STATEMENT BY ELIZABETH WICKENDEN IN BEHALF OF THE AMERICAN PUBLIC WELFARE ASSOCIATION

The American Public Welfare Association, organization of State and local public-welfare departments and individuals engaged in public welfare at all levels of government, strongly favors an expansion of the social-security program and must, therefore, express opposition to the pension provisions of H. R. 3095, which are inconsistent with the established basic principles of social security. Since the Ways and Means Committee is currently considering amendments to the Social Security Act which would add protection against permanent disability in both the old-age and survivors' insurance and assistance programs, it is our sincere hope that the Committee on Education and Labor will not recommend a conflicting and, in our opinion, less satisfactory program for meeting the needs of handicapped persons.

While we also favor all practical strengthening of rehabilitation services for the handicapped as a means of preventing dependency and promoting useful selfsupport, we feel this should be achieved through an expansion of the vocational rehabilitation program within the Federal Security Agency (or Department of Welfare if Reorganization Plan No. 1 becomes effective) where it can be coordinated with related health, welfare, and education services.

OBSERVATIONS ON FEDERAL LEGISLATION PROPOSED TO IMPROVE SERVICES TO THE HANDICAPPED BY E. P. CHESTER, DIRECTOR, DIVISION OF REHABILITATION, STATE OF CONNECTICUT

1. DESIGNATION OF PROGRAM

It was pointed out in some of the testimony before the committee that the name used to designate the State-Federal partnership program for the handicapped currently in operation is meaningless and should be changed to one that more simply describes the nature of the activities involved. The present designation has been in use at least since 1917, when it was applied to the soldier program of World War I. The civilian program established in 1920 used the same terminology. Since that time the term "rehabilitation" has been applied to such programs as the reorganization of banking structures, land, and farm reclamation, adjustments in war-torn countries, etc. Over the years understanding of the term "vocational rehabilitation" has greatly increased in my opinion to the point where it has become meaningful to employers, the medical profession, and to community agencies that come in contact with handicapped persons.

In traveling about my own State inquiry is quite often made of persons contacted to determine their concept of rehabilitation. On one such occasion a small store owner was questioned, who was not born in America, and whose use of English was somewhat limited. His answer to my question surprised me. It was "Rehabilitation, she is grand. She make a man who lost leg or arm learn how to run machine. When he get first pay check, he so happy. He feel just so good like any other man." This man may not have used socially accepted language, but he had certainly caught on to the idea.

In other words, I do not feel it is imperative that the designation given to the program be changed. It is far more important that the nature and scope of services made available to the handicapped be performed with the utmost of equity, ingenuity, practicality, and effectiveness.

2. PENSIONS FOR THE HANDICAPPED

The program of vocational rehabilitation has been operated on the principal that provision of so-called charity or welfare types of services was not an approved nor desirable function of the official rehabilitation agencies. Pensions, or financial aid to the needy blind are generally administered by State welfare departments, rather than directly by rehabilitation agencies for the blind.

In my opinion it is not feasible administratively, nor does it promote the best interests of the handicapped themselves, to assign to the same agency the responsibility for assisting handicapped persons to rehabilitate themselves out of a condition of dependency on the one hand, and for paying pensions to those who cannot make such an economic adjustment on the other.

I do not object to the principle of providing financial aid to needy handicapped persons who apparently cannot be rehabilitated, but it is my opinion that any

such provision as may be found necessary and desirable, should be made a part of general social security rather than rehabilitation legislation. The administration of such a service should be placed in the hands of public-welfare agencies experienced in providing financial assistance, rather than in the hands of rehabilitation agencies experienced in providing services designed to keep handicapped persons out of need for financial relief consideration to the greatest degree possible.

However, in my opinion, legislation covering any such pension provision should carry a condition that the welfare agency administering the pension provision would make payments only upon certification by the rehabilitation agency. In addition I would suggest that provision also be made in the legislation for periodic review of persons receiving pensions to determine if the physical or other conditions upon which certification was originally based had changed sufficiently to warrant renewed effort toward rehabilitation of the individuals concerned.

3. SERVICES FOR THE SEVERELY HANDICAPPED

Since the enactment of Public Law 113 in 1943, which provided for considerable expansion of the vocational rehabilitation program, increased effort has been expended in the States toward the development of services designed to meet the needs of persons with severe disabilities. Fortunately experience has indicated that persons in this category represent a relatively small segment of the total disabled population, probably not more than 20 percent.

With the development of adequate facilities to provide needed services to members of this group it is estimated that the majority of them can be rehabilitated into suitable forms of employment, and that only a relatively small minority will require permanent custodial care. In my opinion the cost of adequately serving this group representing 20 percent of the total disabled population, to the point of accomplishing their rehabilitation, at the present time would far exceed the cost of completing the rehabilitation adjustment of the remaining 80 percent of the less severely disabled.

Funds to purchase the range of services needed by the severely disabled, and to provide the additional personnel required to follow each client through to a successful conclusion, have not been made available generally, either by the Federal Government and the States. In addition facilities to provide services needed at reasonable costs, have been lacking or inadequate in most sections of the country. Furthermore the general public has not yet fully developed a social consciousness of its responsibility toward the severely disabled civilians in terms of financially supporting a substantial program of services needed by them.

For these reasons I favor the proposals made in several of the bills before your committee which would provide Federal grants for the development of new facilities where needed, or for the expansion of existing facilities, for the purpose of stimulating a greater degree of rehabilitation service to increased numbers of severely handicapped persons.

In my opinion there are at least three major areas where assistance to the States through appropriate Federal legislation, would benefit persons with severe disabilities.

(a) Rehabilitation centers.-The "rehabilitation center" is a relatively new term, but the roots of the concept of this type of service go far back in rehabilitation history. A number of the most recently established centers were mentioned by several witnesses before your committee. One of the early roots stems from the program developed in New York City, at the Institute for the Crippled and Disabled, a private institution. It was this institution under the direction of Col. John D. Smith, Jr., which furnished the demonstrated basis upon which adjustment or rehabilitation centers were developed by the various military establishments during World War II.

I believe it was in 1923 that I was engaged by the New York Occupational Therapy Association to conduct a research study of practical therapeuptic services which could be of value in the physical, vocational, and social adjustment of severely handicapped persons. In close cooperation with Mr. F. G. Elton, of the New York State Bureau of Rehabilitation, and under the sponsorship of Dr. Fred H. A'bee, the eminent orthopedic surgeon, a "curative workshop" was organized in New York City, based upon the findings of the research study. This program also represents one of the early beginnings of the rehabilitation center concept. This "curative workshop" is still in operation in perfected form as a practical rehabilitation center under the private sponsorship of the American Rehabilitation Committee, Inc.

You may recall from participation in some of the group meetings conducted by the Retraining and Reemployment Administration, that the Rehabilitation Branch which was my responsibility under General Erskine, made a study of rehabilitation services for the severely disabled. The report of this study recommended the development of rehabilitation centers, suggesting that in general they be established initially by "putting roofs over communities," rather than immediately investing in expensive buildings to house the necessary facilities. In other words the recommendation was that a good beginning could be made toward developing a center by pooling the available services of already established community agencies that could be used to advantage by severely handicapped persons. Naturally some gaps in existing facility programs would have to be filled in, some improvements and extensions of services provided, certain new services and/or equipment supplied, and an over-all plan of cooperation and coordination prepared with which all participating units in the center were in agreement.

I believe the funds estimated required in some of the testimony given at the hearing for the establishment of centers represents a modest request. It would appear to me that plans were carefully laid to establish centers on a realistic basis, using the funds to the best possible advantage of seriously disabled persons in the various communities of our Nation.

(b) Sheltered employment.-As was brought out in much of the testimony at the hearing, not all the handicapped can be expected to find employment in competitive types of jobs. Some cannot work the required quota of hours. Others may, at least for a period of time, require a more sheltered type of work, where the physical and/or mental strain is not as severe as would be the case in competition with normal workers. Some may require closer supervision, even on simple tasks, than would be possible in competitive employment.

Those handicapped persons who do not fit into the pattern of competitive employment because of severe disabilities, but who are sufficiently mobile to get to and from a place of employment without too great difficulty, are deprived of opportunity to utilize their varying capacities in suitable types of productive work, unless special arrangements are made for them.

Here again, in my opinion, with the cooperation of community agencies— including employers-strategically located public or private workshops, providing real jobs under sheltered working conditions, can do much to boost the morale and the economic advancement of those handicapped persons who need this type of adjustment service.

It is to be expected that some of the workers in a sheltered workshop will in time develop abilities to respond to more advanced types of rehabilitation service, and may be prepared thereby for graduation into the ranks of competitive employment. Thus it is to be assumed that all the handicapped persons who are initially assigned to sheltered workshop activities do not represent a permanently static group.

I am in favor of legislation which provides assistance in the establishment of sheltered employment opportunities for those handicapped persons who need this kind of service.

(c) Home industries.—I concur with testimony given at the hearing before your committee that opportunity for self-employment should be provided those persons so severely handicapped they are unable to leave their homes for either competitive or sheltered employment.

To evaluate the potentialities accurately, advise constructively and plan realistically with handicapped persons who are home-bound, with respect to suitable home industry activities, requires of rehabilitation workers and the handicapped persons concerned, all the intelligence, ingenuity, imagination, and realism that can be applied to each individual situation. To put the plans made into execution so that in the end a successful business enterprise emerges, requires all the patience, persistence, managerial skills, and promotional abilities of not only rehabilitation workers and their handicapped clients, but in addition many other appropriate persons in the community whose interest, knowledge, and experience can be "begged, borrowed, or stolen."

In my opinion the operation of a successful business enterprise program for handicapped home-bound persons is as expensive as it is worthwhile, and the expense is mainly in the rehabilitation man-power required for the supervision of the efforts of the handicapped clients served. Therefore it should be anticipated that any legislation seeking to provide increased opportunity to all the handicapped who are home-bound and have capacity to pursue successful business enterprise types of self-employment, should carry an adequate

appropriation for the additional personnel needed to do the job thoroughly and effectively.

Research on both State and National levels as provided in several of the bills before your committee, will be necessary in the fields of design, distribution of raw materials, instruction and supervision of manufacture and especially in the marketing of products made. Otherwise the time and effort of handicapped home industry workers will be expended without appropriate economic return to them. They will become dissatisfied and discouraged with the attempts made to serve them.

4. PLACEMENT OF THE HANDICAPPED

As I recall from some of the testimony at the hearing before your committee, it might be inferred that placement in employment represented a phase of the vocational adjustment of handicapped persons separate and apart from the other services of rehabilitation. As a matter of fact the placement of a handicapped person on a job, the duties of which he is capable of performing with satisfaction to himself and his employer, is a specific and important rehabilitation service. In essence the ability of a handicapped person to engage successfully in suitable remunerative employment is the final test of the adequacy and effectiveness of all previously provided rehabilitation services.

Under regulations based upon current legislation, rehabilitation services are not officially completed until the handicapped worker has been suitably placed and followed up for a period of time, sufficient in each individual case, to determine the satisfactoriness of the occupational adjustment effected.

As brought out in testimony at the hearing, in accordance with the terms of the Wagner-Peyser Act, cooperative working relationships are effected in the States between the employment and rehabilitation agencies. Under this relationship a general procedure is established whereby handicapped registrants whose disabilities prevent their consideration as qualified candidates to fill current employer job orders are referred to the rehabilitation agency by the Employment Service. Handicapped persons who accept such referral to Rehabilitation agencies, are given the benefit of careful physical and vocational diagnosis, and evaluation is made of services found needed for the correction or reduction of the effects of the disability, and/or for the acquisition of marketable skills. When these handicapped potential workers are determined ready for employment, they are referred back to the Employment Service by the rehabilitation agencies for placement in the fields of work for which they are qualified. Through this cooperative relationship many handicapped persons are adjusted into suitable jobs.

However, in actual practice, this working relationship between rehabilitation and employment agencies in the States presents some difficulties to both agencies. Handicapped persons registering at Employment Serice offices naturally want jobs immediately, and in many cases react unfavorably to any suggestion that they take advantage of available rehabilitation services to improve their capacities for suitable work to the extent necessary for referral to employers by the Employment Service. As a result some of these handicapped persons develop a hostile attitude toward the Employment Service, and go out on their own seeking any kind of a job.

Usually after fruitless efforts, the majority of these persons-often upon the counsel of employers contacted-realize the futility of their attempts to secure jobs for which they are not qualified, and finally make application for needed rehabilitation services. At the completion of services, when ready for consideration of employment, some of these potential workers refuse referral to the Employment Service, preferring to make renewed attempts to secure suitable jobs on their own. Even in such instances representatives of the Rehabilitation Agency attempt to work with the Employment Service by obtaining advice with respect to available work opportunities, but still find it necessary to direct and supervise the efforts of their clients to find a type of employment compatible with their physical and other abilities.

In making the above comments I do not intend to be critical of the cooperation offered rehabilitation agencies by the Employment Service. Logically these two agencies were not established nor organized to function on the same basis of service. It would be humanly impossible and financially prohibitive for the Employment Service to be assigned the responsibility for the individual placement of every person out of work. As I understand it, the Employment Service is organized to catalog its evaluation of the qualifications of every person who

applies for placement assistance. This in itself is a large order. As job orders are received from employers, the qualifications of unemployed registered workers are matched against the demands of available jobs, and candidates selected for referral who appear to meet the job specifications of the employer.

The Rehabilitation Agency functions to assist prepared potential handicapped workers find selected jobs that match their capacities and abilities. In maintaining this function rehabilitation agencies should and generally do utilize the facilities of the Employment Service to the fullest possible extent. However, the investment of public funds, as well as the time and effort of handicapped persons spent in preparing themselves for suitable employment must be safeguarded. Therefore rehabilitation agencies are held responsible to follow the handicapped potential workers all the way through into suitable jobs, which in all necessary instances means direct assistance in placement.

5. INTEGRITY OF STATE REHABILITATION PERSONNEL

I am one of the "rehab boys," as Paul Strachan referred to us at the hearing before your committee. He inferred we were backing the administration bill to promote our own, rather than the interests of handicapped persons. If I did not know Paul rather well, some of his statements might be taken much more seriously. However, in my opinion, it is unfortunate, even for the best interests of the handicapped whose cause he champions, that he exhibits such hostility toward the Rehabilitation Agency personnel. I became acquainted with Paul Strachan when temporarily employed as Assistant Administrator of the Retraining and Reemployment Administration, on leave from my position as director of the division of rehabilitation in the State of Connecticut. Through association with him, I learned to appreciate his motives, although I could not always agree with his ideas for ameliorating some of the conditions he felt should be corrected with respect to services for handicapped persons. It was impossible to overlook his intense interest and his great concern for improvement of opportunity for the handicapped civilians of our Nation.

During my 30 years experience in the field of rehabilitation, I have learned to know the personnel operating in the States fairly well. Also while at the Retraining and Reemployment Administration, our rehabilitation branch made studies of the effectiveness of civilian rehabilitation programs in a number of States. As a result I would state that by and large the caliber of personnel employed in rehabilitation programs of the States is excellent. These workers are sincere, capable, resourceful, and energetic. They have a deep interest in the handicapped clientele. They serve, and put forth earnest effort to assist them in finding the ways and means of achieving success as productive members of society. This group of rehabilitation workers is fully cognizant of responsibilities in the expenditure of public funds appropriated for the specific purpose of restoring to working usefulness the handicapped individuals who really need assistance. In general these workers are realistic and practical in the approach made to work with their handicapped clients in effecting a constructive solution of their problems.

Individual differences affecting motivation, attitudes, judgment, the will to do, and all the other human characteristics found in so-called normal persons, are equally present in persons who are handicapped. All of these handicapped persons do not respond cooperatively when attempts are made to assist them. Some few, including their parents, want to make their own determinations of services needed, regardless of a preponderance of evidence that the program of services requested will not achieve the result desired in terms of developed abilities to secure and maintain employment in fields of work matching their capacities. Such persons may write letters to the President, to their Senators, or Representatives, or perhaps to Paul Strachan, stating they have been denied services by their State rehabilitation agencies. In reality they have not been willing to cooperate in the working out of reasonable solutions of their personal and vocational problems on a basis of sound judgment and common sense.

The "rehab boys" have made mistakes. We all do. However they have been providing to the handicapped with increased quality and quantity, rehabilitation services based upon sound judgment and realistic planning. Those of them who do not know or understand Paul as well as I think I do resent keenly his insinuations that as a group they place their own best interests over and above those of handicapped persons.

No single group interested in the welfare of handicapped persons has a patented process for solving all of the problems involved in this human engi