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 voluntary 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 4600 TV370 140 3910 3650 8450 8220 2990 2760 2530 2300 2070 1840 1610 1380 1150 920 1690 60 230 1934-35 35-36 36-37 37-38 38-39 39-40 40-41 41-42 42-43 43-44 44-45 45-46 46-47 47-48 94238-49-13 Rehabilitation placement closures of persons with a history of tuberculosis as reported by State Divisions of Vocational Rehabilitation,1 fiscal 1934-35 1935-36 1936-37 1937-38 1938-39 1939-40 1940-41 1941-42 1942-43 1943-44 1944-45 1945-46 1946-47 1947-48 1 Data are based on closed case reports submitted by State vocational rehabilitation agencies to the Office of Vocational Rehabilitation and may vary slightly from data available 3 Indicates a figure estimated from a 50 percent sample of persons rehabilitated during the 1946 fiscal year; therefore, due to errors of random sampling, the figure may vary from the act al nu nber. Total partially estimated. Did not participate in this fiscal year. Utah Vermont. Virginia. Washington Wisconsin. West Virginia. Wyoming. Grand total |