons, targeted recruitment, realistic education and experience requirements, and new approaches to selection including the use of nonverbal tests and structured interviews when appropriate. The Office responded to State requests for technical assistance in various areas of personnel administration. For example, 44 of the 50 States were supplied examination materials. A report was issued on application of automatic data processing to State merit sysfems. In four States, assistance was given in establishing statewide civil service systems which succeed grant-in-aid merit sytems. Defense Coordination The Department is required to maintain continuity of organization and essential functions under conditions resulting from attack or natural disaster. This requires both headquarters and regional relocation sites and a system of coterminous regional boundaries with the 66 Department of Health, Education, and Welfare, 1968 Office of Emergency Preparedness and the Office of Civil Defense. These arrangements are maintained in constant readiness. The Department maintains an emergency medical stockpile valued at approximately $150 million and 2,500 packaged disaster hospitals pre-positioned among all 50 States and able to move quickly to any area where casualties or refugees need added medical facilities. Authority is also available to help restore educational and health facilities which may be damaged or destroyed. The Department also conducts several types of citizen training to help families cope with sudden emergencies. Through State departments of education, 374,391 persons completed the personal and family protection 12-hour training course during the fiscal year. Through State health departments, 2,320,928 persons completed a 16-hour course in medical self-help during the same period. In addition to training programs, seven special research projects related to emergency requirements were underway as of June 30. In 32 natural disasters during the year coordination of HEW assistance was performed by the Department’s regional offices, working with counterpart State agencies and with the Office of Emergency Preparedness, which is part of the Office of the President. In a post-nuclear disaster regional directors have delegated authority to commit departmental resources and take all necessary action on behalf of the Secretary, if headquarters communication is cut off. To monitor and coordinate emergency readiness measures for the Secretary, a small staff unit is assigned to the Assistant Secretary for Administration. Each operating agency and each regional office also provides staff support for this purpose. The overriding concern of HEW personnel in a crisis situation is to channel all possible aid and assistance to meeting emergency health and welfare needs of people. Community and Field Services Programs Dealing With Children and Youth In the summer of 1967 the Office of the Assistant Secretary for Community and Field Services prepared a departmental report, Parents as Partners, on the ways and degree to which parents are involved as participants and planners in the Department’s many programs relating to children. As a result of that report, a work group was formed in February 1968 to make recommendations for policy in this area. Office of the Secretary 67 On June 20-21, 1968, this office cooperated with the Children’s Bureau in sponsoring two 2-day meetings dealing with the concerns of youth in our society. Papers were prepared and delivered by youth and young people participating in the meetings as coequal (and often dominant) participants. Out of these meetings came a report, Identity in a Troubled Time, and proposals for involving young people in the processes of government in a meaningful way. The Office also cooperated with the Department of Labor and the Office of Economic Opportunity in a joint effort to stimulate and support programs which provide promising new models for the involvement of youth such as the Neighborhood Development Youth Program (NDYP) in Washington, D.C. In conjunction with participation on the President’s Council on Youth Opportunity, this office was involved in several activities, for example: The President’s Council desired a systematic evaluation of the summer programs to provide guidelines for future program directions. Therefore, this office initiated a contract with the Trans-Century Corp, for such an evaluation. The resulting report, titled From the Streets, urged youth involvement in the OEO planning and operation of summer programs. The report also stressed programs which continued beyond the summer and emphasized the involvement of youth in decisionmaking roles. The Department funded the Community Action Training Program in the District of Columbia out of its special funds. This was a model program designed to reach older hard-core youth through the use of innovative education programs dealing with youth roles in the community. Activities in relation to juvenile delinquency assumed high priority throughout the year. Staff of the Office coordinated the Department’s efforts to develop a new and expanded program—the Juvenile Delinquency Prevention and Control Act of 1968. Staff also worked with the Department of Justice to develop a coordinated approach to the problem of crime and delinquency. A series of conferences at the National, State, and local levels was spearheaded by the Office as a means of stimulating comprehensive, coordinated efforts to prevent and control delinquency. Social Services and Welfare Programs In May of 1968 the Office was charged with coordination of this Department’s response to the Poor People’s Campaign. While the campaign was actually in progress, the Office coordinated the responses submitted by the agencies and prepared the drafts which 68 Department of Health, Education, and Welfare, 1968 became the basis for the Department’s official response. Activities in this regard have been extended into fiscal year 1969. The Program Analysis Group on Exits from Poverty examined and prepared a report on the conditions which lock people into poverty and alternative means of achieving the goal of eliminating poverty. Specifically, the group considered the earning power and income maintenance programs that would be required to lift the poor out of poverty and made recommendations to this effect. In March of 1968 the Office, with the Department of Labor, sponsored a 2i/2-day conference on new careers in the following fields: education, social services, health, and corrections. That same month Secretary Cohen called together a task force of experts in social services to develop a point of view and make recommendations on the allocation and organization of the social services in the United States. The task force recognized that social services previously had never been defined and described as a field with its own unique identity. During the spring of 1968 the task force gave consideration to over 50 issue papers related to basic concepts for the development of social services, allocation of resources and the issue of priorities, organization and financing, planning and coordination, and manpower. A preliminary report was scheduled to be presented to the Secretary in October 1968 and a final report in the spring of 1969. Consumer Services Consumer aspects of the Department’s programs were strengthened by the appointment of a special assistant to the Secretary. He was appointed to represent consumer interests and advise the Secretary on improved techniques for meeting consumer needs. Through this special focus, expanded program activities were developed affecting the status of consumer education, as well as information and service for the low-income consumer. These activities were coordinated both within the Department and with related programs in other agencies. This focus also provides HEW with a contact point for consumers and representatives of consumer organizations seeking assistance. In addition, consumers have been invited to participate in departmental planning meetings and informational conferences for the purpose of considering the consumer viewpoint in program planning and disseminating information on programs of special concern. Field Coordination A key departmental priority was better coordination of programs— within the Department, with other Federal agencies, and with State Office of the Secretary 69 and local government—for the purpose of improving delivery of services to the people. The Office of Field Coordination and regional directors were delegated responsibility for administration of the model cities program in the field. They worked closely with the 75 “first round” model cities, now in various stages of their planning effort, and with 200 cities seeking model cities status. They carried out other priority programs requiring the coordinated efforts of the agencies such as neighborhood service programs, family planning, and the youth opportunity program. In addition, the Office helped increase communication on mutual problems among all levels of government through seminars and conferences of Federal, State, and local officials and their associations. Civil Rights SCHOOL DESEGREGATION Between the 1954 Supreme Court decision and the 1964 Civil Rights Act, there was almost no desegregation in Southern schools. In 1963 only 1.17 percent of Negro students were attending school with whites, while in 1968 20.3 percent were attending desegregated schools. Thus, in contrast to the 1964 picture, nearly every school district today has some student desegregation. Similarly, teachers were rigidly segregated before 1964. Today, nearly all of the districts with white and Negro teachers have begun the process of faculty desegregation, and are making steady progress each year. A key to this progress has been the application of the title VI sanction where necessary. OCR has initiated enforcement proceedings against 480 school districts. However, as of June 30, 1968, only 96 districts were actually barred from Federal assistance on account of noncompliance. The most recent policies affecting school desegregation, issued in March 1968, required all school districts still in the process of eliminating the dual school system to complete the process no later than the beginning of the 1969-70 school year. This marked the first time the Department has notified all school districts eliminating the dual system under voluntary plans (as opposed to court orders) of the target date by which they must be completely integrated or face the possibility of losing Federal financial assistance. The new policies have resulted in nearly 300 school districts adopting acceptable plans during the past year. The Office for Civil Rights is negotiating with the remaining 340 voluntary plan districts for the submission and implementation of plans by September 1969. To date, the Office has received statistical information from over 2,000 Northern school districts indicating the extent to which minority group students and faculty members are attending schools with white 328-184—69----6 70 Department of Health, Education, and Welfare, 1968 students and white faculty members. Through June 30, 1968, preliminary reviews were initiated in five school systems in California, and five full reviews have been conducted in California, Connecticut, Pennsylvania, New Jersey, and Ohio. Higher Education The higher education compliance program was launched in August 1967, with a nationwide questionnaire on racial enrollments sent to 2,300 colleges and universities receiving Federal financial assistance. On the basis of data received, approximately 300 colleges having a minority enrollment of less than 1 percent were selected for compliance review and, by June 30,1968, OCR staff had visited 30 colleges to determine whether racial discrimination exists. HEALTH AND SOCIAL WELFARE As of June 30, 1968, 98 percent of all hospitals in the Nation were officially committed to provide all services without discrimination. More than 3,000 of these hospitals changed their previous policies and practices to comply with title VI. Most of these changes were achieved voluntarily. Only 35 hospitals have been involved in the hearing step of enforcement proceedings. And only nine have lost Federal financial assistance because of non-compliance with title VI. Twelve cases are pending; the remainder came into compliance voluntarily. During fiscal year 1968 comprehensive compliance reviews were conducted of the health and welfare programs in 12 States. In these reviews visits were made to 354 agencies and health and welfare facilities including 54 hospitals and 55 nursing homes. In addition, routine compliance reviews and complaint investigations were conducted in 232 hospitals and 32 nursing homes. OCR made compliance reviews of hospitals and nursing homes and other health and welfare agencies including local welfare agencies, child care facilities, day care centers, rehabilitation centers, special programs for the aged, and mental health facilities. Any noncompliance problems were identified and corrective action was initiated to assure full compliance with title VI of the Civil Rights Act. CONTRACT COMPLIANCE Contract compliance specialists have been assigned in five regional offices; 40 reviews were conducted by June 30, 1968. The purpose of these reviews was to evaluate employment policies, practices, and affirmative action measures being observed by HEW contractors. Another major concern in these reviews has been to identify community resources which could provide minority group candidates for employment by contractors. Office of the Secretary 71 INTERAGENCY LIAISON AND COORDINATION The Office for Civil Rights coordinated its title VI program with the model cities program. In conjunction with the Center for Community Planning, OCR worked with the Model Cities Administration to assure that agencies of cities receiving model cities grants are in compliance with title VI. Because of the relationship between certain programs of the Department of Housing and Urban Development and HEW’s civil rights responsibilities, OCR has maintained close liaison with HUD. In this context, the Renewal Assistance Administration and OCR have developed policies which would allow cash credit for school construction occurring outside urban renewal site areas when such construction would facilitate school desegregation under title VI. Center for Community Planning The Center for Community Planning, which completed its organization and staffing during 1968, was established to coordinate the Department’s response to urban problems. The Center also serves as HEW’s urban affairs liaison with HUD and other Federal departments. The initial emphasis has been on Model Cities, neighborhood service, and parent and child center programs. In organizing for this effort, the Center established HEW’s Urban Coordinating Committee, which links the activities of separate HEW agencies and advises on strategies essential to the Department-wide effort. During the course of the year, the Center organized a system of regional response to technical assistance planning needs of Model Cities. Evaluation teams were established in Washington and in the regions for the review of applications from cities seeking Model Cities planning grants from HUD. Recognizing the need for a clearer understanding among HEW personnel of urban needs and of HEW’s role in solving them, the Center undertook a series of training programs for topflight HEW executives in the problems of the inner city. This orientation program included a living experience in an inner city ghetto. The Center and the Public Health Service also held a series of meetings throughout the country bringing together for the first time city, neighborhood, social service agency, State and Federal agency representatives in an effort to identify their roles in Model Cities planning. The Center developed a series of publications for the information not only of HEW personnel, but of city and State planners concerned with the development of model neighborhood programs. These range from monthly publications highlighting HEW efforts in connection with the Model Cities program to inventories of the existing grants 72 Department of Health, Education, and Welfare, 1968 relevant to model neighborhood activity and to comprehensive review of the kind of planning, the kind of problems, and the kind of programs necessary in model neighborhoods. The HEW Handbook, City for Man, and the monthly Forum are examples of CCP publications. Working with the Comptroller’s office, the Center developed and tested a system of earmarking funds for the wide variety of grant programs to meet the needs of coordinated service delivery projects in 14 cities as part of the Neighborhood Service Center program. The lessons learned in this effort are being applied in efforts to fund model neighborhood programs. Center representatives and regional staff have met throughout the country with representatives of State Governors to assist them in identifying model neighborhood needs in terms of State involvement. Working with HUD, the Center developed Federal agreement on a partnership for States in the Model Cities effort. This partnership means that States may take part in joint technical assistance to model neighborhood planners, participate in joint evaluation of model neighborhood plans, and seek to develop State funding plans tied in with the Federal effort to make certain Model Cities are adequately financed. Secretary's Committee on Mental Retardation The Secretary’s Committee on Mental Retardation coordinates the Department’s mental retardation programs and advises the Secretary on issues related to the field. During the year the Committee was particularly concerned with the support of mental retardation university-affiliated facilities and improved training programs for personnel serving the mentally retarded. Federal participation in programs designed to serve the mentally retarded in poverty areas received special attention. The Committee also coordinated the Department’s response to recommendations of the President’s Committee on Mental Retardation in its 1968 report. The Under Secretary serves as chairman of this Committee. Other Activities The Assistant Secretary for Community and Field Services represented the Department on the United States-Mexico Border Development Commission, whose members visited several border towns in both the United States and Mexico. There they held hearings with local officials to determine special needs of the border towns and to establish a cooperative effort to meet these needs using the resources of both governments. Office of the Secretary 73 This office represented HEW on the National Advisory Commission on Rural Poverty. After conducting an in-depth study of current economic situations and trends relating to American rural life, the Commission offered recommendations as to how local, State, and Federal agencies could best mobilize their resources to offer assistance to the rural poor. Health and Scientific Affairs Extensive reorganization of the Department’s health activities, and designation of the Assistant Secretary for Health and Scientific Affairs as the Secretary’s alter ego on matters of health policy and programs, resulted in major changes in the functions and responsibilities of the ASHSA. In March the Assistant Secretary was given responsibility for direction of supervision of the Public Health Service and the Food and Drug Administration, agencies which were later consolidated in an expanded Public Health Service. In all, programs budgeted at nearly $3 billion for fiscal year 1969, involving some 45,000 of the Department’s employees, were placed under the supervision of the Assistant Secretary for Health and Scientific Affairs. At the same time he was made responsible for health policy direction of health programs administered by other Department agencies including Medicare, Medicaid, and the health activities of the Children’s Bureau. These programs brought the total health and medical care expenditures by the Department to approximately $11 billion. The Surgeon General of the Public Health Service was designated principal deputy to the Assistant Secretary for Health and Scientific Affairs, to serve as the Department’s senior career health professional with expanded responsibilities for Department-wide leadership and guidance of health policies and programs. The reorganization and the assignment of greatly expanded responsibilities to the Office of the Assistant Secretary for Health and Scientific Affairs reflected the need to establish a joint point for health policies in the Office of the Secretary, to provide program direction from the Office of the Secretary, and to achieve improved coordination and administration of departmental health activities that have tripled in the past 3 years alone, from $2.6 billion in 1966 to $10.9 billion in 1969. They reflect also the impact of more than 30 major pieces of health legislation for which the Department is responsible that have been enacted in the last 4 years including Medicare and Medicaid, comprehensive health planning, and numerous other measures ranging from aid for health manpower development to air pollution control. 74 Department of Health, Education, and Welfare, 1968 In recent years the Federal role in health and medical affairs has expanded rapidly. In addition to its longstanding role as a major source of support for biomedical research, for the development and improvement of health facilities, and for aid to State and local programs of health services, the Federal Government now is a major purchaser of health care for the elderly, for the poor, for mothers and children, and for the disadvantaged. In addition, the Federal Government is now supporting a variety of efforts to improve the organization and delivery of medical care. Although expenditures have grown most rapidly in these areas, equally complex and important problems face the Nation in the field of environmental health. The Federal Government has become a major partner with State and local government, the health professions, health care institutions, voluntary agencies, and the vast private health enterprises of the Nation in seeking to achieve our national health goals. The Office of the Assistant Secretary for Health and Scientific Affairs now serves as the Department locus for directing a coordinated departmental effort as our contribution to this vast undertaking. Six staff offices are organized to assist in the execution of these functions: the Office of Planning and Program Coordination, Office of Science, Office of Health and Medical Care, Office of Family Planning and Population, Office of Health Manpower, and the Office of International Health. The responsibilities of the Office of the Assistant Secretary for Health and Scientific Affairs include: • Development, coordination, review, and evaluation of policies and priorities. © Direction, review, evaluation, and policy review of programs of each PHS operating agency. • Coordination of programs throughout the Department and on an interdepartmental basis. • Development of health goals and program objectives; initiation, as well as the review and approval, of legislative, budgetary, and program planning proposals of PHS operating agencies. • Liaison with professional and voluntary organizations, public and private institutions, State agencies, and other organizations to the extent that they relate to departmental policies and responsibilities. • Interdepartmental coordination and liaison as well as representation on policy-related councils, e.g., Federal Council on Science and Technology. Office of the Secretary 75 • Intergovernmental policy and program coordination in relation to international health activities. • Overall administration and direction of the Department’s patent policy activities. Planning and Program Coordination This office is responsible for review and coordination of health activities within the Department. The Office serves the Assistant Secretary for Health and Scientific Affairs, the Surgeon General, and the staff offices directly serving the Assistant Secretary for Health and Scientific Affairs. This office also provides liaison with other staff offices in the Office of the Secretary. The Office of Planning and Program Coordination is responsible for coordinating departmental concerns in comprehensive health planning and the activities related to the development and review of legislation, budget, and program planning. The Office serves as the Assistant Secretary’s focal point for liaison with professional and voluntary organizations, private institutions, and State and local agencies; provides staff and secretariat for the National Advisory Health Council; provides policy guidance in the management of health grants throughout the Department; coordinates grant-related staff activities of the operating units reporting directly to the Assistant Secretary; and serves as the focal point for liaison and coordination with the Division of Grant Administration Policy in the Office of the Assistant Secretary, Comptroller. International Health The Office of International Health is the principal adviser to the Assistant Secretary for Health and Scientific Affairs on international health matters. This responsibility includes providing analyses of information necessary for policy formulation, review, and program coordination in three areas: International programs operated within the Public Health Service; professional and technical participation with multilateral health agencies and organizations; and technical support to U.S. bilateral health programs operated outside the Public Health Service, primarily by the Agency for International Development, including liaison with WHO, PAHO, UNICEF, UN, and UNESCO. The Office of International Health has responsibility for providing effective coordination, evaluation, and policy direction for the special international research program (Public Law 480). During fiscal year 76 Department of Health, Education, and Welfare, 1968 1968 a method was established to utilize the resources of the World Health Organization for the development and implementation of programs supported by excess foreign currencies. Health and Medical Care This office provides guidance on policy and program coordination, resource allocation, and legislative planning for HEW programs providing, purchasing, planning, or developing health and medical care services; for recommending priorities for health services research and development; and for liaison with governmental and other organizations providing, planning, developing, or purchasing health or medical care services. New legislation enacted in fiscal year 1968 improved the capacity of the Department to deal with health services organization and distribution problems. Of particular significance were the health services and facilities amendments which emphasize regional medical programs, health services for migrating farmworkers, mental health and mental retardation programs, extension of loans to hospitals, and consumer protection services. One of the most promising methods of distributing scarce medical manpower is group practice. In group practice several physicians can provide medical service to a far greater number of people than the composite of their individual positions. A Task Force on Group Practice reviewed the recommendations of the Conference on Promotion and Group Practice, held in 1967, and reported to the Secretary on implementation. And a working arrangement was established with the National Medical Association providing technical assistance to their foundation in setting up group practices in areas where they have sufficient membership. Population and Family Planning This office provides guidance on policy and program coordination, resource allocation, evaluation of legislative and program proposals in the field; coordinates the role of concerned operating agencies, particularly with the programs of other departments and agencies; and develops and maintains liaison with Federal and non-Federal organizations and institutions. In fiscal year 1968 a committee of representatives of departmental operating agencies was set up to help in the coordination of population and family planning programs and projects within the Department. The office worked with various professional organizations to develop Office of the Secretary 77 professional school curriculum related to family planning, and an interagency committee was established to develop a plan for a uniform reporting system on family planning services. Science This office provides guidance on policy and program coordination relating to biomedical research and research training; research and development related to the occupational and environmental determinants of ill health and the elimination of environmental and work hazards; consumer protection; and drug development, evaluation, and utilization. It serves as the focal point for liaison on matters of science; provides guidance on program priorities and resource allocation among HEW biomedical science activities; participates in the development and review of legislative proposals related to science, environmental health, and consumer protection activities; and administers the patent policy program of the Department. During fiscal year 1968 this office served as a focal point for the development of a variety of programs such as initiating a program in response to the Federal Radiation Council’s deliberations on lung cancer in uranium miners, working for the passage of the Radiation Control Act for Health and Safety of 1968, and working with the Department of Agriculture on standards for instant nonfat dry milk. Health Manpower This office provides guidance on policy and program coordination in health manpower development, guidance on HEW health manpower training priorities, resource allocation for program development, liaison with government and other organizations involved in health manpower matters, liaison with health professional schools and other educational institutions in policies related to institutional support for education and health manpower development, and the development of legislative proposals related to health manpower and policies related to educational institutions. During fiscal year 1968 this office participated in the development and presentation of proposals culminating in the Health Manpower Act of 1968. This office played a key role in the analysis and implementation of the report of the National Advisory Commission on Health Manpower. In conjunction with the Department of Labor, Veterans’ Administration, and the Department of Defense, a program for recruiting discharged military servicemen trained in health occu 78 Department of Health, Education, and Welfare, 1968 pations into civilian positions (Project Remed) was organized and implemented. Education International Affairs In the Office of the Assistant Secretary for Education, the Office of International Affairs provides advice and assistance to the Secretary and his staff on the development and implementation of HEW international policies and programs. The Office provides departmental leadership and coordination in developing international programs in the fields of education, health, social security, rehabilitation, maternal and child welfare, and social development. The Office also is responsible for: developing U.S. policy positions for international meetings; liaison with other agencies and international and nongovernmental organizations; and representation on 23 interdepartmental and departmental committees and working groups, as well as one public advisory committee. The office also coordinates the Department’s overseas research programs under the special foreign currency program authorized by the Agricultural Trade Development and Assistance Act (Public Law 83-480). In fiscal year 1968 the Department’s international programs, costing approximately $90 million, were carried out by about 1,000 staff members. Thousands of additional HEW staff members have some contact with international programs. COOPERATION WITH INTERNATIONAL ORGANIZATIONS HEW staff members actively participate as consultants and advisers to international intergovernmental organizations, participate in expert panels, workshops, committees, and study groups, and represent the United States on official delegations at international meetings. During fiscal year 1968, 380 staff members carried out these assignments overseas at more than 200 international meetings including such organizations as the World Health Organization, UNESCO, Pan American Health Organization, and UNICEF. The UN General Assembly designated 1968 as the International Year for Human Rights. The Secretary was designated as a member of the President’s Commission for the Observance of Human Rights Year 1968, and was represented by the Assistant Secretary for Education at Commission meetings. An ad hoc HEW committee planned activities within the Department to observe Human Rights Year, emphasizing programs which further human rights. Office of the Secretary 79 EXCHANGE VISITOR WAIVER REVIEW BOARD The Exchange Visitor Waiver Review Board reviews and evaluates requests for waiver of the 2-year foreign residence requirement applicable to exchange visitors. In 1968 the Board considered 566 applications for waivers: 398 applications for exchange visitors in the medical and paramedical fields, and 158 in the education field. Applications are submitted to the Department on behalf of the foreign visitors by colleges and universities, hospitals, local community organizations, and other institutions in all parts of the United States. In fiscal year 1968 the Board requested the Department of State to recommend to the Attorney General that the residency requirement for 77 exchange visitors be waived. The Office of International Affairs chaired a working group, established by the Interagency Council on International Educational and Cultural Affairs, to review and to make recommendations for any needed modifications in existing visa waiver criteria and procedures. The working group affirmed the validity of current waiver criteria, called for a pilot study to determine the actual outcome resulting from waivers granted to alien physicians, and recommended that sponsors of exchange visitors assume more responsibility for the programing, training, and return of exchangees to their home countries. International Education The Office of Deputy Assistant Secretary for Education (International Education) was created at the beginning of the fourth quarter of fiscal year 1968. Its principal responsibilities are to: (1) Followup on the recommendations of the Conference on the World Crisis in Education held at Williamsburg, Va., in the autumn of 1967. (2) Develop plans for the International Education Year adopted by the United Nations General Assembly, upon motion of the United States, and expected to be celebrated during 1970. (3) Supervise a study of international education in the Federal Government directed by the Congress. INTERNATIONAL CONFERENCE ON THE WORLD CRISIS IN EDUCATION The International Conference on the World Crisis in Education, held October 5-9, 1967, in Williamsburg, Va., was cohosted by then Secretary John W. Gardner and James A. Perkins, president of Cornell University. One hundred and forty-six leaders from 50 countries participated in the Conference in their individual capacities to provide direction toward solving the world educational crisis of narrowing the gap between 80 Department of Health, Education, and Welfare, 1968 what the world community expects from education and what the educational system can produce. President Lyndon B. Johnson and Rene Maben, the Director-General of UNESCO, were two of the major speakers at the Conference. The Conference summary report recommended action to improve the performance of education in six areas: information about education; management and structure; content and methods; teachers and students; educational resources; and international cooperation. The report also recommended the designation of an International Education Year to mobilize energies and inspire worldwide initiative to give the crisis in education the priority it deserves. The United Nations General Assembly supported that recommendation by provisionally designating 1970 as an International Year, subject to review of preparations at the 24th General Assembly Session. The Conference was called by President Johnson and was financed by 10 foundations and the Department of HEW. The Conference Secretariat was established in the Department under supervision of the Office of International Affairs and direction of the Assistant Secretary for Education. The Conference was unique in that it was a cooperative effort of public and private sectors, it was financed by both public and private sources, and the participants came in their own individual capacities rather than as representatives of their governments or institutions. Office of Indian Affairs The Office of Indian Affairs (OIA) was established late in 1967 within the Office of the Assistant Secretary for Education to serve as the focal point for: ® Developing departmental goals for providing services to Indians in cooperation with operating agencies. • Coordinating HEW research, demonstration, and action programs in the field of Indian affairs. • Relating the special needs of the Indian community, on and off Federal Indian reservations, to operational decisions within the Department. The Office also must make sure that Indians are aware of HEW’s more than 200 health, education, and social welfare programs, and fully participate in them. Establishment of this departmental focal point on Indian affairs and its subsequent efforts was consistent with principles set forth in the President’s March 6,1968, message to the Congress “The American Indian.” Office of the Secretary 81 Specific Highlights A plan has been developed to meet OIA responsibilities consisting of three basic components. The primary component is program development aimed at identifying and meeting Indians’ needs. OIA has identified areas for Department-wide program emphasis and has developed goals, objectives, and priorities concerning Indians for each HEW agency. The two supporting components can be useful in overcoming problems which beset the Indians and the several agencies which serve them, including HEW. OIA has planned a training institute to provide orientation and other necessary learning experiences for those who serve, or will serve Indians and for Indians who are now ill-equipped to play leadership roles in programs. OIP also began planning a mechanism for gathering, storing, retrieving, and disseminating statistical and related data on Indian populations, their needs, and services to meet needs. Significant organizational steps have been taken to expedite agency response to Indians’ needs. Responsibility for Indian education within the Office of Education was delegated to the Office of Programs for the Disadvantaged, and a full-time staff has been acquired. Inter-Bureau and Inter-Administration task forces on Indian services were formed in the Office of Education and the Social and Rehabilition Service. Departmental policies were reviewed and are continuing to be reviewed to assure that program services and benefits apply fully to Indians. In this regard, a program planning system, including a management information system closely attuned to the departmental planning-programing-budgeting system, was developed and is being implemented throughout the Department. The Federal Interagency Committee on Education The mission of the Federal Interagency Committee on Education (FICE) is to achieve more meaningful coordination of educational programs and to encourage better planning among all agencies concerned with education. Meetings FICE is concerned with and provides direction to all the educational efforts of the Federal Government. While the major focus was on higher education, FICE devoted meetings to a wide range of topics including the Education Resources Information Center (ERIC), the work of the Interagency Committee on Manpower Research, and short-range strategies to urban education and urban problems. The Committee called for a larger role for the humanities in higher education. 82 Department of Health, Education, and Welfare, 1968 FICE also worked with the President’s Council on Youth Opportunity. Accomplishments of Special Projects • An agreement by member agencies to reinstate fellowships, awarded on the basis of national competition, to graduate students entering military or equivalent service was announced on March 27, 1968. FICE later amended it to extend coverage to conscientious objectors who serve as Public Health Service commissioned officers, and officers of the Environment Science Services Administration. • The Report of the Task, Force on Fellowships and Traineeships. issued in June 1968, surveyed the fellowship and direct traineeship programs of the AEC, NASA, NSF, OE, and PHS. The report stated that Federal fellowships and traineeships in relation to graduate enrollment began to decline in 1968. Support for students in the natural and physicial sciences and engineering also declined as a proportion of total awards. The task force recommended study of all sources and types of support, as well as an examination of future manpower needs, so that Federal agencies will be better prepared to plan their support programs. • The Report of the Task Force on Selective Service, sent to the White House November 30,1967, recommended more equitable treatment for all draft-eligible men. It stated that unless the Federal Government responded to the decrease in attendance at the graduate schools, the future of graduate education might be imperiled. As a result of the work of the FICE task force, the FICE office has become a central source of information and action on issues relating to the draft. • The Veterans Administration, at the urging of FICE, agreed to accept junior college candidacy for accreditation as tantamount to accreditation. Starting in October 1967 this enabled VA to pay comparable education benefits to veterans enrolled in degree-credit courses at both types of schools. ® A report on the Miller bill to the Senate Committee on Labor and Public Welfare in February 1968 suggested consideration of broad criteria for the establishment of an institutional grants program to provide maximum benefit to all types of higher education institutions. Subcommittees In response to the growing need for a standard Government directory of information on postsecondary institutions, FICE established its Subcommittee on Universe of Post-Secondary Educational Institutions in February 1968. The subcommittee proceeded to pull together all Government and non-Govrnment statistics and other pertinent information on every educational institution in the United Office of the Secretary 83 States beyond the secondary level. Its end product, the FICE Directory, will provide a common institutional serialization for machine data processing storage and retrieval which all Federal agencies may use. The other three FICE subcommittees—the Student Support Study Group, the Subcommittee on Government-University Relations, and the Subcommittee on Manpower—met on a regular basis throughout the year. It is through this subcommittee system that the major portion of the work of FICE is carried out. Model Secondary School for the Deaf PLANNING OBJECTIVES During fiscal year 1968 initial planning began for the Model Secondary School for the Deaf but engineering, architectural design, and construction was not to begin until the following year. The school will be located in Washington, D.C., on 17% acres of land provided by Gal-laudet College on the northern end of its campus. When fully constructed, the school will offer a comprehensive high school program for deaf students, who will attend on both a day and residential basis. The Model Secondary School for the Deaf Act (Public Law 89-694) specified that the school be a model in architectural and engineering design. Appropriate equipment for special visual and auditory presentation, particularly for control of acoustic and visual stimuli, will be incorporated in the facilities. The buildings will also be so designed as to facilitate the use of and accessibility to technological aids such as computers and closed circuit television. Gallaudet College will provide many supporting services directly and the remainder through contracts. The chief administrative officer of the Model Secondary School for the Deaf will be appointed by the board of directors of Gallaudet College upon nomination by the president of Gallaudet College, to whom the administrative officer will report directly. TARGET POPULATION Students will be admitted to the Model Secondary School for the Deaf from the District of Columbia, Maryland, Virginia, West Virginia, Pennsylvania, and Delaware. A comprehensive curriculum will be developed, including academic, technical, vocational, and other offerings which appear to hold promise in secondary education for the deaf. The curriculum will emphasize individualized learning in order to prepare students for postsecondary and terminal education. The school will begin an interim program in 1969 with approximately 50 deaf students on a nonresident!al basis from the National Capital Area. 84 Department of Health, Education, and Welfare, 1968 RESEARCH Gallaudet College will develop a unit on research and demonstration in the Model Secondary School for the Deaf, and will evaluate the effectiveness of methods and materials at the school. The college will encourage relevant research both by its own faculty and by faculties of other institutions. National Technical Institute for the Deaf ESTABLISHMENT The Rochester Institute of Technology was selected as the institute of higher education to enter into an agreement with the Secretary of Health, Education, and Welfare, as directed by Public Law 89-36, for the establishment and operation, including construction and equipment, of the National Technical Institute for the Deaf. The only one of its kind in the world, the institute provides a residential facility for postsecondary vocational and technical training and education of deaf persons to prepare them for successful employment. PROGRAM The National Technical Institute for the Deaf’s curriculum, developed this year, includes courses of study designed to: correct deficiencies in the educational background of incoming students ; provide assistance to students in counseling and orient them as to available and appropriate technical courses of study; and offer special supportive services to students pursuing existing Rochester Institute of Technology diploma programs. Plans for the extensive use of computer technology and instructional television in the development of curriculums were currently being implemented this year. ENROLLMENT AND SERVICES Full enrollment for the National Technical Institute for the Deaf will be 750 deaf students. The first interim class of approximately 70 entered in September 1968, using existing Rochester Institute of Technology facilities. NTID provided extensive supportive services for interpreting, notetaking, guidance and counseling, audiological evaluations, and speech and hearing therapy. FACILITIES When completed, the National Technical Institute for the Deaf facilities will consist of an academic complex including a speech and hearing clinic, an auditorium-theater, two dormitories, and a dining hall-commons. Office of the Secretary 85 ACTIVITIES OF THE STAFF Ill order to accomplish maximum possible integration of deaf students with hearing students attending Rochester Institute of Technology, National Technical Institute for the Deaf staff gave a special orientation and training program to 105 student leaders and volunteers from Rochester Institute of Technology in February and March of 1968. An intensive 6-week summer institute was provided to 50 members of the faculty and staff of Rochester Institute of Technology. In September 1968, Rochester Institute of Technology students who will be National Technical Institute for the Deaf residence hall advisers, and other nonteaching staff, attended orientation sessions dealing with communicative and educational aspects of deafness. RESEARCH Several research activities have been undertaken by staff members of the National Technical Institute for the Deaf. A long-range study of NTID deaf and hearing students beginning RIT programs will compare progress of the two groups at various stages through graduation and employment. Special notebooks of pressure-sensitive paper have been developed to refine notetaking procedures. The notebooks were field tested with hearing students in the spring, were improved, and are now in general use. Further field testing is anticipated with highschool-aged deaf students. Studies began on various applications of educational technology, particularly in mathematics. An IBM 1500 computer-assisted instruction system serves as the basis for these more advanced curriculum innovations. President's Council on Physical Fitness and Sports MAJOR TRENDS During fiscal year 1968, there were two major changes in the responsibilities and operations of the President’s Council on Physical > * Fitness and Sports. The first involved a shift in emphasis from physical fitness of American youth to physical fitness of American adults. Previously, the Council had concentrated on youth fitness, operating > t through the elementary and secondary school systems, both public and private. In 1968, while continuing to maintain the youth fitness program, the Council expanded contact with public and private organizations to stimulate development of physical fitness programs for their adult employees. In a second major change, the Council placed greater stress on sports participation as a physical fitness means. 328-184—-69----7 86 Department of Health, Education, and Welfare, 1968 HIGHLIGHTS Executive Order 11398, issued on March. 4,1968, provided the mandate for a number of changes in Council policies and operations. The Executive order— • Changed the Council’s name to “President’s Council on Physical Fitness and Sports”; © Established the Vice President of the United States as Chairman; • Added the Secretary of State, the Director of the Office of Economic Opportunity, and the President’s Consultant on Physical Fitness and Sports to the Council; • Charged the Council with responsibility for expanding opportunities for more Americans to engage in a wider range of sports activity; and • Created a Citizens’ Advisory Committee to the Council, established its maximum size at 15, and directed the Council to take measures to activate the Committee. At fiscal year’s end, the Council had made recommendations concerning membership of the Citizens’ Advisory Committee and had submitted them to the White House for its consideration and decision, and had begun planning and initial implementation of broadened sports participation opportunities. PRESIDENTIAL PHYSICAL FITNESS AWARDS During the 1967-68 school year, 70,619 boys and girls, ages 10-17, earned the Presidential Physical Fitness Award, nearly double the 37,165 winners in 1966-67. The 1967-68 winners represented approximately 5,000 schools in all 50 States, the District of Columbia, and six U.S. territories. There also were 223 winners from 11 foreign countries, most of them from Canada. Winners of the award must meet demanding performance standards (adjusted according to age and sex) in seven events. They receive an award emblem and a certificate bearing the Presidential seal and signature. ADULT AND INDUSTRIAL FITNESS In the area of adult and industrial fitness, the Council joined forces with the Department of the Interior to promote jogging, which resulted in four jogging courses being established in national parks in the National Capital area and one on the Mall opposite the Department of Agriculture for use of Federal employees. Office of the Secretary 87 The Council also helped eight Federal agencies and six private companies or associations design new employee physical fitness programs or revise existing recreation programs to incorporate a fitness program element. PHYSICAL FITNESS CLINICS The Council conducted five physical fitness clinics during the year: Philadelphia, Pa.; Fullerton, Calif.; New Orleans, La.; Milwaukee, Wis.; and St. Louis, Mo. A total of 6,500 school administrators, physical education specialists, teachers, recreation leaders, YMCA directors, and others participated. Approximately 1,500 boys and girls in elementary and secondary schools were involved in demonstrations. The clinics were aimed at strengthening programs of physical education and recreation in schools and community agencies. OTHER ACTIVITIES The first of its kind, a “Symposium on Exercise and the Heart,” was sponsored by the Council, the American Medical Association, and other groups. The program featured addresses by eminent medical authorities on the relationship of exercise to heart disease, the prevention of cardiovascular disease, and exercise in the rehabilitation of persons who have suffered coronary heart disease; and demonstrations of ways to assess physical condition and how to properly perform selected exercises. One of the Council’s most significant projects affecting youth fitness was the Demonstration Center Schools. During 1968,117 schools in 15 States were cited by their respective State departments of education for high-quality programs of physical education and physical fitness. The Council presented each school with a pennant to fly on its flagpole and a certificate of recognition and publicized the Demonstration Centers nationally. The President’s Council continued to provide leadership and service to Governors’ Councils throughout the Nation. Nineteen States had such councils (or commissions) in operation in 1968, including a newly established unit in North Dakota. Connecticut sponsored a “swimming for fitness” clinic. Georgia conducted statewide physical fitness tests, and presented individual and team trophies. North Dakota declared July “physical fitness month” and sponsored a “jog-in” around the Capitol mall. Wisconsin established bicycle routes throughout the State. PUBLICATIONS AND PUBLIC INFORMATION Three new publications were developed: The Fitness Challenge in the Later Years (an exercise guide for senior citizens developed jointly 88 Department of Health, Education, and Welfare, 1968 with the Administration on Aging) ; Exercise and Weight Control (a pamphlet explaining the role of physical activity in controlling and reducing weight, prepared jointly with the American Medical Association’s Committee on Exercise and Physical Fitness) ; and Community Recreation: How You Can Help (explains how to overcome financial, organizational, and legal obstacles to making school sports facilities available for use as neighborhood fitness centers). The Council initiated two nationwide public service advertising campaigns, one in the fall of 1967 and the other in the spring of 1968. The first (“President’s All-America Team”) urged schools and young people to participate in the Presidential Physical Fitness Award program; and the second (“Don’t Fence Me Out”) urged communities to make their school sports facilities available for public use as neighborhood fitness centers. Office of Public Information The Secretary’s Office of Public Information develops and implements the Department’s overall policy for communicating with the public directly and through the news media, and for providing information support to HEW’s many programs and services. Within this area, the Office coordinates and supervises the extensive information activities of the Department’s six main constituent agencies. And as the primary clearinghouse for the Office of the Secretary’s information efforts, OPI conducts a wide variety of information activities on behalf of the Secretary, the Under Secretary and the Assistant Secretaries of the Department. These functions are carried out by OPI through its Press Office, Editorial Service, Television and Radio Services, Visitors-Informa-tion Center, and Regional Information Coordinator. Press Office OPI’s Press Office has final responsibility for all news announcements that emanate from the Department. Last year, it produced more than 800 news releases for national distribution to the press, and conducted nine major press conferences at which the Secretary and his associates met with representatives of the news media. The Press Office also held special press conferences on such subjects as alcoholism, the health consequences of smoking, and traffic safety, and assisted the National Institutes of Health in press briefings on “the state of the art” in such areas as cancer, biomedical research, diabetes and dental research. Office of the Secretary 89 The Editorial Services branch of OPI was responsible for the Department’s Annual Report for fiscal year 1967; the HEW Forum Papers, a compilation of addresses to Departmental employees by senior members of the staff, and for the Department’s section of the Catalog of Federal Domestic Assistance, a handbook of all Federal domestic programs. Editorial Services also assisted in the preparation of various speeches, magazine articles, special materials for the White House and for Members of Congress, and the Secretary’s progress reports issued in fiscal 1969. Freedom of Information On July 4,1967, the Public Information Act of 1966, known as the “Freedom of Information Act,” became effective. Its purpose is to provide freer access to information about the programs and policies of the Federal Government. To implement this legislation, the Secretary established the post of Associate Director of Information for Public Services to administer the Act and to improve the Department’s direct services to the public. Of 67 formal requests for information received under the Act during the fiscal year, 54 were granted and 13 were denied as constituting invasions of personal privacy, revealing trade secrets, or as otherwise exempt under the law. Plans were developed and construction started on a Visitors-Infor-mation Center on the first floor of HEW’s headquarters building. In March 1968, a model of the Center was unveiled at a public ceremony attended by Congressman John Moss, the chief architect of the Public Information Act, the Hon. L. J. Andolsek, Vice Chairman of the Civil Service Commission, and representatives of other Government agencies. By the end of the year, the temporary Center was receiving an average of 400 to 500 visitors and 400 to 450 telephone calls of inquiry each week. Radio and ^Television A special office was established within the Office of Public Information in September 1967, to be concerned with television and radio. The first nine months were devoted primarily to developing methods of support to the electronic media, to creating new links between these media and the constituent agencies of the Department, and to servicing the agencies in response to their television and radio needs. Plans also were developed for the installation of the “Spotmaster” electronic system for making taped messages and announcements about HEW’s 90 Department of Health, Education, and Welfare, 1968 programs available via telephone to callers. Statements by Department officials are now accessible to callers across the country. Regional Information Program Fiscal year 1968 was the first year in which the Department was fully staffed with a Public Information Officer in all nine of the Department’s regional offices. The Office of Public Information has the responsibility for coordinating this activity, although regional Public Information Officers are administratively responsible to their Regional Directors. The new regional Public Information Officers devoted this first year to familiarizing themselves with the special characteristics of their regions—which consist of four to seven States—and with the various ways in which the Department’s many programs affect each region. At the same time, a two-way information link between Washington and the regions was firmly established; valuable information was received from the field on the effectiveness of HEW programs, and Washington was able to keep the regional offices posted daily—sometimes hourly, when necessary—on significant policy developments and other vital information. The regional Public Information Officers also were able to create new lines of cooperation with their counterparts in State and local governmental agencies and in private service organizations, thus providing productive new channels of communication between the Department and the general public. Career Development The Office of Public Information continued the development of a Career Service Board to serve public information professionals throughout the Department and to assist in the recruitment of new professional talent in this area, The Board established a formal plan for career development within the information field in the Department; it was presented to the Department’s Career Development Council and later received the Secretary’s approval. Social Security Administration Introduction The Social Security Administration administers the Federal social security program, which provides retirement, survivors, and disability insurance, and health insurance for the aged. The program is the Nation’s basic method of assuring income to the worker and his family when he retires, becomes disabled, or dies, and of assuring hospital and medical benefits to persons 65 or over. During working years, employees, their employers, and self-employed people pay social security contributions which are pooled in special trust funds. When earnings stop or are reduced because the worker retires, dies, or becomes disabled, monthly cash benefits are paid to replace part of the earnings the family has lost. One portion of the workers’ and employers’ contributions goes into a separate hospital insurance trust fund so that when workers and their dependents reach 65 they will have help in paying their bills for hospital and related services. Voluntary medical insurance, also available to people 65 or over, helps pay doctors’ bills and other medical expenses. This program is financed by premium payments shared equally by the people who sign up and by the Federal Government. The Bureau of Federal Credit Unions, a part of the Social Security Administration, administers the Federal credit union program. Federal credit unions provide their members a place to invest their savings and a source from which they may borrow easily and at reasonable rates of interest. Developments in Social Security About 89 million people contributed to social security in calendar year 1968. Today, 95 out of 100 mothers and children are protected against the risk of loss of income because of the death of the family breadwinner. The survivorship protection alone, as of June 30, 1968, had a face value of about $950 billion. About 24.1 million men, women, and children were receiving monthly social security benefits as fiscal year 1968 ended. The beneficiaries 91 92 Department of Health, Education, and Welfare, 1968 include about 15.3 million retired workers and dependents of retired workers, 2.3 million disabled workers and their dependents, and 5.8 million survivors of deceased workers. About 0.7 million noninsured persons 72 and over were receiving special payments that are provided to certain aged persons getting no public assistance payments and little or no other governmental pensions. Virtually the entire cost of these special payments is borne by general revenues of the U.S. Treasury. Ninety percent of those who were 65 or over at the beginning of 1968 were receiving benefits or would be eligible to receive benefits when they or their spouses retire. Of those who reached 65 in 1968, 92 percent were eligible for social security cash benefits. Under the health insurance program for the aged, nearly all of the 19.7 million persons in the Nation 65 and over on June 30, 1968, were eligible for basic hospital insurance protection. An estimated 18.6 million aged persons were enrolled in the voluntary supplementary medical insurance plan on June 30,1968. This was 95 percent of those eligible to enroll. What the Program Did in Fiscal Year 1968 Beneficiaries and Benefit Amounts Benefits paid under the old-age, survivors, and disability insurance program totaled $22,825 million—an increase of $2,078 million over the amount paid in the preceding fiscal year. Of this increase, about $1 billion was due to changes in the law provided by the 1967 amendments. Total benefit payments to disabled workers and their dependents were $2,088 million, 12 percent more than in fiscal year 1967. Old-age and survivors insurance monthly benefits rose 10 percent to $20,481 million. Lump-sum death payments amounted to $256 million, about $10 million more than in the previous fiscal year (chart 2). The number of monthly benefits in current-payment status increased by 0.9 million (4 percent) to 24.1 million (charts 1 and 2) during the year, and the monthly rate rose $337.2 million (20 percent) to $2.0 billion (chart 3). The increase in the monthly rate was due mainly to the higher benefit scale provided in the 1967 amendments and, to a smaller extent, to the normal growth in the beneficiary rolls. Since only a relatively small number of the claims which resulted from the 1968 legislation could be paid in the closing months of the fiscal year, changes in the law had little effect on the growth of the benefit rolls. In June 1968, $94 a month was the average old-age benefit being paid to a retired worker who had no dependents also receiving benefits. When the worker and his wife were both receiving benefits, the average Social Security Administration 93 CHART 1.—24.1 MILLION OASDI BENEFICIARIES NUMBERS BY TYPE OF BENEFICIARY ARE IN THOUSANDS JUNE, 30, 1968 Disabled workers 1 245 / ‘ Wives and children of ^disabled workers Young widows ] 013 494 Children of retired and deceased r? 1,092,098 978,027 11.7 Other assets . 75,852 61,536 23.3 Members’ shares 5,420,663 641,780 4,944,033 9.6 Reserves and undivided earnings 575,028 11.6 Other liabilities 145,714 149,880 -2.8 Summary of income and expenses: Total income 503,477 456,255 10.3 Interest on loans 447,994 406,553 10.2 Other income 55,483 49, 702 11.6 Total expenses 192,747 172,841 11.5 Salaries „ 78,159 70,613 10.7 Other 114,588 102,228 12.1 Net income 310,729 283,414 9.6 1 Represents U.S. Government obligations (including Federal agency securities), savings and loan association shares, and loans to other credit unions. 122 Department of Health, Education, and Welfare, 1968 contracts with other organizations or directly through general revenue appropriations. Appropriations for fiscal years 1970-71, for consumer education projects only, are also authorized, a new departure for the Federal credit union program, which up to now has gotten its funds from fees of member credit unions. In the 1968 fiscal year, the Bureau also authorized a number of Stateside Federal credit unions serving Department of Defense personnel to establish offices at European and Far East installations. The program was arranged with the Department of Defense in order to permit U.S. military and civilian personnel in foreign countries to have access to the same credit union services enjoyed by members of the Armed Forces in this country. Office of Education Introduction The Elementary and Secondary Education Act of 1965, which authorized large-scale Federal aid for elementary and secondary school programs, continued to support the largest enterprises of the Office of Education during fiscal year 1968. The Act and its amendments authorize programs for the education of children of low-income families, for the acquisition of library materials, for the establishment of supplementary educational centers and services, for the strengthening of State departments of education, and for the education of the handicapped. As a result of the amendments of 1967, which also extended the Act to continue through fiscal year 1970, improvement in the planning and operation of both old and new programs may be expected, since appropriation of school aid funds may now be authorized a year before they are to be used. To develop the great potential of noncommercial television and radio, the Congress passed the Public Broadcasting Act of 1967, which authorizes $500,000 for HEW to produce a comprehensive study of school uses of television, radio, and allied electronic instructional media. The Act also extends for 3 years the construction program which helped build 92 noncommercial television stations over the past 5 years. The Congress extended for one year the 100 percent Federal share of the Library Services and Construction Act of 1964, for State inter-library cooperation, for State institutional library services, and for library services to the physically handicapped. As it entered its second century of operation, the Office also administered programs under the Education Professions Development Act of 1967, the Higher Education Act of 1965, the Vocational Education Act of 1963, and amendments to the Manpower Development and Training Act and the Economic Opportunity Act. Included among the established programs were ones to assist landgrant colleges and universities, State and local educational agencies, school construction and maintenance, training of teachers, and research in education. 123 124 Department of Health, Education, and Welfare, 1968 Planning and Evaluation Activities In fiscal year 1968 major issues were identified and program priorities established in the areas of education of the disadvantaged, education of the handicapped, and educational innovation. Two analytical studies were published: Education in the Seventies, a forecast and projection of trends in education to the year 1975, and Students and Buildings, on issues of student aid and facilities construction in higher education. Equal Educational Opportunities The Division of Equal Educational Opportunities was established m the Bureau of Elementary and Secondary Education on November 17, 1967 to carry out provisions of title IV of the Civil Rights Act of 1964, which provides funds to assist local school districts in the elimination of all school segregation and to help them solve educational problems arising from desegregation. Prior to this date, provisions of title IV and of title VI (under which Federal funds for programs that discriminate as to race, color or national origin are prohibited) were administered jointly in the Office. Under the Equal Educational Opportunities program, funds and services of Office personnel are used to help school systems which request such aid. Technical assistance, special training for educational personnel, and coordination with relevant Federal programs are provided through: ® Grants to school boards. • University desegregation assistance centers. • Short-term or regular session institutes held at institutions of higher education. • State education agency technical assistance units. • Direct assistance from Office specialists. In fiscal year 1968 grants to local school systems totaled $3.1 million ; to universities for desegregation assistance centers, $2.9 million and for institutes, $941,936; and to State Education Agencies for Technical Assistance Units, $1.47 million. Staff Work on Behalf of the Disadvantaged During fiscal year 1968 the staff: ® Conducted a survey on recipients of Educational Opportunity Grants awarded under title IV of the Higher Education Act of 1965, to study Federal assistance at the high school through college level, the characteristics of college student recipients, the ade Office of Education 125 quacy of the financial aid, the recipients’ potential for success and their employment capabilities. More than 1,000 students were interviewed in a representative sampling of 31 colleges and universities. • Conducted a study of projects supported through title I of the Elementary and Secondary Education Act of 1965, to determine individual program costs in relation to the number and nature of component offerings and the number of children served per program. • Prepared a report on migrant education based on visits to six Southeast and Southwest States. • Collected demographic data on the Gypsy population. • Conducted a survey to determine the extent to which Negro history and culture were incorporated in elementary and secondary school curriculum. ® Served as liaison with organized community groups, college administrators and State personnel interested in Federal funding opportunities. • Organized an Indian Unit to be responsible for coordinating activities with the Bureau of Indian Affairs. • Published State Profile on School Dropouts, Unemployed Youth, Juvenile Delinquents and Related Federal Programs, FY ’66; Profiles of Fifty Major American Cities; Federal Programs in Job Training and Retraining; and Federal Research and Demonstration Programs Benefiting the Disadvantaged. Opportunity for Educationally Deprived Children For the third consecutive year, under title I of the Elementary and Secondary Education Act of 1965, more than a billion dollars was obligated for special education to help about 9 million educationally deprived children. The largest proportion of Federal funds was appropriated for rural counties in the South and slum areas in the larger cities. The 50 States of the Union, the District of Columbia, Puerto Rico, the Territories of American Samoa, Guam, and the Virgin Islands, and the Territory of the Pacific Islands (which the Nation administers under the United Nations Trusteeship System) are eligible under this program. All except American Samoa participated. In addition to grants to local educational agencies, funds were also available through amendments to title I of the Elementary and Secondary Education Act of 1965 to State educational agencies for projects involving special groups of children (Table 1). 126 Department of Health, Education, and Welfare, 1968 Table 1.—Federal assistance to help meet special educational needs of educationally deprived or handicapped children: liscal Year 1968 allocations Juvenile Dependent Local Handicapped delinquents and neglected Migratory States, other eligible areas, and educational children in institutions children in children Total Admimstra- Total Department of the Interior agencies (State (State institutions (State program tion agencies) agencies) (State agency) agencies) Total $1 100,287,599 $24,746,993 $9,168,720 $1,113,455 $41,692,425 $1, 177,009,192 $13,990,808 $1,191,000,000 Alabama /// 36 988 984 244,616 114,105 ________ 425,652 37,773,357 377,734 38,151,091 Alaska --------- 1 805 503 .......................... 10,979 __________________ 1,816,482 150,000 1,966,482 Arizona 8 422 776 222,941 165,606 ________ 1,165,372 9,976,695 150,000 10,126,695 Arkansas'"’.. /k...... 22 673 547 346,752 92,047 _________ 379,435 23,491,781 234,918 23.726,699 California" _________ 7^ 00^ 208 883,294 894,795 ________ 6,150,119 85,936,416 859,364 86-795,780 Colorado 7,798,580 593,274 116,638 29,483 1,134,220 9,672,195 150,000 9,822,195 Connecticut""_____ _____________ 7,907,261 728,372 111,403 25,711 290,066 9,062,813 150,000 9,212,813 Delaware "’ ____________ 2,084,729 235,275 67,716 -------- 147,587 2,535,307 150,000 2,685,307 Florida ’ 26 445 029 689,163 344,390 ________ 5,454,573 32,933,155 329,332 33,262,487 Georgia .............. /..______ 36 829 728 276,789 136,445 ________ 438,419 37,681,381 376,814 38,058,195 Hawaii"""/’"!.”./_______________ 2,226,608 181,925 22,229 ------------------ 2,430,762 150,000 2,580,762 Idaho 2 475,984 69,452 37,594 ________ 512,723 3,095,753 150,000 3,245,753 Illinois 46,230,999 462,308 351,682 79,503 375,350 47,499,842 474,998 47,974,840 Indiana 14 580 136 805,473 139,034 110,329 338,581 15,973,553 159,736 16,133,289 Iowa ’ 15,153,804 323,005 75,789 79,341 42,642 15,674,581 156,746 15,831,327 Kans'es" . ________ 9,608,706 338,323 83,283 -------- 465,229 10,495,541 150,000 10,645,541 Kentucky " 32 483 284 174 397 27,507 . —_____ 186,398 32,871,586 328,716 33,200,302 Louisiana---------- I-——- 31 530 268 456 293 278 977 ________ 408,033 32,673,571 326,736 33,000,307 Maine ” _____ 3 403 277 134,820 62,151 ________ 5,617 3,605,865 150,000 3,755,865 Maryland."/:://".///:::.__________ Asoo/is 318,287 421,390_____________ 153,204 15,482,996 154,830 15,637,826 Massachusetts. _ . . ______ 16,422,153 1,115,839 221,037 -------- 155,247 17,914,276 179,143 18,093,419 Michigan 30,670,217 1,211,650 303,382 2,084,085 34,269,334 342,693 34,612,027 Minneota" lS^W 778,541 217,307 157,289 20,020,502 200,205 20,220,707 Office of Education 127 Mississippi--------------------- 38,788,595 118,478 73,133 ......... 579,622 39,559,828 395,598 39,955,426 Missouri-------------,---------- 23,086,158 723,378 189,342 ........ 418,247 24,417,125 244,171 24,661,296 Montana------------------------- 2,993,356 158,490 46,048 26,772 441,483 3,666,149 150,000 3,816,149 Nebraska------------------------ 5,666,795 182,744 49,107 17,652 112,861 6,029,159 150,000 6,179,159 Nevada.... ---------------------- 879,759 17,583 49,178 16,852 963,372 150,000 1,113,372 New Hampshire------------------ 1,296,376 98,306 37,586 6,639 1,438,907 150,000 1,588,907 New Jersey------------------ 22,865,209 1,325,535 267,424 1,013,700 25,471,868 254,719 25,726,587 New Mexico--------------------- 9,629,504 201,412 99,716 564,301 10,494,933 150,000 10,644,933 New York-------------------- 115,776,356 3,191,922 1,026,749 1,102,303 121,097,330 1,210,973 122,308,303 North Carolina---------------- 51,096,076 768,829 324,376 934,544 53,123,825 531,238 53,655,063 North Dakota------------------- 4,042,272 89,114 21,434 314,579 4,467,399 150,000 4,617,399 Ohio-------------------------- 34,197,997 411,353 406,715 110,614 716,995 35,843,674 358,437 36,202,111 Oklahoma---------------------- 17,214,771 219,592 80,814 61,793 529,575 18,106,545 181,065 18,287,610 Oregon------------------------- 6,982,937 325,132 166,380 952,163 8,426,612 150,000 8,576,612 Pennsylvania------------------ 46,699,583 1,965,588 207,229 146,485 327,346 49,346,231 493,462 49,839 693 Rhode Island-------------------- 3,481,096 158,525 40,176 14,164 _______ 3,693,961 150,000 3,843,961 South Carolina-------T---------- 31,540,454 305,387 128,978 39,098 396,798 32,410,715 324,107 32,734 822 South Dakota-------------------- 5,649,685 112,605 23,666 ________ 29,619 5,815 575 150,000 5 965 575 Tennessee----------------------- 33,763,326 269,894 196,388 112,992 75,070 34,417,670 344,177 34 761 847 Texas.------------------------ 65,260,201 848,750 472,044 107,830 10,433,192 77,122,017 771,220 77,893,237 Utah---------------------------- 2,724,300 292,875 49,325 -------- 115,414 3,181,914 150,000 3,331 914 Vermont.--------------------- 1,484,141 238,232 39,758 3,064 1,765,195 150,000 1,915,195 Virginia------------------------ 28,130,476 434,333 148,154 433,057 29,146,020 291,460 29,437,480 Washington.-------------------- 9,840,169 779,232 224,576 ...______ 1,121,964 11,965,941 150,000 12 115 941 West Virginia.------------- 17,193,348 158,566 62,887 9,298 40,344 17,464,443 174,644 17,639 087 Wisconsin------------------------ 14,357,585 444,001 233,045 308,961 15,343,592 153,436 15,497,028 Wyoming ------------------- 1,235,793 81,403 30,706 19,382 233,891 1,601,175 150,090 1,751,175 District of Columbia------------ 5,397,367 234,945 178,300 123,008 _______ 5,933,620 150,000 6 083 620 American Samoa------------....-- 75,000 .----------.------------------------------- 75,000 25,000 100,000 9uaip-1;-.----....— ------------ „ 614,867 ---------------------------------------- 614,867 25,000 639,867 Puerto RiCO-.----------------- 21,013,645 21,013,645 210,136 21,223,781 Trust Territories.-------------- 794,398 ------------------------------------------ 794,398 25,000 819 398 Virgin Islands.---------------- 308,743 308,743 25,0JO 333 743 Dept, of Interior............ 9,000,000 ..--------------------------------------- 9,000,000 _____ 9,000 000 128 Department of Health, Education, and Welfare, 1968 A total of $24.7 million was made available to State agencies for the education of handicapped children at schools supported or operated by them. In addition $9.17 million became available for educational programs in State-operated or State-supported institutions for delinquent children; $1.1 million was authorized for neglected youngsters in State institutions; and $41.7 million was authorized in grants to educational agencies for intrastate and interstate educational programs for children of migratory agricultural workers. The amendments also provided for $9 million to the Department of the Interior for educational programs in 254 Bureau of Indian Affairs schools, which served 50,000 children. Supplementary Educational Centers and Services The Projects to Advance Creativity in Education program (PACE), authorized by title III of the Elementary and Secondary Education Act of 1965, is intended to support vitally needed supplementary services and to encourage application of new knowledge. Grants may be awarded for projects which invent a creative solution to a problem, demonstrate an exemplary program, or adapt an exemplary program for local use. In fiscal year 1968, $187.9 million was allotted for title III programs. A total of 1,678 project proposals requesting $215.5 million were submitted in fiscal year 1968 (see Table 2). A total of 566 projects requesting $70.6 million were approved; and 92 other projects were in “hold” status, pending negotiations for approval. It is estimated that operational projects will serve 9,400,000 elementary and secondary school pupils and 900,000 preschool and out-of-school children, teachers, and other adults. Guidance, Counseling, and Testing Title V-A of the National Defense Education Act of 1958 provides assistance to the States in establishing and maintaining guidance, counseling, and testing programs in elementary and secondary schools, junior colleges, and technical institutes. Latest available reports indicate that in fiscal year 1967 the States and areas employed the equivalent of 43,500 full-time professional personnel in guidance and counseling programs at a cost of more than $290 million. The Federal contribution to this total was $24.3 million. Office of Education 129 Table 2.—Projects submitted in fiscal year 1968 for the supplementary educational centers and services program authorized under title III of the amended Elementary and Secondary Education Act of 1965 Category- Total Planning Opera- number 1 projects tional projects Evaluative programs: Deficiency survey______________________1— Curriculum requirements-------------------- Resource availability and utilization------ Total____________________________________ Instruction/enrichment: Arts_______________________________________ Foreign languages__________________________ Language arts______________________________ Remedial reading--------------------------- Mathematics________________________________ Science____________________________________ Social science and humanities-------------- Recreation and physical education---------- Vocational and industrial arts_____________ Physically handicapped--------------------- Mentally retarded__________________________ Disturbed and learning disabilities-------- Dropouts----------------------------------- Minority groups and other disadvantaged---- Total..__________________________________ Instruction addenda: ETV and radio._____________________________ Audiovisual aids________________:---------- Demonstration and learning center programs Library facilities------------------------- Materials and service centers-------------- Data processing---------------------------- Total....____________________________— Personal services: Medical and dental------------------------- Social and psychological and guidance------ Total____________________________________ Other__________________________________________ Grand total1 2_______________________— Number of different projects------------- 276 50 226 469 90 379 285 50 235 1,030 190 840 368 28 340 156 14 142 441 30 411 300 24 276 375 25 350 415 32 383 456 32 424 245 20 225 221 16 205 117 6 111 147 14 133 135 12 123 123 10 113 155 15 140 3, 654 278 3,376 164 13 151 356 24 332 326 13 313 205 12 193 299 22 277 130 12 118 1,480 96 1, 384 124 10 114 277 22 255 401 32 369 250 25 225 6,815 621 6,194 1,678 280 1,398 1 Estimated. 2 Projects may be included in all applicable categories. The number of counselors increased from 34,500 in 1966 to 38,000, and these served more than 80 percent of secondary school students. The ratio of full-time counselors to students increased from 1 to every 460 in fiscal year 1966 to 1 to every 450 in fiscal year 1967. More than 9 million scholastic ability and achievement tests were administered in the public schools and more than 400,000 in nonpublic schools during fiscal year 1967. Testing agencies working under contract in 39 States also tested nearly 275,000 additional pupils in nonpublic schools. During the first 9 years of the program State-approved guidance, counseling, and testing programs have cost $1.4 billion. Of this amount, NDEA title V-A funds accounted for 8.4 percent, State funds for 4.7 percent, and local funds for the balance. 130 Department of Health, Education, and Welfare, 1968 Instruction Materials and Equipment School Library Resources, Textbooks, and Other Instruction Materials Under title II of the Elementary and Secondary Education Act of 1965, grants are made to States and Territories on the basis of plans submitted by them. The $99.4 million made available in fiscal year 1967 (the latest report available) provided materials for use by a total of 44.6 million public and private school children and 1.8 million teachers, representing an increase over fiscal year 1966 of about three percent for participating children and about six percent for participating teachers. (American Samoa and the Department of Defense did not participate.) Among the three categories of eligible materials—school library resources, textbooks, and other instructional materials, the States continued to give priority to school library resources: $83.8 million, or about 92 percent of the entire amount, was expended for such acquisitions. Prominent in this category were audiovisual materials. In fiscal year 1968 the States continued to revise their planning, with several States giving unusual consideration to the need for materials for economically and educationally disadvantaged children. Thirty States are making special purpose grants to provide instruction programs for the use of children and teachers in special or exemplary instruction programs. State plans must also include provision for making loaned materials accessible through catalogs or lists of materials acquired with title II funds. In fiscal year 1967, 4,850 new public school libraries were established. Of these, 4,260 were public elementary school libraries serving 2.0 million public school pupils, and 590 were public secondary school libraries serving 381,567 public school pupils. Strengthening Instruction in Critical Areas This program, authorized by title III of the National Defense Education Act of 1958, seeks to strengthen elementary and secondary school instruction in subject areas of critical importance by providing-funds for the acquisition of equipment and materials other than textbooks and for administrative services. By 1968 the critical areas included civics, English, geography, history, reading, economics, and industrial arts, as well as the original areas of science, mathematics, and modern foreign languages. A total of $78.24 million was allocated for fiscal year 1968. Of this amount $75.24 million was for grants to States, $1 million for loans Office of Education 131 to nonpublic schools, and $2 million for administration of the State plans. Although no funds were appropriated for supervisory services, $5.5 million was added to the 1968 appropriation for strengthening State education agencies (under title V of the Elementary and Secondary Education Act), thus enabling States to continue support for supervisory services. In fiscal year 1968 the 50 States, District of Columbia, Guam, Puerto Rico, and the Virgin Islands participated in the program. Projects approved for equipment acquisition totaled $110 million in Federal, State, and local funds. This figure represents an overmatching by State and local agencies of 50 percent. Thirteen loans for acquisitions by 11 nonpublic schools were approved for a total of $248,311. As in the previous year, the largest percentage of the amount approved for loans was for science equipment—62 percent in 1968. Modern foreign language equipment continued to account for about 15 percent of the funds. Loans for audiovisual equipment amounted to more than 11 percent. In 1958, before the program began, there were 33 supervisors at the State level for science, mathematics, and modern foreign languages. By the end of fiscal year 1967, at the latest count, there were 108 in science, 98 in mathematics, and 69 in modern foreign languages. Strengthening Instruction in the Arts and the Humanities Under Section 12 of the National Foundation on the Arts and the Humanities Act of 1965, allotments of $440,000 for grants and $60,000 for loans were made to 55 jurisdictions. Loans to two private schools were approved for a total of $9,416. College Instructional Equipment Part A in title VI of the Higher Education Act of 1965 authorizes two grant programs to help colleges and universities improve undergraduate instruction. In fiscal year 1968 $14.5 million was appropriated for the programs. Table 3 shows Federal funds granted in fiscal year 1968, by State, under this program. Improving Qualifications of School Personnel The Teacher Corps The Teacher Corps received authorization for $33 million for fiscal year 1968, $46 million for fiscal year 1969, and $56 million for fiscal year 1970. 132 Department of Health, Education, and Welfare, 1968 Table 3.—Number of approved applications by State 1 with amount of Federal grants in fiscal year 1968 under the Higher Education Act of 1965, title VI, part A (for equipment, related minor remodeling, and materials to improve undergraduate instruction) Grants for equipment, minor remodeling,and materials (other than textbooks) State Laboratory and other Closed-circuit special equipment television Number Amount Number Amount Alabama 17 $214,103 6 $24, 704 Alaska .. .. 2 7,522 .... Arizona 8 149, 639 3 17,266 Arkansas 7 124, 712 1 14,296 California 47 1,421, 587 8 164,029 Colorado 11 180,592 3 21,098 Connecticut 14 147, 542 2 17, 024 Delaware 3 23, 705 2 2, 735 Florida 18 346, 368 5 39,965 Georgia 13 228, 476 6 26, 363 1 fawaii . 2 46, 048 2 5, 314 Idaho 8 55, 669 1 6, 430 Illinois 19 574, 954 7 66,341 Indiana 16 329, 704 3 34, 012 Iowa 17 230,486 8 26, 595 Kansas 27 196,475 7 22, 670 Kentucky. 9 213,125 5 24, 592 Louisiana 11 248, 493 2 28, 672 Maine 9 53,911 2 6, 220 Maryland 18 182,886 3 21, 417 Massachusetts 21 452, 923 9 52,261 Michigan ... 23 576, 059 5 66,468 Minnesota . 18 284,999 3 32, 885 Mississippi 9 166, 604 1 19,224 Missouri . 31 311, 367 9 35,927 Montana 6 53,155 1 6,133 Nebraska .. 7 115, 495 3 13, 326 Nevada 1 13, 418 1 1,548 New Hampshire . . 6 55, 911 2 6,451 New Jersey 12 223,944 2 25,840 New Mexico 8 71, 663 2 8,269 New York. 52 1, 014,470 7 117,053 North Carolina 23 326, 964 4 37, 726 North Dakota . 8 60,183 2 6,944 Ohio 18 597, 024 1 68,888 Oklahoma . 10 218, 697 2 25, 234 Oregon 12 170,258 3 19, 645. Pennsylvania ... ... 36 667, 690 13 77, 041 Rhode Island 5 69, 697 2 8,042' South Carolina 13 137, 566 2 15,873: South Dakota 5 63, 769 1 7,358 Tennessee .. 16 272,215 4 31,409 Texas 28 730, 942 4 84,339 Utah.. 4 142,114 1 17,296 Vermont 7 40, 092 1 4,626. Virginia . . 9 224,857 2 25,945. Washington _ . _ 23 271,432 4 32,342 West Virginia.. . 15 125,109 3 14,436. Wisconsin 14 314, 790 5 36,322 Wyoming 2 23,963 1 2,973. American Samoai 2 District of Columbia . 10 97, 092 2 11, 203. Guam 3 Puerto Rico 6 81,952 1 7,389 Virgin Islands 1 1,536 ... — Total 735 12,953,947 179 1,490,159. i Sec. 801 (b) of Public Law 89-329 (Higher Education Act of 1965) specifies: “The term ‘State’ includes,, in addition to the several States of the Union, the Commonwealth of Puerto Rico, the District of Columbia,, Guam, American Samoa, and the Virgin Islands.” 2 American Samoa has no institutions of higher education as defined in sec. 801 (a) of Public Law 89-329.. 3 No institution in Guam applied for a grant under this program in fiscal year 1968. Office of Education 133 The Teacher Corps is actually a group of 49 programs funded by the Office of Education. Each one is operated locally by a university and one or more school systems, to provide interns with 2 years of professional training and service in poverty-area schools. Interns who complete their work successfully receive a master’s degree and State certification. The Federal Government pays 90 percent of an intern’s salary, the local school system employing him, 10 percent. Experienced teachers, recruited from the local school systems, serve as leaders for the teams of interns during the 2-year training period. In June 1968 the first Teacher Corps interns completed their on-the-job training and masters’ programs and began full-time teaching. A survey revealed that 72 percent planned to continue teaching in schools serving disadvantaged children. The actual appropriations of $3.8 million (1967 supplemental) and $13.5 million (fiscal 1968) did not permit the corps to expand in size. Approximately 1,150 new interns and team leaders were recruited and enrolled in 32 programs. Seventeen programs continued with the initial group of interns. During the 1967-68 school year, 1,800 Teacher Corps members served disadvantaged children and assisted regular teachers in 125 school systems in crowded urban ghettoes, on Indian reservations, in the heart of Appalachia, and in other areas. During the second academic year of the Teacher Corps program, school administrators and teachers became increasingly involved in the planning and operation of the program. Local school systems developed ways to utilize Teacher Corps teams more effectively, to effect changes in curriculum and teaching techniques, to release regular teachers for planning and inservice education, and to increase parent and community participation. Universities began to offer courses “on site” at local schools, thus bringing the school and university into a genuine working partnership. In response to the needs of local programs, the Teacher Corps developed a model intensive language training institute for interns who would be working with Spanish-speaking children and their parents. A joint VISTA-Teacher Corps project was also established at the New York City Correctional Institution for first offenders on Riker’s Island. The number of applications and inquiries relating to the Teacher Corps program continued to increase. Applications to the national office totaled over 7,000, while inquiries and requests averaged over 2,000 monthly. Plans for 35 programs were tentatively approved for a third training cycle to begin in the fall of 1968. These included 10 new programs, 328-184—69----10 134 Department of Health, Education, and Welfare, 1968 six of which were to be conducted in States which had previously had none. The promise of full support for existing programs and some forward funding allowed the Corps to plan for major expansion of its efforts for the first time. Experienced and Prospective Teacher Fellowships Fellowship awards for graduate study, authorized by part C of title V of the Higher Education Act of 1965, are designed to raise the quality of elementary and secondary school education by improving the qualifications of those pursuing or planning a career in such schools. During the 1967-68 academic year, programs were conducted for 1,503 experienced teacher fellows and for 2,336 prospective teachers. These were funded at a cost of $25 million from the previous year’s appropriation. During the year $5 million was also available for institutional assistance. In fiscal year 1968 awards were announced authorizing fellowships for 1,636 experienced teachers and 2,306 prospective teachers in programs to be conducted during the 1968-69 academic year at a cost of $27.5 million. Institutional assistance awards of $7.5 million were also made during the fiscal year to help strengthen teacher education programs in 111 of the institutions conducting fellowship programs. Institutes for Advanced Study in 12 Areas Institutes for Advanced Study are authorized under title XI of the National Defense Education Act of 1958 in 12 areas—English, English for speakers of other languages, modern foreign languages, reading, geography, history, civics, economics, industrial arts, international affairs, and for teachers of disadvantaged youth and educational media specialists. During the 1967-68 academic year, 517 institutes were conducted with funds from the previous year’s appropriation of $30 million. Most were short-term programs held during the summer of 1967. An exception was the Tri-University Project in Elementary Education, funded jointly at a cost of more than $1 million with title XI funds and support from the Bureau of Research. It was designed to focus national attention on the need for more effective preparation of elementary school teachers. The cooperative program, conducted on three university campuses, included post-doctoral college trainers of teachers and elementary teachers participating in NDEA institutes. During fiscal year 1968 the title XI appropriation was again $30 million. From the 1,435 proposals received, 480 institutes were ap Office of Education 135 proved, most to be held during the summer of 1968 for 20,284 participants. The Tri-University Project was also continued for a second year with an award of more than $1.5 million from title XI and Teacher Fellowship funds. A major new program, the Triple T Project for Training the Teachers of Teachers, was launched during the fiscal year. Four universities were provided with funds to be used for planning and for support of preliminary activities of 64 teams throughout the country, whose objective was to develop projects to improve the training of the teachers of teachers through an all-university effort conducted with school systems. At midnight June 30, 1968, 10 years after its creation, title XI of the National Defense Education Act ceased to be an authorizing law. The Education Professions Development Act of 1967, however, authorizes a variety of training programs which include institutes similar to those previously conducted under that and other, earlier authorizations. As fiscal year 1968 came to a close more than 3,000 proposals had been received under the new Act. Institutes in the Arts and the Humatiities Twelve institutes for advanced study to strengthen teaching of the arts and humanities in public and private nonprofit elementary and secondary schools, authorized by section 13 of the National Foundation on the Arts and the Humanities Act of 1965, were held in the summer of 1967. The cost of nearly $500,000 was covered by funds obligated in the previous fiscal year. Eleven programs scheduled to be conducted in the summer of 1968 were approved in fiscal year 1968. Counseling and Guidance Institutes Part B of title V of the amended National Defense Education Act of 1958 authorizes grants to colleges and universities for conducting short-term and regular-session institutes for advanced training in the counseling and guidance of students in elementary and secondary schools and in higher education institutions. Fifty-four institutes were held during the summer of 1967 and the 1967-68 academic year using fiscal year 1967 funds. There were 1,584 participants in the program, which was conducted at a cost of $7.25 million. During the 1968 fiscal year 44 awards were announced for institutes to be conducted in the summer of 1968 and the 1968-69 academic year. A total of 1,368 participants were scheduled to be enrolled at a cost of $7.25 million. 136 Department of Health, Education, and Welfare, 1968 Training for Education of the Handicapped Although there are now approximately 87,000 special education teachers, an estimated 237,000 more are required to serve more than 5 million handicapped children. For academic year 1968-1969, Federal funds totaling $24.5 million were made available under this program to State and other education agencies (including those of the District of Columbia, Puerto Rico, the Virgin Islands, and Guam) and 249 colleges and universities, to train 13,269 teachers and students. The grants included 75 awards to 63 educational institutions to develop training programs for special education personnel. Training programs include academic year undergraduate and graduate programs, special study institutes and summer traineeships. Special projects conducted during fiscal year 1968 demonstrated the feasibility of training new types of support personnel and helped set standards for improving training. Special projects were funded at six universities to meet anticipated manpower needs in developing and implementing these new approaches. Strengthening State Departments of Education Appropriations under title V of the Elementary and Secondary Education Act of 1965, as amended, for “Grants To Strengthen State Departments of Education,” totaled $29,750,000. This does not represent an increase over the $22 million appropriation of the preceding year, however, since the 1968 figure includes $5.5 million formerly appropriated to assist States in supervisory services under title III of the National Defense Education Act of 1958 and $2 million for statistical services under title X of the same Act. Under a formula involving public school enrollment, 85 percent of the available amount was allocated to the States, the District of Columbia, Puerto Rico, Guam, the Virgin Islands, American Samoa, and the Trust Territory of the Pacific Islands. The States devoted 23 percent of aid funds to improving instruction services to local educational agencies, 38 percent to strengthening general administration, and lesser portions to statistical and data processing services, and to study, planning, and evaluation. Some 1,275 professional and more than 1,135 nonprofessional positions were supported by these grants. The remaining 15 percent of the appropriated funds was reserved for special project grants (generally multi-State grants) to solve prob Office of Education 137 lems common to the educational agencies of all or several States. Twenty-six such projects, covering all 56 State Educational Agencies, were initiated or continued in fiscal year 1968. Assistance to Federally Affected and to Disaster Areas Public Laws 81-815 and 81-874 were enacted in 1950 to assist school districts in the maintenance and operation of schools and construction of school facilities where federally conducted military and civilian activities placed financial burdens on local educational agencies by increasing school populations and removing real property from local tax rolls. Assistance in the repair and replacement of school facilities damaged or destroyed by major natural disasters was authorized by an amendment to each of these laws contained in Public Law 89-313, approved November 1, 1965. Amendments to the basic provisions of both Public Laws 815 and 874 were made in Public Law 89-750, approved November 3, 1966. School Construction During fiscal year 1968, $11.7 million in Federal funds was allocated to 46 school districts for 38 construction projects. These provided 924 classrooms and related facilities for 27,908 children under Public Law 81-815. An additional $7.8 million was obligated for construction to provide classrooms and related school facilities for children living on Federal installations. In fiscal year 1968 there were 14 declared disasters in 13 States. School districts in these States have submitted 72 applications under section 7 of Public Law 81-874 and one application under section 16 of Public Law 81-815. School Maintenance and Operation In the 1968 fiscal year 4,200 school districts were eligible for $486 million in Federal funds under Public Law 81-874. This sum includes an estimated $14 million for children who reside on Indian properties or with a parent employed on Indian properties, or both. The $486 million is approximately 5 percent of the current operating expenses of eligible school districts. In terms of average daily attendance, it was paid on behalf of 2.76 million of the approximately 16 million children in these districts. 138 Department of Health, Education, and Welfare, 1968 In fiscal year 1968, $27 million in Federal funds provided schooling for over 50,000 children living on Federal property. These are children for whom such services were not otherwise available. Construction Service During fiscal year 1968 the Office of Construction Service, established in 1967, became fully operational in Washington, D.C., in the regional offices, and in 24 district offices. Work was begun on 694 educational facilities construction projects during fiscal year 1968, representing a direct Federal support share of approximately $0.5 billion of the total estimated cost of $1.5 billion. The office developed streamlined architectural/engineering procedures to improve and accelerate service to the educational community, and established an Equal Employment Opportunity program for beneficial compliance on the part of educational institutions, construction contractors, and (indirectly) the construction trades. Two new approaches to planning were developed in the area of facility development. The first, “operational simulation,” was developed under contract with the Washington Center for Metropolitan Studies. It is a computer-assisted training process designed to develop a widened perspective among architects, educational leaders, and urban and community planners. It stresses the interrelated facets of education, urban land use, tax structure, employment, and housing, population, and income patterns. The second approach, known as a design charette, is a workshop technique of interdisciplinary planning in which educational facility development and investment are stressed as catalytic factors in the preservation or revitalization of the urban scene. A feature of key importance under this approach is commitment of local resources to the planning process, with significant Federal support represented but nevertheless limited to a “seed-money” proportion of the total value invested. Financial Aid for Students Educational Opportunity Grants This program, authorized by title IV, part A, of the Higher Education Act of 1965, provides grants for able students from low income families who need financial assistance to obtain a postsecondary education. During the program’s three-year existence approximately 400,000 Office of Education 139 such, students have received initial year grants enabling them to pursue education beyond secondary school. In fiscal year 1967, $112 million was appropriated to support 202,000 students attending 1,615 institutions. Awards averaged $415. The adjusted appropriation of $131,413,279 in fiscal year 1968 will assist some 292,600 students in 1,780 institutions, with grants averaging $460. College Work-Study Under the college work-study program grants are made to institutions of higher education, area vocational schools, and certain proprietary schools to expand work opportunities for needy students. Federal assistance usually provides about 80 percent of the student compensation and a portion of the extra overhead costs of the colleges involved. An estimated 375,000 students in 1,860 accredited institutions of higher education in the United States were part of the program in 1968. They earned approximately $140 million in the work-study programs. Guaranteed Loans for Higher Education Under this program, authorized by part B of title IV of the Higher Education Act of 1965, students may borrow from private commercial lending institutions to help pay for the costs of higher education. Loans provided by the lender are guaranteed by either a designated State or private guarantee agency or by the Federal insurance program. During fiscal year 1968, with the program operative nationwide, over 488,000 loans totaling more than $412 million were made by participating private lenders. Guaranteed Loans for Vocational Education Established under the National Vocational Student Loan Insurance Act of 1965, this program is similar in purpose and operation to the loan program for higher education. As of June 30, 1968, the program was operative in 48 States, the District of Columbia, and Puerto Rico. During fiscal year 1968, participating private lenders made over 27,000 loans totaling nearly $24 million. National Defense Education Act Student Loan Funds More than 1.2 million students have borrowed approximately $1.25 billion from funds at colleges and universities in the past 10 years 140 Department of Health, Education, and Welfare, 1968 since this program was authorized by title II of the National Defense Education Act of 1958. In fiscal year 1968 approximately $235 million was lent to 430,000 students in 1,800 institutions. Federal funds totaled $190 million; colleges and universities contributed $21.1 million. The remainder represents repayments that were reloaned. The amount of loan cancellation, based on teaching service, has been increased for teachers of handicapped children and for those who teach in areas of high concentrations of low income families. Encouraging Utilization of Educational Talent For fiscal year 1968 a total of 72 contracts was awarded for talent search projects in 39 States, the District of Columbia and Puerto Rico, under authorization of section 408 of the Higher Education Act of 1965. The program, which had an appropriation of $4 million in 1968, authorizes contracts of up to $100,000 for State and local educational agencies and other public or nonprofit organizations and institutions for the following purposes: • To identify qualified youths of exceptional financial need and to encourage them to complete secondary school and undertake postsecondary training. • To publicize forms of student financial aid. • To encourage secondary school or college dropouts with demonstrated aptitude to re-enter educational programs. Higher Education Facilities Grants and loans for construction of academic facilities, authorized under the Higher Education Facilities Act of 1963, were made to 698 higher education institutions (and their branch campuses) in fiscal year 1968. In contrast, grants and loans were made to 888 in fiscal year 1967. As in previous years, some institutions received funds under more than one title of the legislation. Table 4 shows grants and loans by geographic area made under this program in fiscal year 1968. Grants under title I provide up to 40 percent of the development cost of facilities at public community colleges and technical institutes and up to 33^ percent for facilities at other higher education institutions. The 203 Federal grants to public community colleges and technical institutes, totaling $70.5 million for fiscal year 1968, compared with 251 grants totaling $1Q1.6 million the previous year. Office of Education 141 The 555 grants to other higher education undergraduate institutions amount to $203.5 million. These figures compare with 804 grants for $349.09 million the previous year. Construction grants under title II provide up to a third of the development cost for facilities at graduate schools or cooperative graduate centers. The fiscal year 1968 appropriation was $50 million, but only $32,423,006 was released for the program. This amount, together with funds recovered from awards made in previous fiscal years, brought the total fiscal year 1968 funding to $33,000,000 for 54 grants. Due to funding limitations, most grants awarded were considerably smaller than the amounts requested. At the end of the fiscal year, there was a backlog of grant requests totaling approximately $63 million. Loans for construction under title III require that at least a fourth of the development cost be financed from non-Federal sources. Title III was amended by the Participation Sales Act of 1966 to create a revolving loan fund and provide for participation under the Federal National Mortgage Association Charter Act. In fiscal year 1968, 197 new loans and 43 supplemental loans were approved for a total of $147.6 million. This compares with the approval of 211 loans totaling $199.99 million the previous fiscal year. State Administration and Comprehensive Planning The Higher Education Amendments of 1966 authorized $7 million for grants to State commissions for administration and comprehensive planning to determine construction needs of institutions of higher education. During fiscal year 1968, the second year of the program, obligations totaled $5.96 million. Disaster Assistance No disaster relief funds were requested in fiscal year 1968 under the Disaster Relief Act of 1966, which amended the Higher Education Facilities Act to provide Federal assistance to public institutions of higher education which suffer a major disaster. Accreditation and Institutional Eligibility As a result of lengthy deliberations during fiscal years 1967 and 1968, a new Accreditation and Institutional Eligibility Staff was established in the Office in fiscal year 1968. It coordinates all activities pertaining to accreditation and to the eligibility for funding of institutions of higher education and of vocational schools wishing to par- 142 Department of Health, Education, and Welfare, 1968 Table 4.—Grants and loans by geographic area to 698 higher education institutions (and branch campuses) in fiscal year 1968 for construction of academic facilities under the amended Higher Education Facilities Act of 1963 Grants for undergraduate facilities (title I) Grants for graduate Loans for academic ---------------------------------------------- facilities (title II) facilities (title III) States1 Sec. 103 2 Sec. 104 3 Total Number Amount Number Amount Number Amount Number Amount Number Amount Alabama ____________ 11 $2,081,890 11 $3,525,974 22 $5,607,864 1 $127,207 6 $2,820,000 Alaska . ___________ 0 0 1 250,972 1 250,972 1 600,000 1 950,000 Arizona . ... _________________ 4 640,961 6 1,877,254 10 2,518,215 1 452,296 0 0 Arkansas . _________________________ 2 157,505 7 2,424,251 9 2,581,756 0 0 6 1,604,000 California 14 5,510,083 39 22,770,923 53 28,281,006 2 2,598,126 5 1,676,000 Colorado .....- - _____________ 4 248,359 5 3,129,478 9 3,377,837 2 317,181 0 0 Connecticut_________________________ 2 763,269 8 2,676,180 10 3,439,449 2 1,352,204 3 2,183,000 Delaware. . _____________________________ 2 139,307 2 516,926 4 656,233 0 0 1 491,000 Florida 4 2,329,696 23 5,526,744 27 7,856,440 1 440,164 7 2,291,000 Georgia ... ____________ 2 430,589 14 5,553,318 16 5,983,907 2 958,549 4 922,000 Hawaii_______________________________ 2 2 76,813 2 857,813 4 1,134,626 1 841,520 0 0 Idaho .... 2 33,0,390 2 854,005 4 1,184,395 0 0 1 12,000 Illinois ... __________________________ 4 2,776,977 22 10,439,144 26 13,216,121 2 1,500,000 11 6,875,000 Indiana__________________________________ 7 2,991,611 11 4,606,774 18 7,598,385 2 714,815 11 9,474,000 Iowa____________________________________ 3 1,185,139 11 3,445,771 14 4,630,910 3 1,716,940 5 2,285,000 Kansas___________________________________ 2 624,135 7 2,908,099 9 3,532,234 0 0 2 574,000 Kentucky_________________________________ 7 2,258,584 9 3,189,651 16 5,448,235 0 0 16 9,632,000 Louisiana________________________________ 2 1,478,016 6 3,676,876 8 5,154,892 0 0 19 13,473,000 Maine____________________________________ 0 0 5 1,353,033 5 1,353,033 0 0 1 190,000 Maryland_________________________________ 2 1,427,793 7 3,590,930 9 5,018,723 0 0 1 680,000 Massachusetts____________________________ 2 1,732,775 12 6,379,032 14 8,111,807 2 2,500,000 4 716,000 Michigan________________________________ II 6,981,435 8 5,678,517 19 12,659,952 0 0 6 2,831,000 Minnesota________________________________ 3 1,515,629 10 4,251,238 13 5,766,867 2 1,383,086 3 3,473,000 Mississippi______________________________ 7 1,156,088 10 2,530,296 17 3,686,384 2 445,096 1 584,000 Missouri_________________________________ 4 1,682,650 6 5,129,496 10 6,812,146 1 418,033 4 2,892,000 Montana__________________________________ 4 292,342 4 1,237,001 8 1,529,343 1 229,794 1 492,000 Nebraska_________________________________ 1 270,275 5 1,966,169 6 2,236,444 0 0 2 829,000 Office of Education 143 Nevada-- ....------------------------ 0 0 2 421,948 2 421,948 0 0 1 318,000 New Hampshire---------------------------- 1 247,537 4 856,176 5 1,103,713 1 402,384 0 0 New Jersey------------------------------- 2 1,829,837 12 5,281,400 14 7,111,237 1 1,196,850 4 3,355,000 New Mexico------------------------------- 3 63,667 12 1,841,833 15 1,905,500 1 380,666 1 718,000 New York .--------------------------- 3 4,309,379 20 17,906,116 23 22,215,495 2 2,314,583 9 10,782 000 b01!.,1 Carolina------------------------ 15 2,169,511 12 4,854,262 27 7,023,773 1 1,000,000 5 1,879,000 North Dakota------------------------- 4 402,759 5 525,545 9 928,304 0 0 1 120 000 Ohio.-------------------------------- 6 4,077,474 31 11,149,073 37 15,226,547 0 0 6 4 758 000 Oklahoma--------------------------------- 6 557,267 21 3,218,986 27 3,776,253 1 553,153 0 0 Oregon.....------------------------------ 4 1,020,884 13 2,571,233 17 3,592,117 3 1,859,065 6 1,910,000 Pennsylvania---------------------------- 2 4,325,660 25 11,036,512 27 15,362,172 4 3,910,055 17 11,862,000 Rhode Isiand----------------------------- 1 306,428 7 1,048,887 8 1,355.315 0 0 1 106,000 South Carolina----------------------- 8 2,436,631 10 1,657,006 18 4,093,637 0 0 4 1 343 000 South Dakota------------------------- 0 0 4 1,185,946 4 1,185,946 0 0 2 716 000 Tennessee---------------------------- 4 1,536,015 8 3,800,692 12 5,336,707 1 441,872 4 1,715 000 -----------------’------------------ 11 3,827,937 23 12,209,445 34 16,037,382 3 2,186,862 18 11,440.000 Utah. --------------------------- 4 32,901 7 2,428,883 11 2,461,784 2 445,563 0 0 Vermont------------------------------ 1 223,372 3 648,417 4 871,789 0 0 2 615 000 Virginia----------------------------- 4 1,707,311 14 3,742,069 18 5,449,380 1 350,000 4 3,198’000 Washington.-------------------------- 1 1,358,537 10 3,916,035 11 5,274,572 0 0 6 3 769 000 Westvirgmia-------------------------- 2 618,228 6 2,271,473 8 2,889! 701 0 0 7 2 347 000 Wisconsin---------------------------- 3 1,724,477 8 4,926,670 11 6,651,147 4 2,308,427 13 18,750’000 Wyoming ----------------------------- 2 145,961 1 465,602 3 611 553 0 0 0 0 American Samoa...-------------------- 0 00 00 00 00 0 District of Columbia----------------- 0 0 5 1,469,313 5 1,469,313 1 237,225 3 814 000 LT'----------------------------- 0 0 2 97,713 2 97,713 0 0 0 0 Puerto R.co.------------------------- 3 797,038 6 2,041,632 9 2,838,670 0 0 5 1 687 000 Y1JF=tI£antdS------------------------ 1 57’824 0 0 1 57,824 0 0 0 Adjustment--------------------------- —2.557,366 —8,440,465 —10,997.831 —1,181,716 —2,013,000 Grand total---------------------- 199 70,50,570 524 203,478,267 723 33,000,000 240 147,629,000 La'7 V204 Education Facilities Act of ilot programs in 14 cities and the youth opportunity program in 50 cities. The office maintains continuing relationships with the Office of Education, Public Health Service, Social Security Administration, Office of Assistant Secretary for Administration, Office of the Comptroller, and Office of Field Coordination. During the year, the Office enlisted the participation of and coordinated the activities of staff members from all Bureaus, the Office of Research, Demonstrations, and Training and Social and Rehabilitation Service regional staff in the urban program areas mentioned above. These activities included reviews of comprehensive plans for social and rehabilitation services, medical care, income maintenance, and services for the aged in 89 cities, development and funding of various programs in 14 pilot neighborhood service centers at a cost of approximately $2 million, special efforts directed toward the involvement of Social and Rehabilitation Service counterpart agencies at State and local levels in urban neighborhood programs, and special efforts by State and local agencies in behalf of disadvantaged youth. Plans were made to provide employment and training opportunities for more than 700 youths in universities, hospitals, and social and rehabilitation agencies under programs financed by SRS research and demonstration project funds. In addition, State and local agencies agreed to provide meaningful jobs to many hundreds more. By waiving public assistance requirements, 17 States allowed youths in summer jobs to use their earnings for future educational purposes. The Office promoted cooperative planning by the Children’s Bureau and Medical Services Administration with the Office of Comprehensive Health Planning of the Public Health Service regarding development of health services and medical care in neighborhood service centers. The Office also encouraged cooperative programing by State agencies administering the public assistance, child welfare and vocational rehabilitation programs. Thirty-six SRS staff members through efforts of the office, participated in the Department’s training program relating to inner city problems and needs. The Office also helped plan and conduct training institutes sponsored by the Department and the Departments of Housing and Urban Development and Labor as well as the American Public Welfare Association, and national training laboratories for State and local personnel to stimulate model cities program planning. OFFICE FOR HOUSING AND COMMUNITY IMPROVEMENT Plans for the establishment of an Office for Housing and Community improvement in the Social and Rehabilitation Service were initiated immediately following the request of the House Committee on Social and Rehabilitation Service 187 Ways and Means for a study and report on home ownership and housing standards of welfare recipient families in reporting out the 1967 public welfare amendments to the Social Security Act. The Secretary of HEW requested SRS to plan and conduct the study and to indicate where responsibility should be placed for carrying forward the Secretary’s recommendation to Congress. As a result of a growing concern in the Department with the substandard living environment of many recipients of public assistance and its deleterious effect on health and social rehabilitation of recipient families, a beginning had been made in the former Bureau of Family Services and the Administration on Aging to develop a policy of housing assistance and housing improvement services at State and local levels. The request that SRS prepare a comprehensive study and report of housing needs as identified in each of its component agencies made clear the necessity for a centralized approach to the complex area of housing-welfare cooperation. The Office is expected to be established and staffed early in fiscal year 1969. Office of Policy Coordination A fundamental objective in the creation of SRS was to improve the delivery of services, by combining into one administrative organization, programs previously administered separately. To develop a coordinated and unified approach to policies and requirements for the various SRS programs, a temporary SRS task force was established in the fall of 1967. The major initial assignment was to develop proposals for implementing the 1967 amendments to the Social Security Act. Subsequently, in March 1968, SRS established within the Office of the Administrator a unit for policy coordination. With the enactment of major legislation in SRS programs other than those authorized by Social Security Act—vocational rehabilitation, juvenile delinquency, and services for the aging—the new policy coordination office also turned its attention to the development of a simplified, unified system for State plans for all SRS grant programs which will be initiated during the next fiscal year. Office of Public Affairs The Office of Public Affairs was established toward the end of calendar year 1967 to plan, direct, and coordinate the public affairs programs of SRS. 188 Department of Health, Education, and Welfare, 1968 Major activities of the Office during fiscal year 1968 included: • Organization and development of a public affairs program and staff for the Social and Rehabilitation Service. • Preparation of a nationwide campaign on disability and rehabilitation, sponsored by SRS and carried out by the Advertising Council, the public service aim of the advertising industry. The campaign, scheduled to begin in fiscal 1969, will include television and radio spot announcements, advertisements in newspapers and magazines, and display cards in buses and subways. Its purpose is to encourage the millions of disabled American adults and parents of disabled children, who have not previously been reached, to seek help from public and voluntary agencies to overcome disabilities and achieve productive lives. • Public information on new directions in welfare and related programs—envisioned in the establishment of SRS and called for by the Social Security Amendments of 1967. Principal emphasis in public information has been on the application to these programs of the broad concept of rehabilitation, in order to help people become self-reliant and independent, with the basic theme “Helping People Help Themselves.” • Information to reach welfare recipients and other poor persons. This has included issuance and distribution of materials by SRS and encouragement to State and local agencies to issue materials and utilize other media to inform persons in need about the programs available. • Preparation for the establishment of a centralized public inquiries system in SRS. Centralization, to' be accomplished in 1969, is designed to provide better service, more efficiently, to poor persons and others seeking help and requesting information. Office of Research, Demonstrations, and Training RESEARCH AND DEMONSTRATIONS DIVISION Rehabilitation Research and Demonstration Grants The vocational rehabilitation research and demonstration program is increasingly focused on problems of the socially and culturally disadvantaged. Whenever possible, projects are located in model city neighborhoods or ghetto areas or among the rural poor. Motivating people to work, long a priority in rehabilitation, is being expanded now into many poverty situations. Four multipurpose centers have been established—in Atlanta, Ga.; Cleveland, Ohio; Hot Springs, Ark.; and East St. Louis, Ill.—for the purpose of demonstrating and evaluating the provision of comprehensive welfare and rehabilitation services to members of pov Social and Rehabilitation Service 189 erty groups. These centers will demonstrate the coordination of all relevant parts of SRS in focusing on problems of the socially and culturally disadvantaged. Cultural fair assessment of rehabilitation clients has become increasingly important as selection for jobs extends to cultural handicaps. To help solve this problem for retardates, the recently completed Vocational Interest and Sophistication Assessment Test, a simple pictorial inventory, has been standardized on 3,000 retarded persons. It predicts what job an individual will find most satisfying in terms of his interests. Research on mental patients has emphasized the involvement of the community in supporting and facilitating the transition of patients to independent living. A particularly successful project of this type has placed patients in boarding houses with nonpatients while they received outpatient care from a local psychiatric clinic. This method of involving nonhandicapped persons with the emotionally handicapped resulted in eventual independent living and employment for the majority of the patients. A number of projects have provided important devices and procedures to help secure employment for the deaf and blind. One project developed a complete bibliographic reference card catalogue of literature relevant to the rehabilitation of the blind. Another completed a braille medical dictionary for use by blind medical technicians. A training program to prepare the blind for employment as tax assisters, developed with the cooperation of the Internal Revenue Service, has been extremely effective and has aroused widespread interest. The National Theatre of the Deaf, developed by the Eugene O’Neill Memorial Theatre Foundation, continues to successfully demonstrate employment and training of deaf actors. The theater also has brought about closer communication between the deaf and hearing, including considerable response from groups of culturally disadvantaged persons. The regional facility for the deaf-blind continues to provide innovative services for this group of individuals in anticipation of the establishment of the National Center for the Deaf-Blind, expected to become operational in fiscal year 1970. In the field of rehabilitation medicine, maxillofacial rehabilitation continues to receive strong emphasis and there are now eight such programs in each of eight HEW regions. Guidelines have been prepared for the establishment of spinal cord injury centers, emphasizing immediate posttraumatic care and complete follow-through during the entire rehabilitation process; it is anticipated that a network of such centers for prompt treatment of these pa 190 Department of Health, Education, and Welfare, 1968 tients will be established throughout the country. Leprosy is a long-neglected disease now receiving attention; a unique yet inexpensive technique has been developed for assisting such patients by immediately informing them of areas of pressure on hands or feet which, if allowed to persist, could cause further damage. Major advances in biomedical engineering resulting from SRS research have been: improved lower extremity prostheses based on findings on normal and pathological gait; widespread introduction of the concept of the immediate or early postsurgical prosthesis; development of externally powered upper-extremity orthotics devices for quadriplegic patients; and development of a technique for combining orthopedic surgery and orthotic expertise in the treatment of acute lower extremity fractures to dramatically reduce chronic disability and hasten healing by immediate mobilization and weight bearing. At the core of the rehabilitation program is the relationship of counselor and client, which has stimulated numerous studies. The Regional Rehabilitation Research Institute, recently established at the University of Missouri under the SRS program, was completing a state-of-the-art monograph on problems of the counseling interview which stresses cross-cultural counseling of the socially and culturally disadvantaged. Short-term directive counseling for rehabilitation clients, a new approach to this relationship, was implemented this year in projects in Kentucky, Virginia, and North Carolina, where it reportedly has shortened counseling time and has proven successful with members of poverty groups. New patterns of service have been extended to a number of new groups. Innovative vocational rehabilitation procedures are being developed for long-term inmates of a maximum security State prison, for Indian alcoholic clients in Iowa, and for disabled labor union members in Iowa. Projects specifically developed for the socially and culturally disadvantaged emphasized the involvement of the clients themselves. A project in Durham, N.C., is demonstrating the effectiveness of group therapy and a halfway house in helping girls of low income families cope with and adjust to normal work situations. Another project is identifying the values, behavior, and attitudes of individuals from various subcultures in the United States so that more effective training materials may be prepared for socioculturally disadvantaged prospective employees and their middle-class supervisors. An anthropological study is analyzing the effect of school-home-peer relationships of culturally disadvan- Social and Rehabilitation Service 191 tanged Puerto Rican youths in Chicago, Ill., on their employment potential. Demonstration Projects (Section 1115, Social Security Act) In fiscal year 1968, 175 demonstration projects, authorized by section 1115 of the Social Security Act, were active at some time during the year. A total of $2,716,927 funded 67 new projects and 46 continuations; 10 projects were extended without additional funds and 52 were completed or terminated. Of the 175 projects active during the year, 36 involved direct social services; 25 strengthened administration and stimulated program development; 18 helped develop new methods of administration; 64 aided manpower development and training or strengthened relationships with social work education; 27 developed new approaches to encourage education and prepare for self-support; and 5 helped extend eligibility or increase assistance payments. Projects were in operation in 47 jurisdictions including the District of Columbia, Guam, and Puerto Rico. Among the new projects approved, 23 related to the Summer Youth Opportunity Campaign, and allowed AFDC youths enrolled in the projects to retain their earnings, without deduction from the family assistance grant; seven demonstrations operating in neighboorhood service centers are directed toward bringing about social change by using innovative and nontraditional methods of delivering social services; three are testing the concept of separation of eligibility and services; two are experimenting with new approaches and methods for providing foster home care for the elderly, to keep them in their own community instead of institutions; and two are directed toward finding other alternate care arrangements for the elderly who might otherwise become nursing home patients. Cooperative Research and Demonstration Grants (Section 1110) Fifteen new research grants awarded in fiscal year 1968 reflected interest in problems of high priority to SRS and to the Department. A total of $1.1 million was obligated for new awards and $908,000 was obligated to continue 24 projects previously begun. Major awards included: a study to improve the efficiency of processing vendor drug claims under Medicaid through such methods as automation; a research-demonstration project to train Al DC mothers in clerical skills and develop a self-sustaining program of employment for trainees; and a study of the uiban Kcgio American, focusing on the historical antecedents of current racial and urban problems. 192 Department of Health, Education, and Welfare, 1968 About 30 percent of research grant funds were obligated for projects of interest to the Social Security Administration. They included studies of the effects of coinsurance on medical care utilization; the efficiency in production of hospital services; and an economic analysis of the relationships between tax policies and children’s allowances. Under the directed research program, financed from the appropriation to the cooperative research program, a total of $1.2 million was obligated for major studies of the impact of Medicaid legislation. These projects assessed the impact on organizations and personnel providing health care to low-income people and on the health care patterns and expenses of low-income families. Research Utilization A Research Utilization Branch was established within the Research and Demonstrations in July 1967. The Research Utilization Task Force, appointed by the Administrator in the fall of 1966, submitted its report in December 1967. In January 1968, the Administrator authorized the task force and the branch to implement the recommendations of the report. The overall goals of the branch and the task force are to identify effective research results, bring them to the attention of practitioners and administrators, and promote in every possible way their actual use to improve service programs for the handicapped, the socially and culturally disadvantaged, the aged, and similar groups served by SRS. The branch prepares and distributes a continuing series of Research Briefs, which present significant research findings in usable one-sheet format and highlight their implications for action by practitioners. These are distributed to over 20,000 individuals and agencies throughout the country. The Research Utilization Branch maintains close liaison with research, service, and public information programs within SRS, and— through the regional offices—with the State agencies. RESEARCH AND TRAINING CENTERS DIVISION Rehabilitation research and training centers provided training for a large number of new personnel entering the field of rehabilitation and allied fields, and also furnished advanced training for skilled personnel. The centers also have developed a research environment where highly skilled scientists have advanced new methods of rehabilitating the disabled and disadvantaged. In 1968 there were 19 rehabilitation research and training centers, including 12 medical centers, 3 vocational rehabilitation centers, 3 mental retardation centers, and 1 deafness center. A new medical center was designated at Northwestern University, Chicago, Ill. Of the $10,225,000 appropriated in 1968 for the research and training center Social and Rehabilitation Service 193 program, $8,200,000 was allotted to the medical centers, $950,000 to the mental retardation centers, $825,000 to the vocational rehabilitation centers, and $250,000 to the deafness center. The 19 centers conducted 526 research studies and sponsored 421 short-term courses which benefited approximately 23,800 persons in the field of rehabilitation and the allied disciplines. In keeping with departmental priorities, 10 of the research and training centers are located in nine model cities areas. In 1968, seven of the research and training centers provided research, training, and patient care components in six neighborhood service centers. Nine research and training centers are contributing to the success of central city projects. Particularly noteworthy was the development of employment and training opportunities, associated with rehabilitation and the allied professions, for disadvantaged youth from families receiving public assistance. In addition, many of the centers have given special emphasis to the development of coordinated services for the aged, community studies for programing rehabilitation services for the disadvantaged, and research into the high priority area of motivating people to work. TRAINING AND MANPOWER DEVELOPMENT DIVISION SRS Manpower Development New legislation was passed in 1967 affecting training and manpower development in the programs administered by SRS. First, was the passage of title VII, section 707, of the Social Security Act, providing Federal grants to educational institutions for undergraduate and graduate social work education. The title authorized a $5 million appropriation. This is the first legislation which provides for social work education without regard to a specific field of practice, and for support of undergraduate education in social work in any field of practice. It will thus enable improvement of basic social work education at the undergraduate and graduate level. The second piece of legislation, affecting all of the Social Security titles, provided for, effective July 1, 1969, the training and effective use of subprofessionals as community sendee aides and volunteers. As a result, all State departments of public welfare increased comprehensive staff development activities during fiscal year 1968. Approximately 700 full-time staff development personnel are employed in State and local departments of public welfare. Educational leave was granted to approximately 2,500 persons working in all of the public assistance programs, including medical assistance. Total expenditures including educational leave and in-service training on 194 Department of Health, Education, and Welfare, 1968 the part of the State departments of public welfare for training was approximately $29.8 million. National Citizens Advisory Committee on Vocational Rehabilitation The National Citizens Advisory Committee on Vocational Rehabilitation was formed as a result of congressional interest and a request expressed in April 1965 in the House Report on Appropriations. This report asked this citizens advisory body to make “a comprehensive study of the current vocational rehabilitation program and of the Nation’s vocational rehabilitation needs” and “to formulate goals for the program and make specific recommendations for arriving at those goals.”1 The 16 members of the Committee were appointed by former Secretary Gardner and announced by the President on March 17,1966. The Committee met in July 1967 to review the reports of its seven subcommittees on the hearings they had held in various parts of the country; their meetings with consultants; the answers to the letters of inquiry which they had sent to 637 organizations and individuals with experience, knowledge, or interest in the needs of the disabled; their site visits to rehabilitation facilities and workshops, to unversity training programs in rehabilitation, to research projects, and to public and voluntary rehabilitation programs; and, finally, their recommendations for the vocational rehabilitation program. The Committee’s final report was printed in final form in June 1968. Their most significant recommendations may be summarized as follows: (1) Eligibility.—A change in law to make clear that vocational rehabilitation services are available to any individual who is under a clear vocational handicap, regardless of the cause of the handicap. (2) Right to evaluation.—A change in law to make clear that any vocationally handicapped person has a right to evaluation of his rehabilitation potential, and to authorize additional Federal funds to construct, equip, staff, and operate vocational evaluation and adjustment centers. (3) New patterns of service.—Decentralization and dispersal of State vocational rehabilitation offices in major population centers to provide service in neighborhoods where disabled people live. Establishment by vocational rehabilitation agencies of one-stop multiservice centers in ghettos and other areas where the incidence of disability is high. Employment by the vocational rehabilitation agencies of a vastly increased number of rehabilitation aides (bilingual where necessary) from neighborhoods where service is to be provided. 1 Report No. 272, Apr. 29, 1965, to1 accompany H.R. 7765, making appropriations for the Departments of Labor, and Health, Education, and Welfare for the fiscal year 1966; p. 14, par. 3. 89th Oong., 1st sess. Social and Rehabilitation Service 195 (4) Facilities.—Action by the Rehabilitation Services Administration to assure that the unique resources of rehabilitation facilities and workshops are available to the severely handicapped and particularly to those persons whose lives are blighted by social, educational, and economic disadvantage. (5) Handicapped children.—Establishment of cooperative schoolrehabilitation programs in all schools, public and private, in both urban and rural locations, including a central repository of health and rehabilitation records. Evaluations of disabled children for rehabilitation purpose by vocational rehabilitation personnel at regular intervals during the elementary and junior high years—for example, at ages 8, 12, and 14— to help prepare the child for a meaningful adult vocational career. Legislation to permit furnishing physical restoration and other vocational rehabilitation services for any child who needs them, where such services are not available with reasonable promptness from another source. In addition, the Committee recommended the holding of a national conference on rehabilitation early in 1969. Planning for National Citizens Conference on Rehabilitation of the Disabled and Disadvantaged Intensive planning for this conference began in October 1967, with the meeting of an ad hoc committee which was cochaired by the Administrator of the Social and Rehabilitation Service and a member of the National Citizens Advisory Committee designated by the Committee. At this meeting it was concluded that the scope of the conference should be broadened to include rehabilitation of the disadvantaged as well as the disabled. It was also agreed that the conference should be concerned not only with pinpointing the major problems of the handicapped but with considering how these problems could be solved and how conference participants could use these problem-solving ideas in their own States and communities. Regional planning meetings—1 day in length—were held in each of the nine HEW regions, beginning with one in Boston in December 1967 and ending with one in Chicago in March 1968. During these regional meetings it became clear that the consumers and potential consumers of rehabilitation services should be involved in planning for the conference in addition to participating in the discussions at the conference itself. Accordingly, two meetings were held in May with a consumer advisory group, whose members were then added to the planning committee for the conference. Before the end of fiscal year 1968, the planning committee had agreed that the conference should be held in Washington, D.C., in 196 Department of Health, Education, and Welfare, 1968 June 1969, and had chosen five program content areas for presentation and discussion at the conference: (1) delivery of services; (2) consumer involvement in rehabilitation; (3) inadequately served groups;(4) financing rehabilitation services; and (5) physical barriers and transportation. INTRAMURAL RESEARCH DIVISION The Intramural Research Division focuses major attention and effort on applied social science research relating to policy and program issues of SRS. Major emphasis is placed on the reduction of economic dependency and the amelioration of conditions of social and cultural deprivation. Much of the Division’s research effort utilizes funds provided for directed research under section 1110 of the Social Security Act. Study designs are frequently experimental and pioneering in nature, with considerable attention to research methodology. Intramural research also provides research services and consultation for other units in ORDT, other components of SRS, the Office of the Secretary, the regional offices, States, and other organizations and agencies relevant to the SRS mission. Research conducted or planned during fiscal year 1968 related directly or indirectly to areas of concern considered high priority by the Secretary’s Office. These studies involved such areas as rural poverty, model cities, neighborhood service centers, the employment of AFDC mothers, income maintenance, medicaid, and the use of subprofessionals and volunteers in public programs. Several major studies were completed during the year. Among them were: “The Impact of Work Experience and Training Programs Upon the Life-Styles of AFDC-UP Families in Eastern Kentucky”; and “Characteristics of Accepted and Rejected AFDC Applicants in Baltimore, Md.” DIVISION OF INTERNATIONAL ACTIVITIES The Division of International Activities is the focal point for the development of all SRS international activities. These include program operations in the fields of maternal and child health, services to crippled children, social welfare, and vocational rehabilitation. As part of the reorganization, international staff of the former Welfare Administration’s Children’s Bureau and International Office, and of the Division of International Rehabilitation Activities in the Vocational Rehabilitation Administration, were brought together in one unit to administer programs designed to supplement and complement domestic programs, to strengthen relationships with other countries and to Social and Rehabilitation Service 197 further U.S. foreign policy goals. These programs include and are strengthened by cooperation with other Federal and intergovernmental agencies and with national and international organizations. Financial support from the Agency for International Development has been a bulwark for programs of providing training services to visitors from overseas, recruitment of U.S. personnel for assignment abroad, and other technical consultation and cooperative services, and implementing an agreement between HEW and AID for carrying out provisions of section 632(b) of the Foreign Assistance Act of 1961, as amended. A major segment of the international program has been the development and support of cooperative rehabilitation research and demonstration projects in certain foreign countries. This program, financed with U.S.-owned foreign currencies derived from the sale of agricultural commodities, was initiated by the Vocational Rehabilitation Administration in 1961. In 1962, a similar program of cooperative research was launched in the fields of social welfare and maternal and child health. A vital adjunct to these research activities is the interchange-of-experts program authorized under the International Health Research Act. Under this authority, VRA had, since 1961, arranged for the interchange of scientists and experts engaged in rehabilitation and research between the United States and countries participating in the cooperative research program. Cooperation With Other Agencies Cooperation With United Nations and the Organization of American States.—The Division of International Activities cooperated with the Department of State and other agencies in preparing and reviewing position papers, speeches, and other materials for intergovernmental meetings, including the United Nations Economic and Social Council, the U.N. Commission on Social Development, U.N. Regional Commissions, the Organization of American States, and other specialized intergovernmental organizations. In response to an invitation from the Secretary-General of the United Nations, statements describing United States experience in the social welfare field were prepared for the U.N. Conference of Ministers Responsible for Social Welfare and forwarded to the United Nations through the Department of State. The 19th session of the United Nations Commission on Social Development was held at the U.N. headquarters in New York, 328—184—69----14 198 Department of Health, Education, and W elf are, 1968 February 5 to March 1, 1968. Representatives of the Division of International Activities served as advisers to the Commission. The Preparatory Committee for the Conference of Ministers Responsible for Social Welfare met at the United Nations headquarters from August 28 to September 6, 1967. The Division of International Activities prepared technical materials and provided staff service in connection with this meeting. The 13th Pan American Child Congress, which met in Quito, Ecuador, June 1968, considered the topic, “The Population Increase and its Effect on Children, Adolescents, Youth and the American Family.” The bulk of the U.S. documentary material, except that relating to education, was prepared in the Social and Rehabilitation Service. The Children’s Bureau contributed to the preparation of documents and position papers relating to health, nutrition, child welfare, and youth services. Vietnam.—A. staff member of the Division of International Activities participated in an AID Social Welfare Task Force which visited Vietnam for approximately four weeks to study social welfare problems and to recommend to USAID/VN and USAID/Washington policies and programs to meet these problems. Subsequent to the study, considerable time was devoted to preparation of the report, debriefings, and briefing of persons going to Vietnam. Cooperation With N ongovemmental Agencies.—At the request of the U.S. Committee of the International Council on Social Welfare, the Division of International Activities served as the liason between the Committee and all Government agencies in securing Government publications for display at the U.S. exhibit at the International Conference on Social Welfare, which was held in Helsinki, Finland, in August 1968. The Division was also instrumental in arranging for films from various Government agencies to be shown at the Conference. During fiscal year 1968, several international organizations in the field of rehabilitation cooperated with the Division in its research and interchange program overseas. The American Foundation for Overseas Blind provided consultants to work with SRS staff in developing rehabilitation programs for the blind in Karachi, Pakistan and Tunis, Tunisia. Other staff members from that organization reviewed a number of research and demonstration proposals on blindness submitted from India and Pakistan. The World Rehabilitation Fund also provided consultants in prosthetics and orthotics to develop research and demonstration projects in Tunisia, Morocco, Guinea, India, and Pakistan. Similarly, the American Leprosy Mis Social and Rehabilitation Service 199 sions assisted in developing and reviewing research proposals in leprosy. The International Society for the Rehabilitation of the Disabled assisted the Division of International Activities in distributing research reports, publications, and other materials to researchers in various countries not participating in the P.L. 480 program. Recruitment.—The Division of International Activities, by agreement with the Department of State, recruits for United Nations social welfare positions and, on request, for social welfare positions with AID and for the Fulbright programs. Information on social workers interested in overseas assignments is also made 'available to the voluntary agencies. A total of 323 potential candidates were referred to various agencies and organizations during the fiscal year. This included direct referrals of candidates for openings and indirect referral through informing agencies of persons who were available for overseas service. A total of 34 candidates were referred to the United Nations for consideration for employment, and four were referred to AID. Extensive recruitment activities were carried on to provide to the Government of Vietnam advisors in the field of social welfare. A roster of qualified candidates was developed as a result of these activities. Training Program The interest of other countries in training opportunities in the United States continued during 1968. SRS international training staff provided services for foreign students, scholars, and experts for advanced academic and observation study experiences in the United States. Services for participants from 66 countries included programs arranged for 72 U.N. and WHO fellows. AID participants included 27 primary participants and 203 other visitors, making a total of 230. Two hunderd and eighty (280) persons came under the auspices of the Department of State, their own Government, private foundation grants, or with their own resources. More Western European countries sent experts in community mental health, maternal and child welfare, social work education, and psychiatric social work to study recent trends in these fields in the United States. Many social workers from Australia studied in graduate schools in the United States on study-observation trips to this country combined with Canadian and European conference programs. As part of the U.N. Human Rights Year observance, human rights fellows observed and studied U.S. social and economic programs focusing on the needs of disadvantaged groups, including Indians, 200 Department of Health, Education, and Welfare, 1968 Negroes, Puerto Ricans, Mexicans, and residents of Appalachia. Other human rights fellows studied legal, social, and economic programs related to the rights of women and children. Observation programs included juvenile courts, probation, rehabilitation centers, and community activities for youth. Research and Demonstration Program The special international research program enables professionals in the fields of rehabilitation, social services, maternal and child health services, and services for crippled children to make personal contacts with colleagues in participating countries, exchange information, and discuss research approaches. In 1968, an appropriation of $5 million was authorized for the purchase of foreign currencies to support the rehabilitation research and demonstration program. Obligations in local currencies for new projects totaled almost $4.5 million. Increases to previous grants, awards for the interchange of experts and for student fellowships, and cost of travel by consultants accounted for the remainder of the appropriated amount. Grants were approved for 45 research and demonstration projects in seven countries: Maternal Rehabili- Social and child tation welfare health Value Ceylon_______________________________________________ India________________________________________________ Israel_______________________________________________ Pakistan_____________________________________________ Poland_______________________________________________ Tunisia______________________________________________ Yugoslavia___________________________________________ 1 2 0 10 0 4 0 3 1 0 0 1 0 14 1 $174,489 4 1, 366, 831 0 379,471 0 490,999 0 100,000 0 318,743 4 1, 522, 784 From the initiation of the international program in 1961 until the end of June 1968, awards had been granted to conduct 222 projects in 11 countries. These included 143 research and demonstration projects in vocational rehabilitation, 51 in social welfare, and 28 in maternal and child health. This was the first year in which Ceylon came into the program. India and Yugoslavia received the largest share of funds during the year because of previous commitments and the availability of suitable proposals developed in the course of communication in previous years. Thirty-four projects launched in 1968 reflect the gamut of concerns in the domestic program in methods to rehabilitate persons disabled by chronic or catastrophic conditions such as diabetes, cardiovascular Social and Rehabilitation Service 201 and respiratory disabilities, sensory disorders, mental illness, mental retardation, orthopedic disabilities, and severe burns. In the field of social service, SRS awarded funds for five projects: two to extend to India the multinational studies of older persons; two to assess the rehabilitation of juvenile delinquents identified in the first phase of a study of the work of juvenile courts; and one to train mothers in the development of mentally retarded children. Interchange of Experts and Seminars Seminars held in Yugoslavia, Pakistan, India, and Israel brought together principal investigators on vocational rehabilitation projects sponsored by the Social and Rehabilitation Service within those countries. Participants also included members of the SRS staff and specialists from rehabilitation centers in Houston, Tex., and New York City. A total of 72 U.S. and foreign specialists participated in the program for the interchange of rehabilitation experts. U.S. experts aiding projects abroad represented the fields of psychology, rehabilitation center operations, physical therapy, prosthetics, low-vision aids, neurology, and speech therapy. Thirty-five specialists from five countries were awarded fellowships to facilitate programs in the United States. They represented rehabilitation of the deaf, the mentally retarded, the arthritic, the severely burned, the blind, paraplegics, and the ortho-pedically disabled. Considerable attention and staff work were devoted to the maternal and child health student fellowship program. As of June 30, 1967, 34 fellowship grants had been made, and an additional four awards were made in the early summer. Twenty-three fellowships were awarded for the period January 1,1968-June 30,1968. CORRECTIONAL REHABILITATION STUDY ACT The Correctional Rehabilitation Study Act of 1965 provided for a 3-year objective and thorough nationwide study of correctional manpower and training. On April 1, 1968, a grant of $800,000 was made to the Joint Commission on Correctional Manpower and Training for the third and final year of the study. The joint commission has completed its data gathering and has released a series of reports summarizing information gathered. Such reports as The Public Looks at Crime and Corrections and Attitudes of Correctional Personnel Toward the Criminal Justice System have been widely acclaimed as first-time nationwide studies. These reports highlight problems of the correctional field having a direct relationship to critical shortages of trained manpower. 202 Department of Health, Education, and Welfare, 1968 Administration on Aging The Administration on Aging, a major component of the Social and Rehabilitation Service since the departmental reorganization of August 1967, was established by the Older Americans Act of 1965 and charged with concern for the whole range of older people’s needs. There are two groups in which the Administration on Aging is particularly interested: The more than 19 million people 65 years of age and over, 12,000 of whom have passed their 100th birthday; and the 17 million men and women aged 55-64 who will be tomorrow’s older Americans. The older population is a constantly changing group. Every day 3,900 people reach their 65th birthday. Every year there is a net gain of 300,000 older persons. It is estimated that by 1985, there will be 25 million people 65 years of age and over. A major highlight of fiscal year 1968 was the unanimous passage of the Older Americans Act Amendments of 1967, which extended the Older Americans Act of 1965 and increased its funding levels. State agencies on aging are providing the central focus and leadership for all aging programs in each participating State and are mobilizing and coordinating State resources to meet the needs of the older population. Research and demonstration projects are paving the way to more effective coordination and implementation of services and to the establishment of new service techniques to improve the quality of older people’s lives. Training programs in more than a score of educational institutions and in dozens of community agencies are equipping people of all ages with the knowledge of gerontology and the specialized skills required for planning and providing services for the older population. During the fiscal year, the Administration on Aging worked with other Federal agencies, State and local government, and private organizations to better meet the material and nonmaterial needs of older persons. Among the major objectives were adequate income, decent housing, improved health care, meaningful activity in retirement, and a service role for the older person in society. To carry out its responsibilities, the Administration on Aging is organized into six major units: the Office of the Commissioner; the Division of Older Americans Services; the Division of Program and Legislative Analysis; the Division of Information; the Division of Research, Demonstration, and Training; and the Division of Administration. In each of the Department’s nine regional offices there is an Associate Regional Commissioner on Aging, who, along with his staff, works with State and local agencies. Social and Rehabilitation Service 203 Ill fiscal year 1968, Congress appropriated $18,450,000 for AoA and provided for a central office staff of 78. The first two titles of the Older Americans Act authorized establishment and organization of the Administration on Aging. The next three titles provided for services to older people through three grant programs. Grants for Community Planning, Services, and Training Under title III of the act, $10,550,000 was appropriated for carrying out State and community programs for older people. This section of the act authorizes grants for community planning, services, and training. Ten percent of each State allotment or $25,000, whichever is greater, may be used on a 50-50 matching basis by the State for administration of the State plan. In order to participate in the title III program, each Governor was responsible for designating a State agency to submit the State plan, which outlines long-range objectives for the older population and what services the State intends to develop to carry out these goals. By the end of the fiscal year, 46 States, the District of Columbia, Puerto Rico, and the Virgin Islands had approved State plans and were actively implementing the program. The bulk of each State allotment supports local community projects, which are administered by either public or nonprofit private agencies. By the end of the year, 688 community projects were operating under title III. An estimated 580,000 older people were directly benefiting from these projects. Of the 688 projects, 491 provided direct services, 133 provided for community planning activities (4 million older persons live in these community planning areas), and 64 were training special personnel. Title III projects served older people in a variety of ways: meals-on-wheels projects helped 17,341 elderly; transportation services aided 41,472; telephone reassurance, home maintenance, and friendly visiting helped 82,743; health services were provided to 40,114; and homemakers or home health aides served 6,178 aged. Information and referral projects served 227,000; 28,974 senior volunteers helped other older people; 10,916 aged found employment through title III project referrals; and 5,980 persons were trained to work with the elderly. Many of these activities are being carried out through multipurpose senior centers, which, in hundreds of communities throughout the country, have become the older person’s focal point of social life and 204 Department of Health, Education, and Welfare, 1968 contact point for services vital to health and welfare. In 1966, a national directory showed 375 senior centers. By the end of fiscal year 1968, it was estimated that the number had grown to 3,000. A contract has been awarded to the American Rehabilitation Foundation to update the National Directory of Senior Centers and to compile data on services offered by current centers, including a profile of center personnel and members utilizing services. Among the projects being carried out under title III are: • In Ryan, Okla., a town with no real industry, 40 percent of the residents are older people. Until 1966, when the “Senior Citizens Activity Center” was developed under a title III grant, there was little to occupy the elderly. In addition to a broad recreational program, the center offers arts and crafts, adult education, information and referral, counseling, and transportation. During the fiscal year, more than 1,200 different people took advantage of center activities, some of them coming from 20 or 30 miles away. The success of the center is attributed to the energy and dedication of the elderly director and other senior volunteers, the donations—cash, furniture, and supplies—of private citizens, and the solid support of the community. • In South Routt County, Colo., many older people live in isolated mountainous areas 21 miles from the nearest doctor or hospital. Most of them have no transportation. In this project, friendly visitors call at least once a week on old people who are homebound or live alone. In some cases, volunteers telephone daily so that isolated elderly have reassurance and support. If emergency or routine medical care is needed, volunteers drive patients to the hospital or doctors’ offices. • In Wichita, Kans., a community planning and development project has successfully involved many community groups and agencies in developing and coordinating a variety of needed programs for the aging, including: Planning a geriatrics clinic at a local medical center; coordinating activities of downtown churches to reach urban older people; developing special activities through the YWCA; establishing an information and referral service; publishing and distributing a “Guidebook to Community Resources.” • In Louisville, Ky., 50 older adults are volunteering their time and skills in public junior high schools to give individualized instruction to students. This arrangement is helping students who are behind in studies as well as superior students, who are offered such additional opportunities as piano instruction. It also contributes to the well-being and usefulness of the older person. Social and Rehabilitation Service 205 SOCIAL SERVICES With the establishment of the Social and Rehabilitation Service, I he Administration on Aging was given responsibility at the Federal level for development of policies, standards, guide materials and for data gathering and consultation in connection with the social services to elderly public assistance recipients under titles I, XVI, and XIX of the Social Security Act and to the aged before and after hospitalization for mental illness. State and local departments of public welfare administer these programs. Of the more than 2 million persons on old age assistance eligible for such services, 200,000 were receiving them in 36 states in the quarter ending September 30, 1967. Principal services included: Services to secure health and medical care (108,000 cases) ; protective services (60,000 cases) ; educational and vocational training (9,200 cases). More than 10,000 caseworkers in the public assistance program served the aged. Costs of social service programs to the aged, excluding eligibility determination, in fiscal year 1968 exceeded $50 million. Of the 440 local public welfare agencies in 39 states providing home-maker services, 115 helped the frail aged with home management assistance and 93 provided personal care services. Formal volunteer services to the aged have been established in eight States. Six States have undertaken the establishment of social group services to the aged. In 23 States, a State-level specialist on aging has been employed to supply impetus and leadership in providing services to the elderly. Ten States have carried out demonstration projects in county welfare departments for or on behalf of the aged. Projects include such activities as: • Establishing specialist positions at State and local level in aging and in community planning, homemaker services and foster family care. • Developing special service units demonstrating new methods of delivery in such areas as protective services, group services and foster family care. • Developing housing assistance and improvement services, including encouragement of home repair and improvement programs in housing owned or rented by OAA recipients. • Screening elderly residents of nursing homes to determine their health status and if alternate living arrangements would be appropriate. Grants for Research and Demonstration Authorized by title IV of the Older Americans Act, the research and demonstration program supports studies of older people’s living con 206 Department of Health, Education, and Welfare, 1968 ditions, demonstration and development of new methods and techniques for meeting their needs, and projects devising new ways to coordinate comprehensive community services for the Nation’s elderly. The projects are funded through grants or contracts with public or nonprofit private agencies, organizations, and institutions. During fiscal year 1968, 68 new and continuation projects were funded under an appropriation of $4,155,000. Research grants are probing such areas as: Problems of adjustment after retirement; the effects of social isolation on older people’s nutritional habits; and the role of senior centers in enabling elderly to remain active in the community. Development and demonstration grants are investigating such areas as: methods of providing low-cost meal services; administrative techniques for coordinating comprehensive health and welfare services for the aging; paid and volunteer employment in the performance of community service roles; and new means of delivering services to special groups of elderly such as the non-English speaking, the homebound and residents of rural areas. The following projects illustrate the approaches being tried to better serve the needs of older people and make retirement more meaningful: • In Des Moines, Iowa, Drake University is conducting an organized effort to evaluate the impact of preretirement education on the subsequent adjustment of persons to retirement. During the first year, 500 persons were divided into discussion groups of 20 to 30 persons and provided legal, financial, social security, health, and other information vital to successful retirement. During fiscal year 1969, the project plans to enroll an additional 500 persons. • In six rural counties of Arkansas, basic services are being provided to low-income older persons in isolated rural areas lacking such services. During fiscal year 1968, 1,194 senior citizens were interviewed. Among services they received were home repairs, medical and nursing care, transportation, and recreation. More than 300 homes have been repaired, 300 ill or handicapped persons have received help at home, and 781 persons have been referred to appropriate agencies for social and health services. • In Staten Island, N. Y., 250 older people have been brought out of retirement and into volunteer service at a State school for the retarded, two hospitals, a school for homeless children, the public schools, and in several additional service programs. They are engaged in such activities as filling warehouse supply orders, stamping new clothing, recreation work, physical therapy, feeding and playing with children, and friendly visiting with adults and children. Social and Rehabilitation Service 207 Studies have documented the fact that the diets of older people often are lacking in many basic nutrients. Changes in life after retirement— reduced income, altered living patterns, physiological changes such as loss of teeth or diminished sensitivity of taste and smell, and psychological disorders resulting from loneliness and anxiety—may prevent older people from buying, preparing, and consuming a well-balanced diet. To combat this problem, President Johnson, in his message on older Americans to the first session of the 90th Congress, called for a special program to improve nutrition service for the aging. Congress appropriated $2 million for development of such a program under Title IV of the Older Americans Act. AoA’s Research and Development Grants Staff this year approved 29 grants and contracts totaling $2,095,101 for nutrition. Among the approaches being tested are: • In New York City, a multipurpose senior center located in a large public housing project is serving 200 older people a hot noon dinner 5 days a week. A consumer education program is being coordinated with the meals service. • In the poverty-stricken Mississippi Delta, region, older people are being brought together to plan, prepare, serve, and eat one hot meal a day, 5 days a week, at a daily cost of 25 cents per person. • In Kentucky, elderly from isolated Appalachian mountain communities are coming to community centers every Saturday night by bus for a hot, nutritious dinner and an old-fashioned “country gathering.” • In Nebraska, Omaha and Winnebago Indians are learning good nutrition practices and economical meal planning in their own homes and in group meal centers located in tribal housing projects. Grants for Training The field of aging urgently needs men and women who are attracted to it because they find it vital and challenging work. There is a particular need for competent, informed, well-trained people to administer retirement housing projects, homes for the aged, multipurpose senior centers, and food programs for the aging at the local, State, or national level. Title V authorizes grants for training professional, technical, and lay personnel to plan for and serve older people in programs related to the broad purposes of the Older Americans Act. During fiscal year 1968, 30 grants were funded, for which Congress had appropriated $2,245,000. These grants provided long-term training 208 Department of Health, Education, and Welfare, 1968 for 214 career personnel and short-term training for 1,475 persons. Priorities in training were the following: Broad planning and administration in aging for work at Federal, State and local levels; planning, administration, and management training in the field of retirement housing, villages, and homes for the aged. Additional priorities included: Planning, administration, and program supervision for personnel of multipurpose senior centers; training for specialists in aging within such professions as recreation, religion, adult education, architecture, and retirement preparation; training of faculty and specialists in aging within established professions; leadership training for members of State and community committees on aging and for older adults who wish to become active in their communities; and training for semi-professional and technical personnel to serve under professional direction as library and recreation aides and aides in housing projects, senior centers, homes for the aged, and institutions, and in homemaking and meals services. To these ends, the following projects are examples of training being undertaken with title V funds: • The University of Georgia, Athens, Ga., is conducting 2-week training institutes for retirement housing personnel to better acquaint them with the special needs of older people. During 1968, 127 persons were trained; 120 will be trained in 1969. • At the Jewish Home and Hospital for the Aged in New York City, more than 500 persons were enrolled in such courses as geriatric neuropsychiatry, occupational therapy, auxiliary nursing personnel training, and institutional administration. The hospital staff and other authorities in their field provide the instruction while an adult educator from Teachers College, Columbia University, provides consultation and develops evaluation procedures. • At Brandeis University, Waltham, Mass., a curriculum of graduate education in aging leading to masters’ and doctoral degrees is training teachers, administrators, and community leaders for high-level teaching, research, and executive positions. One of the principal activities of the training grant program is that of encouraging the development of university-based centers on aging for training, research, and service. One of the outstanding eight or nine such centers receiving support from the Administration on Aging is the University of Michigan-Wayne State University Institute of Gerontology. This institute, with support from the State of Michigan, Ao A, and other Federal agencies, performs significant research in aging; trains personnel for housing management, senior center direction, architecture, public administration, community Social and Rehabilitation Service 209 organization, and milieu therapy programing in mental hospitals; and provides consultation and other essential services to State and community agencies and voluntary organizations. Pursuant to authorization contained in the Older Americans Act Amendments of 1967, the Administration on Aging made grants or contracts with four organizations for studies of personnel supply and demand in the field of aging. Preliminary reports revealed that shortages of personnel in the field are far greater than had been recognized. The Advisory Committee on Older Americans Title VI of the Older Americans Act authorized the appointment of 15 prominent citizens and leaders in the field of aging to the Advisory Committee on Older Americans, which is chaired by the Commissioner on Aging. The Committee is charged with advising the Secretary of Health, Education, and Welfare on his responsibilities under the act and recommending new programs for the aged. The advisory committee this year discussed the need for trained personnel in aging, coordinated services for older people, the impact of Senior Citizens Month, and the organization of the newly formed Social and Rehabilitation Service. The Foster Grandparent Program This program enables low-income persons over 60 to serve approximately 20 hours a week in hospitals or institutions working with retarded and handicapped children. Older people in the program derive great satisfaction from the role they play in the rehabilitation of these youngsters and the knowledge that society needs their services after retirement. Also, the payment they receive is an important supplement to retirement income. The children benefit because they are able to identify with a person who cares deeply about them and is able to give them the individual attention that they so vitally need. By the end of the fiscal year, there were 68 projects in 40 States and Puerto Rico using the services of 4,000 foster grandparents to help 8,000 children. Thirty-seven percent of the foster grandparents were 70 years of age or over and the oldest foster grandparent was 91. Total committed resources for fiscal year 1968 were $9,455,214, of which the Federal Government supplied $8,329,444 and local sources provided $1,125,770. The program is managed by the Administration on Aging with funds supplied by the Office of Economic Opportunity. 210 Department of Health, Education, and Welfare, 1968 Senior Citizens Month For the sixth consecutive year, the President proclaimed May as Senior Citizens Month. “Meeting the Challenge of the Later Years,” which was the 1967 theme, was selected as a continuing theme and, for 1968, special emphasis was placed on the contributions older people are making to their communities. More than a million copies of informational materials were mailed out to national organizations, State and local aging units, and to individuals. Local newspaper interest in older people, their activities and their contributions, was substantial in 1968 and hundreds of news items, feature articles, photographs, and editorials were printed in newspapers all over the country during May. In connection with Senior Citizens Month, the staff, in cooperation with the Food and Drug Administration and the President’s Committee on Consumer Interests, developed a folding wallet card, “Consumer Guide for Older People.” The document was so well received by older people and their organizations that half a million of the cards were requested and distributed in only 2 months. It was necessary to order a third printing of 250,000 to meet requests. Relationships With Other Federal Agencies and Clearinghouse for Information The Administration on Aging has been actively working with other Federal agencies such as the Office of Economic Opportunity, on development of programs to meet the needs of the elderly poor, and the Department of Housing and Urban Development, to make sure that needs of the aging are included in Model Cities proposals. Members of the AoA staff have reviewed model city applications and have prepared criteria for project review teams outlining what these applications should stress concerning older people. Papers prepared by AoA and inserted in Model Cities Planning Kits stress planning for the aging, developing a senior center program, and formulating an information and referral program. The President’s Council on Aging provides a forum for the exchange of information and ideas about aging and aging programs. The Executive Committee of the President’s Council is chaired by the Commissioner on Aging. The Council’s report, A Time of Progress for Older Americans, published during 1968, was a complete review of activities on behalf of older people by all of the Departments represented on the Council from 1965 to 1967. In October 1967, the Department of Transportation and the Office of Economic Opportunity were added to the Council, increasing its membership to 10. Social and Rehabilitation Service 211 In April 1968, the Administration published the model of a consumer education program for older people, “Project Money wise-Senior,” which was developed in coordination with the Bureau of Federal Credit Unions. Money wise-Senior was successfully pilot-tested by the Massachusetts Commission on Aging in Boston in September 1967. This model program can be implemented by any State agency on aging. Other significant publications by the Administration on Aging during the year were: The Fitness Challenge in the Later Years, An Exercise Program, for Older Americans; What Churches Can Do, another in the Designs for Action series; seven new grant program descriptions in the Federal Financial Assistance for Projects in Aging series; Some Basic Priorities in Services for Older Americans and A Profile of the Older American both originally speeches; a brief general description of AoA programs, Charged with a Concern for the Whole Range of Needs of Older People; and a new, categorical list of AoA publications. Aging, the official publication of the Administration on Aging, continued to be a major informational medium for professionals in the field. Monthly circulation during the year was 14,600 of which 6,100 were paid subscriptions and sales. Legislative Highlights Two key pieces of legislation were introduced during the fiscal year. A joint resolution calling for a White House Conference on Aging in 1971 passed the Congress and was signed by the President after the close of the year. The Older Americans Act Amendments of 1968 were still pending when Congress adjourned in October 1968. These amendments would strengthen the ability of State agencies on aging to carry out statewide planning, coordination, and evaluation of programs for older people; increase funding for State administration ; authorize 10 percent of title III appropriations to be used on a project-by-project basis for statewide, regional, metropolitan, or areawide model projects; provide fourth-year matching funds for certain title III projects providing essential community services; and establish a program of “service roles in retirement” for older people. Assistance Payments Administration The Assistance Payments Administration deals for the most part with the money payment programs under aid to families with dependent children, old-age assistance, aid to the blind, and aid to the 212 Department of Health, Education, and Welfare, 1968 permanently and totally disabled. It develops policies, standards, and methods for (1) administering those programs and the public assistance aspects of the work incentive program;* (2) determining eligibility for money payments and, in cooperation with the Medical Services Administration, eligibility for medical assistance; (3) determining and measuring need, income, and resources; (4) providing money payments; (5) providing for fair hearings; and (6) safeguarding information about applicants and recipients. Program Coverage and Expenditures In June 1968, federally aided assistance under old-age assistance (OAA), aid to the blind (AB), and aid to families with dependent children (AFDC) was available in all 54 jurisdictions of the country—the 50 States, the District of Columbia, Puerto Rico, Guam, and the Virgin Islands. Aid to the permanently and totally disabled (APTD) was available in all jurisdictions but one (Nevada). General assistance (GA), wholly State and/or locally financed, was available in some form for some persons in all 54 jurisdictions. PROGRAM COVERAGE About 9.1 million persons were receiving money payments under public assistance programs in June 1968. This number included 2 million aged persons receiving OAA; 5.6 million dependent children and their parents or other caretakers (including 4.2 million children in 1.4 million families) receiving AFDC; 670,000 disabled receiving APTD; 81,000 receiving AB; and 737,000 receiving GA. Vendor payments for medical care also were made on behalf of many of the recipients of public assistance money payments, as well as for some other medically needy persons. (See report of Medical Services Administration.) The total number of persons receiving public assistance money payments had increased 5 percent by June 1968, compared with June of the previous year. The largest program increase was in AFDC— 11 percent; the nonfederally aided program of GA grew 10 percent and the APTD program rose 6 percent. The AB program decreased 3 percent; the OAA program declined 2 percent, in part as a result of the increase in old age, survivors, disability, and health insurance benefit levels under social security, as well as the extending of monthly OASDHI benefits to formerly ineligible individuals. *Work incentive responsibilities transferred to Children’s Bureau in fiscal year 1969. Social and Rehabilitation Service 213 Because each public assistance program defines—and thus limits— the groups it is intended to help, many needy people are not eligible for assistance under any program. Needy persons aged 21-64, for example, cannot be helped by any Federal-State assistance program unless they are blind, disabled, or are parents or close relatives caring for children who are receiving AFDC. There are also Federal policies that are optional with the States. Some States have programs as broad as the Federal law permits, and others have programs that contain only what the Federal law requires. The following are illustrations: Nevada does not have an APTD program; 33 jurisdictions do not provide aid to families in need because a parent is unemployed (AFDC-UP) ; almost half the jurisdictions (24) do not provide for foster care of children; 21 jurisdictions do not permit earned income exemptions in OAA; 11 do not permit payments to children up to 21 years of age, if attending school or a vocational or technical training course; 26 do not make payments in behalf of aged patients in institutions for the mentally ill; 31 do not make payments in behalf of aged patients in institutions for tuberculosis; and 17 do not provide assistance to persons on conditional release from mental institutions under specified circumstances. And, there are State restrictions that limit eligibility in other ways. They include residence requirements, citizenship requirements, and narrow definitions of disability. EXPENDITURES A total of $466 million was expended for public assistance money payments in June 1968, representing a 15-percent increase from June 1967. Assistance money payments during 1968 represented less than 1 cent per dollar of total personal income in the Nation during 1967. Expenditures By Program Total money payments to recipients from Federal, State, and local funds for the month of June 1968 were about $138 million for OAA; $235 million for AFDC; $34 million for APTD; and $7 million for AB. For GA, a total of $33 million was expended from State and/or local funds only. With the exception of OAA, all the programs providing money payments to recipients reported higher expenditures in June 1968 than in June 1967. They include a 28-percent increase in GA; 27 percent in AFDC; 15 percent in APTD; and a 2-percent increase in AB. OAA decreased 3 percent. 328—184—69--15 214 Department of Health, Education, and Welfare, 1968 Monthly Average Payments National monthly average public assistance money payments in June 1968 were $68 per recipient of OAA; $42 per recipient of AFDC ($170 per family); $81 per recipient of APTD; $91 per recipient of AB; and $45 per recipient of GA ($93 per case). Average payments not only are low, but vary widely from State to State as evidenced in the range of payments in June 1968. Among the 50 States, monthly payments for a dependent child ranged from a low of $9 in Mississippi to a high of $58 in New Jersey; and for an old-age recipient from a low of $36 in Mississippi to a high of $100 in California. Each State establishes its own assistance payment level, which reflects both the State’s fiscal capacity and prevalent social attitudes. Because of insufficient funds, a number of States reduce the amount of the payment; some set arbitrary maximums regardless of the size of the family; and others pay only a certain percentage of need computed under the State standard or impose unrealistic policies with respect to other potential income or resources or relatives’ responsibility that serve to prevent meeting full need. Relation To Social Insurance Nearly three-fifths of the OAA recipients received public assistance money payments to supplement their OASDHI benefits in order to meet basic or special needs. The percentages of other types of public assistance recipients who also received social security benefits were considerably smaller—about 18 percent in AB, 14 percent in APTD, and 6 percent in AFDC. The increases in OASDHI benefits, which became effective with February payments, brought a decline in the number of assistance recipients. For the 5-month period ending June 1968, the States reported a total of 45,600 case closings—26,500 in the OAA program, 8,100 under APTD, and 8,100 under AFDC. The estimated number of persons in all cases that were closed was about 75,000. Work Experience and Training Program Authorized by title V of the Economic Opportunity Act of 1964, the work experience and training program is designed to move unemployable heads of families who are presently or potentially assistance recipients toward self-support by improving their employability. Work experience and training, education, maintenance, medical care, and other social services needed by the unemployed parent and his family Social and Rehabilitation Service 215 are used to improve employability. Generally the title V recipient is an unemployed parent who is receiving public assistance and is part of the hard-core unemployed, the most unskilled and undertrained of the poverty stricken. Administration of the program was delegated by the Office of Economic Opportunity to the Department of Health, Education, and Welfare and further delegated to the Social and Rehabilitation Service, Assistance Payments Administration. To finance the program, money grants are made to State public welfare agencies for projects developed and operated at the community level. Obligations during the 43 months the program has been in operation, from December 1964 through June 1968, have been approximately $364 million, with $42.3 million of this being obligated during fiscal year 1968. Major adjustments were required to carry out legislative changes that affected title V during 1968. The 1966 amendments to the Economic Opportunity Act directed that greater emphasis be placed on strengthening the manpower aspects of title V program. Projects were amended and restructured to include manpower services from the Department of Labor. Amendments to the Social Security Act in 1967 authorized a new work incentive (WIN) program under the administration of the Department of Labor. The title V program will be replaced by the WIN program in all States by July 1, 1969. The WIN program is structured to provide for an orderly transition of title V projects into WIN projects. The WIN program also replaces the community work and training program established in 12 States under the 1962 Social Security Act Amendments. The new obligational authority (NOA) for title V in fiscal year 1968 was $45 million, a decrease of $55 million from the $100 million fiscal year 1967 level. The impact of an NOA of $45 million for fiscal year 1968 and an anticipated further reduction to $20 million in fiscal year 1969, coupled with preparation for phasing into WIN, caused a considerable cutback in title V. Over 70 projects were terminated during the year and man-months of training dropped from 808,000 in fiscal year 1967 to 605,000 in fiscal year 1968. Although nearing termination, title V work experience and training projects served 96,500 trainees in fiscal year 1968. At the end of the 1968 fiscal year, 31,200 were still undergoing training. Omitting 13,600 who left projects because of illness or other problems, the total number of trainees terminated was 51,700. Approximately 70 percent of that number (36,000) met title V’s objective of improving employ a 216 Department of Health, Education, and Welfare, 1968 bility: 46 percent found jobs right away; 7 percent went into advanced vocational training; and 17 percent developed marketable skills, although they did not find jobs immediately. The entire breakdown for the 51,700 went this way: • 23,700 found gainful employment immediately upon completion of training. • 3,400 left various projects to take manpower development training or other advanced vocational training. • 8,900 completed training but did not find jobs immediately. • 10,700 left various projects or were terminated for such reasons as lack of progress, poor attendance, misconduct, or dissatisfaction with or refusal of assignment. • 5,000 left for unknown reasons. Trainees in title V projects during fiscal year 1968 also registered high educational achievement: 36,000 received basic adult education; 4,500 received high school equivalency training; and over 20,700 developed new work skills or upgraded existing skills through full-time vocational education. The majority required no training and entered directly into job training situations. From December 1964—the beginning of the program—through June 30, 1968, about 216,700 trainees have participated, with some trainees receiving more than one type of training: 81,600 received adult basic education; 10,000 participated in high school equivalency courses; and 46,500 developed new work skills or upgraded existing skills through full-time vocational education. A total of 147,100 either completed their training or terminated prior to completion but were in the project sufficient time to measure the effect of title V on the trainee. The status of these 147,100 trainees upon leaving the projects was as follows: • 67,400 (about 46 percent) immediately found gainful employment upon leaving the projects. • 9,700 (about 7 percent) left projects to take advanced vocational instruction. • 25,400 (about 17 percent) completed their training but did not find jobs immediately upon leaving projects. • 30,500 (about 20 percent) left or were terminated from projects for reasons such as lack of progress, poor attendance, misconduct, dissatisfaction with or refusal of assignments. • 14,100 (about 10 percent) left the projects with reason for leaving-unknown. A conservative estimate of the proportion of trainees meeting the program’s objective of improving employability is approximately 70 percent. Social and Rehabilitation Service 217 A followup analysis as of the end of fiscal year 1968 revealed that 56 percent of the former title V trainees had been employed at some time during the 3-month period following termination from title V. Nearly four out of five of these trainees were still employed at the end of the 3-month period. Of the trainees employed at the end of 3 months, four out of five were in full-time employment and their average monthly pay was $274—over 73 percent greater than the average monthly AFDC payment of $158. The average monthly pay of part-time workers was $133. Nearly 37 percent of the trainees who had not found jobs a week after leaving a project did find jobs by the end of the 3-month period. Administrative Developments ORGANIZATION AND MANAGEMENT APA worked out plans to start an automated centralized information exchange between the Social Security Administration and the State welfare agencies. These procedures will reduce the flow of paperwork between local offices of SSA and State welfare agencies. A survey of fraud reports from State agencies shows very few cases of fraud in OAA, AB, APTD, or AFDC programs. Of 5,000,000 individual and family cases in 1966, for example, less than 0.4 percent (18,200) showed indications of fraud. APA provided the following administrative services this year: Technical assistance and published materials to a number of States on administrative and fiscal procedures; comprehensive surveys of organization and procedures to the Kansas State welfare agency and to the Franklin County Welfare Department in Ohio; a complete survey of the Boston Department of Public Welfare, including consultation to Massachusetts in relation to its shift, effective July 1,1968, from local administration of the public assistance programs to State administration; consulting services to Ohio on setting up a management information system; and consulting services on data-processing problems to the State of California. In addition, APA prepared, for publication in the Federal Register and for issuance to State agencies, assistance payments regulations and policies to implement the 1967 amendments. SEPARATION OF PAYMENTS In March 1968, APA was assigned the responsibility for working with the States toward simplification of public assistance payments. The separation of payments from social and rehabilitation services, which is a major part of the simplification, permits trained social 218 Department of Health, Education, and Welfare, 1968 workers to spend more of their time and talents in providing rehabilitation services. The APA separation staff has developed a system which can be used to compile, in an organized way, a State-by-State analysis, evaluation, and work plan. It provides a systematic method for determining impediments to simplification and separation, as well as the identification of areas where progress has been made by States. Technical assistance has been given to State agencies in planning and implementation of separation of payments and services. Eighteen States had taken action by the end of June 1968 toward reorganization and reemphasis of programs which will contribute toward the simplification of payments and more effective provision of services. Public Information Among publications issued during the year, two on Community Planning helped to delineate the key role of public welfare in neighborhood coordination of services. Another, When the Needy Ask, for Help, originally written as a guide on Federal-State public assistance for use of clergymen, proved valuable in explaining the programs to the general public. More than 21,000 public inquiries about public assistance were answered, editorial assistance was provided to Bureau staff, and approximately 500,000 publications were distributed. Children’s Bureau The Children’s Bureau assists the States, through technical and financial aid, in enhancing and protecting the well-being of children and youth through child health services and family and child welfare services. The Bureau also studies many types of conditions affecting the lives of children and youth, makes recommendations to promote better practices in child health, family and child welfare, and juvenile delinquency, and helps establish standards for the care of children. The consolidation of the Federal resources in public welfare into a new agency, the realignment of functions, and the Social Security Amendments of 1967 broadened and improved the Bureau’s programs for children and their families, with emphasis on the areas of infant mortality, family planning, mental retardation, a unified program of services to children and their families, day care, youth services, and training of child care workers. Social and Rehabilitation Service 219 1968 Appropriations The amounts appropriated for Children’s Bureau programs for fiscal year 1968 were: Salaries and expenses_______________________________________ $6,151, 000 Grants for maternal and child welfare_______________________ 235, 600, 000 Maternal and child health services_______________________ 50, 000, 000 Services for crippled children___________________________ 50, 000, 000 Child welfare services___________________________________ 46, 000, 000 Special projects for maternity and infant care----------- 30, 000, 000 Special projects for health care and services for school and preschool children______________________________________ 37, 000, 000 Research projects relating to maternal and child health and crippled children’s services____________________________ 5, 900,000 Research, training, or demonstration projects in the field of child welfare___________________________________________ 9, 700, 000 Training of professional personnel for care of crippled children _______________________________________________ 7, 000, 000 Interdepartmental Committee on Children and Youth The Interdepartmental Committee on Children and Youth is composed of representatives of 40 Federal agencies whose programs affect the well-being of children and youth. The Chief of the Children’s Bureau is First Vice Chairman and Acting Chairman by delegation of the Secretary of Health, Education, and Welfare, who is Chairman. The Bureau also provides the secretariat. During fiscal year 1968, the Committee published Federal Programs Assisting Children and Youth. Originally intended as a document for use of member agencies, the publication became a handbook and guide for State committees for children and youth, libraries, universities, and colleges. The Subcommittee on Transition From School to Work completed the second revision of From School to Work—Federal Services To Help Communities Plan With Youth. The subcommittee’s work centered on finding causes of problems encountered by local programs set up to help young people make the transition from school to work. The Subcommittee on Parent and Family Life Education prepared a statement on family planning education, the purpose of which was to provide a channel for a coordinated approach by Federal agencies. The Committee authorized a Special Committee for the 1970 White House Conference on Children and Youth. 220 Department of Health, Education, and Welfare, 1968 State Committees for Children and Youth State Committees have been preparing for the 1970 White House Conference on Children and Youth, giving emphasis to participation of individuals from all sections of each State, youth involvement, and coordination of activity among the numerous groups and organizations. White House Conference on Children and Youth The dates of February 15-21, 1970, were set for the 1970 White House Conference on Children and Youth. As part of its background paper preparation for the conference, the Bureau published The Story of the White House Conferences on Children and Youth. Federal Model City Program The Federal model city program specifically requires many agencies and local citizens to develop a coordinated attack on problems of selected urban areas. Bureau staff, cooperatively with the Social and Rehabilitation Service and the HEW Center on Community Planning, reviewed the proposed model city and multiservice neighborhood center applications for their community planning aspects and their effective utilization of Bureau programs. Regional staff helped State agencies develop cooperative goals and service programs in over 100 model city communities and in 11 demonstration neighborhood centers. Programs of the Bureau RESEARCH AND CHILD LIFE In addition to issuing its own studies and cooperating in joint studies, the Bureau supported research in child health and welfare through two grant programs. Maternal and Child Health and Crippled Children’s Research Grants Fiscal year 1968 funds of $5,579,578 funded 68 maternal and child health and crippled children’s research grants. Final reports were received on 22 projects. Among them were: “Developing a Method for Evaluation of Quality of Nursing Service to Maternity Patients”; “Medical Needs of Children in Institutions for the Mentally Retarded”; “Long-Term Expenditures on Behalf of Clients in a State Program for Handicapped Children”; “Studies of Maternity Care and Perinatal Mortality in the Southeastern Region of the United States”; and “Health and Medical Care of Mothers and Children in an Urban Community.” Social and Rehabilitation Service 221 Child Welfare Research and Demonstration Grants Grants totaling $3,996,021 for 39 child welfare research and demonstration projects were awarded in fiscal year 1968. Final reports were received on 15 projects, including: “A Demonstration of Reorientation of Illegitimately Pregnant Teenage Girls Living in Rural Areas”; “The Feasibility of Training and Using Unskilled Personnel as Aides to Professional Personnel in Caring for Retarded Children”; “A Research Project to Develop and Test a Data Collecting Instrument for Universal Use of Agencies Serving Unmarried Mothers”; “Magnitude and Scope of Family Day Care Problems in New York City”; and “Family Emergency Services.” International Comparative Study of Juvenile Delinquency With financial assistance from the Foreign Currency Fund program, the Bureau conducted an international comparative study of juvenile delinquency in Belgrade, Yugoslavia; Ljubljana, Yugoslavia; Jerusalem, Israel; Warsaw, Poland; and San Juan, Puerto Rico. The aim of the study was to determine whether it is possible to obtain reasonably uniform information about the behavior of youngsters involved with the courts of different systems of justice, and whether such information would explain differences in the results of such court actions. A report will be prepared in 1969. Research Reports The Bureau began a new series of publications during the fiscal year: Children’s Bureau Research Reports. This series reports findings of studies of child health and welfare services, some of which will be conducted as part of the Bureau’s program of research and demonstration grants. Research Report No. 1, On Rearing Infants and Young Children in Institutions, was released in March 1968. Research Report No. 2, The Webster School: A District of Columbia Program for Pregnant Girls, and Research Report No. 3, Prelude to School: An Evaluation of an Inner-City Preschool Program, went to press by the end of the fiscal year. Some Facts and Figures The provisional number of births in the United States during 1967 was 3,533,000, or 96,000 less than in 1966. The birth rate for 1967 was 17.9 births per 1,000 population, the lowest annual birth rate on record. In March 1967, there were 28.5 million families with related children under 18 years of age. Of this number, 25.1 million (89 percent) were husband-wife families, 2.9 million (9 percent) were families with a 222 Department of Health, Education, and Welfare, 1968 female head, and 0.4 million (2 percent) were families with a male head. Children under 21 numbered 81.6 million on July 1, 1967, an increase of 1.1 million over the preceding year. An estimated 1,913,000 marriages were performed during 1967. The provisional 1967 annual marriage rate of 9.7 per 1,000 population was slightly higher than the rate for 1966 (9.4 per 1,000). An estimated 534,000 divorces were granted in 1967. The 1967 divorce rate of 2.7 per 1,000 population was slightly higher than the 1966 rate of 2.5 per 1,000 population. According to the most recent data available, 60 percent of divorces involve children. There were 10.5 million mothers in the labor force in March 1967, or about 600,000 more than in March 1966. Thirty-eight percent of all mothers in the population with children under 18 were working in March 1967. The figures included 4.1 million working mothers with children under 6, and 6.5 million with children 6-17 years of age. The infant mortality rate for 1967 was 22.1 per 1,000 live births, a decrease of 6 percent from 1966. According to the poverty index used by the Social Security Administration, which is based upon a food cost-income relationship to family size and composition, there were 12.5 million children under 18 in 4.2 million families living in poverty in 1966. This means that nearly 20 percent of the children under age 18 in the United States were growing up in a home where the family income was below the poverty level. An additional 6.6 million children lived in homes where the family income was only slightly above the poverty level. Children of nonwhite families or of families with a female head were more likely to be poor. More than four out of 10 such families had an income below the poverty level. MATERNAL AND CHILD HEALTH AND CRIPPLED CHILDREN’S SERVICES The Social Security Amendments of 1967 When the Social Security Amendments of 1967 made Child Welfare Services a part of title IV, title V became Maternal and Child Health and Crippled Children’s Services. The amendments to title V were designated as the Child Health Act of 1967. They increased the authorizations for child health as follows: $250 million in fiscal 1969; $275 million in fiscal 1970; $300 million in fiscal 1971; $325 million in fiscal 1972; $350 million in fiscal 1973 and for each year thereafter. The act also: • Called for services to reduce infant mortality and otherwise promote the health of mothers and children. • Spelled out, for the first time, family planning services as a regular part of health services to our Nation. Of the amounts Social and Rehabilitation Service 223 appropriated for title V each year, not less than six percent shall be available for family planning. ® Continued the program of maternity and infant care project grants and of comprehensive grants for the health of preschool and school children until June 30, 1972, after which they become a part of each State maternal and child health and crippled children’s services plan. ® Authorized support of up to 75 percent of the cost of projects to provide comprehensive dental health services for children of low-income families. These projects will study ways of organizing community dental health programs, including ways to increase the efficiency of dentists by using assistants and auxiliary personnel. • Combined the maternal and child health program and crippled children’s services into one program and required that the States assume responsibility for project grants in 1972. It also required the States to make more vigorous efforts to screen and treat children with disabling conditions through intensified casefinding and periodic screening of children in schools. ® Specified that 10 percent of the authorization for title V for each year shall be allocated for research and training. Special emphasis will be given to projects which can increase the effectiveness of health care programs by making maximum use of health personnel with varying levels of training. Numbers Served During fiscal year 1967, State and local maternal and child health programs provided maternity clinic services for 366,400 expectant mothers, as compared with 282,000 in 1966. About 73,300 mothers and 7,000 premature infants received inpatient hospital care. About 89,900 expectant mothers received dental care. About 1,631,900 children (of whom, 603,700 were under 1 year of age) were seen in well-child conferences. Over 1,711,700 school children were examined by physicians in school health programs, and, where necessary, referred for further treatment. Over 8,986,600 school children were screened for visual defects; 5,457,500 for hearing defects; and 2,549,100 for dental defects. Some 2,321,000 children received immunization (including boosters or revaccinations) for smallpox; 2,364,100 for whooping cough; 4,350,400 for diphtheria; and 4,550,600 for tetanus. Public health nurses, working in the homes and elsewhere in the community, served 480,500 mothers. In addition to the nursing services offered in individual conferences and at schools, nursing care was provided to almost 3,000,000 children. 224 Department of Health, Education, and Welfare, 1968 CHART 1.—MATERNAL AND CHILD HEALTH SERVICES, 1947-67 1160 - 1000 - / goo-------------------------------------------------------------------------------------------------------- 800 ~ 700 - OTHER children served / BY WELL CHILD CONFERENCES / ________ 600 -----------------------—------------------/---------yS ' *------—-------------------------N g 500 — / = J \ INFANTS SERVED BY | 400 - ----- WELL CHILD CONFERENCES 300 -----A --------------------------- ~ ~ ' - __— 200 - —______________________ / ~~~ MOTHERS SERVED ... / BY MATERNITY 100- MOTHERS ATTENDING MEDICAL CLINIC SERVICE PRENATAL CLINICS H--------1---1---1------I---!----1-----1---1---1-----1-----1--1-------1—4-----1-----1-----1----i----1---F 1947 1949 1951 1953 1955 1957 1959 1961 1963 1965 1967 State and local public health agencies spent an estimated $143.6 million in fiscal year 1967 for maternal and child health services. This included expenditures of $93.1 million from State and local funds (65 percent of the total) and $50.5 million from Federal funds (35 percent). Official health agencies reported services for more than 448,700 children with crippling conditions in fiscal year 1967. The crippled children’s program reaches between five and six children per 1,000 in the population. State and local crippled children’s agencies spent an estimated $117.8 million in 1967 for crippled children’s services. This included expenditures of $67.5 million from State and local funds (57 percent of the total) and $50.3 million from Federal funds (43 percent). Maternity and Infant Care Projects Fifty-three maternity and infant care projects were providing comprehensive care to mothers and infants from low-income families on June 30, 1968. During fiscal 1968, these projects admitted 118,000 new maternity patients; 83,000 new patients for family planning; and 43,000 infants (of whom, 36,000 were project born). Authorized were 46,500 visits by physicians to 18,400 infants. Greater coordination of community services in the projects brought services closer to the families who needed them through such arrangements as mobile clinics. Hours of operation were ex- Social and Rehabilitation Service 225 CHART 2.—CHILDREN SERVED IN THE CRIPPLED CHILDREN’S PROGRAM, 1948-67 600 1————————————------------------------————----------------r6 rate 500-----------------------—-----——j--------------------------5 c 400 -------------------------■-------------------■---——;-----4 = / I • ’ !i ;i!H I J a O / .np-lll:--.” •-TS--.3 Q. £ / 7 4:j'N: 8. 5 ' , H g 7 300 ------------------------ I" i —I----------——■ -■■! ■- 3 o Q O 5- C •o ! 3 O I • : u ■ u o a u 200 ---—---------------------------------p-----------------n-2 * V ‘ 1 f5 j S 100 ,——J-r-— —-----------------k -...- .........——™-.i------- 1 - : ,.il.........—|_i ..........................—i—[-U-L. 1948 1950 1952 1954 1956 1958 1960 1962 1964 1966 1967 tended to nights and weekends to make them more convenient for the patient. Patients increasingly registered earlier for prenatal care and family planning. In some projects, husbands as well as their wives were included. Transportation was arranged for families where public transportation was inadequate. Needy, pregnant women were provided additional food stamps or food commodities and nutritional services. In some projects, homemakers extended the services of nurses and home economists by teaching child care and food serving and preparation in the home. Greater use of radio, television, signs, and billboards helped inform the public of services available through these projects. Many projects expanded their services for schoolgirls. For example, the maternity and infant care project in Baltimore found that informing teachers, elementary through senior high, of the services available resulted in early casefinding of pregnant schoolgirls. The District of Columbia project conducted social work group sessions for pregnant adolescents and their parents biweekly. One effect of the projects has been to demonstrate to communities that their efforts on behalf of mothers and infants were measurable in improved mortality rates and lowered incidence of prematurity. Some examples of health indices which show the effect of the maternity and infant care projects on maternal and infant health are: In Dade County, Fla., maternal mortality for the nonwhite population was reduced by 75 percent. The stillbirth (fetal death) rate 226 Department of Health, Education, and Welfare, 1968 for project deliveries dropped from 18 per 1,000 live births in 1966 to 10.8 in 1967. The percentage of low-birth-weight infants was reduced from 19 percent in 1966 to 11.8 percent in 1967. Children and Youth Projects On June 30, 1968, there were 58 projects providing health care and services to preschool and school children, particularly in areas with low-income families. These projects serve low-income areas in which an estimated 2,100,000 children live. Since the beginning of the program in 1966, children and youth projects have registered approximately 220,000 children for comprehensive care. Of these, 31,225 were new patients during the period January-March 1968. The children and youth project in Baltimore developed cooperative arrangements with a variety of agencies. Welfare personnel operated out of the health center as AFDC family service caseworkers. In cooperation with the Department of Education and VISTA, a professional team examined school children to detect behavioral and learning problems at an early stage; and VISTA trainees tutored them. In cooperation with a private organization, an audiometric screening program was conducted, using volunteers. Also being utilized were an OEO-sponsored neighborhood health center, an adult education program for parents of project children, and other such community resources as camping, little theatre, arts and crafts. Coordination of Crippled Children’s Programs With Other State Programs Some State crippled children’s agencies have agreements with agencies administering title XIX medical assistance funds. These agencies were able to provide services to a larger number of crippled children because title XIX funds pay for inpatient hospital care for patients eligible under the State’s medical assistance program. State crippled children’s and vocational rehabilitation programs have increasingly combined their efforts to extend services to children. Mental Retardation Services By June 30, 1967, there were 150 mental retardation clinics supported in whole or in part by Children’s Bureau funds. Reports from clinics indicated that children were served at the rate of 37 per 100,000 children. New patients represented only half of the patients served. About one-third of the patients visited clinics only once during the year, while one-fifth made five or more visits. Services provided through these clinics included diagnosis, evaluation of a child’s capacity for growth, the development of a treat Social and Rehabilitation Service 227 ment and management plan, interpretation of the findings to the parents, and followup care and supervision. Training of Personnel for Health Care and Services to Mothers and Children The Social Security Amendments of 1967 broadened the grants program of training personnel for health care and related services to mothers and children, particularly mentally retarded children and children with multiple handicaps. The amendments required that special attention be given to programs providing training at the undergraduate level. Professional personnel being trained during fiscal year 1968 included physicians, dentists, audiologists, nurses, physical therapists, occupational therapists, nutritionists, social workers, psychologists, and speech specialists. FAMILY AND CHILD WELFARE SERVICES Broadened Responsibilities When the Social and Rehabilitation Service was established in August 1967, the Children’s Bureau became responsible for services to AFDC families and children while the Assistance Payments Administration was made responsible for money-payment aspects of the program. With the enactment of the Social Security Amendments of 1967, child welfare services became part of the Social Security Act title IV program—Grants to States for Aid and Services to Needy Families With Children and for Child Welfare Services. The amendments required welfare agencies to design a program of family and child welfare services for each parent and child, based on their special circumstances and requirements. The amendments also required the establishment of a single organizational unit within the State or local agency to provide services on behalf of families and children under the State plans for AFDC and child welfare services. Effective July 1,1968, States were required to furnish needed childcare services for each AFDC recipient referred to the Department of Labor for training and employment in the work incentive program (WIN). Family planning services also must be offered. The Amendments also required the establishment of advisory committees on AFDC and child welfare services by State and local welfare agencies. At least one-third of the committee members must be recipients of financial assistance or social services. The committees will participate in both policy development and program administration. Numbers Served According to State reports for the quarter ending September 30, 1967, social services were provided to 844,000 families with 2,621,000 228 Department of Health, Education, and Welfare, 1968 children. This number represented 61 percent of the families receiving financial assistance through the AFDC program. These services were directed toward improved family functioning, health-care, self-support, self-care, and the protection of children. About 607,900 children were receiving child welfare services from State and local public welfare agencies on March 31, 1967, 7 percent more than on March 31, 1966. Forty-eight percent of the children were in their own homes or the homes of relatives; 34 percent were in foster family homes; 10 percent were in institutions; 7 percent were in adopted homes; and 1 percent elsewhere. Voluntary child welfare agencies and institutions were serving 215,000 children on March 31, 1967. Twenty-six percent of these children were in their own homes or the homes of relatives; 21 percent were in foster family homes; 35 percent were in institutions; 17 percent were in adoptive homes. State and local public welfare agencies spent an estimated $452.7 million in fiscal year 1967 for public child welfare services. This amount included expenditures of $239.2 million from State funds, $167.8 million from local funds, and $45.7 million from Federal funds. Compensatory Education Program Bureau staff participated in a study of a compensatory education program for preschool children in California, which was financed par- CHART 3.—CHILDREN RECEIVING CHILD WELFARE SERVICES FROM PUBLIC WELFARE AGENCIES BY LIVING ARRANGEMENTS, MARCH 31, 1967 OWN HOMES ll!IWIImiti;iiirin iililihtlmtitiHlmhi! illllnimdlffila-lill ggfflgffiffis FOSTER w tmnHHWyiHW Wffl 111® 1 FAMILY fe liHlIS lili i I home s i!® ma® llilllal® 11 Smiliffll® B INSTI- TUTIONS ADOPTIVE — / TOTAL \ HOMES j | CHILDREN \ ®®ffl I SERVED I \ 607,900 / ELSEWHERE j 0 50 100 150 200 250 children served (in thousands) Social and Rehabilitation Service 229 tially by AFDC funds and operated through a contract between State welfare and education agencies. Findings showed greatly improved functioning of the children involved and improvement in learning ability and conceptualization. The study documented the interest and active participation of the parents, particularly in minority group areas with Spanish-speaking children and parents. Both teachers and social workers believed that the experience was meaningful for parents and children; teachers expressed greatly changed attitudes toward disadvantaged families. The project also resulted in improved communication between welfare and education agencies at State and local levels. Day Care Public welfare departments were faced with the fact that they must provide day care resources in larger volume than in the past. Each State began assessing its need for day care and planning for expansion. Under title IV, parts A and B, of the Social Security Act, States can establish and operate day care facilities or purchase care from approved or licensed private, public, or voluntary facilities. As of March 31, 1967, the capacity of licensed or approved day care facilities was 475,000 children, as compared with 310,400 in September 1965. Of these, 393,300 were in group day care centers, and 81,900 were hi family day care homes. Twenty-one States, Puerto Rico, and the Virgin Islands were operating 430 public day care centers for children. Bureau staff was represented on the new Federal Panel on Early Childhood, which developed the Federal interagency requirements and guidelines for day care programs. Foster Care The number of children in public and voluntary child welfare foster family care increased from 219,900 on March 31,1966, to 231,200 on March 31,1967, an increase of 5 percent. Both public and voluntary agencies began to develop sequential training programs for foster family groups and to move toward payment for service as well as full reimbursement for the maintenance of the foster child. Agencies also put emphasis on greater involvement of the foster father. Policies and procedures for planned permanent foster family care were made also for children who have no realistic chance to return home or to be placed in adoptive homes. Child welfare agencies in Eos Angeles, Calif., and Washington, D.C., found that reasonable payment for the job, along with training of the foster parents, resulted in a better quality of foster care and much less turnover. 328-184—69----16 230 Department of Health, Education, and Welfare, 1968 To help in the recruitment of foster parents, the Bureau issued the pamphlet .4 Child Is Waiting. Group Care of Children Public and voluntary child welfare agencies reported mounting pressures to find good quality residential group care resources. Rising costs in operating institutions ($3,000-$5,000 per child per year) made it difficult for families with incomes under $15,000 to afford residential care for their emotionally handicapped children. States have been rapidly developing agency-operated group homes as a relatively new residential resource, especially for moderately disturbed children. During 1968, 19 junior colleges established one or more courses to train child care workers for residential institutions. Dutchess Community College in New York State and Fall River Junior College in Rhode Island have 2-year curricula, including supervised field training. Knox College in Illinois has a 4-year program. In March 1968, the Department of Labor funded a $1 million project to train 500 low-income child care workers in Baltimore, Chicago, Cleveland, Newark, and New York. The project will be administered by the Child Welfare League of America, with supervision by the Office of Education and consultation from the Children’s Bureau. The project is scheduled to terminate on December 24,1969. Licensing of Child Care Facilities The Jane Addams Graduate School of Social Work at the University of Illinois and the Children’s Bureau sponsored a Conference on the Regulation of Child-Care Facilities, December 13-16,1967, for 35 representatives of schools of social work, State welfare agencies, and national agencies concerned with children’s services. The Licensing of Child Care Facilities by State Departments of Public Welfare, a new Children’s Bureau publication, provided a basis for discussion. Goals of the conference were identification and training of leadership in child care licensing and initiation of periodic conferences to define the socio-legal base of licensing as a child welfare service. Homemaker Services States reported that homemaker service programs wTere growing, both in numbers and size. The in-home services and services that help improve family living continued to receive more attention nationally, along with the emphasis on the problems of poverty and isolation of groups with their accompanying social problems. A total of 34 States have staff responsible for developing homemaker services in public welfare programs; 19 States have child welfare staff assigned to give special attention to development of homemaker services. Social and Rehabilitation Service 231 In November 1967, the Children’s Bureau held a 4-day workshop for 28 State consultants and specialists on homemaker services—-the first such meeting. Requests were made for further meetings to examine and explore developments, problems, practices, and areas of need. Even though the Child Welfare League of America and the National Council of Homemaker Services have homemaker service standards available, the States need help in establishing their own standards. Child Welfare Services for the Mentally Retarded Extension of the basic child welfare services has continued to increase resources for mentally retarded children and their families, particularly in the areas of family counseling, homemaker services, day care, and foster family care. By conservative estimates, 42,500 mentally retarded children received services from public child welfare agencies during the fiscal year. The university-affiliated training programs, although just beginning, are expected to have substantial effect on the child welfare services available to the retarded and their families and on the teaching-learning patterns of the various professions involved. During the 1966-67 school year, 74 mental retardation agencies with related child welfare services provided field experiences for 185 students, as compared with 27 such agencies and 65 students in the preceding school year. Protective Services for Neglected and Abused Children Protective services, in varying degrees, were available in 49 States, the District of Columbia, Puerto Rico, the Virgin Islands, and Guam. Two-thirds of the States, however, lacked adequate geographic coverage. About 25 States have established specialized protective service units. To achieve statewide coverage, five States used special units exclusively; the other 20 States had one or more specialized protective service units serving a single district, county, or city. Twenty-four hour coverage was provided in 18 States; in 22 States, informal and partial coverage was offered. In many of the States, broad child welfare programs for child protection (rather than specifically for neglected and abused children) demonstrated additional utilization of homemakers, volunteers, and nonprofessional personnel in crisis and emergency situations. Services to Unmarried Mothers The number of births out of wedlock rose from 240,200 in 1961 to 302,400 in 1966, the latest year for which figures are available. The 232 Department of Health, Education, and Welfare, 1968 rate for girls 15-19 was 17.5 per 1,000 unmarried women, as compared to 16.7 in 1965. A number of States emphasized staff training for child welfare workers providing services to unmarried mothers. As of January 1, 1968, there were 45 programs providing comprehensive services, including academic education, social work counseling, and medical care for teenage unmarried mothers. Adoption Services The number of children adopted rose from 152,000 in 1966 to 158,000 in 1967. The proportion of nonrelated children adopted through social agency placement increased from about 50 percent in 1951 to 74 percent in 1967. By exercising flexibility in policies, some States permitted adoption of children by single persons. Publicity encouraged greater numbers of single applicants to apply. Both public and voluntary agencies expanded their efforts to serve “hard-to-place” children. Increased efforts resulted in adoption for blind, deaf, crippled, and mentally retarded children. Child Welfare Training Grants A total of $5.7 million was awarded for 165 grants to strengthen teaching programs in the field of child welfare, 762 traineeships for master’s degrees, 40 traineeships at the post-master’s level, and 10 short-term training projects. JUVENILE DELINQUENCY Increases in Delinquency The Nation’s population increased 10 percent from 1960 through 1967; however, the volume of serious crimes increased 88 percent. During this same period, the population of youth aged 10-17 increased 22 percent, but arrests of youth 10-17 increased 72 percent. About 811,000 juvenile delinquency cases (excluding traffic offenses) were handled by juvenile courts in the United States in 1967, compared to 745,000 in 1966, an increase of 9 percent. These cases represented 699,000 children, or about 2.3 percent of all children 10-17 years of age. The rate of juvenile delinquency court cases in urban areas was three times higher than in rural areas. However, the number of semi-urban and rural court cases increased 13 percent from 1965 to 1966, the latest years for which figures are available. On June 30, 1966, there were approximately 51,000 children living-in public institutions for delinquent children, an increase of 16 percent over 1964. There were 304 public institutions serving children committed by juvenile courts. Of these, 206 were training schools; 87 Social and Rehabilitation Service 233 CHART 4.—JUVENILE DELINQUENCY IS STILL INCREASING 1,300 -r 1,200 — / 1,100 - / 1,000 -- delinquency cases (including traffic) j 900 — J 800 — S"-* 700 -- / ^7 J 600 - II c II rt / / W / / I 500 ” / I delinquency cases O j ' (excluding traffic) __ g 400 ~ 7 -S w / £ ° / 5 >, fXzA / ° s I \ / +J | 300 — / \ 7 4- 30,000 o •S / \ . 1 O ■—j I \ f •' 1 M v / V / I rt / : ° / / I / / • rt 200 - i 4- 20,000 Y ___ child population । ’ a, ''s__ (10-17 years of age) [ $96, 378,306 $2,100,739 2 $252,806 $16,000,000 $7,534,877 $1,245,659 $312,496,699 $97,876,771 Alabama_________________________ 9,555,000 3,184,997 45,211 5,023 410,000 207,257 23,028 10,217,468 3,213,048 Alaska___________________________ 356,955 1 126,474 ______________ 25,000 167,783 55,326 549,738 181,800 Arizona_________________________ 2,854,327 951,441 25,000 2,778 233,500 32,877 3,653 3,145,704 957,872 Arkansas________________________ 6,553,142 2,184,378 26,892 2,988 196,900 20,357 6,461 6,797,291 2,193,827 California_______________________ 21,791,217 7,263,732 260,222 28,914 1,779,100 521,213 57,991 24,351,752 7,350,557 Colorado________________________ 3,747,849 1,249,282 27,193 3,021 236,176 200,148 33,529 4,211,366 1,285,832 Connecticut_____________________ 2,674,958 891,652 39,431 4,381 95,978 86,673 72,681 2,897,040 968,714 Delaware_________________________ 592,356 1 248,419 25,000 2,778 15,430 15,000 12,657 647,786 263,854 District of Columbia_____________ 690,542 1 538,688 12,375 1,375 20,000 251,014 13,956 973,931 554,019 Florida__________________________ 10,491,545 3,497,178 81,721 9,080 619,500 78,892 15,342 11,271,658 3,521,600 Georgia_________________________ 12,531,875 4,177,287 51,670 17,223 550,000 226,686 25,988 13,360,231 4,220,498 Guam_____________________________ 279,592 93,197 ___________________________________________ 279,592 93,197 Hawaii__________________________ 1,118,292 372,764 15,000 53,892 5,988 1,187,184 378,752 Idaho____________________________ 679,800 226,600 25,000 2,778 20,000 ________________ 724,800 229,378 Illinois__________________________ 12,500,000 4,166,663 451,900 436,173 62,550 13,388,073 4,229,213 Indiana_________________________ 2,645,493 881,830 22,042 2,449 111,300 132,384 14,708 2,911,219 898,987 Iowa____________________________ 4,266,300 1,422,099 37,786 4,198 314,200 108,057 13,254 4,726,343 1,439,551 Kansas__________________________ 1,544,973 514,990 30,329 3,370 114,936 68,683 15,253 1,758,921 533,613 Kentucky_______________________ 4,325,000 1,441,665 43,782 4,865 185,000 58,922 6,928 4,612,704 1.453,458 Louisiana________________________ 6,099,340 2,033,111 178,500 171,672 17,976 6,449,512 2,051,087 Maine_____________________________ 787,170 262,390 22,500 2,500 47,859 12,334 1,370 869,863 266,260 Maryland________________________ 5,711,428 1,903,807 49,699 5,522 358,861 144,832 26,443 6,264,820 1,935,772 Massachusetts___________________ 5,432,412 1,810,802 37,049 4,117 43,704 140,415 20,226 5,653,580 1,835,145 Michigan______________________ 8,899,720 2,966,570 85,677 9,520 584,224 231,567 25,730 9,801,188 3,001,820 Social and Rehabilitation Service 255 Minnesota________________________ 6,399,467 2,133,154 32,221 3,580 275,000 147,112 16,346 6,853,800 2,153,080 Mississippi______________________ 4,485,896 1,495,297 21,600 2,400 490,000 305,750 33,972 5,303,246 1,531,669 Missouri_________________________ 6,683,578 2,227,857 36,540 4,060 320,000 155,054 19,072 7,195,172 2,250,989 Montana____________________________ 938,363 312,787 22,500 2,500 107,600 44,546 4,960 1,113,009 320,247 Nebraska________________________.. 1,966,600 655,533 24,999 2,778 80,400 47,663 5,296 2,119,662 663,607 Nevada____________________________ 480,551 > 169,881 25,000 2,778 117,000 225,920 25,103 848,471 197,762 New Hampshire_____________________ 519,335 173,111.________________ 40,427 35,360 4,150 595,122 177,261 New Jersey______________________ 7,092,352 2,364,115 48,383 5,376 340,000 238,602 26,512 7,719,337 2,396,003 New Mexico------------------------ 912,576 304,192 15,930 1,770 75,000 20,524 2,281 1,024,030 308,243 New York_____________________ 19,338,972 > 6,827,698 210,767 23,419 1,444,563 293,281 82,721 21,287,583 6,933,838 North Carolina___________________. 9,963,518 3,321,169 68,776 7,642 522,715 122,971 16,342 10,677,980 3,345,153 North Dakota______________________ 930,000 310,000 ________________ 125,000 43,000 5,624 1,098,000 315,624 Ohio______________________________ 8,811,641 2,937,211 7,162 796 987,072 434,462 101,256 10,240,337 3,039,263 Oklahoma______________________ 5,405,929 1,801,975 9,990 1,110 269,100 139,239 15,471 5,824,258 1,818,556 Oregon___________________________ 2,975,682 991,893 26,892 2,988 255,600 146,866 57,963 3,405,040 1,052,844 Pennsylvania___________________ 20,799,680 6,933,220 149,687 16,632 974,562 411,413 123,772 22,335,342 7,073,624 Puerto Rico_______________________ 3,100,000 1,033,332 _______________ 10,000 20,000 2,222 3,130,000 1,035,554 Rhode Island____________________ 1,626,845 542,281 15,000 1,667 52,474 26,719 2,969 1,721,038 546,917 South Carolina_________________ 8,022,973 2,674,322 35,571 11,857 371,600 53,365 5,930 8,483,509 2,692,109 South Dakota..__________________ 1,008,960 336,320 25,000 2,778 104,264 17,550 1,950 1,155,774 341,048 Tennessee_______________________ 5,379,300 1,793,098 45,428 5,048 212,900 86,055 9,561 5,723,683 1,807,707 Texas____________________________ 14,566,459 4,855,481 147,896 16,433 931,500 324,634 38,717 15,970,489 4,910,631 Utah______________________________ 2,220,000 739,999 ________________ 50,100 ___________________ 2,270,100 739,999 Vermont___________________________ 962,748 320,916 9,378 1,042 54,671 ________________ 1,026,797 321,958 Virginia__________________________ 7,072,975 2,357,656 55,458 6,162 350,984 438,263 48,695 7,917,680 2,412,513 Virgin Islands____________________ 100,000 33,333 ____________________________________________ 100,000 33,333 Washington______________________ 4,573,255 1,524,417 40,991 4,555 386,400 144,225 23,128 5,144,871 1,552,100 West Virginia_____________________ 5,453,973 1,817,989 _______________ 315,000 60,000 6,666 5,828,973 1,824,655 Wisconsin_______________________ 8,270,169 2,756,720 51,991 5,777 100,000 170,472 21,606 8,592,632 2,784,103 Wyoming________________________ 670,000 223,333 25,000 2,778 29,000 15,000 12,416 739,000 238,527 1 Adjusted to reflect the 1965 level of expenditures of State funds. 2 Matching ratio 90-10 for all States, except for two projects at 75-25 ratio: 3100 percent funding. 256 Department of Health, Education, and Welfare, 1968 Table A.—Federal Grants and State Matching Funds in 1968 Under Sections 2 and 3 of the Vocational Rehabilitation Act and Social Security Trust Funds for the State Agencies for the Blind 1 State or territory Section 2 Section 3 Social security trust funds1 2 3 4 Total pounds), led investigators to confirm that almost all cerebral palsy cases classified as spastic diplegia occur in this weight group. The Institute is intensively investigating many of the factors believed related to the causes of cerebral palsy at its Laboratory of Perinatal Physiology in Puerto Rico. Using the rhesus monkey as the experimental animal, scientists there are investigating such major problems as the role of asphyxia in brain damage, placental blood flow, placental insufficiency, and placental abruption. These are known complications in humans linked with infant death and high prematurity rate. Scientists in the Puerto Rico laboratory found that the brain may not be as vulnerable to loss of oxygen for short periods as now commonly believed. It was found that the sudden production of total circulatory arrest is tolerated by the animal for up to 16 minutes without brain damage. Apparently less extreme but continued impairment of blood supply is the more common cause of the usual forms of cerebral palsy. 386 Department of Health, Education, and Welfare, 1968 EPILEPSY RESEARCH Epilepsy is another condition occurring early in life. Affecting a large number of people in the United States, epilepsy has been a major emphasis of the Institute’s research program since its founding. The major attack on epilepsy is being carried out through clinical research centers, established by NINDB in universities. These investigators are studying basic electrical activity of the brain, the way in which it can be surgically altered to reduce epileptic seizures, effects of drug therapy, and the basic mechanisms of epileptic discharges in animals. A pioneer computer laboratory is producing new information about the essential nature of the electrical nerve discharge. Recognizing the need for better communication of research knowledge in epilepsy, the Institute has developed a new service, Epilepsy Abstracts. Each monthly issue digests approximately 200 articles related to epilepsy from the world’s biomedical literature. DISORDERS AFFECTING THE AGED At the other end of the long scale of human development are disorders that affect the aged. These include stroke, Parkinson’s disease, and many other neurological and sensory disorders. New hope for sufferers of Parkinson’s disease has been raised by the recent discovery of a possible new therapy. As a result of limited clinical trials, scientists now have evidence that L-DOPA, a synthetic amino acid that leads to the formation of dopamine in the brain, is effective in relieving the symptoms of parkinsonism in some cases. Whether these encouraging results presage a therapeutic breakthrough in parkinsonism remains to be seen. A second condition which also largely affects the aged is cerebrovascular disease, or stroke. Stroke is one of the major targeted areas of the Institute. In addition to an extensive program of research projects in this area, 18 cerebrovascular research centers are now being supported in major population centers of the country. Each center is concentrating on a major approach to the disease problem. Factors being studied are the dynamics of cerebral blood flow, the biochemistry of blood constituents, the effect of anticoagulant drugs, cerebral cellular metabolism, and aphasia. SCLEROSING DISORDERS Another group of diseases or conditions which affect people mainly in their middle and most productive years are the sclerosing disorders. Multiple sclerosis (MS), the most common disease of this group, is a disease of temperate climates. A worldwide epidemiologic survey has revealed that the place where one spends early childhood is a determining factor in whether MS develops in later life. A study is now being National Institutes of Health 387 planned to determine the latency of this disease and the most common age at which it is actually acquired. Among the most dramatic developments highlighting the area of clinical investigation have been those relating to the role of unusual viral-like agents in degenerative disorders of the nervous system. The role of such an agent in kuru, a rare neurological disease found only in New Guinea, has now been well established. The role of a viral agent in subacute sclerosing panencephalitis has been virtually proven. There are indications that an atypical or incomplete form of measles virus is responsible for this disease, now found to be much more prevalent than previously recognized. These findings have wide implications for other chronic neurological disorders. NEUROMUSCULAR DISEASES A large group of disorders, the neuromuscular diseases, especially affect children and young people. These include muscular dystrophy (MD) in its various forms, myasthenia gravis (MG), and a number of less prevalent conditions. Knowledge of the fundamental mechanism in myasthenia gravis is progressing rapidly. The disease is clearly related to abnormalities of the thymus gland. Institute studies now show that thymectomy is a useful procedure, especially in young women. The use of anticholinesterase drugs is increasingly effective. Germine diacetate has been found effective in treating MG patients who cannot be helped with anticholinesterase medication. The specific metabolic defect present in each of three inherited, retarding, and progressively fatal disorders of infancy—in Niemann-Pick, Gaucher’s, and Fabry’s diseases—has been identified by Institute researchers, and blood tests developed to detect these diseases. HEAD INJURY RESEARCH Many of the estimated 10 percent of the population who suffer from some neurological condition are victims of accidents and have suffered head and spinal cord injury. The Institute is conducting a laboratory program for head injury directed toward understanding the factors causing brain swelling after head injury. It has been proved this year that whiplash injuries, even without direct impact to the head, may cause brain concussion and bleeding. Experimental whiplash injury in rhesus monkeys has demonstrated that cerebral concussion, bleeding and contusions can be produced by rotational jarring of the head on the neck alone, without direct head impact. RESEARCH ON SENSORY SYSTEMS To the physician, the eye is one of the most valuable sources of information for diagnosis of systemic disease. By examining the back of 388 Department of Health, Education, and Welfare, 1968 the eye, he can learn a great deal about other diseases of the brain and its blood vessels. To improve the precision of such an examination, the Institute is developing a special television camera that can observe and measure subtle changes in the minute structures of the eye. EYE RESEARCH PROGRAM The Institute’s eye research program is largely concentrated in 12 large clinical research centers. Research in these centers has recently produced notable advances in the successful repair of retinal detachment by better techniques of examination, surgery, and care. The laser has been used successfully to “spot weld” the retina in certain types of retinal detachment. The successful treatment of some patients with diabetic retinopathy has been accomplished by the removal of the pituitary gland. Other advances include better diagnosis and treatment of glaucoma, more effective grafting of corneal transplants, tests to detect the harmful side effects of such drugs as chloroquine, and new methods of detecting and treating ocular tumors. A new drug, isosorbide, has been found to be a useful agent in acute primary and secondary glaucoma, and as a preoperative medication for various types of eye surgery. The significance of advances of fundamental knowledge in vision research was highlighted this year when two of the Institute’s grantees received Nobel Prizes for their contributions—Dr. Hal den Keffer Hartline for studies of the physiology of vision, and Dr. George Wald for contributions to the understanding of the chemistry of the visual pigments. INFORMATION NETWORK To hasten dissemination of scientific information and to aid in program analysis, the Institute this year established a National Informaton Center on Vision Research at the Harvard University library. Objectives of the center are to define, identify, and store for retrieval the literature of vision so that the information may be more useful to research scientists, teachers, and practitioners. The vision center is the last of four such centers comprising the Institute’s Information Network. This network is now providing scientific information to scientists through the world, covering basic and clinical neurology areas and communication. Clinical Center The Clinical Center provides necessary facilities and support services for the clinical investigation programs of the various NIH Institutes through its 516-bed research hospital. Primary consideration, however, is the welfare of the individual patient. National Institutes of Health 389 During fiscal year 1968, Clinical Center patients numbered 6,510. Readmitted patients outnumbered almost 2 to 1 those admitted for the first time. First registrations were 1,378; readmissions, 2,649. Outpatient registrations totaled 2,483. There were 4,027 patients admitted. Patients (adult and pediatric) were hospitalized for an average of 33 days; 69 percent of the beds were occupied on the average. Construction of two additional floors (sixth and seventh) on the D wing was completed. The new area totals approximately 14,000 square feet. Occupancy by patient care staff took place in June. In its first full year of operation, the Department of Nuclear Medicine conducted 3,246 complete studies and performed more than 1,300 laboratory and other surveys. Television engineering was increasingly used in various diagnostic techniques. Installation of two new video tape recorders enabled the staff to completely tape biplane procedures from the Heart Catheterization Laboratory and images produced by the Nuclear Medicine Department’s gamma scintillation camera. More effective utilization of blood by the blood bank permitted 20,962 transfusions of blood or components from total acquisitions of 16,308 pints. Clinical Pathology staff members worked with Bureau of Standards personnel on development and use of highly purified chemicals as standard materials for clinical chemistry. Notable progress was made on instrumental design for automated urine analyses. Division of Biologies Standards The Division of Biologies Standards (DBS) is responsible for administration of those provisions of the Public Health Service Act concerned with the Federal licensing and control of biologic products that are offered for sale in interstate commerce or for export or import. These biologies include the vaccines, serums, toxins, antitoxins, as well as human blood and its derivatives, that are used for the prevention and treatment of diseases in man. RUBELLA VACCINE In the past several years, great strides have been made in rubella research. Infections of this disease during early pregnancy frequently result in spontaneous abortions, stillbirths, or birth of infants with grave defects such as blindness, deafness, heart disease, and brain damage. It has been estimated that during the last epidemic in the United States (1964-65), rubella led to 30,000 fetal deaths and the birth of 20,000 deformed children. 328—184—69---26 390 Department of Health, Education, and Welfare, 1968 In 1966 two DBS scientists reported the attenuation or “taming” of the virus. They used their weakened virus (named HPV-77) to prepare the first effective experimental rubella vaccine. The HPV-77 strain was made freely available to investigators and pharmaceutical manufacturers here and abroad. Vaccines prepared from this strain had been administered to approximately 20,000 persons by June 30, 1968. No vaccinees have experienced adverse reactions from the vaccine, and more than 90 percent have developed antibodies indicating immunity. Continued evaluation of the first children inoculated 2 years ago by the DBS team indicates that the level of vaccine-induced protective antibodies in their blood is unchanged. These observations encourage investigators to feel that the immunity conferred by the HPV-77 attenuated strain will be of long duration. Trials with HPV-77 vaccines have been conducted in the United States, Canada, England, France, Russia, Holland, Finland, Sweden, and Taiwan. Studies have shown that the attenuated HPV-77 strain does not spread to contacts of vaccinees, such as other family members or, in institutional settings, other infants, children or young adults. This past year, a simple blood test (HI test) to determine rubella immunity was perfected by DBS scientists. This procedure has now moved from the DBS research laboratory to international application in vaccine development centers, hospitals, diagnostic laboratories, and doctors’ offices. In vaccine work, the HI test is used to identify appropriate candidates (persons susceptible to rubella) for vaccine studies and to determine the antibody (immunity) response induced by the vaccines. Because of its simplicity, precision, and speed, the HI test is expected to advance the target date of a final rubella vaccine by about 1 year, and to result in a saving of over a million dollars in Government expenditures for rubella vaccine research. RHo (D) immune globulin Each year, about 300,000 babies whose mothers have Rh-negative blood and whose fathers have Rh-positive, are possible victims of Rh disease (erythroblastosis fetalis). It occurs in about 10 percent of all pregnancies in which an Rh-negative mother gives birth to an Rh-positive baby, and is estimated to cause the death of 5,000 infants in this country annually. Rh incompatibility becomes a problem when, during birth, red blood cells pass from the fetus into the mother’s blood stream. If the baby’s cells have the Rh-positive factor, the Rh-negative mother’s body may begin to develop antibodies against them, just as though it had been National Institutes of Health 391 invaded by an infectious disease. The first child of an Rh-incompati-ble union is rarely affected, but serves to sensitize the mother so that, in future pregnancies, the sensitized mother’s antibodies may enter the Rh-positive baby’s blood stream and destroy the red cells. The principal therapy for affected infants has been exchange blood transfusion, but for the past 8 years scientists in this country and abroad have been looking for a practical means of preventing the disease. After 12 months of intensive study, the DBS developed standards for Rh0 (D) immune globulin, a form of gamma globulin used to prevent Rh disease. This product, under the trade name of Rn0GAM, was licensed in April 1968. MULTIPLE ANTIGENS DBS research on biological products is necessarily related to current public health and medical practice. Because of the many diseases which can be prevented by immunization, there has been a growing tendency to use multiple vaccines combined in one injection. The usefulness of multiple antigens, however, must be determined on the basis of the combined effect, and with the assurance that no component inhibits the immunogenic effect of another. DBS scientists have pioneered over the past several years in investigating the possibility of combining certain live virus vaccines. In their early work (Upper Volta, West Africa 1964) they found that combined measles, smallpox, and yellow fever vaccines could be administered safely and effectively by jet inoculation into susceptible children. Such combinations are especially useful for mass immunization campaigns in the developing countries of the world. Based in part on these early findings of DBS, one of the larger pharmaceutical manufacturers began developmental work on the combination of live measles and smallpox vaccines for commercial production. This cooperative effort resulted in the licensing in late 1967 of a combined measles-smallpox vaccine, the first commercial combination of live virus vaccines. It is anticipated that additional multiple antigens will be developed, and DBS research in this area is continuing on that premise. MUMPS VACCINE A live mumps vaccine, under extensive testing for safety and potency in DBS laboratories for a year and a half, was licensed in December 1967 for commercial distribution. The new, single-injection live vaccine, which was developed by the manufacturer over a 5-year period, is prepared in chick embryo culture—the system which is already in use for the production of live measles vaccines. In the nationwide clinical tests, approximately 95 percent of the susceptible children 392 Department of Health, Education, and Welfare, 1968 and adults to whom it was administered developed protective antibodies. The vaccine is recommended for children approaching puberty, adolescents, and adults who have not had mumps. It is not recommended for younger children pending development of more information on the duration of immunity. Mumps infects about 80 percent of the population before adulthood and is usually regarded as an innocuous disease in childhood, although complications may occur. After the onset of puberty, however, the virus may affect the reproductive organs. INFLUENZA VACCINES Influenza vaccine was first licensed in 1945. Unlike vaccines against other virus diseases, the protection provided by influenza vaccines depends on representation of prevalent virus strains known to have caused recent influenza epidemics. The properties of these viruses do not remain constant but change from time to time in unpredictable ways. Since influenza has a worldwide incidence, DBS keeps in close contact with influenza centers throughout the world. A yearly review of epidemiologic and laboratory data obtained from many sources on the prevalent influenza viruses enables DBS to establish a vaccine formula suitable for the next year’s influenza season. Early in the spring of 1967, all influenza vaccine manufacturers were advised by the DBS of the desirability of making available two influenza vaccine formulas for the 1967-68 season: a newly introduced bivalent vaccine and the traditional polyvalent vaccine. The bivalent provides greater protection against current strains of influenza, whereas the polyvalent vaccine stimulates a broader immunologic response. Both the bivalent and the polyvalent vaccine formulas contain the same total quantity of influenza antigens, but the bivalent includes considerably greater representation of contemporary A2 and B strains than is possible in the polyvalent. Division of Computer Research7and Technology The Division of Computer Research and Technology is charged with planning and conducting research, developmental and demonstration programs in mathematical and other computer-related sciences, including information processing, in support of NTH programs. The Division provides a technical advisory resource in relevant areas of mathematics and other computer related sciences. National Institutes of Health 393 UTILIZATION OF ELECTRONIC DIGITAL COMPUTERS During fiscal year 1968 conversion of the central computer facility to OS/360 equipment was achieved. A third 360/50 was installed in May 1968, and significant advancements were made in modifying the vendor-supplied operating system to provide reliable, efficient and responsive machine servicing to the broad computer needs of NIH. Computational and programming support to research and management programs was increased. In fiscal year 1968 the Division took initial steps in establishing a computer center to handle all computer needs and requirements of the Institutes and Divisions. Currently, the center has approximately 700 users. Ultimately it will enable any NIH scientist to type out in program language a request for information, send it to the center via telephone lines, and promptly receive the required information. Two projects, both of which will increase computer efficiency while resulting in reduction of costs, were initiated. One project involved implementation of two systems—HASP and SPOUT—on the 360/50 computers, and increased computer throughput by about 30 percent while realizing an estimated savings of $30,000 in fiscal year 1968. The two systems, operating in defined segments of the computer’s memory at the same time, increased the total of jobs processed per day from 350 in January 1968 to well over 600 per day in May. A shared libraries project involved establishing a central library for programs which all Division computers may use, which is expected to significantly reduce costs. OTHER PROGRAM ACHIEVEMENTS A 360 program for adaptive filtering of bioelectric signals was completed and documented, and supplementary methods of programming were developed by the Laboratory of Applied Studies. This technique permits analysis of noise patterns in relation to signal content, and estimating of signal/noise ratios in many experimental situations. A system of linked computer programs completed in fiscal year 1968 made it possible to analyze continuously recorded measurements of cardiac pressures and blood flow obtained during heart surgery and diagnostic procedures. In the Laboratory of Physical Sciences, numerical procedures and programs were developed for interpreting nuclear magnetic resonance data. A mathematical model was developed for the effects of noise on nerves. The Heuristics Laboratory was established in midyear to develop concepts, techniques, and programs for automatic answering of questions and deductive solving of biomedical problems. 394 Department of Health, Education, and Welfare, 1968 A major effort by the Computation and Data Processing Branch molded the vendor-supplied IBM 360 software into a reliable, responsive, and expandable computer system. Computers are now able to operate with four simultaneous streams. While computation of one program is underway, input for the next few jobs is simultaneously being read in and stored. Results for the last several jobs are being printed simultaneously, with one output stream and one printer devoted to systems messages, diagnostics, and small scientific results that have immediate relevance, and another output stream and printer to large printing loads resulting from administrative and management data processing. Tablemaker II became operational on new hardware early in the year. This device enables anyone with no computer experience to take a basic file of data, extract relevant information, recode the control variables or otherwise regroup or reexpress the data. The data can be operated on by logical or arithmetic operations to computer frequencies, averages or expectancy tables, and then presented along with appropriate descriptive material in tabular form. Division of Environmental’Health Sciences The mission of the Division of Environmental Health Sciences is to determine the significance and magnitude of the health hazard of low-level concentrations of biological, chemical, and physical agents present in or introduced into our environment. The Division tests selected contaminants, singly and in combination, to determine the underlying mechanisms of adverse response, with the goal of determining standards and guidelines for protective or preventive control measures. CONSULTATIVE SERVICES During the year, the Division provided consultative services, guidance, and documents for the following environmental problems to other F ederal agencies: • Lung-cancer hazards to uranium miners. • Hazards associated with the asbestosis problem. ® Position documents on smoking and health. ® Pesticide hazards to man including DDT, DDD, and DDE in milk and milk products. ® Potential hazards of Mace as a riot-control agent. • Problems of drinking-water quality standards and the water recycling program. • Carcinogenic hazards associated with particulate contamination of the air. National Institutes of Health 395 LABORATORY RESEARCH During this fiscal year, an in-house laboratory research program was launched at the National Environmental Health Sciences Center (NEHSC), the intramural research component of the Division. ANIMAL SCIENCE AND TECHNOLOGY The Animal Science and Technology Branch, during the year, conducted research in the following areas: interactions between chemicals, such as heavy metal salts and pesticides, and viral infections; the effect of a prototype alkylating agent on the immune responses of rabbits to an attenuated viral vaccine; the effect of whole body gamma radiation on the immune response of rabbits to an attenuated viral vaccine; a project to test the suitability of hydroponically grown grass as a supplement for laboratory animal diets; and a study of embryo development as a measure of environmental changes. CELL BIOLOGY Research programs being carried out by Cell Biology Branch scientists included: studies on toxin production by fungi found on vegetables and other foodstuffs for human consumption; studies of the effects of compounds, such as pesticides and heavy metals, on enzymatic and other processes involved in collagen synthesis and differentiation of cells and tissues; studies on the effects of selected alkylating agents in inflammatory reactions, on the synthesis and functioning of peptide hormones, and on specific enzymes and metabolic processes; and studies on the effects of pesticides and other environmental toxicants on cell membrane structure and function. PHARMACOLOGY AND TOXICOLOGY Pharmacology and Toxicology Branch research was designed to study the chronic effects of long-term, low-level exposures to environmental agents. Projects centered on such areas as: the influence certain compounds which pass the placental barrier have upon the fetus; teratogenic responses to administration of specific drugs; the postnatal effects of prenatally administered chemicals on the developing fetus; and genetically determined characteristics that modify response to chemicals. ANALYTICAL AND SYNTHETIC CHEMISTRY Accomplishments of the Chemistry Branch included: the assembly of environmental chambers for the elaboration of the effects of ultraviolet radiation, ozone exposure, and other factors on the stability of certain groups of pesticides; the separation and identification of components of oils of calamus and nutmeg by chromatographic and spectroscopic techniques; and the synthesis of intermediates for metabolic and teratogenic studies. 396 Department of Health, Education, and Welfare, 1968 OCCUPATIONAL STUDIES The Occupational Studies Program continued and completed several studies transferred from the National Cancer Institute in July 1967: Also, an analysis of uranium miner data led to a report to the Federal Radiation Council for a review of radiation exposure in miners; assessment of steelworker mortality findings; updating of mortality findings on chromate paint workers; and assessment of data on other industrial workers, such as those in the cutting oil industries. RESEARCH PROJECT GRANTS The increasing use of soaps, cosmetics, detergents, antibiotics, diuretics, and tranquilizers containing photochemical agents is multiplying the number of patients experiencing externally induced skin diseases. Grantees of the Division have developed a phototesting unit that facilitates the development of screening tests for the prediction of the photoactivity of chemicals prior to their commercial use. Although satisfactory procedures for the detection of pesticides in fat tissue have been available for some time, these methods are not sufficiently sensitive to detect these pesticides in tissues such as liver, brain, gonad, and kidney in the minute concentrations in which they are present in the general population. A group of grantees has developed a rapid, reliable procedure capable of detecting pesticides in concentrations of a fraction of a part per billion. This highly sensitive chemical procedure was then utilized in an attempt to discern current levels of exposure to pesticides in the general population as well as the occupationally exposed. The role of the home usage of pesticides in the variable concentrations of pesticides stored in human bodies has been investigated by DEHS grantees. A striking correlation was observed between the concentration of the insecticide DDT and the degree of household exposure. The average DDT concentration in a group of people associated with high household usage of the insecticide was over four times the average concentration among individuals who rarely used pesticides in the home. The results suggest that while an average baseline concentration may be produced by pesticide-contaminated food, the household use of pesticides is responsible for increased pesticide levels in the body. Swedish observations that heredity is an important factor in certain coronary and respiratory symptoms in smokers have been confirmed by Division grantees. A questionnaire addressed to almost 15,000 male twins sought information concerning medical data, smoking, and occupational activities. The lack of difference in the prevalence of coronary symptoms between smoking and nonsmoking twins suggests the importance of genetic factors in the development of coronary National Institutes of Health 397 symptoms. Respiratory symptoms were more prevalent among smoking twins than among their nonsmoking counterparts, although the difference was not as marked as that found between smokers and non-smokers in the general population. These findings indicate that both genetic factors and smoking influence the onset of respiratory symptoms. The continuing release of new chemicals into the environment as a consequence of technological progress results in new and potentially hazardous exposures to human populations. Inasmuch as certain of these chemicals are accumulated in body tissues, the question is raised concerning the role these stored agents may play in interference with biological mechanisms and in development or exaggeration of chronic disease. A group of DEHS grantees has developed a method of measuring the concentrations of zinc, copper, cadmium, and lead in hair. A study of over 200 individuals of various ages in an urban population sample revealed gradual but varying increases in the metals over a lifespan. Inasmuch as cadmium tends to localize in such organs as the liver and kidney and to displace zinc, which is essential in trace amounts in certain cellular functions, further study is indicated concerning the role of long-term exposure to cadmium in human health. Table 6.—Division of environmental health sciences, distribution of appropriation [In thousands] 1967 1968 actual actual Research grants: Regular program: N oncompeting.......... Competing______________ Supplemental.. ........ New____________________ Total, regular......... Special program: General research support. University-based centers. Total, special________ Total, research grants.. Fellowships____________________ Training grants________________ Total grants..----------- Laboratory and clinical research. Research contracts_________ Review and approval------------ Program direction______________ Management fund________________ Total, direct operations_ Total____________________ $1, 654 $3,631 896 360 67 34 1,451 924 4,068 4,949 ....... 547 2,529 3,000 2,529 3,547 6,597 8,496 99 42 3,693 3,763 10,389 12,301 1,113 2,825 (100) (583) 270 302 145 274 434 1,006 1,962 4,407 12,351 16, 708 398 Department of Health, Education, and Welfare, 1968 UNIVERSITY-BASED CENTERS A considerable portion of the Division’s resources has been devoted to the development and support of comprehensive university-based centers for research and research training in environmental health— with particular relevance to human health. These centers provide a focus for continuous problem definition, synthesis of existing knowledge, research stimulation and training, as well as a collaborative attack on a host of current and emerging research problems. During the past year an additional center was created, bringing the total number to five. This new center at the Harvard University School of Public Health will emphasize studies of the biological effects of atmospheric pollution, pesticides and other food residues, and the effects of body burdens of radionuclides and other chemicals. Table 7.—Research grants program analysis 1968 Estimate Toxicology______________________________________________________$2,167, 000 Pesticides______________________________________________________ 2, 098, 000 Natural products___________________________________________________ 325, 000 Synthetic organics_________________________________________________ 218, 000 Heavy metals_______________________________________________________ 174, 000 Smoking and health__________________________________________________ 82, 000 Subtotal, regular program____________________________________ 5, 064, 000 General research support grants_____________________________________ 547, 000 University-based centers____________________________________________ 3, 000, 000 Total, research grants______________________________________ 8, 611, 000 Division of Research Facilities and Resources The Division of Research Facilities and Resources seeks to expand and improve the Nation’s institutional resources essential to biomedical research and scientific progress through five programs: special research resources; general clinical research centers; animal resources; general research support; and health research facilities. SPECIAL RESEARCH RESOURCES This program provides biomedical research institutions throughout the United States with the complex, highly specialized equipment needed for advanced research but too expensive for individual projects. In the fiscal year 1968, through grants totaling $10 million, the program supported 50 specialized research resources, of which 41 were computer centers and six were analytic biochemistry instrumentation resources. Computer centers funded by this program made possible high-speed memory storage and retrieval as well as the collection, processing, National Institutes of Health 399 and analysis of data on a massive scale, permitting studies otherwise inconceivable. They also can continuously monitor and automatically modify certain types of research experiments. For example, in a study at Washington University, St. Louis, Mo., a machine was taught to recognize abnormalities in heart rhythm, making it possible to collect and rapidly analyze data on the electrical behavior of the heart following myocardial infarction. Ultimately, it is hoped this will lead to devices to alert the physician to undesirable coronary events taking place. Another intriguing and potentially powerful advancement in computer technology is the capability of the computer to “read” and respond to the user in a conversational mode. While full exploitation of this power is many years away, a Division-sponsored study at the University of California in Los Angeles, has enabled a user to request individual or grouped patient data, ask detailed questions about it, and perform statistical evaluations. He may also display and analyze chromosomal patterns at the console. GENERAL CLINICAL RESEARCH CENTERS This program is designed to translate laboratory findings into new diagnostic and treatment techniques which can more readily be brought to the patient. During the fiscal year, the program provided $30,443,000 to support 91 centers. New advances against disease and disability were made in many areas. A group of hypertensive patients was found to have markedly increased production of certain adrenal hormones. It was found that these individuals have a specific adrenal enzyme defect which results in abnormally high rates of adrenocorticotropin (ACTH) production. In these patients, ACTH secretion has been suppressed by small doses of hydrocortisone, and lifelong hypertension has been cured. Two centers have undertaken thymus transplants, one with notable success, in an attempt to reconstitute immunologic reactivity in patients with fatal deficiencies in this regard. In the successful case, a thymus gland from an aborted fetus was transplanted into an infant born without the gland. Since implantation, the baby has thrived and his blood counts are normal; he can reject a skin graft and has had no significant infections. The diagnosis, treatment, and basic understanding of cancer continues to evoke massive research efforts at the centers. The site of many tumors can now be identified by an elevated temperature of the overlying skin, as heat is produced by the increased metabolic activity accompanying malignancy. Thermography is being utilized to discover previously unidentified foci of malignancy, especially in the breast, and to measure the effectiveness of various kinds of therapy. 400 Department of Health, Education, and Welfare, 1968 A valuable adjunct of the clinical center program has been the training of medical students, interns, nurses, and other medical personnel. Reports for fiscal year 1967, the most recent year for which data is available, indicate that more than 5,000 medical students, interns, residents, and fellows have been trained through this program. Of this number, almost 2,000 were medical students. ANIMAL RESOURCES The animal resources program helps institutions secure the high-quality research animals needed for biomedical investigation. The program supported 58 animal resource projects under an appropriation of $5.1 million. Established in 1967, the Reference Center for the Study of Primate Viruses, a national resource at the Southwest Foundation for Research and Education in San Antonio, Tex., provided such services as a working repository of newly isolated primate viruses, and an information exchange between primate centers and other research organizations using the baboon as a research model; it also served as a source of reference reagents for new and existing prototype viruses. The Animal Resources Branch also awarded eight training grants totaling $318,000 in fiscal year 1968. Awarded to academic institutions to support postdoctoral training for veterinarians in laboratory animal medicine, these grants supported 26 trainees in programs requiring 2 to 3 years for completion. With an appropriation of $200,000, the laboratory animal science fellowship program offered approximately 20 postdoctoral and special fellowships to qualified individuals holding the D.V.M., M.D., or Ph. D. degree. The seven regional primate research centers were instrumental in improving animal care and veterinary medicine for primates. In fiscal year 1968, $10.5 million was appropriated for this program. Also during the year, 111 professional center core staff members were actively engaged in research at primate centers, which provided facilities and assistance for 32 visiting scientists and material for 83 collaborators from numerous domestic and foreign universities. The center core staff was engaged in 44 federally supported project grants totaling $2,532,000. GENERAL RESEARCH SUPPORT The general research support programs help institutions develop their scientific research capabilities so they may become effective partners with the Federal Government in the pursuit of the biomedical research and research training objectives important to both. The program is composed of three distinct elements: general research National Institutes of Health 401 support, biomedical sciences support, and health sciences advancement awards. During fiscal year 1968, $48.2 million was distributed to 311 institutions for GRS support. Of this total, $25.8 million went to medical schools. The next largest category, hospitals, received $8.2 million. At the University of Colorado School of Medicine, Denver, Colo., under this program, a screening test was devised for evaluating the intellectual and behavioral development of children from birth to 6 years. The test has proven so valuable that the American Academy of Pediatrics has recommended its routine use to pediatricians, and it has been adopted on a nationwide basis for evaluating Project Headstart children. Hundreds of requests about this test have been received by the Division from schools and pediatric organizations. The biomedical sciences support grant program was initiated to include nonhealth professional components of the graduate divisions of academic institutions. In 1968, $7.5 million was appropriated for this program and awards were made to 102 institutions. The health sciences advancement award program is a competitive program to encourage comprehensive institutional advancement toward excellence in biomedical research and research training. It provides grants to carefully selected colleges and universities that can become institutionally distinguished in research and research training by developing their facilities, staff, and research potential. The 1968 appropriation of $4 million permitted two new awards, bringing the total to nine. HEALTH RESEARCH FACILITIES The health research facilities construction program, created in 1956 to expand the Nation’s physical facilities for research in the health sciences, supports grants for new construction and remodeling of present facilities. In fiscal year 1968, 45 grants totaling $39,482,293 were awarded; 40 facilities employing construction grant funds were completed. Exciting work in cardiovascular surgery, pioneered by distinguished investigators such as Drs. Michael DeBakey, Adrian Kantrowitz, and Norman Shumway, has been performed in facilities funded partly by grants from the health research facilities program. Similarly, Drs. Arthur Kornberg and M. Goulian did their epoch-making work on the synthesis of DNA—popularly described as the creation of living matter in the test tube—in facilities built with the assistance of health research facilities program funds. In the 12 years since its inception, the health research facilities program has awarded 1,462 grants totaling over $452 million. The 406 recipient institutions have contributed over $600 million in matching 402 Department of Health, Education, and Welfare, 1968 non-Federal funds to these moneys, resulting in the addition of over 18 million net square feet of space to the Nation’s health research resources. Division of Research Grants At the beginning of fiscal year 1968, an office was established within the Office of the Director, DBG, to undertake responsibility for two “single-manner” functions delegated to the Division by the Surgeon General: (1) the evaluation of assurances received from grantee institutions in compliance with PHS policy on projects involving human subjects; and (2) the expansion of the program to authorize certain major PHS grantees to undertake increased management responsibility for prior approval changes in restricted budget categories. In April 1968 the Division assumed responsibility for coordinating and issuing NIH extramural policy and procedural materials. Throughout the period under review, the Division continued to receive and process research, research training, and research fellowship applications for all sectors of the Public Health Service. An estimated 30,000 grant and award applications were received by the Division. Of these, 25,003 research grant applications were processed and assigned of which 11,000 or more were reviewed for scientific merit by the DEG study sections and committees. The Division also received and assigned 5,097 new and competing renewal fellowship award applications; 530 new and competing renewal research career applications, and 2,165 new and competing renewal training grant applications. There was an overall increase in training program applications of 4.5 percent in new and competing renewal, and 1.5 percent in all training applications received and assigned over the previous year. More than 18,000 reprints and 2,000 progress reports resulting from PHS-supported research were received and distributed to appropriate offices and staff. Division of Research Services The Division of Research Services provides scientific, technical, and engineering services to support and further the research programs of the NIH. The programs of the Division may be divided into two broad classifications : programs in direct support of research; and programs related to NIH facilities and proper environment. The Division of Research Services is comprised of eight branches: Engineering Design; Construction Engineering; Plant Engineering; National Institutes of Health 403 Environmental Services; Biomedical Engineering and Instrumentation; Laboratory Aids; the NIH Library; and Medical Arts and Photography. Recently the Division strengthened management of DRS activities by realining functions within and among several of the branches. The most extensive area of reorganization concerns the former Research Facilities Planning Branch and the Plant Engineering Branch. To handle NIH’s increased construction and maintenance workloads, RFPB was abolished and its elements regrouped into an Engineering Design Branch and a Construction Engineering Branch. At the same time, the engineering design and construction activities of PEB were transferred into the appropriate new branches, with PEB retaining responsibility for operation, maintenance, and alterations of the NIH buildings and grounds. In another change, the sectional structure of the Environmental Services Branch was reorganized to enable the branch to be more responsive to Institute needs. The branch organization is now based on functional programs rather than professional disciplines, and recognizes the growing role of biohazards control as a prime factor in maintaining a satisfactory environment. CONSTRUCTION A primary function of DRS is administering NIH construction programs. In fiscal year 1968, design and construction associated with the expansion of NIH facilities continued at a record pace. The current program includes more than 20 projects in various stages of planning, design, or construction, having a total cost in excess of $100 million. Eleven projects were under construction during the year. The Gerontology Research Center, a 93,000-square-foot laboratory building located on the Baltimore City Hospital’s grounds, was completed. Also, three major construction projects were carried to virtual completion during the year. The projects are the NCI virus isolation facility, located southwest of the National Library of Medicine, the library and cafeteria additions to the south side of the Clinical Center, and the 2-story addition to wing D, on the south side of the Clinical Center. The design of several projects, including two multilevel parking facilities, was nearly completed. RESEARCH ANIMALS DRS also provides research animals for NIH scientists. Over a million laboratory rodents and rabbits were produced in 1968. Major emphasis was placed upon data processing of production and animal issue information, to achieve greater efficiency in the utilization of limited production facilities. 404 Department of Health, Education, and Welfare, 1968 Programs to improve the quality of all animals furnished to intramural research programs were continued. For the first year in recent history, the rodent and rabbit production colonies experienced no major outbreaks of disease. Significant improvement was made in the quality of the random source dogs and cats issued. This is directly attributable to the lengthening of the conditioning period from 30 to 45 days. A development of singular importance, the successful establishment of a large colony of donor dogs to furnish whole blood, has resulted in a significant reduction in the number of dogs required for research purposes at NIH. The furnishing of blood, coupled with improvements in the health status of conditioned random source dogs, reduced the need for dogs by 786 animals. Projected dog issues for the year were 3,612, the fewest number of dogs issued since fiscal year 1960. BIOMEDICAL ENGINEERING A dramatic new area of research support in DRS is biomedical engineering, which combines the talents of engineers and medical researchers. Major emphasis was placed on direct collaboration between DRS professional staff and intramural researchers in the conduct of biomedical research and development programs. The biomedical engineering staff was involved in approximately 400 research and development tasks. During the year, the staff made noteworthy original contributions in the areas of artificial organs, materials, laser technology, mechanization, automation, physiological monitoring, patient care, and physiological systems analysis. Federally Aided Corporations Howard University Howard University, located in the District of Columbia, was chartered by an Act of Congress on March 2,1867. The University consists of 10 schools and colleges, and offers programs of higher education 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’s degree are registered in the graduate school; professional students are registered in the colleges of medicine, dentistry, pharmacy, fine arts, schools of engineering and architecture, social work, law and religion. (The school of religion receives no support from Federal funds.) Enrollment of Students The University served a total of 13,236 registrants during the year 1967-68 distributed as follows: 9,391 students during the regular two-semester session; 2,203 students during the 1967 summer session; and 1,642 registrants for special programs. For the regular two-semester term, the 9,391 enrollment for the several divisions was as follows: liberal arts, 5,190; graduate school, 1,231; engineering and architecture, 813; fine arts, 482; social work, 218; medicine, 410; dentistry, 342; pharmacy, 235; law, 417; religion, 53. There were 212 students enrolled in Army ROTC and 515 students in Air Force ROTC. There were 9,727 degree-seeking students from the United States: New England States, 211; Mideastern States, 5,286; Great Lakes States, 608; Plain States, 129; Southeastern States, 3,116; Southwestern States, 204; Rocky Mountain States, 20 ; Far Western States, 151; Alaska, 1; and Hawaii, 6. There were 1,755 foreign students enrolled during the second semester, 1967-68. These foreign students came from 38 countries and 8 island possessions of the British, French, and Dutch West Indies. Faculty There were 1,164 teachers serving the University during the school year. There were 568 full-time teachers and 596 part-time teachers. 328-184—69---27 405 406 Department of Health, Education, and Welfare, 1968 The full-time equivalent of the teaching staff was 704.84. Of this full-time equivalent, 688.57 were teaching at the rank of Instructor or above. Graduates During the 1967-68 school year, there were 1,438 graduates from the 10 schools and colleges, distributed as follows: liberal arts, 679; engineering and architecture, 69; fine arts, 66; graduate school, 207; social work, 99; medicine, 93; dentistry, 72; dental hygiene, 19; pharmacy, 22; law, 97; religion, 15. From the date of its establishment in 1867, Howard has graduated 27,860 persons. The professional programs have produced graduates in the following fields: medicine, 3,833; dentistry and dental hygiene, 2,300; law, 2,002; religion, 477; engineering and architecture, 1,527; and social work, 1,033. Program Developments Among the significant events which took place during the school year 1967-68 were: Exhibition of Paintings and Prints by Charles Mungolo, under the patronage of the Democratic Republic of the Congo; Summer Workshops in the Materials of Negro Culture, sponsored by the National Foundation on the Arts and the Humanities; Institution of a Work-Study program with Government and Industry for students in the School of Engineering and Architecture; Conference on the Medical Genetics of the Negro, sponsored by the Department of Pediatrics, College of Medicine; the Annual Meeting of the American Physiological Society; Expansion of the Continuing Education Program in Dentistry offering short refresher courses and exposition courses designed for the general practitioner; and a symposium on the future of Puerto Rico, held in the School of Law. Three teachers received study grants from the Ford Foundation to assist them in completing work for the Doctor of Philosophy degree. Several members of the faculty traveled abroad collecting materials for publication of books now in process. The Building Program Office had 17 projects under its administration in varying stages of development. They represented an expenditure, when completed, of approximately $50 million. The rising cost of construction, resulting in estimates of cost in excess of appropriations, has delayed the progress of several projects. Federally Aided Corporations 407 Gallaudet College Program Emphasis As its principal activity, Gallaudet College offers an accredited 4-year undergraduate course of studies for the deaf leading to either the BA. or the B.S. degree. In addition, it offers a 1-year college preparatory course for deaf students and, for both the deaf and the hearing, accredited 2-year Master’s degree programs in education of the deaf and in audiology. Partly as a public service and partly to provide laboratory schools for graduate students, it also operates on-campus facilities for education of deaf children from the District of Columbia and adjacent States at preschool, elementary, and secondary levels. Planning for establishment of a model high school for the deaf on campus is in an advanced stage. Research The research activities of the College produced a variety of outputs during the year. The Sensory Communication Research Laboratory developed a visible speech trainer that was tested extensively in the speech training of deaf students. Joint research over the past several years by the Linguistics Research Laboratory, the Office of Institutional Research, and the department of English culminated in a textbook on generating English sentences that was put into classroom use during the year. The Office of Institutional Research produced books and video tapes on some 700 new signs with precise meanings that had been developed specifically to assist instruction in the various departments of the College; these signs were also put into classroom use during the year. The Office of Demographic Studies succeeded in developing a nationwide system for collecting demographic, educational, and audiographic data on hearing impaired children; as a result, a permanent program for an annual census of such children has been established. Enrollment Regular session enrollment in the 1967-68 academic year rose to 968, an increase of 80 over the previous year. Enrollments in subsidiary schools decreased slightly, the nursery school from 50 to 44, and the elementary and secondary school from 185 to 173. A total of 112 Bachelor’s and 33 Master’s degrees were awarded. 108 Department of Health, Education, and Welfare, 1968 Students enrolled in full sessions in the summer of 1968 totaled 134. Of these, some (primarily teachers of the deaf) were attending a graduate institute in science; the rest were newly admitted deaf students taking courses to remove deficiencies in English and mathematics. 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 country. The Federal act “To Promote the Education of the Blind,” originally passed in 1879, authorizes an annual appropriation 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 blindness: “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, talking books, recorded tapes, Braille music publications, large-type texts and tangible apparatus. A rich collection of educational material is thereby provided for pupils from kindergarten through the high school grades. A total of 8,312 blind pupils were enrolled through public educational institutions for the blind and 11,263 through State departments of education—a total of 19,575 blind pupils being served by the Printing House—for the fiscal year ending June 30, 1968. During the year, Braille books, educational periodicals, and music made up approximately 35.25 percent of the materials required by the schools; Braille slates, Braillewriters, maps, and other mechanical devices, 20.27 percent; talking books, 2.44 percent; recorded educational tapes, 0.61 percent; large-type books, 34.45 percent; and miscellaneous items, 6.98 percent. Detailed Contents Page THE SECRETARY’S INTRODUCTION The Stewardship_______________________________________________ 1 Is HEW Manageable?____________________________________________ 4 The Last Health Hurdles______________________________________ 11 Schooling: The Great Steps Forward___________________________ 21 Assuring a Decent Livelihood_________________________________ 28 To Better the Quality of American Life: Paying the HEW Bill_ 35 OFFICE OF THE SECRETARY Legislation__________________________________________________ 45 Education Enactments_____________________________________ 45 Health Enactments________________________________________ 46 Social Security Enactments_______________________________ 48 Consumer Protection Enactments___________________________ 48 General Counsel______________________________________________ 49 Education________________________________________________ 49 Civil Rights_____________________________________________ 49 Consumer Protection and Environmental Health_____________ 50 Social Security__________________________________________ 50 Public Welfare___________________________________________ 51 Program Planning and Evaluation______________________________ 53 Comptroller__________________________________________________ 54 Appropriations and Outlays, Fiscal Year 1968_____________ 54 Finance__________________________________________________ 54 Letter of Credit Operations__________________________ 54 New Computer System__________________________________ 55 Improved Payroll System______________________________ 55 Accounting Systems Development and Approval__________ 55 Accrual Accounting___________________________________ 56 Grants Administration____________________________________ 56 Audit Agency_____________________________________________ 57 Total Audit Concept__________________________________ 57 Cross-Servicing Arrangements_________________________ 58 Utilizing Outside Auditors___________________________ 58 Administration Personnel________________________________________________ 59 Equal Employment Opportunity_____________________________ 61 Management Systems_______________________________________ 62 General Services_________________________________________ 63 Surplus Property Utilization_____________________________ 63 State Merit Systems______________________________________ 65 Defense Coordination_____________________________________ 65 409 410 Department of Health, Education, and Welfare, 1968 Page Community and Field Services________________________________ 66 Programs Dealing With Children and Youth_________________ 66 Social Services and Welfare Programs_____________________ 67 Consumer Services__________________________________________ 68 Field Coordination_________________________________________ 68 Civil Rights School Desegregation___________________________________ 69 Health and Social Welfare______________________________ 70 Contract Compliance____________________________________ 70 Interagency Liaison and Coordination___________________ 71 Center for Community Planning______________________________ 71 Secretary’s Committee on Mental Retardation________________ 72 Health and Scientific Affairs_________________________________ 73 Planning and Program Coordination__________________________ 75 International Health_______________________________________ 75 Health and Medical Care____________________________________ 76 Population and Family Planning_____________________________ 76 Science____________________________________________________ 77 Health Manpower____________________________________________ 77 Education International Affairs______________________________________ 78 Office of Indian Affairs___________________________________ 80 Federal Interagency Committee on Education_________________ 81 Model Secondary School for the Deaf________________________ 83 National Technical Institute for the Deaf__________________ 84 President’s Council on Physical Fitness and Sports_________ 85 Office of Public Information__________________________________ 88 SOCIAL SECURITY ADMINISTRATION Introduction__________________________________________________ 91 Developments in Social Security_______________________________ 91 What the Program Did in Fiscal Year 1968 _____________________ 92 Beneficiaries and Benefit Amounts__________________________ 92 People Protected___________________________________________ 95 Income and Disbursements___________________________________ 96 Legislative Developments During the Year______________________ 98 Changes in the Cash Benefits Provisions____________________ 98 Changes in Disability Provisions__________________________ 101 Changes in Social Security Coverage_______________________ 103 Medicare Provisions_______________________________________ 104 Financing Provisions_____________________________________ 104 Studies Requested by Congress_________________'__________ 105 Administering the Social Security Program___________________ 106 Health Insurance________________________________________ 106 Retirement and Survivors Insurance________________________ 107 Disability Insurance______________________________________ 107 Computer Application and Data Processing__________________ 109 Direct Service to the Public______________________________ 110 Space Acquisition and Office Construction_________________ 111 Manpower Resources______________________________________ 111 Employee-Management Cooperation___________________________ 112 Detailed Contents 411 Administering the Social Security Program—Continued Rage Equal Employment Opportunity_______________________________ 112 Special Employment Programs________________________________ 112 Training and Career Development____________________________ 113 Workloads and Administrative Expense_______________________ 114 Cost Reduction and Productivity____________________________ 114 Administration of the Social Security Program Abroad_____ 115 Financing the Cash Benefits and Health Insurance Program_____ 116 Retirement and Survivors Insurance Benefits________________ 117 Disability Insurance Benefits______________________________ 117 Health Insurance for the Aged______________________________ 117 Hearing and Appeals Activity___________________________________ 118 Research Activity______________________________________________ 119 Major Research Publications________________________________ 120 The Federal Credit Union Program______________________________ 120 OFFICE OF EDUCATION Introduction_________________________________________________ 123 Planning and evaluation activities___________________________ 124 Equal Educational Opportunities______________________________ 124 Staff Work on Behalf of the Disadvantaged____________________ 124 Opportunity for Educationally Deprived Children______________ 125 Supplementary Educational Centers and Services______________ 128 Guidance, Counseling, and Testing_________________________.— 128 Instructional Materials and Equipment________________________ 130 School Library Resources, Textbooks, and Other Instructional Materials______________________________________________ 130 Strengthening Instruction in Critical Areas______________ 130 Strengthening Instruction in the Arts and the Humanities- 131 College Instructional Equipment__________________________ 131 Improving Qualifications of School Personnel_________________ 131 The Teacher Corps________________________________________ 131 Experienced and Prospective Teacher Fellowships__________ 134 Institutes for Advanced Study in 12 Areas________________ 134 Institutes in the Arts and Humanities____________________ 135 Counseling and Guidance Institutes_______________________ 135 Training for Education of the Handicapped____.___________ 136 Strengthening State Departments of Education_________________ 136 Assistance to Federally Affected and to Disaster Areas--- 137 School Construction______________________________________ 137 School Maintenance and Operation_________________________ 137 Construction Service_________________________________________ 138 Financial Aid for Students___________________________________ 138 Educational Opportunity Grants___________________________ 138 College Work-Study_______________________________________ 139 Guaranteed Loans for Higher Education____________________ 139 Guaranteed Loans for Vocational Education________________ 139 National Defense Education Act Student Loan Funds-------- 139 Encouraging Utilization of Educational Talent____________ 140 Higher Education Facilities__________________________________ 140 Comprehensive Planning___________________________________ 141 Disaster Assistance______________________________________ 141 Accreditation and Institutional Eligibility__________________ 141 412 Department of Health, Education, and Welfare, 1968 Page Payments to Land-Grant Institutions___________________________ 144 Aid for Developing Institutions_______________________________ 144 National Defense Fellowships__________________________________ 145 Training for Higher Educational Personnel--------------------- 145 College and Research Library Resources------------------------ 146 Librarianship Training---------------------------------------- 147 Community Service and Continuing Education-------------------- 147 Adult Basic Education_________________________________________ 147 Civil Defense Adult Education--------------------------------- 148 Vocational and Technical Education---------------------------- 148 Programs Under Matched Funds______________________________ 148 Work-Study Program________________________________________ 150 Construction of Facilities in Appalachia__________________ 150 Manpower Development and Training----------------------------- 150 Library Services and Construction----------------------------- 152 Educational Television Facilities----------------------------- 153 Assistance for Cuban Refugees_________________________________ 154 U.S. Loan Program for Cuban Refugee Students_____________ 154 Aid to Dade County Public Schools_________________________ 154 Research and Related Activities_______________________________ 155 Cooperative Research Program______________________________ 155 Vocational Education Research and Training---------------- 160 Educational Media Research and Dissemination------------- 161 Library Research and Development-------------------------- 161 Research in Foreign Languages and Comparative Education._ 162 Research and Demonstration in Education of Handicapped Children_______________________________________________ 162 Preschool and School Programs for the Handicapped in Local Schools_____________________________________________________ 162 Educational Services for the Handicapped in State Schools---- 163 Media Services and Captioned Films for the Handicapped________ 164 Research Activities_______________________________________ 164 Training Activities_______________________________________ 164 Production________________________________________________ 165 Acquisitions______________________________________________ 165 Distribution______________________________________________ 165 Loan Equipment____________________________________________ 165 Other Programs for the Handicapped---------------------------- 166 International Programs, Studies and Services------------------ 166 NDEA Language and Area Centers---------------------------- 166 NDEA Fellowships in Language and Area Studies------------- 167 Overseas Studies and Foreign Consultant Programs---------- 169 Language and Area Research-------------------------------- 170 Interagency Cooperation in International Exchange and Training________________________________________________ 171 International Services and Research----------------------- 172 National Center for Educational Statistics-------------------- 174 Educational Materials Center---------------------------------- 174 Management Review Center-------------------------------------- 175 Public Information Activities--------------------------------- 175 American Education________________________________________ 175 Detailed Contents 413 Page Administration of the Office--------------------------------- 176 SOCIAL AND REHABILITATION SERVICE____________________________ 179 Office of the Administrator__________________________________ 183 Office of Federal-State Relations------------------------- 183 Office of Policy Coordination_____________________________ 187 Office of Public Affairs__________________________________ 187 Office of Research, Demonstrations, and Training---------- 188 Administration on Aging-------------------------------------- 202 Grants for Community Planning, Services, and Training---- 203 Grants for Research and Demonstration_____________________ 205 Grants for Training_______________________________________ 207 The Advisory Committee on Older Americans---------------- 209 The Foster Grandparent Program____________________________ 209 Senior Citizens Month_____________________________________ 210 Relationships With Other Federal Agencies and Clearinghouse for Information___________________________________________ 210 Legislative Highlights____________________________________ 211 Assistance Payments Administration--------------------------- 211 Program Coverage and Expenditures------------------------- 212 Work Experience and Training Program______________________ 214 Administrative Developments------------------------------- 217 Public Information________________________________________ 218 Children’s Bureau____________________________________________ 218 1968 Appropriations_______________________________________ 219 Interdepartmental Committee on Children and Youth--------- 219 State Committees for Children and Youth------------------- 220 White House Conference on Children and Youth-------------- 220 Federal Model City Program________________________________ 220 Programs of the Bureau____________________________________ 220 Research and Child Life_______________________________ 220 Maternal and Child Health and Crippled Children’s Services____________________________________________ 222 Family and Child Welfare Services--------------------- 227 Juvenile Delinquency__________________________________ 232 Youth Services________________________________________ 235 Medical Services Administration------------------------------ 235 Office of the Commissioner________________________________ 237 Training__________________________________________________ 238 Nursing Homes_________________________________________ -- 238 Public Information________________________________________ 239 Health Services___________________________________________ 239 Program Evaluation________________________________________ 240 Program Management________________________________________ 240 Planning and Development__________________________________ 241 Rehabilitation Services Administration----------------------- 241 The Mental Retardation Program---------------------------- 242 Social Services___________________________________________ 243 Innovation Projects_______________________________________ 243 Expansion Projects________________________________________ 243 Improvement, Development, and Construction of Rehabilitation Facilities__________________________________________ 244 414 Department of Health, Education, and Welfare, 1968 Rehabilitation Service Administration—Continued Page Training Rehabilitation Workers___________________________ 244 Architectural Barriers____________________________________ 245 Services for the Blind______________________________________ 246 Social Security Disability Applicants_______________________ 246 Services for Other Specific Groups__________________________ 247 National Interagency Cooperative Programs___________________ 249 Extended Evaluation_________________________________________ 250 Statewide Planning__________________________________________ 250 Serving the Disabled in Rural Areas_________________________ 250 Relationships With Labor____________________________________ 251 New Legislative Authorities_________________________________ 251 Research and Demonstration__________________________________ 251 PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRA- TION Comprehensive Health Planning_____________________________ 259 Medical Care Administration_______________________________ 260 National Center for Health Services Research and Development______________________________________________________ 262 National Institute of Mental Health_______________________ 263 Research Findings_____________________________________ 264 New Clues in Schizophrenia____________________________ 265 Addiction Research___________________________________ 266 Developments in Drugs_________________________________ 266 Cost Cutting__________________________________________ 267 Mental Health Manpower________________________________ 267 Narcotic and Drug Abuse_______________________________ 268 Alcoholism____________________________________________ 268 Suicide_______________________________________________ 268 Child Mental Health___________________________________ 269 Epidemiology__________________________________________ 269 Mental Health Related Problems________________________ 270 National Center for Health Statistics_____________________ 270 Health Record_________________________________________ 271 Births, Marriages, and Divorces_______________________ 272 Regional Medical Programs_________________________________ 273 Chronic Disease Control___________________________________ 274 Cancer Control________________________________________ 275 Chronic Respiratory Disease Control___________________ 275 Diabetes and Arthritis Control________________________ 276 Heart Disease and Stroke Control______________________ 276 Kidney Disease Control________________________________ 277 Smoking and Health____________________________________ 277 Neurological and Sensory Disease Control______________ 278 Nutrition_____________________________________________ 278 National Communicable Disease Center______________________ 279 Health Facilities Planning and Construction_______________ 281 Technical Assistance__________________________________ 281 Grants-in-Aid_________________________________________ 282 Detailed Contents 415 HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION—CONTINUED Page PHS Hospitals and Clinics_______________________________ 282 Services to Indians and Alaska Natives------------------ 283 Emergency Health Services_______________________________ 285 Federal Employee Health___________________________________ 287 Medical Services for Federal Agencies_____________________ 287 U.S. Coast Guard, Department of Transportation_________ 287 Bureau of Prisons, Department of Justice_______________ 288 Bureau of Employees’ Compensation, Department of Labor________________________________________________ 288 CONSUMER PROTECTION AND ENVIRONMENTAL HEALTH SERVICE Air Pollution__________________________________________ 292 The Problem__________________________________________ 292 The Federal Program__________________________________ 293 The Air Quality Act__________________________________ 293 Federal Abatement Activities____________________________ 298 Surveillance of Air Quality________________r----_------ 300 Air Pollution Monitoring___________________________ 300 Manual Monitoring Systems____________________________ 301 Continuous Monitoring Systems________________________ 301 The National Data Bank_______________________________ 301 Evaluation of Fuel Additives______________________--- 302 Environmental Control Administration______________________ 302 Training Program________________________________________ 303 Arctic Health___________________________________________ 304 Neuromuscular Diseases in Eskimos_____________________ 304 Air Pollution_________________________________________ 304 Injury Control__________________________________________ 305 Occupational Health and Safety__________________________ 306 Asbestos______________________________________________ 307 Coal Dust_____________________________________________ 307 Beryllium_____________________________________________ 307 Lasers________________________________________________ 308 Uranium Mining________________________________________ 308 Noise_________________________________________________ 308 Radiological Health_____________________________________ 309 Solid Wastes____________________________________________ 311 Water Supply and Sea Resources__________________________ 313 Food and Drug Administration______________________________ 315 Food Activities_________________________________________ 319 Drug and Device Activities____________________________ 324 Cosmetics_____________________________________________ 331 Imports_____________________________________________ 332 Hazardous Substances Act________________________■■----- 333 Administration of Other Acts____________________________ 335 Court Interpretations___________________________________ 335 New Laws and Regulations________________________________ 337 Scientific Investigation________________________________ 340 416 Department of Health, Education, and Welfare, 1968 NATIONAL INSTITUTES OF HEALTH Page Research Accomplishments_________________________________ 350 Bureau of Health Manpower________________________________ 351 Division of Allied Health Manpower___________________ 351 Division of Dental Health____________________________ 352 Division of Health Manpower Educational Services----- 354 Division of Nursing______________________________________ 356 Division of Physician Manpower_______________________ 358 National Library of Medicine------ ---------------------- 359 Medlars______________________________________________ 360 Regional Medical Libraries___________________________ 360 Communications System Development____________________ 360 Lister Hill National Center for Biomedical Communications____________________ __________________________ 361 National Medical Audiovisual Center__________________ 361 Library Reorganization_______________________________ 361 National Cancer Institute________________________________ 361 Cause and Prevention_________________________________ 362 Diagnosis and Treatment______________________________ 364 National Heart Institute_________________________________ 366 Artificial Heart-Myocardial Infarction Program_______ 367 Coronary Drug Project________________________________ 368 National Blood Resource Program______________________ 368 Intramural Research__________________________________ 369 Training Support_____________________________________ 369 National Institute of Allergy and Infectious Diseases---- 370 Transplantation Immunology Programs__________________ 370 Vaccine Development__________________________________ 370 Chronic Diseases_____________________________________ 371 Acute Infections_____________________________________ 371 Allergies____________________________________________ 371 Information__________________________________________ 371 National Institute of Arthritis and Metabolic Diseases--- 372 Arthritis____________________________________________ 372 Lesch-Nyhan Disease__________________________________ 372 Diabetes_____________________________________________ 373 Artificial Kidney and Transplant Program_____________ 373 Nutrition____________________________________________ 373 National Institute of Child Health and Human Development._ 373 Extramural Activities________________________________ 374 Intramural Activities________________________________ 374 Research Results in Population Dynamics and Reproductive Biology_______________________________________ 375 Maternal and Infant Health___________________________ 375 Research Results on the Developing Years_____________ 376 Research Results on Nutrition in Intellectual Development__________________________________________________ 376 Research Results in Mental Retardation_______________ 377 Results in Aging Research____________________________ 377 National Institute of Dental Research____________________ 377 Preventing Tooth Decay_______________________________ 377 Periodontal Disease__________________________________ 379 Restorative Materials________________________________ 379 Growth and Development_______________________________ 380 Other Disorders______________________________________ 380 Detailed Contents 417 NATIONAL INSTITUTE OF HEALTH—CONTINUED Page National Institute of General Medical Sciences____________ 380 Pharmacology/Toxicology________________________________ 381 Automated Clinical Laboratories________________________ 382 Trauma_________________________________________________ 383 Research Training______________________________________ 384 National Institute of Neurological Diseases and Blindness.. 384 Collaborative Perinatal Project________________________ 385 Epilepsy Research______________________________________ 386 Disorders Affecting the Aged___________________________ 386 Sclerosing Disorders___________________________________ 386 Neuromuscular Diseases_________________________________ 387 Head Injury Research___________________________________ 387 Research on Sensory Systems____________________________ 387 Eye Research Program_________________________________ 388 Information Network____________________________________ 388 Clinical Center___________________________________________ 388 Division of Biologics Standards_________________________ 389 Rubella Vaccine______________________________________ 389 Rh0 (D) Immune Globulin______________________________ 390 Multiple Antigens_____________________________________ 391 Mumps Vaccine__________________________________________ 391 Influenza Vaccines___________________________________ 392 Division of Computer Research and Technology____________ 392 Utilization of Electronic Digital Computers__________ 393 Other Program Achievements___________________________ 393 Division of Environmental Health Sciences_______________ 394 Consultative Services________________________________ 394 Laboratory Research__________________________________ 395 Animal Science and Technology________________________ 395 Cell Biology_________________________________________ 395 Pharmacology and Toxicology____________________________ 395 Analytical and Synthetic Chemistry___________________ 395 Occupational Studies___________________________________ 396 Research Project Grants________________________________ 396 University-Based Centers_______________________________ 398 Division of Research Facilities and Resources_____________ 398 Special Research Resources_____________________________ 398 General Clinical Research Centers____________________ 399 Animal Resources_____________________________________ 400 General Research Support_______________________________ 400 Health Research Facilities___________________________ 401 Division of Research Grants_______________________________ 402 Division of Research Services_____________________________ 402 Construction_________________________________________ 403 Research Animals_______________________________________ 403 Biomedical Engineering_________________________________ 404 FEDERALLY AIDED CORPORATIONS Howard University_______________________________________ 405 Gallaudet College_________________________________________ 407 American Printing House for the Blind_____________________ 408 o 1 University of Louisville Libraries ■■■I 11005 00460652 3 /r A\ if- JUN 3 1969 □) HV 85 .A3812