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A report of the accomplishments of the present State-Federal program filed with your committee by the Office of Vocational Rehabilitation shows that my faith expressed in 1946 has been fully justified. Not only have the numbers rehabilitated been greatly increased but also the quality and completeness of services rendered the handicapped people who were served by the 87 different agencies.

I am more convinced today than ever before that the administration of the program of vocational rehabilitation for the disabled of our Nation should remain at the Federal level in the Federal Security Agency. In my judgment the creation of a commission whether independent or attached to some already existing department can add nothing to the effectiveness of work for the disabled ; rather it would create confusion among the agencies and individuals who are now rendering such excellent service with wholly inadequate funds.

STATEMENT OF R. C. THOMPSON, DIRECTOR OF VOCATIONAL REHABILITATION, STATE

OF MARYLAND I wish to commend the Subcommittee on Labor for the sympathetic interest that it is showing in the problems of the disabled citizens of our Nation. I want to thank particularly Hon. Augustine B. Kelley, chairman, who for many years has devoted much of his time and attention toward improving the conditions under which persons with mental and physical handicaps have to live and work. It was my very great privilege while serving as president of the National Rehabilitation Association in 1946 to meet with the Subcommittee investigating Aid to the Physically Handicapped on several occasions at Mr. Kelley's invitation. The published hearings of that committee constitute the most valuable compilation of pertinent data concerning the handicapped that can be found anywhere today.

My recommendations concerning the legislation which is now before you (H. R. 3095 with its companion bills; H. R. 5370, and H. R. 5577) are based ca more than 20 years' experience as a worker with all types of the handicapped, both as a counselor and as administrator of a State program of vocational rehabilitation. Because of this direct contact with the work that is being done, I want to urge you not to disturb the present State-Federal relationship. We have a plan that has proved satisfactory both to the Federal Government and to all of the States. True, there are thousands of the disabled needing rehabilitation who have not been reached, but the need is for expanded services and adequate appropriations rather than for a change in the method of administration.

I wish to commend to your favorable consideration all of the provisions of H. R. 5577 which represents the result of years of study on the part of rehabilitation personnel. It provides that the Federal office should remain in the Federal Security Agency, according to the recommendations of the Hoover Commission, and it calls for the expansion of services to the home-bound, the severely disabled, and the blind. Particularly important are the provisions for the development of rehabilitation centers, the refinement in procedures for the operation of vending stands by blind persons, and the providing of facilities for research and training which are so badly needed due to the lack of qualified personnel in all phases of work with the handicapped.

Not only do we need legislative authority for the development of additional services, but there must be made available adequate appropriations to support to the fullest extent both the existing services and those that are contemplated in H. R. 5577.

Since the committee has before it already a full and complete statistical statement of the results obtained by rehabilitation agencies throughout the country during the 6 years that have elapsed since the passage of Public Law 113, I shall not attempt to duplicate such testimony. I should like to state, however, that if the committee desires additional data for its consideration, then I shall be most happy to supply it upon request.

STATEMENT OF HOLLAND HUDSON, DIRECTOR OF REHABILITATION SERVICE FOR THE

NATIONAL TUBERCULOSIS ASSOCIATION

Since 1938, I have been employed as director of rehabilitation service for the National Tuberculosis Association. This body brings together the programs of tuberculosis associations in all of the States and Territories and 3,055 local

tuberculosis associations and committees whose work is financed by the Christmas Seal. The work of the associations is chiefly to direct public attention to the hazards of tuberculosis and the means by which it may be controlled. My assignment is to study problems of recovery and to promote a wider interest in the successful and permanent recovery of those patients whose resistance is sufficient to enable them to conquer their disease.

One of the many items in such recoveries is the item of suitable and secure training and employment opportunities. The State programs for vocational rehabilitation of the handicapped provides one very practical and potentially effective answer to this need. However, it has taken a long time to persuade some State officials that the recovered patient is a feasible client, to persuade some physicians that a nonmedical service can observe necessary precautions, and to advise patients and the public that such services are available.

In this educational task, the tuberculosis associations have had the intelligent and consistent cooperation of the Office of Vocational Rehabilitation. I should like to submit to the committee three exhibits which provide visual evidence of the nature and effect of this cooperation.

The first of these is a memorandum of agreement between the Office of Vocational Rehabilitation and our volụntary agency. Those of you who are attorneys will note that it is not a contract but merely a plan for cooperative efforts which serves as a guide to our personnel and our affiliate associations. Pursuant to this agreement, personnel of the Office of Vocational Rehabilitation has participated in a series of conferences, institutes, and seminars for State personnel and technical workers, in which other Federal, State, and local officials and private agency workers also have participated. They have issued and circulated special literature for the information of patients, physicians, counselors, and others having an interest in the disability. Such meetings have been followed by substantial improvements in State service for those disabled by pulmonary tuberculosis.

The second exhibit is a table showing the growth of vocational-rehabilitationplacement closures by the State agencies over a 10-year period. It shows the tangible result of teamwork between the Office of Vocational Rehabilitation, the State divisions of vocational rehabilitation, hospitals and sanatoriums, and our own affiliate agencies.

The third exhibit is a graph which shows very clearly the intervals of most satisfactory increase in service for clients handicapped by tuberculosis. Note the very substantial increase in the last fiscal years.

On the basis of a considerable observation of the case loads of the States, I should like to point out that in the service here represented, the patient with a history of far-advanced tuberculosis, arrested by successful treatment, has not been excluded. He is, in every sense of the term, a severely handicapped individual, with the odds against him, statistically, in terms of actuarial life expectancy. However, by utilizing competent medical advice and a good deal of common sense, a number of the States, with the encouragement of the Federal office, have enabled such clients to establish and maintain a self-supporting, instead of a dependent, invalid status.

This seems to me evidence that the methods and procedures which the Congress provided in Public Law 113 are workable in the case of a disability which presents more than ordinary problems, including a need for competent medical guidance and careful selection of job objectives. However, some further technical improvements would help.

For example, in studying this disability, we are confronted with many patients, recently discharged from hospitals and sanatoriums, who are not ready for immediate employment. This is true particularly in areas where the number of available tuberculosis beds is inadequate and administrators must turn the improved patient out of the hospital or sanatorium to make room for the patient whose disease is highly communicable. Where well-managed sheltered workshop projects have been available, many patients have benefited by such service and the rehabilitation problem has been simplified in these cases. Encouragement to the States to establish shop standards and to extend their use in vocational rehabilitation would be likely further to increase effective service in this disability.

In the few areas where rehabilitation centers have been developed a number of the tuberculous have profited by the availability of such services, either directly. or through an increase in medical and community interest in the problems of the recovering patient.

Currently, State and Federal expenditures for vocational rehabilitation represent today a very substantial outlay with a minimum of clinical and related information upon which to plan their further course. Accordingly, implementation of research studies can serve the interest of economical application of future tax funds.

The experience of this agency and its affiliates supplies reason to hope for the continuation of the present location of the Office of Vocational Rehabilitation rather than its reconstitution as a new and independent agency. The provisions of H. R. 5370 embody implementation which a number of technical workers in our field, many of whom are members of the National Rehabilitation Association, have urged as appropriate lines of development of the current program.

The National Tuberculosis Association through its Division of Rehabilitation Services and the Office of Vocational Rehabilitation have agreed upon the following basic principles of cooperation requisite to a united approach to the development of maximum vocational rehabilitation opportunities for persons with a history of tuberculosis.

REHABILITATION SERVICES

Under the provisions of Public Law 113, the following rehabilitation services are made available for the purpose of rendering persons with a history of tuberculosis fit for remunerative employment or more advantageously employable:

1. Medical, psychiatric, and psychological examinations.
2. Vocational counseling and guidance.
3. Hospitalization, medical, surgical, psychiatric, and prosthetic services.
4. Physical, occupational, and work therapy services.
5. Prevocational and vocational training.

6. Maintenance and transportation during training, occupational licenses, tools, and equipment.

7. Placement, follow-up, and job adjustment after employment.
8. Employer consultation-adjustment of disabled and injured employees.

CONSULTANT SERVICES

The Division of Rehabilitation Services of the National Tuberculosis Association agrees to serve in an advisory and consultant capacity to the Office of Vocational Rehabilitation on problems, projects, and activities undertaken for the vocational rehabilitation of the tuberculous.

RESEARCH AND INFORMATIONAL SERVICES

(a) The Office of Vocational Rehabilitation and the Division of Rehabilitation Services of the National Tuberculosis Association will undertake jointly, from time to time, such studies and projects as might contribute to the vocational rehabilitation of the tuberculous.

(b) The Division of Rehabilitation Services of the National Tuberculosis Association and the Office of Vocational Rehabilitation will undertake jointly the preparation and distribution of literature and information on the rehabilitation of the tuberculous.

STATE RELATIONS

(a) The Division of Rehabilitation Services of the National Tuberculosis Association will encourage its State and local affiliates to establish working relationships with the State rehabilitation agencies.

(b) The Office of Vocational Rehabilitation will encourage the State rehabilitation agencies to establish working relationships with State and local affiliates of the National Tuberculosis Association.

(c) The Office of Vocational Rehabilitation, in making contact with State and local affiliates of the National Tuberculosis Association, will arrange clearance of plans with and submit a report of results of such contacts to the Division of Rehabilitation Services of the National Tuberculosis Association.

(d) The Division of Rehabilitation Services of the National Tuberculosis Association in making contact with State rehabilitation agencies will arrange clearance of plans with and submit a report of results of such contact to the Office of Vocational Rehabilitation.

PLACEMENTS IN EMPLOYMENT BY STATE DIVISIONS OF VOCATIONAL REHABILITATION

OF PERSONS WITH A STORY OF TUBERCULOSIS-FISCAL YEARS 1934–35 THROUGH 1947-48

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years, 1934–47 Rehabilitation placement closures of persons with a history of tuberculosis as reported by State Divisions of Vocational Rehabilitation, fiscal

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Alabama
Arizona
Arkansas.
California
Colorado
Connecticut.
Delaware
District of Columbia
Florida.
Georgia
Hawaii.
Idaho
Illinois
Indiana.
Iowa
Kansas
Kentucky-
Louisiana
Maine
Maryland
Massachusetts.
Michigan.
Minnesota.
Mississippi.
Missouri
Montana
Nebraska
Nevada
New Hampshire.
New Jersey
New Mexico.
New York
North Carolina.
North Dakota
Ohio.
Oklahoma.
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina.

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