The Texas Plan to Combat Mental Retardation

flflflhfMNT R IIMP, EC 003 519 ED 030 227 The Texas Plan to Combat MentalRetardation. Committee Governor's Advisory Committee onMental Retardation Planning,Austin, Tex.; Governor's Interagency on MentalRetardation Planning, Austin, Tex. Spans Agency -Public Health Service(DHEW), Washington, D.C. Pub Date Jun 66 Note -99p. EDRS Price ME -$0.50 HC -$5.05 *Exceptional Child Services, HealthServces, Descriptors -Community Programs,Day Care Programs, Etiology, Medical Treatment, *Mentally Handicapped.Personnel Needs, Prevention, Incidence, Interagency Coordination, Special Classes, State Legislation, *Program Planning, Research Needs,Residential Programs, Social Welfare, *State Programs, VocationalRehabilitation The Texas state plan c.,f actionagains't mental retardation ispresnted. Aspects considered include the evolutionof the plan. the roleof the health services,medical rehabthtation and aspectsofretardation,education andtraining.vocational welfare, Also surveyed arethe following, residentialand day employment. and social concerning the care. manpower,research for preventionand cure. Texas law retarded, localaction and public awareness,organization andcoordination of statewide and communityefforts, and legislation andfinance. (LE) NORGE* *PAMPA

°AMARILLO

PLAINVIEw PAMS WICHITA FALLS e TEXARKANA LUSIOCK ,RAo:NE DENTON

01/IV'S(' 141 tZ1,\ HALTOM Y LONGVIEW FORTWORTeHt;;;41*04::::: MARSHALL AO' * TYLER t ARMEN E t. MG sritiNG

tAIDLAND ODESSA WACO LUFKIN SAN ANGELO

KILLEEN TEMPLE

1RYAN

SEAUMONT ORANGE

AUSTIN HOUVN'le, PORT ARTHUR WEST UNIVERSITY TLACITETIIP AD SELLAIRE1 S CITY GALVESTON DEL MO SAN ANTONIO

ALICE ItPUS CHMSTI LAREDO KINGSVILLE.

EDWIN*. sAN, qo 'NTS,

Tke Twas Pea% taCatxbat Need Reta4datok U.S. DEPARTMENT OF HEALTH, EDUCATION & WELFARE

OFFICE OF EDUCATION

THIS DOCUMENT HAS BEEN REPRODUCED EXACTLY AS RECEIVED FROM THE

PERSON OR ORGANIZATION ORIGINATING IT.POINTS OF VIEW OR OPINIONS

STATED DO NOT NECESSARILY REPRESENT OFFICIAL OFFICE OF EDUCATION POSITION OR PONCY.

THE TEXAS PLAN TO COMBATMENTAL RETARDATION

Prepared By The

GOVERNOR'S ADVISORY COMMITTEE ON MENTAL RETARDATIONPLANNING

And The

GOVERNOR'S INTERAGENCY COMMITTEE ON MENTAL RETARDATIONPLANNING

Austin, Texas June, 1966 JOHN CONNALLY Governor

INTERAGENCY COMMITTEE ON TEXAS MENTAL RETARDATION PLANNING STUDY MENTAL RETARDATION PLANNING Office Location: Mailing Address: 4405 N. Lamar Blvd. STUART C. FISHER, M.P.H. Box S, Capitol Station Ph. GL 3-7231 Planning Director Austin78711

INTERAGENCY COMMITTEE TO THE GOVERNOR, THE INTERAGENCY COMMITTEE, AND THE PEOPLE OF TEXAS:

Chairman: Bill Cobb, Executive Budget Director Gwent's Office Richwd L. Coffman. Completion of the Recommendations for the Development of the Texas Administrator Employment Commission Plan to Combat Mental Retardation was another important step in our J. W. Edgar, Commissioner of Education continuing statewide and community efforts to provide better care and Education Agency more comprehensive services for the mentally retarded. Charles S. Eskridge, Executive Director Regional Mental Retardation Training Center Thousands of Texas citizens, and public officials at every level of The University of Texas J. E. Peavy, M.D., M.P.H. State and local government, have contributed time, talent, and energy Commissioner of Health Department of Health to this project. They have worked together in: James E. Turman, Ph.D., Executive Director Texas Youth Council * Public briefings in 17 major cities. Jess M. Irwin. Jr.. Executive Director Board for Hospitals and Special Schools *Mayors' Commission studies in 58 Texas cities. John Winters, Commissioner Department of Public Welfare * State Task Force writing sessions which brought the findings and recommendations together.

Periodic sessions of the Governor's Advisory Committee. ADVISORY COMMITTEE * Chairman: Judge Herman Jones *Day-by-day work of the State agencies serving the retarded and the State Planning Office.

SPECIAL CONSULTANT Charles Meisgeier, D.Ed. All of the efforts which went into the preparation of the recommendations are greatly appreciated. After approval by your statewide Governor's Advisory Coimnittee, on behalf of the many people who assisted in their preparation, the recommendations were printed in final form and presented to the Honorable John Connally, Governor of Texas, at the Governor's Conference on Mental Retardation in Austin, Texas, on March 17, 1966.

Your Advisory Committee is indebted to you for your leadership and participation in this planning effort and earnestly solicits your continuing support in carrying into action the recommendations embodied in the Texas Plan to Combat Mental Retardation.

THE GO NOR'S ADVISORY COMMITTEE

Herman Jones, Ch an This study was supported in part by a Mental Retardation Planning Grant awarded by

The Public Health Service,

Department of Health, Education, and Welfare

iv FOREWORD

Texas is taking an active part in the nationwide offensive against mental retardation. The Texas Plan to Combat Mental Retardation is the State's blueprint for action. The Governor's Interagency Committee, composed of chief State officers whose agencies have direct or indirect responsibilities for providing services to the mentally retarded citizens of Texas, accepted the Recom- mendations for the Development of the Texas Plan to Combat Mental Retardation from the Governor's Ad- visory Committee. These recommendations, with certain revisions deemed necessary by the Interagency Committee, are presented in this book as the official Texas Plan to Combat Mental Retardation.

Some of the recommendations are directed at the people of Texas in their local communities. Grass roots support will be required for their successful implementation. Other recommendations will requirethe acceptance of the Texas Legislature if they are to be translated into State law. Still other recommendations are directed at certain State agencies, as represented by the members of the Governor's Interagency Committee. These agencies will do what they canwithin the limits of staff, finances, time and legal authorizationto help implement the Texas Plan recommendations.

THE GOVERNOR'S INTERAGENCY COMMITTEE

Bill B. Cobb, Chairman June, 1966 ORGER PAMPA

N PARIS SHERMAN

EENVILLE '0

MARSHALL

11G SPRING

LUFKIN SAN ANGELO

KILLEEN

RRYAN

RANGE

ORT ARTHUR EST UNIVERS!

ITY GALVESTON DEL RIO

VICTORIA

ALICE PUS CHRISTI LAREDO KINGSVILL

KEY EDINIU(G, IO cL Mayor's Commissions NSVILLE Mayor's Commissions and Public Briefing

Map showing areas covered by Public Briefings and cities with activeMayor's Commissions

The 17 Texas cities represented by Public Briefings on Mental Retardation Planning areindicated by the large circles on the above map. Cities represented by the Mayors' Commissions arenamed and indicated by the small dots covering all major population centers in Texas. ( Map drawing courtesyof Texas Talk, official publication of the Texas Asso-iation for Retarded Children.) CONTENTS

Page

Letter of Transmittal from the Governor's Advisory Committee iii

Foreword

Contents vii

1.Evolution of the Texas Plan 1

2.The Role of Health Services 7

3.Medical Aspects of Mental Retardation 21

4.Education and Training 37

5.Vocational Rehabilitation and Employment 41

6.Social Welfare 45

7.Residential and Day Care for the Retarded 51

8.ManpowerThe Key to Providing Needed Services 59

9.Research for Better Methods of Prevention and Care 63

10.Texas Law and the Mentally Retarded 67

11.Local Action and Public Awareness 73

12.Organization and Coordination of Statewide and Community Efforts ... 79

13.Legislation and Finance 83

Appendix 85

Interagency Committee on Mental Retardation Plann!ng 85

Governor's Advisory Committee on Mental Retardation Planning 85

The 12 State Task Forces 86

The 58 Mayors' Commissions on Mental Retardation Planning: Mayors, Commission Chairmen, Members 87

Chairmen, State Agency Planning Committees 98

State Planning Office Staff 98

vii 1.EVOLUTION OF THE TEXAS PLAN

MENTAL RETARDATION DEFINED their limited energy on making ends meet; they have neither the means nor the skillto provide their children with stimulating environmental surroundings The mentally retarded are identified as children such as good conversation, books, and other intellec- and adults who, as a result of inadequately developed tualandculturaladvantages which are almost intelligence, are significantly impaired in their ability automatically bestowed upon children of the middle to learn and to adapt to the society inwhich they and upper income groups. live. Two general types of mental retardation exist: ( 1 ) Those conditions which are the direct result of Children in these less fortunate families arrive organic pathological processes, either anatomical or at school age equipped with neither the experience bio-chemical, which damage the brain, and ( 2) those nor the skills necessary forformal education, They conditions which result from environmental circum- are backward in language and inthe ability for stances and have no known physiologic or anatomic abstract thinking which is necessary for reading and basis but are either psychogenic or socio-cultural writing and numerical activities. in origin. From these families come many of the dull, the special classes. Fifteento twenty per cent of the mentally borderline individuals who fill retarded suffer from the first, or pathological type. Their failure to learn becomes complicated by frustra- It has been estimated that there are two or three tion and anxiety, and some may graduate into patterns hundred diseases resulting in pathological damage to of delinquency or ultimately to an institution. thebrain, many new diseasesbeing discovered monthly. Among thesediseasesorconditionsis Down's Syndrome, better known as Mongolism, a SIZE AND SCOPE OF THE PROBLEM disease associated with abnormality of the chromo- OF MENTAL RETARDATION somes of the body cells.

Prematurity resultsin subnormal intelligence in In the United States: It is estimated that there many cases, also abnormal development of the brain are more than 5% million people in the United States of the infant during pregnancy. This may occur when ( 3 per cent of the population ) who should be identi- the mother contracts German measles or suffers from fied as mentally retarded before they are 15 years of some other disease during the early weeksof preg- age. By 1970, natural population growth can be nancy. Children who survive brain damage due to expected to increase the total to 6% million unless very meningitis, encephalitis, accidents, and poisoning are stringent preventive measures can be introduced. common inthe mental deficiency category. Also Estimates made in 1963 and reported by the National among the etiological factors are hereditary diseases Association for Retarded Children indicate that there such as phenylketonuria and galactosemia and many are about 5 million mildly retardedindividuals, other similar types of disease. 350,000 moderately retarded, 200,000 with severe retardation, and a much smaller group of about The second type of mental retardation is the 85,000 who are profoundly handicapped by mental more common. It is socio-cultural in nature. It occurs retardation. in children of the more disadvantaged classes of society characterized by low income, limited educa- In Texas: No state, including Texas, can provide tional opportunity, unskilled occupation, and generally an accurate count of the number of mentally retarded impoverished environment. These families concentrate persons in its population because of the difficulties of

1 makinga"headcount,"inconclusivediagnoses, public health services, and in welfare sery' yes. The families on the move, and other factors. However, public school programs are reaching only a few of certain counts of limited populations of mentally the many children who need this service. Recruitment retarded persons in Texas are a matter of record. of teachers for the educational programs must be stepped up drastically. Techniqu as for identifying, In 1965-66 the Texas public schools were pro- diagnosing, and referring young retarded children to viding special classes for 24,602 educable retarded the proper programs is dependent upon the develop- children and 2,634 trainable retarded children, for a ment of more adequate centers and better diagnostic total of 27,236. The six State Schools for the Menially procedures. Retardedrecentlyreportedpopulationstotaling about 11,500. New approaches must -ae developed legally to provide for protective services, guardianship, and Severalhundred more retardedpersonsare economic security for the retarded adult. A constant enrolled in private schools and care facilities across improvement and expansion of state-supported insti- the State. Thus, while a generous estimate would tutions and facilities is part of the total picture, even identify some 41,000retardedpersonsreceiving though relatively few of the retarded will be using services in Texas, 3 per cent of the State's current large centralized facilities. The most extensive plans population ( .03 x 10,230,209) would indicate a pre- today are for the rapid improvement of services at sumed population of nearly 307,000 retarded persons. the communiiy level, and much of the following This leaves a balance of about 266,000 Texas citizens report is designed to assure more grass roots interest who are presumed to be retarded to some degree, and more community support for these many services but who are probably undiagnosed and certainly needed at home for all ages and all levels of the untouched by organized services, either local or State. retarded population.

The number of births in the Stateisabout 240,000 live births per year. The use of an incidence THE TEXAS PLAN factor of 3 per cent of the total population indicates TO COMBAT MENTAL RETARDATION that 7,200 of these live births each year (1 in every 33) will be mentally retarded. After many years of planning and working, Texas Only four significant disabling conditionsmental isready to wage all-out war against retardation, illness, cardiac disease, arthritis, and cancerhave a which now blights the lives of more than 300,000 higher prevalence; but they tend to come late in life, Texans. The Texas Plan to Combat Mental Retarda- while mental retardation comes early. Mental retardation is ready. It will become the battle plan for a tion afflicts twice as many individuals as blindness, massive assault against retardation in allits forms. polio, cerebral palsy, and rheumatic heart disease Governor Connally took the first steps in preparation combined. for such a giant effort in February, 1964 when he appointed the Interagency Committeeon Mental The State of Texas is denied many millions of Retardation comprised of the chief executives of dollars of economic output because of the under- seven Texas state agencies whose programs repre- achievement, underproduction, and in somecases sented the nucleus of services for the retarded. To complete incapability of the mentally retarded. Much chair this important group Governor Connallyap- human anguish and loss of happiness and feeling of pointed his Executive Budget Director, Bill B. Cobb. well-being results from the presence of mental retardation in thousands of families in Texas. The cost of Shortly thereafter, the Governor appointedan caring for a mentally retarded person is staggering; Advisory Committee on Mental Retardation madeup estimated cost of lifetime care for the retarded in of leadingcitizensof Texas frombusiness,the state institutions approaches $100,000 per person. professions, and organizations suchas the Texas However, economic costs cannot compare with the Associationfor Retarded Children. An able civic misery and frustration that parents realize in attempt- leader, the Honorable Herman Jones, Judge of the ing to get their child prepared for something close 53rd District Court, was appointed by the Governor to a happy, productive adulthood. to serve as chairman. The original 20-member committee was expanded to 53 members in October, 1964. As the President's Panel on Mental Retardation so dramatically pointed out, there is need for activity While the Connally administration in Texas was in many areas to combat this problem. Much needs to mobilizing for strong action on behalf of the retarded, be done in preventive research, in the extension of the Kennedy administration was moving with great

2 force on the national scene. In fact, the last piece of national professional recognition in the field. Together legislation signed by President Kennedy before his they produced a "Plan for Planning" that probed into death was the one which provided the foundation local communities, into the homes, schools, and job for all state planning. It provided $2.2 million "to situations of the retarded, obtaining firsthand knowl- assist the states in planning comprehensive action to edge of their problems and needs. Where else could combat mental retardation." the real answers be found? Specifically, the goal of the planning study was the development of a blueprint for a massive assault THE NATIONAL PLAN against mental retardation in all the areas of Texas TO COMBAT MENTAL RETARDATION life where its blight is found. A bold plan was needed that would bring together the now-splintered efforts of thousands of Texans laboring in unrelated pro- In October, 1961 President Kennedy appointed grams for the retarded and to add to them thousands a panel of 27 scientists and specialists in mental more in urgently needed new programs. retardation and presented them with a mandate to prepare a National Plan to Combat Mental Retarda- tion. One year later, in October, 1962 A Proposed PHASE 1DEVELOPING Program for National Action to Combat Mental THE TEXAS BATTLE PLAN Retardation was presented to the President. It outlined the size and scope of the problem in the United States and provided a blueprint for a comprehensive How to combat mental retardation? Texas needed program of action to prevent mental retardation and a plan. How to develop a plan? Texas needed a Plan for Planning. Mr. Fisher and Dr. Meisgeier, architects to minimize its effects on human development. of the Plan for Planning, developed a structure to guide Texans in the study of their own needs. It The President's Panel report formed the basis provided the opportunity for parent groups, state for two extremely important pieces of legislation agencies, and any interested citizens to participate passed by the 88th Congress. They ushered in a new in the development of the Texas Plan to Combat era in the care of the mentally retardeda shift from Mental Retardation. custodial care in institutions set apart from communities to a new emphasis on prevention and community- The Planning Plan was completed in September, centered treatment and rehabilitation. The first, P.L. 1964 and approved at the first meeting of the Gover- 88-164, provided the funds to plan for the construc- nor's Advisory Committee on Mental Retardation and tion of mental retardation facilities; the second, P.L. by the Governor's Interagency Committee. 88-156, provided funds to each state to set up Mental Retardation Planning Projects.

PHASE 2 PUBLIC BRIEFINGS TEXAS MENTAL RETARDATION AND STATE AGENCY PLANNING PLANNING STUDY Thousands of Texans from all fields and professions, from State and private agencies and from all The Texas Mental Retardation Planning Study walks of life participated in the second phase of the came into being in July, 1964. Its director was Stuart planning. Seventeen highly successful Public Briefings C. Fisher, M.P.H., a man with broad knowledge of were held in key population centers throughout the Texas state government and public administration State. and a wide interest and background in the health field. At the time of his appointment, Mr. Fisherwas Prior to the briefings, each of the 17 chairmen Director of Administration for the New Mexico State attended a special workshop in San Antonio con- Department of Health. ducted by Mrs. Dora Huston, chairman of the Public Briefings Committee and one of the most capable CharlesMeisgeier,Ed.D.,specialconsultant, and active women on the Texas scene today. Special brought to the project a wide-ranging, fiirsthand materialsfilm clips, speeches, press releases, radio knowledge of mental retardation in Texas along with and TV spots, and resource materialswere distrib-

3 uted to each chairman, thus assuring unifornity of aback by the scope of the problem. Wholehearted presentation at each of the 17 meetings. support was given to the work of the commissions. The Commission reportsspringing from local com- Each Public Briefing presented a detailed over- munities and prepared by parents, teachers and those view of the problems involved in mental retardation working directly with the retardedmake up the and of its scope. The purpose and methodology of the bedrock foundation of the Texas Phut as it finally Texan Plan was thoroughly presented and discussed. evolved. Thus the Plan reflects practical needs as Attendees were urged to participate in the planning expressed on the homound of the retarded rather activities in their local communities. than wholly from academic thought or "expert" opinion. The State agencies represented on the Inter- agency Committee were also deeply involvedin With the receipt at the planning study head- planning. Each one appointed its own agency planning quarters in Austin of the complete Mayors' Commis- committee to do a thorough study of its program and sion reports, the third phase of the Planning Project to develop its recommendntion for the comprehensive was completed. plan to combat mental rjtardation.

PHASE 4 SECOND SERIES PHASE 3 MAYORS' COMMISSIONS: OF PUBLIC BRIEFINGS HEART OF THE PLANNING A second series of Public Briefings was held in Every Texas community of any size was active May, 1965again under the capable leadership of in the third and largest phase of the planning. Com- Mrs. Huston. The purpose of these meetings was to munity leaders, parents, concerned citizens, public hear the reports of the Mayors' Commissions, to bring officials at every level of governmental and civic life regional needs into focus, and to present them to expressed the needs of the retarded as they saw the public. them. How? Again a preparatory meeting was held for brief- The mayors of 58 Texas cities with populations ings chairmen, and special materials were prepared of 19,000 or mire responded to Governor Connally's to publicize the work of the local commissions and request to establish Mayor's Commissions on Mental to announce the Public Briefings. Governor Connally Retardation Planning. To prepare for the workcon- made a video tape. Dan Blocker of "Bonanza" tele- fronting them, the Commission chairmen attendeda vision fame and Judge Jones narrated additional two-day workshop in Austin to study their manual, video and radio tapes for statewide use. Guidelines for Community Planning in Mental Retar- dation, prepared and developed foruse by the Commissions. PHASE 5 STUDY OF Each Commission was organized intoseven task MAYORS' COMMISSION REPORTS force study areas: Health, Education, Welfare, Re- habilitation and Employment, Residential and Day Care, Law and the Mentally Retarded, and Public Great stacks of material were received and pro- Awareness and Local Action. cessed in the Planning Office. Special State Reports, Mayors' Commission Reports, Agency Reports, and Specific data were collected by each task force, other materials had to be studied and separated into facilities and programswere studied in detail, legis- areas of specialty. Mr. John Jackson and Mr. Preston lation was recommended, gaps and overlapsin Clark had joined the TMRPS staff to help Mr. Fisher services were described. Each task force report then and Dr. Meisgeier with the work. This phase of the was reviewed by the whole commission, compiled planning was completed in September, 1965 when and finally approved in open meeting. The final report the data were compiled into a publication titled of each Mayor's Commission was presented formally Guidelines for State Task Forces on Mental Retarda- to the Mayor and the City Council of each of the tion Planning. 58 cities. Information in "Guidelines" included a composite In nearly every case the city fathers were taken of the recommendations compiled by the seven task

4 force areas in the 58 communities. Alsoincluded was Draft of the Texas Plan to CombatMental Retarda- information prepared for task force action infive tion, this document was reviewedby the Interagency other major areas: Medical Aspectsof Mental Retar- Committeeandvariousreviewingandwriting dation, Research and Training, Manpower, Organiza- committees. Each Agency PlanningCommittee edited tion-Coordination, and Legislation and Finance. and revised the Task Force reports pertinent toits program. Theserevised and uniformly organized sections then were presented to theGovernor's Advisory Commiicee on Mental Retardation in January,1966. PHASE 6STATE TASK FORCES With the exception of the report on Organization These recommendations for the developmentof and Coordination, the Preliminary Draft of the Texas the Texas Plan to Combat MentalRetardation began Plan to Combat Mental Retardation was approved by to take final shape underthe 12 State Task Forces the Governor's Advisory Committee. An Executive appointed by Advisory Committee Chairman,Judge Committee, appointed by Judge Jones and chaired by Dr. Peck was authorized to rewrite the report of Jones. the Task Force on Organization and Coordination Dr. Sam Nixon of Floresville put allthe data of and to edit the approved draft. health services, the report of the Departmentof Health, the recommendations from the Mayors' Com- This Executive Committee met on January 30, missions, and other materials before themembers of 1966, and completed the final work on the Recom- his Task Force on Health Services for theMentally mendations for the Development of the Texas Plan Retarded. Together they formulated a single plan for to Combat Mental Retardation. The reportthen was coordinated State and iocal action to meet the needs given to the Planning Office for printing in prepara- of the retarded for health services. Each Task Force tionfortheGovernor'sConference onMental worked the same way. Retardation. Dr. Richard H. Hungerford of Victoria chaired the Task Force on Education. Mr. Wilfrid Calnan of Corpus Christi beaded the group that worked on FINAL PLANNING PHASE: Welfare Services. Mr. George Parker, a Fort Worth attorney, chaired the Task Force on Law; Mr.Frank THE GOVERNOR'S CONFERENCE Borreca of Houston, the one on Vocational Rehabili- tation and Employment. From Fort Worth, Mrs. E. E. Searcy took charge of the Task Force on Residential The culmination ofallplanning activitiesto and Day Care. determine what action is needed to combat mental retardation in Texas and what resources are available Mrs. Marilyn Schwartz, wife of the State Senator or needed for this purpose came in aone-and-a-half from Galveston, served as chairman of the Task Force day Conference on Mental Retardation called by on Local Action and Public Awareness. Dr. John R. Governor John Connally for March 17-18, 1966. At Peck of the University of Texas in Austin headed the this meeting the Recommendations for the Develop- Research Task Force; and Dr. George A. Constant, ment of the Texas Plan to Combat Mental Retardation Victoria, was in charge of the Manpower Develop- were to be presented to the Governor,the Interagency ment Task Force. Dr.PhilipRoos, Austin, was Committee, and the people. Everyone who partici- chairman of the Organization and Coordination Task pated in the planning project throughout the State Force; and Dr. Doman K. Kee le of Denton headed was invited to attend. Also invited weremembers of un the group working on the Medical Aspectsof the Interagency Committee, the Governor's Advisory Montal Retardation. The Task Force on Finance and Committee, the State Agency Planning Committees, Legislation was directed by StateRepresentative the State Task Forces, the Mayors' Commissions, and G. F. (Gus) Mutscher of Brenham, Chairman; and many other interested citizens. Dr. Meisgeier, Co-Chairman. This phase of the work was completed in December, 1965. From the Recommendations for the Development of the Texas Plan to Combat Mental Retardation, the Interagency Committee prepared this official Texas Plan to Combat Mental Retardation. PHASE 7 THE FINAL PLAN Success of the Planning Study is a tribute to the The work of the State Task Forces was blended leadership of Governor John Connally, the Governor's into a single workable plan. Called the Preliminary Advisory Committee, the Interagency Committee, and

5 the active interest and participation of the members the implementation staff under a $223,000 Federal of the Mayors' Commissions, organizations such as implementation grant awarded to Texas. The real TARC, and the thousands of Texans who comprise effort to combat mental retardation is just beginning. the "Society of the Concerned." As a result of this initial planning effort, a true social movement exists in its crescive stage focused upon the objective of combatting mental retardation in all its forms. The success of the initial effort must not be LOOKING AHEAD lost but must be used as the basis for an expanded program of implementation, coupled with the development of adequate information r. nd coordination of Planning and action must go together. The Texas resources, needs, and personnel in this long-neglected Mental Retardation Planning Study staff now becomes area of health, education, and welfare service.

6 2. THE ROLE OF HEALTH SERVICES

INTRODUCTION extension of such health services in conjunction with specially developed facilities will be the most effective method of meeting the total health needs of the The full range of health services for the mentally retarded. retarded will, of necessity, cover a broad spectrum of health activities including prevention, diagnosis, This goal can be realized only if the services of evaluation, treatment, rehabilitation, and overall care. many professions, agencies, and programs are corre- These health services will be carried out at different lated. It is recognized that use of existing concepts levels and ultimately will require the coordinated and development of new concepts of interdisciplinary, effort of individual, community, regional, State, and interagency, and intercommunity responsibility are Federal action. The prime goal of these coordinated essential for the success cf this goal. Inherent in the health efforts, however, must always be the provision philosophy of providing health services for the re- of a continuity of services for the retarded when and tarded is the core concept of needing to mobilize where required. Highly specialized health facilities local, community, and State resources to meet the at regional, State, and local levels for work with the health needs of the total population. retarded should be developed. Existing facilities and programs should be coordinated or merged with In this way, health programs for the retarded new programs. will become an integral part of the health services available toallcitizens, and the development of In addition to health programs geared to the specialized facilities can take place free of the need special needs of the retarded, much can and must for meeting the obligations best discharged by existing be provided as a routine and integrated part of the programs. Retarded persons need the health services daily health activities of now existing agencies and required by all people, with the addition of special- programs. Gaps in State, community, and local health ized services to meet their own unique needs. services must be bridged. These programs, serving large segments of the population, should be made immediately available to the mentally retarded. Public SCOPE OF PROBLEM health programs in the area of prevention, amelioration, maternal health, health education, school health, well child conferences, and many other health activi- The total scope of the problem of health services ties must be available to the mentally retarded. for the mentally retarded in Texas is unknown. Main aspects of the problem are: Not knowing how many Regional centers and specialized State institutions retardates there are in the State; finding ways to can and will play a significant role in providing provide services for those who are known; and deter- health services and health leadership for the mentally mining the various causes of mental retardation. retarded. It is mandatory, however, that each com- Some known facts are available and are supplemented munity play a major role in providing its part of the by percentages and estimates. continuity of care needed to adequately meet the problems of the retarded. In short, better and more Although the exact number of retardates in the comprehensive programs of health services for the State is not known, approximately 11,500 are enrolled total child and adult population, regardless of condi- in the six State Schools; approximately 27,236 are tion or severity, should be the aim of allhealth enrolled in special education classes in public schools; programs. When this goal is pursued, a large portion those cared for in child care facilities probably total of the health needs of the retarded will be met. The fewer than 500. However, the number of undiagnosed

7 retardates who are kept ai: home, out of society, is What brings about or causes mental retardation? not known. The question also ariseswhether some What preventive measures can be taken? There are children classified as retarded have actually been numerouscauses,includingmaternalconditions, properly diagnosed. metabolic disorder, and accidental braindamage; however, many causes of mental retardation remain Research Using accepted percentages in estimating the unknown and some are not well understood. continues toprogress. Methods for preventing a mildly (2.5%), moderately ( .4%), and severely (.1%) number of these causes have been found. Research retarded and the estimated 1964 population of Texas that those (10,230,209), the following figures indicate the num- in some instances has progressed so rapidly who are in a position to put the research findings into ber of these groups in the State: practice have not been able to do so. Recognizing that much can be accomplishea, more prevention and Mildly retarded 255,755 detection practices are being carried out in the fields of full health services for all children as well asthose Moderately retarded 40,520 affected by this condition. Severely retarded 10,230 TOTAL 306,505

Of the 254 counties in Texas, only 64 counties WHAT IS BEING DONE contain 73 per cent of the State'spopulation. This would indicate that approximately 27 per cent, or 82,756, of the retarded persons in the statereside in Prevention of mental retardation is the ultimate 190 counties. goal and best hope since it has been stated by author- itiesthat one-half of the future cases of mental Ninety-nine counties in Texas have a population retardation could be prevented if present scientific knowledge were used in current practice. To survey of less than 10,000: what is being done by health services one must face Number realistically the shortage of qualified medical and paramedical personnel in Texas. This is a very com- Population of Counties plex picture throughout the United States and one Less than 1,000 3 which requires a multi-pronged attack with money and resources far beyond that which has been ex- 1,000 3,000 23 pended previously if adequate services are to be 3,000 5,000 21 provided. 5,000 7,000 22 Texas, with an estimated population of 10,230,209 7,000.-10,000 30 in 1964, has one local health officer in each of the 254 counties whose responsibility is the general super- (See map on next page) vision of the health of the public under hisjurisdiction. Most of the county health officers are part-time local general practitioners with very limited time to devote Realizing the vast areas which are sparsely popu- to this public service, or retired physicians withlittle lated and the low income which they would have, incentive for the work. Preventive health services are itisunderstandable why health services are not available through the Texas State Department of readily available. Health and 60 local health departments serving 69 counties. There are about 240,000 live births per year in Texas. The use of an incidence factor of 3 per cent of the total population indicates 7,200 of thesechil- dren, each year, will be mentally retarded. MATERNITY SERVICES How does mental retardation compare withother handicapping conditions? Nationally, it afflicts twice as many individuals asblindness, polio, cf.rebral palsy, Since prenatal service is a vital factor in preven- and rheumatic heart disease combined. The estimated tion of mental retardation and must be improved at cost of life-time care for a mentally retarded person alllevels,itis important to review facilities and in a State institution is $100,000. resources available in this area.

8 TEXAS COUNTIES WITH LESS THAN 10,000 POPULATION (1960 Census)

POPULATION

less than 1,000 g 1,000 to3,000 3,000 to5,000

5,000 to7,000

7,000 to 10,000

9 PRENATAL CARE and special hospitals, three hours are givenby nursing personnel with less preparation.

Analysis of birth certificates in relation toprenatal Outpatient clinic services are provided in144 care for 1963 in Texasindicates that live births totaled hospitals and by 27 local health departments operat- 239,016, and 19,710 of these (8 percent) were pre- ing 82 maternity conferences. At first glancethese prenatal mature births. statistics appear to show that a very adequate supervision programisprovided for mothersin Prenatal Care Total BirthsPrematures Texas. Other important facts reveal shortages of other key health personnel when compared with the ratio Unstated 2.0% 13.4% of public health personnel to the population as recom- None 7.0 2.9 mended by the American Public Health Association. Month not stated but did 1.9 1.9 have some care APH A Recommended Texas Began prenatal care: Discipline Standards Situation 1st month 5.9 5.4 2nd month 22.9 19.8 Physicians 1:50,000 1:200,000 3rd month 27.0 22.8 Nurses 1:5,000 1:7,000 4th month 11.7 11.5 Dentists 1:70,000 1:400,000 7.0 7.5 5th month Health Educators 1:50,000 1:600,000 6th month 5.3 5.8 7th month 4.5 4.6 Sanitarians 1:15,000 1: 20,000 8th month 3.3 3.2 Clerks 1:15,000 1:20,000 9th month 1.3 1.4

Analysis of this data shows that 3.4 months was DELIVERY SERVICES the median at which expectant mothers first sought prenatal care, while the percentage of mothers deliv- ering without any prenatal care atall and those Referring again to the study of the 1963 birth seeking care late in pregnancy was dangerously high. certificates it is observed that 95 per cent of deliveries were in hospitals and 95.9 per cent of all deliveries There are only 683 obstetricians and 3,366 gen- were attended by physicians. However, approximately eralpractitionersavailabletoprovidematernity 12,000 mothers failedtoavail themselves of the services. Approximately 520 midwives provide far services of a physician or the hospital. This means less than adequate prenatal information to expectant educational programs for all socio-economic levels mothers even though they perform 4.2 per cent of must be strengthened to help expectant parents to the total deliveries in Texas. The midwife is usually recognize the importance of seeking prenatal super- limited in formal education and often totally unaware vision as soon as the mother is aware that she is of the danger she can cause through the mishandling pregnant. of mother and infant. In areas where the services of physicians are unavailable or where cultural groups demand, the midwife becomes a necessity. The solu- INFANT AND tion to this problem appears to be the professional CHILD HEALTH SERVICES nurse-midwife.

The shortage of nurses is well known in spite of Infant and Child Health Services are provided the fact that there are more nurses working today predominantly through family physicians who are than ever before. Though there are approximately general practitioners, and less through pediatricians. 17,222 registered professional nurses in Texas actively There are approximately 450 pediatricians and 3,366 employed, there are more vacancies for nursing posi- general practitioners in Texas for services to infants tions than ever before. To meet this shortage, less aild children. qualified personnel such as vocational nurses and nurses aides have been added in hospitals and nursing One of the important preventive services in men- services. In 1962 the American Hospital Association tal retardation programs was started by the Texas reported a ratio of registered professional nurses to State Department of Health when the voluntary licensed vocational nurses of 2.9:1. In Texas the ratio program of screening newborns for phenylketonuria is 1.5:1. It is further shown that for every hour of (PKU) began in September, 1963. This program nursing care provided by registered nurses in general continued until August 31, 1965. During this period

10 66,961 PKU tests were performed, from which five Medical Directors, 10; dentists, 0; nurse directors, 5; cases were detected. The law enacted bythe 59th nurse supervisors, 17; staff nurses,778; health, physi- Legislature requiring persons attending a delivery cal education and recreation supervisors, 30. of an infant to subject the infant to atest for phenylketonuria reasonably assures the early detec- All but 74 of the 254 counties in Texas have one tion and possible prevention of this form of mental or more school nurses. Rangeof services provided by reLrdation. these staffs include screening for defects and deviations from the normal; medical examinations followed by referral for follow-up s,ervices to family physician, PREMA7URE SERVICES dentist, or to other appropriate community services; and consultation on health matters with other school personnel and parents. Review of total births for 1963 in Texas shows that 8 per cent were premature and that 3.7 was the median month of gestation in which these mothers SERVICES TO MIGRANTS sought prenatal care. Education of these mothers, urging them to seek early prenatal care, may influence markedly this incidence of prematurity. Services for Another group for whom special services are the care of these infants are provided by local com- needed are 129,000 migrants who claim Texas as their munity hospitals, primarily in the metropolitan cities home or who seasonally are visitors in Texas from and larger towns. More recently hospitals in some of other states. The number of mentally retarded among the smaller towns are expanding facilities and acquir- migrant families is not known, but applying the same ing equipment for the care of the larger premature percentage as applied to the general population it is infant. It is to be desired that the very small prema- realized, then, that services for these possible 3,870 ture be cared for in the intensive care premature mentally retarded persons should be available. nurseries in the larger hospitals. Nursing care of these infants is a great problem because of the shortage of nurses with special training in care of the premature. Follow-up care of prematures is provided through FAMILY PLANNING SERVICES special clinics until the infant reaches the regular well child conference developmental level. Family planning services are available through family physicians and attending obstetricians, the WELL CHILD SUPERVISION Planned Parenthood Association clinics located in 15 Texas cities, and the clinics administered by one local health department. These are not sufficient to take In addition to services which are provided by care of the parents needing this service.According family physicians and pediatricians, through private to figures from the Regional Office of Planned Parent- practice and through outpatient clinic services of hoodWorld Population, the followingrelatesto community hospitals, 38 local health departments in Texas: Texas operate 239 well child conferences for infants and preschool children. These conferences provide 1. Total Population-1960 Census 9,579,023 medical examinations to determine normal growth and development, and discover defects and deviations 2. Number of Medically Dependent from the normal; immunizations for prevention of Females of Child Bearing Age . 216,807 certain communicable diseases; public health nursing 3. Number of Married Women in Need services which include instruction for mothers; and of Contraceptive Service 98,655 supervision for follow-up care needed in the homes. 4. All Women ( Married and Single) of Nutritionalinstructionisgiven mothers regarding Child Bearing Age, Fertile and in feeding of tbe entire family as well as infant feeding. Need of Contraceptive Service 156,000 5. New Patients Served 12,160 SCHOOL HEALTH 6. Old Patients Served 9,740 7. Total ( New and Old) Patients Served 21,900 8. Per cent of No. 3 ( above) Served 22.2% Of the independent school districts in Texas, 1,475 districts employ the following health personnel: 9. Per cent of No. 4 ( above) Served 14.0%

11 Snyder' stated that in a study of 113non-institu- MENTAL HEALTH tionalized handicapped children, only 3 per centof ANC MENTAL RETARDATION needed dentalwork had been accomplishedas opposed to 50 per cent for the normalpopulation. Poor oral hygiene and periodontaldisease are the The Texas Department of MentalHealth and most serious problems forthe mental retardate.2 Mental Retardation, created by the 59thLegislature, Lozano" estimated that the average mentallyretarded administers 29 institutions ( as of September 1,1965). child entering a State Special School requiresimmedi- Of this number, 6 are hospitals for treatmentof acute ate treatment for 13 teeth. The mostpressing problem mental illness, 4 for the care of aged psychotic pa- is a high incidence of periodontal involvementand a tients, 11 for outpatient clinic services topatients not high prevalence of carious teeth due to the inability requiringtotalhospitalization; and 6 are Special of the patient to help himself. This is amplified bythe Schools for training, supervision and care of mentally conspicuous absence of routine dental services.4 retarded persons. State Schools for the Mentally Retarded are located in Abilene, Austin ( Austin State Dental Services available to the mentally retard- School and Travis State School), Denton,Lufkin ed person can be divided into two groups: (1) Service and Mexia. for non-institutionalized private patients, and( 2) services for residents of State custodial institutions. ClinicEvaluationServicesforthe Mentally Retarded and the Multiple-Handicapped are provided through the following: 1. Child Study Center, Inc. Fort Worth NON-INSTITUTIONALIZED RETARDATES 2. The Diagnostic and Evaluation Center, Denton State School Denton The dental service being obtained by mentally 3. Gulf Bend Center for Children retarded persons in the private practice situation can and Youth Victoria only be estimated. If Snyder's study is applicable to 4. Mental Evaluation Clinic, Junior Texas, it is quite apparent that this need is not being League Outpatient Department, met. Conjecture leads to conclusions that either the Texas Children's Hospital Houston parents are not seeking care, the dentists are not providing the care, or both. In one study5 of 52 den- 5. The Austin Evaluation Center, Inc. tists, 70 per cent responded that they provided dental ( Not ready for operation at this service for both severely and moderately retarded writing, but in the process of re- children. cruiting personnel for staff ) Austin 6. Child Development Center, The It is of interest to note that in Georgia,6 90 per UniversityofTexasMedical cent of the handicapped children are only mildly Branch Galveston retarded. Projecting this figure to Texas, approximately 270,000 retarded persons (90 per cent of Other services for the Mentally Retarded may 300,000) can be considered as routine dental patients be secured through the Division of Maternal and capable of being treated in general practice offices. Child Health, Texas State Department of Health, and through the Texas Association for Retarded Children, The Texas State Board of Dental Examiners in a voluntary, parent-inspired association. Additional 1963 listed 3,481 dentists licensed in Texas with services are provided by very active on-going study approximately 3,000 available to the population at and action committees of professional organizations, health and allied disciplines. iSnyder, J. R., Judith Knopp, and W. A. Jordan. Dental Problems of Non-institutionalized Mentally Retarded Children. Northwest. Dent., 39:123-133, 1960; 41:11-15, 1962. 2Cohen, M. M. Periodontal Disturbances in Mental Retar- HEALTH SERVICES DENTISTRY dation. Proceedings of the workshop on dentistry for the handicapped, pp. 30-37. Philadelphia, University of Pennsyl- vania School of Dentistry, 1958. ( 121 pp.) The need for dental service for mentally retarded 3Lozano, Carlos, personal communication. persons is an unknown quality. However, some gen- 4Wilson, John, personal communication. 5Guidelines for Slate Task Forces on Mental Retardation eralizations can be made from information available Planning, p. H-4. from various sources. 6Wilson, John, Op. Cit.

12 large. The 1964 dentist population ratio for Texas7 is tion ratio and number of ancillary dental personnel 1:2708 as compared with a national ratio8 of 1:1712 (information as of November, 1965). and a suggested ideal ratio of 1:1500( American Dental Association). This ratio varies geographically All dental services are available in the State as the heavily populated areas exhibit a lower ratio. Schools with the exception of most of the specialty Four counties have 47.9 per cent of the State's total services. (Consultative oral surgery service is the only number of dentists. Forty-four counties in Texas have specialty service available.)Itis presumed that a no dentist available. Only 368 dental hygienists were majority of these State School residents would require licensed as of September, 1964. a dentist with specialty training in order to receive adequate treatment. The 10 per cent level (30,000) classified as mod- An inspection of the dental service for the Board erately or severely retarded9 would probably req ire for Texas State Hospitals and Special Schools (now dental service from a specialty practice. Since more the Texas Department of Mental Health and Mental than 11,000 are residents of State Special Schools Retardation) was undertaken in 1962-63. The inspec- some 19,000 would be seeking the services of dentists tion team noted the following:( 1) Physical size and who are specialists in pedodontics. The Texas State space planning of the clinics was poor; (2) equipment Board of Dental Examiners listed 74 of these special- for propersterilizationofinjection and surgical istsin1963. This produces, therefore, a ratio of instruments was inadequate; (3) in-service continuing specialists to moderately or severely retarded chil- education programsforstaffdentists vere non- dren of 1:270. The majority of these specialists are existent; (4) pay scale for the dentists was less than located in heavily populated areas of the State. that for medical personnel of comparable seniority or grade; and (5 )there was no overalldental director to coordinate and supervise the various dental treatment programs of the State Schools. One might STATE SPECIAL SCHOOLS summarize by noting that the Special School Dental Clinics are under equipped, understaffed, underpaid, and lack the specialty services. Six State Schools provide dental service for the mentally retarded. The table below shows location Actions needed to improve the situation for non- of the State Schools, resident populations, number of institutionalized retarded persons would include: (1) dentists employed ( some part-time), dentist popula- Increase the number of dentists and dental hygienists in Texas; (2) Use dental hygienists at Mental Evalua- tion Centers as Dental Health Consultants te parents 7Distribution of Dentists in the United States by State, of mentally retarded children; and ( 3 )Increase the Region, District, and County, American Dental Association, emphasis on continuingeducationforpracticing 1965. SIbid. dentists, particularly regarding the dental needs of 9Wilson, Johr, Op. Cit. mentally retarded children.

TABLE: DENTAL SERVICES IN TEXAS SPECIAL SCHOOLS, 1965

State Resident Ratio of Dentists Dental Dental School Population Dentists(DDS) to Population Hygienists Assistants Abilene 2243 2 1: 1121 0 1

Austin 2459 134 1:1640 1 2 Denton 1738 00 1: 1738 1 1 Lufkin 388 a 1:776 0 1 Mexia 2738 2 1:1369 1 2 Travis 1364 1 1:1864 1 1

°The Denton State School recently affiliated with Baylor University School of Dentistry, Dallas,o provide dental service in conjunction with a teaching program for the graduate students in the Department of Pedodontics. This program provides an equivalent full-time dentist.

13 Actions needed to improve thesituationfor 1.Prevention of the occurrence of retardation retarded persons in the State Schools would include: through application of preventive measures (1) Employment of dental hygienists and other against each causative factor as rapidly as ancillary personnel to institute effective preventive such is recognized. dental programs ( oral hygiene teaching and supervision, topical fluoride treatments, dietary counseling, 2. Earlydiagnosisand treatment(including and extra-dietary fluoride programs );(2) emphasis rehabilitation ) that may modify or reverse the on a continuing education program for institutional course of the disease. dental personnel; (3) institution of pay scales for dental staff comparable to those for the medical staff. 3. Prevention of handicaps likely to superimpose themselves on the retarded person.

WHAT SHOULD BE DONE? 4.Diagnosis and treatment (including rehabilitation) as early as possible, of those handicaps that have superimposedthemselves on In recent years new medical discoveries have the retardate. generated fresh optimism and renewed efforts in case- finding, diagnosis, treatment, and habilitative tech- Implementation of these principles requires an niques for many problems affecting mankind. With awareness and alertness on the partof physicians, each advance there has resulted an improved knowl- nurses, social workers,teachers, psychologists, and edge of preventive measures through which lowered other paramedical specialists; utilization of all existing incidence and even eradication of specific conditions services with expansion of such services as necessary can be brought about. to meet the total need; expansion of research to pinpoint better the causative factors and to develop Mental retardation is a symptom manifested by practical every-day application of new findings to a limitation in functional characteristics, impairments the areas of prevention, diagnosis, treatment, and in intellectual functioning, and social adaptations of rehabilitation; development of diagnostic and evalua- the individual. Vigorous and effective application of tion centers; and development of area hospitals for present knowledge can significantly reduce the occur- those retardates requiring institutionalization. rence of mental retardation. The high incidenceof causative factors and enormous cost of a lifetime of care for each retarded person justifyon economic grounds alonethe expenditure of large sums for PREVENTION prevention. Itis recognized that many preventive measures are overlapping in their benefits to the total health of mankind; therefore,the expansion and Biological Aspects: Biological prevention offers improvement in quality of such preventive services great opportunities through application of existing should not be considered from a singular viewpoint. and newly acquired knowledge to every expectant mother and newborn infant. Optimum application of health services requires thatallsuch servicesjointogether ina logical Itisessential that expectant mothers receive progression and that the retarded individual be inte- adequate prenatal care beginning early in pregnancy grated, within the limit of his capabilites, into normal inorder that maternalconditions(metabolicor society. Greater emphasis should be placed on the endocrinologic disorders, infections, genetic factors, prevention of mental retardation and the promotion and physical conditions) may be recognized and of social-emotional and physical healthin health proper therapeutic measures instituted, and to prevent services for mothers and children. The latter implies complications of pregnancy. The objectives, in addi- a need for making updated information available to tion to preventing maternal morbidity and mortality, all medical practitioners and allied health workers, are: (1) Prevention of damage to the fetus during and an even greater need for recognition by indivi- pregnancy; (2) prevention of premature births; and duals of their responsibility to utilize the scientific (3) prevention of damage to the infant at time of knowledge and services available. birth. There are three broad fronts on which prevention Much progress has been made toward getting of mental retardation can be pursued. These deal expectant mothers to avail themselves of medical with the problem from the biological, psychogenic knowledge and skills during pregnancy and at the and socio-cultural aspects. Thus, itis essential that time of delivery. Prenatal care has been made avail- health services be directed toward: able to many of those in the economically deprived

14 segmentsofthe populationthrough community Better understanding of geneticallydetermined health services. However, in spite of the fact that a enzymatic diseases in which inborn errorsof metabo- physician is in attendance at approximately 96 per lismallowtoxicsubstances which causesevere cent of all deliveries in Texas, morethan 21 per cent damage to the brain to accumulate in thebody has of these women who deliver each year failed to seek opened a new horizon to preventive possibilities. medical supervision until after the fifth month of pregnancy. The 59th Texas Legislature in 1965 passed alaw requiring phenylketonuria (PKU) testingof every Each local community should evaluate carefully newborn infant. Every support should be given to assure that such testingis successfully carried out, and periodically the statistical data pertaining to its medical births in order to determine the community's needs. and to assure that no suspected case is lost to Data for small geographical areas of large commun- supervision due to lack of knowledge or unconcern the on the partof the parents. The Texas State Board ities should be utilized so as to best determine knowledge in segment or segments of the population not receiving of Health should review developing adequate prenatal, natal and postnatal care; such order to declare periodically which test or testswill data may be kept by census tract. In addition to a be considered as acceptable. thorough analysis of statistical data, the community evaluation should include a determination of the Throughout all aspects of prenatal, natal, and availability of service to all segments of its popula- postnatal care, there should be closecoordination tion, adequacy of facilities used, utilization of the between the health personnel involved.Knowledge services, and the quality of care available. Serious of home environment and family conditionsshould consideration should be given to those facilities pro- be correlated with the physician handlingthe specific videdforthedisadvantaged,particularlyasto case. In those cases requiringfollow-up, the physician adequacy of number available to meet the total needs should correlate his information with the personnel and as regards accessibility to those needing the responsible for the follow-up so as to permitsuch services. to be of the best qualitypossible.

Each community needs to evaluate its facilities, Past experience shows, however, that it is not as regards number andquality of care, for delivery eno,Igh to have preventive tools available.It has of mothers; utilization of the facilities especially from been frequently observed that those wbostand most the viewpoint as to the segment of the population in need of services are in factthose who seek and not using them; provisions for care of newborns with utilize them least. A considerable amountof health particular emphasis on care available for premature education directed to personal motivation intheir infants; and the extent and completeness of referral acceptance and use is necessary. Inaddition, health to the public health nurse of those mothersand education should be directed toward preventionof infants identified as needing follow-up after discharge diseases, particularly those for which vaccines are from the hospital. Particular attention should be given readily available. Health education in the areaof to the availability and utilization of acoordinated safety should also be stressed in order toreduce the program for prematures. incidence of injuries, especially those of thebead, and the incidence of poisonings. Adequate laboratory services should be available to physicians, maternal and child health centers, and Professional workers need to be provided oppor- to hospitals. For the more highlytechnicaltests, tunities in the form of formal courses or meetingsand arrangements should be made to have such available staff meetings or refresher courses. Allprofessionals even though it might be bestthat they be performed should be kept up-to-date on techniques andmethod- in regional laboratories. ologies in current use and under study. Newknowl- edge should be made available to eachprofessional Community health services for postpartum exam- worker aE coon aspossible. Each physician and ination and care of mothers and for health supervision nurse workingwith infants and children should be of infants should be available and should include kept acquainted with tbe behavioral anddevelop- provisions for follow-up bv public health nursesof mental inventory of infants and youngchiHren. those not availing themselves of such services. The most powerful weapon at band is the provisionof It is recognized that the key individual inthe easily accessible child health supervision of a standard health services described is the physician. Tosupple- whichapproachesthatoutlinedinthemanual, ment the services of the physician incharge of any "HealthSupervisionof Young Children," ofthe individual problem case, to provide general preven- American Public Health Association. tive programs for the economicallydisadvantaged,

15 and to correlate total health education of the com- child. This should not be interpreted as encouraging munity there are 60 full-time local health departments, over-protection of the child; over-protection can be affiliated with the Texas State Department of Health, as damaging as passivity or lethargy. which are responsibleforservicetotheentire population they serve. These local departments serve 69 counties of the 254 in the State; approximately 75 served. per cent of the State's population is thus DIAGNOSIS, EVALUATION, TREATMENT Obviously, the extent of services provided by any one department is basically dependent upon the Identification and diagnosis of mental retardation amount of local financial support it receives. Each can be one of the most challenging problems to community should be more aware of its total health confront the physician who first sees the infant follow- needs and recognize its obligations to meet them to ing delivery. Itis the physician who has the first the best of its ability. State and local officials should opportunity to make the parents realize that medical intensify their efforts to promote the establishment of interest in the child is a continuous process, and not additional full-time local health departments. The one that is limited to those periods of lifewhen the State should supply funds to supplement local funds child is ill. in order to assure good quality health services. With exception of those few instances where Health education should be recognized as a basic mental retardation is apparent from the first, it is the program of each such department and should be physician, by careful observation and recording of expanded to the level whereby it reaches tbe entire growth and development of the child, who is in the population served, and not be limited to the old best position to suspect deviation from the normal concept that "every public health worker is a health range and to initiate additional diagnostic procedures. educator." The latter istrue, but results in health The physician also has a most important role in knowledge reaching too few people in a piecemeal continued supervision, guidance, and support for the basis when atotalhealth education programis child and parents, assessment and determination of lacking. activities best suitedfor comprehensive care and Psychogenic and Socio-Cultural Aspects: The treatment, and coordination of community resources, concept of psychogenically-based retardation is gen- that may be brought into play, from the standpoint erally accepted, and the origins of such retardation of the individual retardate. may be from conditions in the environmental aspect or conditions within the individual, or both. Mothers of retarded children need to be seen periodically, just like mothers of normal children. All workers with children,especiallyinfants, All mothers need to have their questions answered, need to keep abreast of clinical and experimental to be told about feeding, development and behavior, research regarding the individual's need for sufficient immunizations, and all the other points that concern and appropriate stimulation in order to develop an mothers. In instances of mental retardation, the father adequate mentalcapacity.Further knowledgeis needs explanations and help to accept the situation needed to pinpoint appropriate stimuli for proper age and to be supportive to the mother. levels, and to determine the best approaches to reversing mental retardation due to such causes. The mentally retarded child is more susceptible to illness; thus, there needs to be close follow-up of Use of foster homes, rather than institutions, for his physical condition. Mentally retarded children the care of infants and children needing suchcare may have dental,nutritional, orthopedic, hearing, is commendable and should be encouraged. Where and/or speech problems, and need to have such it is necessary for working mothers to place infants problems recognized as early as possible. Correction and children in day care centers, it is essential that of handicaps, which superimpose themselves on the they be selective in choice of such centers. Foster mentally retarded child, can often increase the child's parents, institutional workers, and workers in child- total functional capacity. care centers need to be made aware of child behavior and development patterns of children. Inspectors of Itisrecognized that mental retardation may foster homes and child-care centers need to place result, at any age, from bacterial infections affecting more emphasis on these aspects. the brain directly or secondarily as complications of such infections elsewhere in the body; head trauma Parents need to become more aware of the needs fromaccidents,prolongedfebrileseizureswith of children, and to better relate themselves to the asphyxia, and poisonings. The physician is in the best

16 mental retardation may be It is further felt that a Diagnosticand Evaluation position to recognize that of each a final resultof such conditions and to utilize tech- Center should be established in the area niques and knowledge aimedatpreventingor medical school located in the State, andthat these modifying such results. In spite ofeverything possible centers should include theprofessional and procedural being done, there will be a number of cases ofmental research sovitally needed. These centers should retardation resulting from such causes. Early recogni- provide consultative services to other centers not so tion of retardation, evaluationof the individual's located, and should periodically make known n-.w capabilities, family guidance and support, andcoordi- research findings, especially evaluationsof procedural nation of community resources are asimportant in research, so that all centers may operate atthe highest caring for those who becomeretarded at a later professional level possible. period in life as for those cases recognized ininfancy. Diagnostic and Evaluation Centers shouldprovide Diagnostic and Evaluation Centers: Although the necessary link with the communitiesthey serve. the primary physician may strongly suspectmental Referring physicians should be kept fullyapprised retardation, he may need or desire theconsultative of their respective cases, and there shouldbe full services of other medical and paramedicalspecialists utilization of those health services available inthe and a wide variety of laboratory teststo better home community. Conversely, the primaryphysician establish the diagnosis and to determine,after evalua- and the community resources broughtinto play retarded tion of the total individual, those measuresbest suited should keep the Center apprised of the for the individual case. The importanceof utilizing person's progress. interprofessional consultants is further borne out by the fact that a person who seemsretarded may be A decision needs to be made concerningwhether suffering from defective hearing or vision,cerebral or not thespecialized centers should include services palsy, communication or speech disorder,emotional for all chronic handicapping conditions,including disorder, malnutrition, or another chronicillness. cerebralpalsy,congenital malformations, epilepsy and multiple handicaps. Continuedfragmentation of To assist the primary physician in hisdiagnosis services by specific entities can onlyresult in excessive and evaluation of the suspect case, there isneed for costs and lowered efficiencyof services for the total confusion to theestablishmentofDiagnostic and Evaluation individual needing help, as well as Centers where professionals of diversetechnical com- parents who are already confusedand who are seek- ponents are concentratedand have availableall ing professional help. necessary testingtechniques and laboratory facilities. Institutional Care: No type of retardation is in felt that the Diagnostic andEvaluation itself an indication for residential care,but such care Itis who Centers should be available to all handicappedchil- isappropriate for severely retarded patients require a degree of physical care whichtheir families ability of the dren on a fee basis according to the are unable toprovide. parents to pay for such services. Astatewide plan to assist parents, especially those who are economically The type of institution used for any particular deprived, to obtain the services of such centers is patientisa decision tobe resolved through the urgently needed. Such a plan could be established evaluative process discussed above. Theretarded placed in:(1) Tax supported or Crippled person may be in accordance with procedures used in the privately sponsored facilities called hospitals,schools, Children's Program. colonies, or homes; (2) general, mental, orspecial hospitals; or (3) halfway houses, boarding, nursing, Diagnostic and Evalution Centers should be located or foster homes. in sufficient numbers throughout Texas so as tobe available to all areas of the State. A basic considera- The acceptedsolutiontodayfavorssmaller tion for the establishment of such centersshould be facilities rather than large hospital-type institutions. the provision of needed professionals (pediatricians, The concept callsfor the establishment of such psychiatrists, neurologists, psychologists,etc.)and facilities at multiple locations in the Statearegional the necessary testing and laboratory facilities.Pro- concept having patients closer tohome rather than visions should be made to assist parents to accompany in a large facility requiringfamilies to travel great children referred to such centers, and such assistance distances or to forego ever visiting the patient. should include expenses for travel, board and room provide opti- while the childisat the center. The experiences The regional-type facility should gainedinthe State Congenital Cardiac Program mum opportunitiesfor education to all residents. The could be used to establish procedures. staff should be oriented toward fulldevelupment of

17 concerned merely with his Students of medicine, nursingand other allied the individual and not about the complexi- physical well-being. The institutionshould be inte- health fields need to know more with appropriate com- ties of mental retardation.Such teaching needs to be grated as closely as possible supplemented by education in theeffects of psycho- munity activities with a viewof providing each individual individual with maximum opportunityfor personal logical,social, and cultural factors on should be to return as development, as wellas thedevelopmental and development. The objective individuals. Such teaching possible to their homes. behavioral patterns of many patients as should be integrated into thevarious departments those utilized from whereby and disciplines inside, as well as There should be a plan of operation outside, the schools. the family, primary physician,diagnostic and evaluation center where theindividual was first seen, and residence are kept Professional workers need to bebrought up to the health services of the home especially on future aware of theretarded person's progress. Planningfor date on present knowledge and should be sufficient to knowledge. New techniques ofdiagnosis, use of return home of any patient genetics, allow for a fluid transition from oneenvironment to specificprocedures, new knowledge of screening programs toward recognitionof causative another. factors, etc., all need to he brought tothe attention of physicians and allied medical workersthrough semi- learning,memory, Researchonmotivation, nars, profcssien9l programs,and in-service training retention of skills, andattitudes toward self and should be utilized retarded person is sorely sessions. Every available technique society on the part of the to disseminate information.Diagnostic and evaluation needed. This research should beconducted by the and institutional care centers usable informa- centers, research centers, regional, hospital-type facilities, and should maintain a free flow ofinformation from one tion should be passed on toall professionals working to the other and serve asinformation centers to the in the field of retardation.Techniques developed educational methods of diagnostic and communities served. All such should be exchanged with the staffs should be on a continuing basis. evaluationcenters,andwithspecialeducation studies and decision- teachers, for use in evaluation and making as regards future patients. There should be provided, through State Fed nal levels, opportunities for keypersonnel to obtain courses on a postgraduate level. It isessential Communities should be encouraged toestablish for scholarships requiring that these plans include provisions facilities at home for retarded persons not and stipends to encourage individuals totake advan- the close supervision available atthe regional facility. loss of livelihood. At the day tage of such courses without a Much attention needs to be given to assure local levels, those in charge of funding agencystaffs care center, boarding,nursing or foster home provides should be made aware of the value of staffpersonnel the desired opportunity of meetingthe educational, having opportunities to attend seminars orrefresher retarded. vocational, and recreational needs of the courses that maybe presented on a statewide or regional basis. There is urgent need for alldisciplines in the health and alliedfields to be refreshed in the behavioral and developmental patternsof children EDUCATION and in present knowledge related tomental retardation; however, once refreshed,each worker needs to be kept abreast of new knowledgeand techniques. There is need for improved awareness onthe part of the general public towardthe overall needs of the handicapped, especially the mentallyretarded. This should be accomplished througheducation of RECOMMENDATIONS the average taxpayer, if all the recognizedneeds are to be satisfactorily met. Abetter public understanding of the known causes of mentalretardation It is recommended that existinghealth facilities, will result in:(1 )Removal of erroneous concepts services and personnel be expandedand up- which now exist; (2) prevention of guiltcomplexes graded to meet community health needs.This, in parents of retarded children; (3)improved aware- in turn, will mean a betterment ofmental re- ness that retarded personshave potentialities that tardation services. need to be developed; (4) awareness of thetotal needs of the retarded; (5) an improvedapplication It is recommended that healtheducationvital of known preventive measures. to prevention of mental retardationbeimprov-

18 ed at all levels. This should includeeducation communities must evaluate and organizehealth on maternaland child health services, especially services thoroughly and effectively toachieve prenatal, immunization, and safety programs. this goal. It is recommended that there bedeveloped a It is recommended that current information, in- plan for the responsible growth of regional cluding new researchknowledge,be made evaluation and diagnostic centers,to provide available on a continuing education basis to alliedhealth comprehensiveservicesforthementallyre- allmedicalpractitionersand tarded. workers. These individuals should continue to recognize their responsibility to use available knowledge, techniques, and services. It is recommended that major research centers be located near medical schools and that pro- It is recommended that continuous actionbe grams be developed incooperation with them. taken at the State level for specific planning on It is recommended that health services forthe the role of State institutions, their building pro- retarded person and his family be furnished as grams, and their coordinationwith regional and close to the basic family unit as possible. Local area diagnostic centers.

19 3. MEDICALASPECTS OF MENTALRETARDATION

The report and recommendationsconcernings SECTION 1 GENERAL themedicalaspectsofmentalretardationare RECOMMENDATIONS FOR MENTAL presented in five sections: RETARDATION PLANNING Section IGeneral Recommendations forMental Retardation Planning. Principles important inthe Planning and action to combatmental retardation general approach to the problem ofplanning for require financing, facilities, expertconsultation, and mental retardation are presented. leadership at State and local levels.They require an assessment of availablefinances and facilities, and Section IIRecommendations for the Prevention call for medical consultationand leadership, in asso- of Mental Retardation. Prevention is theonly way to ciation with other disciplines.Expert advice and cope effectivelywith mentalretardation.Present consultation can be obtainedfrom the following knowledge and means for making a great impact on medical organizations, amongothers: Texas Medical the overall incidence of mentalretardation through Association, Texas Pediatric Society,Texas Academy prevention are limited. Because of thecatastrophic of General Practice, TexasPsychiatric Association, Obstetrics and Gynecology. natureofmentalretardation,however,feasible and Texas AF,ociation of methods of prevention should be seriouslyconsidered in mental retardation planning. It is recommended that necessarymedical consultation and leadership beprovided to assist in planning, development and utilizationof facilities Section IIIRecommendations for Management at State and locallevels. of Mental Retardation. "Management"includes diagnosis of cause, evaluation of thecapabilities of the analysis of existing training. It is recommended that an retarded patient, counseling, and care and facilities and available funds forstudy, prevention, and total needs ofthe mentally retarded be Section IVReccmmendations for Researchand made continuously at State andlocal levels and Education in Mental Retardation. Research isneeded be used for planning to meetchanging needs. in every aspect of mentalretardation and is an importantpartofmentalretardationplanning. Recommendations for education concerneducation for workers in the field of mentalretardation and, in addition, education of the public in preventionand SECTION II management of mentalretardation. RECOMMENDATIONS FOR PREVENTION

Section VPriority Recommendations.Because of the broad scope of the medical aspectsof mental Introduction. Mental retardationrefers to sub- retardation, and -because of the limitationof funds, average generalintellectual functioning which usually available facilities, and personnel, priorityhas been originates during the developmentperiod andis given to certain recommendationsin this report. associated with impairment ofadaptive behavior. Thus, an individual may meet the criteriaof mental The recommendations are italicizedand are pre- retardation at one time and not atanother. A person's ceded by an explanation of tbeprinciples involved. status may change as aresult of changes in social Pertinent references are notedthroughout the text standards or conditions or as a resultof changes in and are given at the end of the section. efficiency of intellectual functioning,with the level of

010121 efficiency always being determined in relation to automatically on many children of the middle the behavioral standards and norms for the individ- and upper income groups. ual's chronological age group. Children of these lessfortunate families Two general types of mental retardation exists: arrive at school age equipped with neither the (1) Those conditions which are the direct result of experience nor the skills necessary 2or formal organic pathological processes, either anatomical or training. They are backward in language and biochemical, which damage the brain ( References 1, in the ability for abstract thinking necessary for 2, 3, 4); and (2) those conditions which result from reading, writing, and counting. From these chil- 1environmental circumstances and have no known dren come many of the dull borderline individ- physiologic or anatomic basis, but are either psy- uals who fill the special classes. Their failure to chogenic or socio-cultural in origin.( References 3, learn becomes complicated by frustration and 4, 5.) anxiety; they may graduate to the streets and ultimately to the institution." (Reference 6.) It has been shown repeatedly and unequivocally that there is a remarkable correlation between the In order to prevent mental retardation due to incidence of mental retardation and the adverse "cultural deprivation," intellectual and cultural social, economic, and cultural status of families. It is stimulation must be provided beginning in in- of interest that conditions which are associated with fancy and extending into adulthood. (References many other health and socialproblems are, to a large 7, 8, 9.) For the infant and preschool child from extent, the same ones that are involved in the problem a low socio-economic background who is "high of mental retardation. In a depressed socio-economic risk"for cultural deprivation, major attention environment the incidence of both types of mental should be focused on learning to understand the retardation isat least five times greater than the world of things and people, communicating with incidence found under more satisfactory economic others, and developing attitudes and abilities and social circumstances. conducive to school learning. (Reference 8.) Opportunities for learning and motivation From a medical standpoint, the most significant for older infants and preschool children should and meaningful approach to reduction in the inci- be established. This could be accomplished in dence of mental retardation is a concerted attack on special classes and education centers. For the the socio-economic conditions which produce most "culturally deprived" child, adolescent and adult, of the patients. (Reference 3.) In general terms, an special education classes should also be set up immediate course of action is clear: General improve- according to different intellectual levels, handi- ment in such services as health care, guidance, special caps, and educational and job-training needs. education, vocational education, and the like directed at those economic groups especially prone tomental It is recommended that the medical profession, retardation. The same preventive measures which including the individual physician and the various strike at the basic causes of mental retardation also medical societies, evaluate, support, and become may help to overcome otherproblems such as juvenile involved in public and private efforts to improve delinquency and general poor health. the general conditions and educational opportunities of the low socio-economic groups of A. Socio-economic Influences. There are three society. major areas in prevention of mental retardation associated with low socio-economic conditions: 2. Child Health Supervision. Poor health leadstosub-optimalintellectual performance. 1. Improvement of general conditions and Health supervision from birth onward is neces- educational opportunities. "A majority of the sary for maintenance of physical well-being and mildly retarded are children of the more dis- early detection of deviations of mental growth advantaged classes of our society, characterized and development. Child health supervision in- by low income, limited educational opportunity, cludes: Routine periodic physical examinations, unskilled occupation, and generally impoverished routine periodic dental evaluations, routine per- environment. These families must concentrate iodic mental developmental testings, routine lab- their meager energies on keeping body and soul oratory examinations, and routine immunizations. together; they have neither means nor skills to In addition to providing good health, such pro- provide their children with stimulating conversa- cedures facilitate early detection of diseases and tion, books, music, travel, or other intellectual abnormalities of child-rearing practices which and cultural advantages, those bestowed almost result in mental retardation.

22 In addition to low socio-economic conditions, tion and materials for family planning amongthe the following conditions are associated with an economically and culturally deprived. increased risk for mental retardation in the involved infant and child: Parental consanguinity; B. Genetic Influences. Certain genetic and fam- pregnancy in the elderly mother; pregnancyin ilial diseases which result in mental retardation can the adolescent mother; maternal history of re- be prevented through genetic counseling and family peated abortions and premature labor; out-ofplanning. Early detection of a few genetic diseases wedlock pregnancy; prolonged maternal infer- a---.:ompanied by appropriate treatment started in the tility; first trimester maternal infection with rubel- newborn period may prevent or lessen brain damage. la; maternal syphilis; toxemia and bleeding dur- (Reference 1.) Examples of genetic diseases resulting ing pregnancy; multiple births; premature births; in mental retardation are phenylketonuria, galacto- perinatal hypoxia; neonatal hyperbilirubinemia; semia,familialgoitrouscretinism, homocystinuria, infantile dehydration;meningitis;encephalitis; translocation Down's syndrome, the neuroectodermal head trauma; maternal deprivation; convulsions; dysplasias, Hurler's syndrome, etc. congenital anomalies and cerebral palsy. (Ref- erence 10.) This list will increasewith expanding Confirmation of diagnosis and management of knowledge; involved infants and children should these diseases frequently require expert consultation be followed closely for development of mental and counseling, elaborate diagnostic facilities, hos- retardation. pitalization,and expensivetherapeuticmeasures; many cannot afford these services, and manydo not An excellent method of providing health have access to public facilities because of residential supervision for each newborn infant and child is barriers such as city and county lines. continuous supervision by a private physician, pediatrician, or well-child clinic. (Reference 8.) The recent legislationconcerning phenylketonuria (P.K.U.) testing points up the necessity for It is recommended that all infants and children uniform testing throughout the State. Major impedi- have comprehensive health supervision, including ments to effective implementation have been:(1) preventive services and care of sick children. The brief hospital stay of some normal newborn Expansion, improvement, and establishment of infants, particularly those delivered in the charity additional facilities for child health care should hospitals of our large cities; and (2) lack of effective be made with emphasis on the economically follow-up of these newborn infants to assure early deprived groups. testing after discharge from the hospital.

3. FamilyPlanning.Culturaldeprivation It is recommended that groups containing a high often is characterized by lack of family living percentage of mentally retarded persons, such as and of knowledge concerning family planning. institutions for the retarded, special education In addition, mothers who come from socially classes, speech clinics, seizure clinics, neurology disadvantagedhomeshavemoreabortions, clinics, and cerebral palsy clinics and schools be ectopic pregnancies, anemias, toxemias, and more appropriately screened in order to detect and babies with congenital malformations and men- provide appropriate management of genetic and tal retardation. (Reference 11.) Anatomy and familial diseases which result in mental retarda- physiology and family planning should be dis- tion. cussed beginning injunior highschool and repeated in high school. It is recommended that the Texas State Depart- ment of Health continue to provide and expand, Itis recommended that education for family where needed, the following laboratory tests for life, including family planning, be provided in use by physicians, hospitals, clinics, etc. for diag- junior high school and again in high school. nosing and managing genetic and related diseases: Chromosomal analyses, phenylalanine and other It is recommended that local school, health and aminoacid blood tests, phenylalanine tolerance social agencies establish community education tests, exzymatic blood tests, qualitative and quan- programs in family life planning for adolescents, titative urinary bio-chemical (including amino- adults, and young couples with consultation acid) analyses, and others. from the Texas State Department of Health and the Texas Education Agency. Itis recommended thatexistingpublic and private facilities be expanded and utilized for It is recommended that health facilities under the diagnosis, care and treatment of genetic direction of qualified personnel provide informa- diseases which result in mental retardation.

23 Itis recommended that legislation concerning which increase the hazards of childbearing for mother P.K.U. testing continue to be reviewed by the and for infant: Toxemias of prInancy; hemorrhage; Texas State Department of Health in conjunction dystocia;anemia; malnutrition;hypertension;dia- with an obstetric-pediatric advisory committee. betes; infections; isoimmunization problems; multiple pregnancy;threatened premature labor;maternal C. Prenatal Influences. history of premature births, miscarriages, etc.; pregnancy in women under 16 and over 40 yearsof age; out-of-wedlock pregnancy; and history of previous Prenatal Care. Inadequate prenatal care, irregu- birth of infants with cerebral palsy, metabolic dis- lar care, care only during the last month of pregnancy, orders. or no care atall,isassociated with high infant mortality and morbidity. Kane's analysis of the data It is recommended that expansion, improvement, from the Foundation for Medical Research shows that and establishmentofadditionalfacilitiesfor American mothers generally have not been convinced maternity care be made so that all women will of the need for prenatal care. (Reference 12.) have readily available continuing care under the supervision of a qualified physician with em- The number of women attending public spon- phasis on the economically and socially deprived sored prenatalclinicshas decreasedsince1950. groups. ( Reference 13.) In general, the percentage of women admitted to the hospital in labor with no prenatal D. Perinatal Influences. care is on the increase.Obstetrical complications are nearly double in this group, when compared with 1. Newborn care. Follow-up studies indicate women who had six or moremonths of prenatal care. that 68 to 75 per cent of premature infants weighing less than 1,500 grams (3 pounds, 5 Little evidence exists to indicate that medical ounces ) at birth have various physicaland men- prenatal care by itself can prevent mental retardation. tal disorders such as cerebral palsy, mental re- Nevertheless, first-class prenatal care is one factor as- tardation, speech and hearing disorders, visual sociated with decreased morbidity and mortality, and disorders, and behavioral problems.( Reference this is reason to believe that improved prenatal care 16.) may also result in thelowering of the incidence of mental retardation.( Reference 14.) Prematures are more susceptible to infections, respiratory disorders, and the deleterious The reasons usually given for not attending pre- effects of certain drugs. Premature care requires natal clinics by women are: ( 1 ) They sometimes had special trained nursing personnel, neonatal pedia- to wait six or eight hours for the five-minute check-up; tricians, and special equipment and facilities. ( 2) the clinics were poorly organized and staffed ( Reference 16.) Special facilities and personnel so that the mothersseldom got to know the doctors are also required for tbe care of all newly born or even the nurses; and( 3 ) there was no continuity infants.( References 17, 18.) of treatment and no plan was evident to the patients. Itis recommended that additional premature Many Texas cities, counties, hospitals, and foun- centers be established in suitable medical facili- dations have no plan for the care of indigent patients. ties in areas of need with the assistance of the In others, the care is haphazard and based on "emer- Texas State Department of Health; that increased gency admissionLarge numbers of women in low- adtfisory and consultation services be provided income families who are receiving poor or no prenatal by the Texas State Department of Health; that care, have a high incidence ofcomplications of safe and specialized transportation of infants to pregnancy and deliver prematurely two orthree times these centers be provided, when needed, by the as frequently as the averagefor the nation as a Texas State Department of Health. whole.( Reference 11.) Such infants are especially vulnerable to brain damage, neurologic disability, It is recommended that premature and full-term and mental retardation. ( Reference 15.) nurseries be evaluated and licensed by the Texas State Department of Health in accordance,th The objective of maternity care is to find the the standards recommended by the American more vulnerable patientsearly in pregnancy and to Academy of Pediatrics and the American College provide preventive health services and medical care of Obstetricians and Gynecologists. for those who are likely to have conditions which are hazardous tothemselves or their infants. The 2. Perinatal Study Committee.( Reference following are examples of conditions or circumstances 19. )There is no organized statewide perinatal

24 study committee in Texas. The major purpose of d. Stimulating youth groups and service a perinatal study committee isto attempt to organizations to program accident pre- reduce fetal and neonatal deaths and to gain vention talks and projects (e.g., use of insight into the causes of non-lethal handicaps in National Safety Council packet ). surviving individuals. This requires complete investigation into the cause of each fetal and neo- e. Encouragingschool systems to include natal death. Since autopsy findings are essential accident and poisoning preventionin to accurate definition of the cause ofperinatal theirhealtheducation program(e.g., mortality, the number of autopsies among still- traffic rules, bicycle safety). births and neonatal deaths must be increased in this State. f.Assisting industrial campaign efforts (e.g., safety rules for use of electricity). It is recommended that a statewide perinatal study committee be set up jointly by the Texas g. Confronting the public constantlywith Medical Association and Texas State Department educational information. of Health to provide guides for perinatal studies, and toestablish methods and procedures of (1) Newspaper reports of accidents, sta- obtaining and reporting epidemiological data. tistics, projects, safety awards, etc. (2) Reports from hospital em ergency E. Postnatal Influences. rooms. 1. Accidents and Poisons. (References 20, (3) Fire marshal's findings in home and 21, 22.) Accidents sometimes can cause brain industry inspection. damage which resultsin mental retardation. (4) New dangers. Examples might be: Some examples are automobile involved acci- (a) Suffocation with balloons or plas- dents, falls, and athletic injuries. Poisons also can cause brain damage and mentalretardation. This tic bags; (b) small fireworks explos- may be a result of chemical damage to thebrain ive resembling candy; (c) new in- or interference with oxygen supply tothe brain. dustrial or agricultural poisons. Statewide programs in accident and poisoning (5) Stressing importance of local educa- prevention should be organized. In developing tionalefforts. This might be done such programs, the following things should be through: (a) Medical self-help cours- considered: es; (b) YMCA swimming and water safety courses;(c)firearmsafety a. Developing physician responsibility for courses; (d) courses in resuscitation. prevention of accidents and poibsining by: h. Expansion, establishment, and improve- (1) Teaching medical students and resi- ment of driver education courses. dentphysicianscoursesandap- proaches to prevention. i.Studies and programs by Health Panels of Community Planning Councils, etc. (2) Inculcatingsenseofresponsibility for and statusofthispreventive Encouragement and enhancement of effort. athletic safety programs in schools. (3) Practicing physicians approached k. Enhancement of seat belt programs. through professionalsocietiesand hospital staffs by programs, volun- It is recommended that all persons having re- teer talks to lay groups, etc. sponsibility for health care of the individual or for public health be challenged to utilize effec- b. Encouraging Public Health Services to tively the avutlable knowledge in prevention of utilizetheir personnel in programs of accidents; that the Texas State Department of prevention. Health be involvedinthe coordination and organization of a program in accident prevention. c.Stimulating hospitals, paramedical groups, and their auxiliaries to focus effort on It is recommended that the Texas State Depart- this problem. ment of Health continue to expand thestatewide

25 ,

poison control program in consultation and co- which are commonly complicatedyencephalitis operation with established poison control centers. and sometimes irreversible brain damage are There should be better utilization of available preventable through active immunization. Two knowledge for educational purposes and public such common diseases are measles ( References awareness. 28, 29) and whooping-cough ( References 30, 31). 2. Infections. Infections of the central ner- It is recommended that appropriate care facilities vous system (meningitis andencephalitis) cause for children with infections which interfere with neurologic damage and, frequently, mental re- mental growth and developmental potential be tardation. (References 1, 2, 10, 23.) Infection of utilized. the gastro - intestinaltract(gastroenteritisor diarrheal disease), frequently causes dehydration It is recommended that surveillance and control which results in brain damage. (References 24, measures forthearbor- virusencephalitides, 25.) already in effect in Texas, be increased, including mosquitocontrolmeasures,researchefforts About one-fifth of the deaths due to diarrheal towards the elucidation of all possible reservoirs disease in the United States occur in Texas. of infection, maintenance of a reporting system (References 26, 27.) Some of the neurologic of all possible clinical cases, and maintenance of sequelae which cause mental retardation can be diagnostic facilities. prevented by early diagnosis and vigorous treatment of meningitis, encephalitis, and gastroen- It is recommended that parents be encouraged teritis. Certain medical centers in Texas treat to see that their children have routine immuni- large numbers of these cases. zations, including measles and whooping-cough, except for cases where there are specific con- It is only natural that better management is traindictions. available in such a setting rather than in a hospital in which experience islimited to a very few cases. The expense of transportation to such centers and the cost of specialized hospital SECTION III care is often a deterrent to optimum manage- RECOMMENDATIONS FOR MANAGEMENT ment. Financial assistance in this situation would result in improved care, particularly for residents of rural areas and small towns. Introduction. Management means providing for the needs of the individual. In planning for the needs Certair viral encephalitides transmitted by of the retarded individual, the family should also be mosquito bites can be prevented through mos- considered and plans made for both the individual quitocontrol.Inaddition,certaininfections and his family. ( See Figure 1.)

FIGURE 1 MAJOR AREASOF NEEDS OF RETARDED PATIENT AND FAMILY A. Regional Diagnostic and C. Regional Institution Evaluative Facility for the Retarded

B. Community

(1) Local Care Patient and Family (5) Foster Home Team (2) Local Short Term (4) Special Work Care Facility Facility (3) Special Education and Vocational Training Facility

26 A retarded individual manifests thefollowing which the family lives. A retarded personand his symptoms: Impaired intelligence,delayed maturation, family may have recurrent or continuing needs inall slowness in learning, and failure in social adjustment. three areas during a lifetime. (Figure 1.) Such abnormalities present many problems tothe patient and his family producingmuch suffering, loss A. Regional Diagnostic and Evaluation Facility. of work time, and expense. A regional diagnostic and evaluation facility (Figure I) is characteristically a center to which the patient Family problems associated with retardation in and his family can be referred for obtaining diagnostic a member are asfollows: studies, evaluation, counseling, and recommendations for management. (Reference 32.) After the patient 1. Obtaining a diagnosis as to the cause of and his family have been seen at the center, they retardation. This is important for treatment of return to the community to be followed bythe pri- the patient and family planning since the retar- vate physician and/or local team ( discussedbelow). dation in certain instances tends to be familial. Additional services, counseling and recommendations are provided on a continuingbasis by the regional 2. Obtaining an evoluation of the patient's diagnostic and evaluation center as further problems capabilities. This is important in making deci- arise. Such a center usually has available: sions concerning education, training for work, and future role in society for the retarded person. 1. Comprehensive diagnostic and evaluative outpatient and hospital facilities. 3. Family counseling has many facets. This is necessary to make it possible for the family tc 2. Services of a team of interprofessional care for the child at home.The family also needs personnel. Pediatrics, psychiatry, neurology, psy- counseling in dealing with its emotional problems chology, socialservice, nutrition, occupational surrounding the retarded child. Examples of such therapy,speech and hearing pathology, and emotionsareguilt,fear,depression,despair, education are examples. hostility, and non-acceptance of the diagnosis of retardation. The parents also need counseling on A regionaldiagnostic and evaluationfacility how to care for the retarded child. Everyday serves a whole section of the state,several counties, care activities of the normal individualsuch as a county, or a city, depending upondistances involved feeding and dressing are major and complex and the population concentration. Such a facility also problems in retardation. can be a part of anotherfacility which deals with other handicaps, or it can limit itself strictly to mental 4. Special education and vocational training. retardation, depending upon community needs. The There is much that can be done for the patient center can conveniently be located geographically in in helping him to achieve his potential for happi- association with other facilities, such as cerebral palsy ness and work productivity. clinics, day care centers, community hospitals, regional institutions for the retarded, mental health 5. Abnormal behaviorial activities of the re- clinics, medical schools and universities. tarded individual. Abnormal activities such as delinquency, truancy, hyperactivity, destructive- More regional diagnostic and evaluation centers ness, aggression, etc. cause severe management are needed in Texas. At the momentonly four such problems. full-time facilities are available. A minimum of one per every 750,000 population is needed( or 13 centers 6. Medical care. Associated medical prob- for Texas' more than 10 million population) but it lems are congenital anomalies, accidents, cere- is doubtful that personnel for more than a few cen- bral palsy, blindness, deafness, epilepsy, psycho- ters could be available in less than ten years. sis, heart disease, and frequent infection. It is recommended that more regional diagnostic 7. Family and home pathology. Alcoholism, and evaluation centers be established in areas separation or divorce, breakdown of sibling re- where needed throughout Texas. lationship, and financial difficulties are examples. B. The Community. The community has several In making recommendations for "Management," needsin meeting long-term requirements of the three facets must be considered: (1) A regional diag- patient and his family. It i ; important to meet these nostic and evaluation facility; (2) a regional institu- needs because the remedy for the increasing size of tion for the retarded; and (3) the community in waiting list for beds in institutions for the retarded

27 in Texas (References 33, 34) can be metby expand- hearing testing at State expense forthe patient ing means of managing retardates at the community who cannot afford it. This can bestbe done on a these level. private basis by referring the patient to services and facilities locally. 1. Local care teem (Figure 1). A local care team in the community works withthe regional The public health nurse is an important diagnostic and evaluation center and institution member of the lonal care team, Theavailability for the retarded. (Reference 35.)It serves a of a public health nul3e in the communityis a city or a county, depending upon distances and sine qua non for the care ofthe indigent retarded the population concentration. A team is composed patient and his family. A publichealth nurse is of local personnel: The private physician (or the helpful in counseling the family inthe care of public health doctor); the public health nurse; the retardate in the home for allsocio-economic the public welfare worker, the home economist, levels. Many counties in Texas do nothave the the school teacher or nurse, and other interested services of a public health nurse. community professionals. These personnel are part- or full-time depending upontheir avail- 2. Short-teem care facilities (Figure1). One ability and the needs of the population being major problem is specializedshort-term care out- served. side the home for the retardedmember. The care must bespecialized in the se of meeting The local team is useful in case finding, the special care problems involved inretardation. preliminary diagnosis and evaluation, liaison with Short-term care outside the home isneeded for regional diagnostic and evaluation facilities and the following situations amongothers. regional institutions for the retarded, and assisting the family in caring for the patient at the a. Daytime carewhen the mother has to community level. The team also performs a work outside the home. valuable service in organizing and helping establish local diagnostic, care, and training facilities. b. Continuous care for a week orlonger This does not have to be a formal arrangement, when illness or some other catastrophic but an agreement among interested personnel to event temporarily disruptsfamily life. work together. State agencies would have to give their personnelatthe local community level There are many adult, mildly-retarded in- clearance to perform such duties. Such a team dividuals who can work under supervision inthe functions much better when a resource and liai- community in the daytime, but whodo not have son personsuch as asocial service case worker available supelvision after working hours.Half- from the institution or regional diagnostic and way houses are anexcellent means of meeting evaluation centervisits and works with the team such needs and should be establishedwhere in the community setting.( Reference 35.) needed. In addition to the services of a regional Summer camps specialized for the retarded diagnostic and evaluation far:ility, diagnostic and are an excellent meansfor providing vacation evaluation services and facilities are frequently time and training for- the retardate wholives in needed for the private physician and/or local the community and should be established where care team for use atthe local community level. feasible. This has advantages when the services of a regional diagnostic and evaluation center is not At present, many retarded individualsin available. An additional advantage is that the Texas are institutionalized on a residential basis private physician and/or member of the local simply because there are no facilities at the com- care team have usuallyknown the family for munity level where the patient could be leftfor years and frequently cando an excellent job of short-term care. (Reference 34.) Day care cen- counseling and management. ters, half-way houses, summer camps, etc.,should be established where needed and feasible. This can be an arrangement whereby the privatephysicianand/or team couldobtain 3. A special education and vocational train- authorization to get complete physical examina- ing facility and a special work facility (Figure tion, routine laboratory data, blood chemistry, 1) are also community needs of the patient and electroencephalographic,,t-,dies,pediatric and family. Because of impaired intelligence and neurological consultants, and social service assis- slowness in learning, the mentally retarded in- tance, as well as psychological and speechand dividual has these special needs. Many commun-

28 ities in Texas do not have such facilities. For 2. Service policies of institutions. Frequently, similar reasons the mentally retarded individual short-term institutionalization is indicated rather may need a special work facility, such as a than long-term care. It is also not unusual that sheltered workshop. emergency admission is indicated. A team approach includingas a minimumthe services of Special education and vocational rehabilita- aphysician,socialservice case worker, and tion facilities should be provided in communities psychologist should be utilized by the institution where needed. Special education should include in determining the advisability of admission and vocational training and vocational rehabilitation discharge of the patient, and in the training and facilities and services should be specialized to care of the retarded person within the institution. meet the needs of the retardate. The appropriate State agency should establish special work facili- Training, educational and care programs can ties for the mentally retarded in communities only be successful when the retardate is healthy. where needed.Theseservicesandfacilities For this reason appropriate medical care pro- should be provided on a continuing basis as grams should be provided for the institutionalized needed by the patient. individual. (Reference 36.) 4. Foster homes for the mentally retarded. There is often a need for short-term or early Much of the size of the waiting list for admissions institutionalizationof the very young infant. to the regional institutions can be reduced by Frequently, retarded infants with gross anomal- placementofretardedindividualsinfoster ies( anencephaly, for example) or complex care homes. There is no significant utilization of this problems ( tube feeding, etc.) no longer require avenue of placement in Texas. the intensive medicA support available in the regular hospital; however, because of the emo- One thstitiltion for the mentally retarded, tional impact of such problems on the family, the Pacific State Hospital in Pomona, California, institutionalization is indicated. Institutional pol- has placed about 800 of its applicants in foster icies should ie modified to meet such needs. homes. This method has two advantages that institutions usually do not have: (1) Moreper- 3. Court commitment. Court commitment to sonalized attention for the patient; (2)a marked a regional State institution is now a policy. This reduction in per capita cost. The appropriate is often unnecessary and frequently delays place- State agencies should promote foster homecare ment. It also frequently discourages the family. for the mentally retarded. The current policy that all routine admissions to institutions for the retarded be court commit- Itis recommended that State funds beappro- ments should be modified so that retarded in- priated for use by the appropriate Stateagencies dividuals may be institutionalized with or without in the promotion and expansion of community court commitment according to the needs of care and training services and facilities for the the situation. mentally retarded. This should include the establishment, where needed, of local communitycare 4. Programs for delinquent retarded youths. teams, short-term care centers, special education Special facilities are required for the manage- and training facilities, special work facilities, and ment of delinquent retarded youths. Not only foster homes. musf the usualservices of the typicalState School be provided, but detention or security C. Regional Institutions for the Retarded. and special training facilities must be available. Special psychiatric services also are needed. Such 1. Additional regional State institutions for facilities are inadequate in Texas. the mentally retarded. At present, the Statein- stitutions are overcrowded, and have long lists Coordinated programs between tbe Texas of patients waiting to be placed. (Reference33, Youth Council and the Texas Department of 34.) By opening more institutions in strategic Mental Health and Mental Retardation should areas, the census of the present State Schools be iristituted to provide appropriate programs, could be reduced and allow for bettercare. either in existing facilities or in new facilities, Parents, by being closer to the institution, would for the care and treatment of mentally defective feel more secure and would be able to participate delinquentswith increased appropriate psychia- more fully in programs. Additional regional State tric servie-e-s. Specialized programs for the care institutions for the mentally retarded should be of retarded delinquent youths should be develop- provided. ed in one or more State Schools for the retarded.

29 It is recommended that additional State institu- It is recommended that mental healthconsulta- tions for the mentally retarded be established, tion services be promoted andexpanded to in- where needed, and that admission, discharge, chide services for the retarded and their families care, and training services ofthe institutions in in both community and institutionallocations. Texas be modified to more appropriately meet the needs of the retarded individual and his family. SECTION IV RECOMMENDATIONS D. Mental Health Facilities in Mental Retarda- FOR RESEARCH AND EDUCATION tion. A significant number of children are referred because of psychiatric, behavioral, or emotional disturbances. (Reference 37.) Failures of community A. General Recommendations. Research and edu- care programs also frequentlyrelate to parental in- cation '-ave several principles in common. Thesewill ability to cooperate in adequate planning because of be discussed under general recommendations. secondary emotional problems related to the retarded child. 1. Mtdti-disciplinary approach to research Parent of retarded child. (Reference 38.) Mental and education. Problems in mental retardation are often a combination ofcultural, social, legal, retardation in an infant or child routinely gives rise and medical factors. The number of disciplines to feelings of disappointment and anger in parents. currently involved needs to be expanded to in- Mechanisms for handling these perfectly natural but law,anthropology, socially unacceptable feelings frequently lead to dis- clude suchdisciplinesas tortions in the lives of both parents and children. sociology, and epidemiology. For example: (1) Premature placement outside the It is recommended that the Texas program on home or (2) clinging to, and over-protection of, the mental retardation support the recruitment of child kept at home, lead to dependency on the re- necessary personnel into thehigher learning tarded child and sometimes neglect of some or all centers so that researchers and educators can of the other children. make a multiple disciplinary approach to mental The retarded child. (Reference 37.) Constant retardation in research and education. frustration in learning to cope with his body and in trying to understand his environment as well as his 2. Training of personnel. The problem of brothers and sisters frequently leads the retarded professionalandsemi - professionalpersonnel child to employ unhealthy defense mechanisms to shortage in the area of mental retardation is well dull his continual feelings of disappointment. Denial known. It has been shown that supervised un- of his deficit, assumption of a private fantasy world, trained or semi-trained workers can often perform blaming of other people for his failures while believ- tasks which will allow more effective utilization ing them unfriendly and unhelpful, and withdrawal of professional time. The rapid expansion of from peer relationships especially in the teens are programs in diagnosis, treatment and careof the destructive defense mechanisms preventing the re- mentally retarded dictates not only a better tardate from learning about himself, his friends, and utilization of available personnel, but extension his environment. All of these defense mechanisms of programs for training. limit still further his intellectual potential as well as his chances for happiness. In addition, many mildly /t is recommended that State funds be made retarded individuals do not learn because of severe available for development of training centers for mental illness or psychosis. personnel in mental retardation at strategically located universities, at institutions and certain Psychiatric consultation from community mental facilities for the retarded; and that research health centers and child guidance clinics should be studies be conducted to determine what type of made available to physicians, departments of special educational background is essential for each task education, and public health nursing units to increase in prevention, detection, and care. the skills of these individuals who work with patient management and parent counseling. Private practi- 3. Legislation for research. Federal, State tioners of psychiatry should be encouraged to make and private funds are available and should be their services available to families of mentally re- utilized by qualified personnel in Texas to keep tarded individuals. Mental health treatment services abreast of research and development progress. should be initiated within State residential facilities, either independently or in cooperation with State /t is recommended that legislation in the State mental health facilities. of Texas be reviewed so that it will utilize to the

30 fullest the acceptance of Federal, State and Certainly there are many handicapped private funds to pursue research in mental re- adults who are successful and well ad- tardation. justed in spite of their hanidcaps. Ave- nues these individuals used to achieve B. Recommendations for Research in Mental these goalsare diverse. They remain Retardation Planning. It was not considered the re- essentially unknown, and might provide sponsibility of the Medical Aspects Task Force to valuable therapeutic techniques. Research recommend where research should be done or whose should be done to determine the effect research should be funded. The type of research done of sensory and other physical handicaps is determined by the principal investigator in each or intellectual development. project according to his ability, interest, and availability of facilities. Below are listed some areas of Specific areas in research should include needed research in mental retardation which seem investigationofsuccessfulgroupsof worthy of serious consideration for funding. For a handicapped adults to uncover avenues general review of research in mental retardation, see they used in achieving their goals and to Reference 39. determine how those with specific sensory deprivation utilized the intact senses 1. Research in Causes: Medical and Envir- in learning situations. The influence of onmental Factors emotional adjustment on their intellectual development should also be evaluated. a. Research in biological and environmental causes. At present, in only 10-15 per cent of the cases of mental retardation can a 2.Research in methods of identification biological cause be identified. (Reference (diagnosis). Early identification of mental re- 4.) As already indicated, environmental tardation leads to early management and some- factors also play a major role in mental times reversibility. The following are needed: retardation. It has been estimated that 65-75 per cent of all mental retardation a. Research in the evaluation of new tech- is of the socio-economic type. The follow- niques for early detection of handicaps. ing are needed: b. Research into the use of methods of es- (1) Research into a better understanding tablishing a "high-risk" rer stry. of both bio-medical and experiential factors in the cause of mental re- c. Research in methods of adequate screen- tardation. ing of newborns for phenylketonuria and other inborn errors of metabolism. (2) Evaluation of effects of family planning in high-risk populations in the 3. Research in management and treatment prevention of mental retardation. programs. (3 ) The development of central laboratories to conduct research into better a.Research in treatment of disease. Patients methods of identification of genetic with diseases such as galactosemia, phe- abnormalities. nylketonuria and cretinism often benefit from early detection and treatment. (4) Research into the influence of day It is highly likely that other similar con- care centers for infants in poverty ditions exist. Those currently being treat- and deprived areas in preventingre- ed are scagered over the State with tardation. various therapeutic regimen being used. Significant information concerning their b. Research in sensory deprivation. Many progress is not available. The following children who have inadequate mothering are needed: or intellectual stimulation in infancy and early childhood are considered to bere- (1) Researchin the coordination and tarded at some time in their life. Sensory development of treatmentprograms. inputs are extremely important in development. The question of how a child (2 ) Investigation of simpler methods of with a severe deficit compensates, remains bio-chemicalmonitoringofthese unanswered. metabolic diseases.

31 b. Research in management programs for 4. Research in the development of more the retarded. Some studies which might effective preventive techniques. Prevention of be productive are: the causes and, therefore, prevention of mental deficiency should be one of the primary aims of (1)Evaluationof the perceptual and any planned program for mental retardation. thinking processes of the mentally Funds should be appropriated by State and retarded. private agencies for:

(2) Research into the psychological con- a.Research programs on prevention of bio- sequences of training procedures. medical and experiential causes of retardation. (3)Development of techniques of training of the mentally retarded. b. Broader socio-cultural research programs to uncover the optimum conditions of (4) Evaluation of effectiveness of elec- learning in the poverty stricken areas. trical stimulation of the central nervous system in improving function- c.Research into methods of increasing the ing and learning of the mentally effectiveness of prenatal care in prevent- retarded. ing mental retardation. (5)Evaluation of the effectiveness of day 5. Research in area of epidemiological stud- camps and teenage social clubs for ies. There is need for determining total census as the mentally retarded. well as geographic distribution of retardation for long-term planning of community health and c.Research in education programs for par- educational needs. This requires that the inci- ents. In the economically deprived groups, dence and location of persons with mental re- the children may have at a special facility tardation in Texas be determined. an enriched program for a few hours per day, but then return to the same environ- Prevalence studies should be conducted to ment which produced the retardation. determine the number and geographic location The goal should be to alter this environ- of the retarded in the State and the special needs ment by establishing parent training pro- of these retarded persons within certain ethnic grams for homemaking skills, child rear- groups. ing practices, and self-improved projects. Funds should be appropriated to study 6. Research in techniques that can be used the effectiveness of these projects. in service and education. d. Research in education programs for re- a. Making knowledge available. The gap tarded persons. Studies have shown that betweenaccumulatedknowledge and children with Down's syndrome make practical application is rapidly increasing.

better adjustments at home than out- There is a.shortage of trained personnel side the home. Similar studies are needed available. Economy dictates the need for on other types of retarded children to see using information already at hand. Com- which ones can be managed at home or munication from one discipline to another infoster homes ina community and requires more thoughtful and consistent which are in need of institutionalization. attention. Adapting existing knowledge to unique local situations is mandatory. e.Research in genetic counseling. Various techniques are used in genetic counseling, Many educational resources are available and parents use the information in many in oertain communities and at various ways. It has been shown that sound gen- medical centers; however, similar resourc- etic counseling is needed for proper fam- es are not readily available to phvsicians ilyplanning. This informationisalso and other disciplines in small commun- used by siblings in considering the like- ities.It is recommended that funds be lihood of recurrence in their children. appropriated to the appropriate depart- Research should be supported to study ments of the State to: the effectiveness of counseling with parents and of the techniques used by the (1) Study ways and means of putting counselor. existing knowledge into service.

32 (2) Supportdemonstrationclinicsfor There is a shortage of physicians who havesub- p:rofessional and non-professional per- specialty training in mental retardation. While sonnel caring for the retarded in more specialists areneeded to staff the institu- order to determine the best method tions and diagnostic and evaluation centers,there of disseminating current information is also a need to teach practitionersmethods of to communities. prevention, early recognition, counselingof parents, and long-term management. Eventhough (3) Compile an accurate index of exist- some introductorymaterial may have been in- ing resources that are available for cluded in medical curricula, the rapid expansion continuing education. of knowledge in this field demands both concentration in under-graduate as well aspost-grad- b. Management programs. The trend is to uate training for the medical profession. keep the mentally retarded in the community; however, theeffectivenessof It is recommended that State funds be appro- existingcommunityprogramsisnot priated to medical schools for expansion and known. Knowledge is lacking on the exact improvement of quality and quantity of medical effect of various community programs on education in mental retardation in medical school families as well as the adjustment of the curricula. child in the community. Because of this lack of knowledge, there are many chil- Itis recommended that medical schools and dren in institutions who do not belong other institutions of higher learning be encour- there as well as children in communities aged to expand their graduate and postgraduate who should have been institutionalized training programs in order to increase the num- long ago. ber of medical specialists needed in mental retardation and related fields; that these funds (1) Research studies should be conduct- be used for scholarships and fellowships to: ed on the effects of various care programs for the retarded and on their (1) Subsidize promising medical students adjustment in the community. and internes who are interested in working in the field of mental retardation. (2) Adjustment of parents and siblings of both institutionalized and non-in- (2) Increase the number of fellowships in stitutionalized retarded children residency programs for training in men- should be evaluated. tal retardation and related fields (e.g., pediatrics,obstetrics, neurology, anes- (3) Adjustmentofeducablyretarded thesiology, psychiatry, genetics, surgical children compared to the average or sub-specialties). superior students ina community school system should be evaluated (3) Establish postgraduate fellowships in further. mental retardation for general practitioners, pediatricians, psychiatrists, neu- (4) The effect on families of day care rologists, and geneticists. for the retardate outside the home should be evaluated. It is recommended that funds be appropriated to the appropriate State agencies for postgraduate It is recommended that mental retardation plan- courses devoted to mental retardation. ning and action in Texas include an expansion of research in etiology, prevention, care and edu- It is recommended that new knowledge in men- cation in the field of mental retardation. tal retardation be spread widely to all practicing physicians in Texas through meetings, clinics, C. Recommendations for Education in Mental official medical publications, and other accepted Retardation Planning. channels of informing the medical profession. 1. Medical education. Mental retardation is 2. Allied professional education. Since many a medical responsibility even though the cause professions are needed in meeting the problems in many instances is socio-cultural. Knowledge of of the retarded, communication is needed be- all factors involved need to be a part of the tween variousallied workers in the fieldof physician's skill in this area of medical practice. mental retardation. The medical aspects of men-

33 tal retardation should be a part of the curriculum awareness program on the prevention of mental for nursing, occupational therapy, physio-therapy, retardation should include, among other things, specialeducation, public health,social work, the role of prenatal and natal care, immunization, psychology,speechtherapy,audiology,and child health supervision, accidents, poisons, in- others. fections and genetic influences; low socio-economic conditions, and the role of sensory and Itis recommended that information on the intellectualstimulationininfancy and early medical aspects of mental retardation be included childhood. in the curricula of professional schools training persons who will later be giving service to or It is recommended that funds be requested for doing research in mental retardation; thata the appropriate State departments for establish- group of medical educators be made available to ing statewide public information and education assist in such instruction. programs on mental retardation. It is recommended that funds be appropriated to the appropriate State agencies for supporting 4. Universityaffiliatedfacilities and pro- postgraduate courses on medical aspects ofmen- grams. (Reference 40.) Residential centers need tal retardation for allied professionals. to be geographically near medical school campuses for mutually beneficial programs in teach- lt is recommended that funds be appropriated ing and research. The availability of a wide to establish fellowships for allied professionals variety of subjects for clinical experience is a in interdisciplinary training centers in mental difficult problem for many institutions of higher retardation. learning. Residential institutions can provide an excellent resource for student and resident teach- It is recommended that medical guidance and ing programs.Inaddition,rn ul ti-disc ipl i n a ry consultative services to hospitals, daycare cen- teams availableinthe institutionsof higher ters and others serving as caretakers of the learning could provide in-service training and mentally retarded be utilized for educational consultation for management in institutions. purposes. It is recommended that cooperative educational 3. Public information and education. Men- and service programs be continued between in- tal retardation affects everyone and its solution stitutions for the retarded and university teaching involves the cooperation of all; therefore,correct centers; and that funds be requested for estab- information about mental retardation should be lishment of classroom and office facilities on available to the public. Awareness will helpin institutional grounds for use of university per- institution of communityprograms and every sonnel. avenue should be utilized for disseminating information.

Communications media, suchas television, radio, lay magazines, and SECTION V newspapers should be PRIORITY RECOMMENDATIONS encouraged to include information aboutmental retardation in their programing. Filmsare avail- ablefromthe UnitedStatesPublicHealth Service, several State health departments,univer- Due to the broad scope of mental retardation sity teaching centers, and private foundationson and the limitation of funds and available facilities mental retardation. and personnel, priority has been given to certain recommendations in this section. An increase in per- Parent groups of the Texas Association for sonnel in mental retardation and related fields is the Retarded Children are already organizedin many most pressing need because any programs in preven- communities. They should be the focal pointas tion, management, education, and research will be leadersin making known the needsofthe severely handicapped by the lack of such personnel; retarded. The public should be madeaware of therefore, priority should be given to recommenda- medical facts which relate to high-riskgroups tions that will accomplish this. Almost as pressing is within various communities. the need to institute programs which will result in the prevention of mental retardation. Better programs Public awareness is also extremely important for management of the mentally retarded also are in the prevention of mental retardation. A public needed. Priorities are as follows:

34 A. Personnel. Items ( especially items concerning 3. Masland, R.L., Mental Retardation;Birth De- the education of personnel) in the Texas Plan that fects, Ed. by Morris Fishbein, J. B. Lippincott will result in an increase in the number and skill of Co., Philadelphia, Penn., 1963. professional and non-professional personnel in mental retardation or fields related to prevention, manage- 4. Wright, S. and Tarjan, G., Mental Retardation; ment, and education in mental retardation. Top pri- Am. J. Dis. Child. 105:511, 1963. ority should be given to recommendations that will result in an increase in the number and skillof 5. McCandless, B. R., Relation of Environmental medical and allied professional workers in the field of mental retardation. Factors to Intellectual Functioning; Mental Re- tardation: A Review of Research by Harvey A. Stevens and Rick Heber; The University of B. Prevention of Mental Retardation. Items in Chicago Press, Chicago, 1964, pages 175 to 213. the Texas Plan that willresult in prevention of mental retardation. Top priority should be given to: 6. Mental Retardation: A Handbook for the Primary 1. Improvement of general conditions and Physician; A Report of the American Medical educationalopportunitiesofthelow Association Conference on Mental Retardation, socio-economic groups of society. April 9-11, 1964, pages 17-42. 2. Improvement of maternity care. 7. Report of the Task Force on Prevention, Clinical 3. Education in family life and planning. Services and Residential Care; The Pri qidfmt's Panel on Mental Retardation, August, 1d62. 4. Comprehensivenewborn,infant,and child health supervision. 8. Words, J.;Prevention of Mental Retardation; 5. Immunization of infants and children. Am. J. of Orthopsychiatry 35:886, 1965.

6.Institutionsof statewide accident and 9.Kirk, S. A.; Research in Education; Mental Re- poison prevention programs. tardation: A Review of Research by Harvey A. Stevens and Rick Heber; The University of C. Management in Mental Retardation Chicago Press, Chicago, 1965.

1.Local community care teams for manage- 10. Garrard, S. D. and Richmond, J. B., Diagnosis ment of the retarded. in Mental Retardation; Medical Aspects of Men- 2. More diagnostic and evaluation centers tal Retardation, Ed. by C. H. Carter, Charles E. for mental retardation. Thomas, Springfield, Ill., 1965, pages 1-31.

3. More regional institutions for the retarded 11. Reducing Infant Mortality-Suggested Approach- and short-term facilities. es. (Committee on Maternal and Child Care) J.A.M.A. 193: 310-319, July 26, 1965.

12. Kane, S. H.; Significance of Prenatal Care. Ob- REFERENCES stetrics and Gynecology 24: 66-72, July, 1964.

13. Report to the President: A Proposed Program for 1.Penrose, L. S., The Biology of Mental Defect, Grune & Stratton, New York, 1963. National Action to Combat Mental Retardation; The President's Panel on Mental Retardation, 2.Hinton, G. C., Postnatal Organic Causes of Men- October,1962, Superintendent of Documents, tal Retardation, Canad. Med. Assoc. J. 87:501, U.S. Government Printing Office, Washington 25, 1962. D.C., page 52.

35 14.Clifford, S. H., High Risk Pregnancy; New Eng- 29. Report of the Committee on the Control of In- land J. of Med. 271: 243-249 and 302-307, 1964. fectious Diseases, 14th Edition, 1964, American 15. Apgar, V.; Outcome of Prematurity.Clinical Academy of Pediatrics, Evanston, Ill., pages 8-10. Obstetrics and Gynecology, 7:744, 1964. 16. Silverman, W.A.; "Programs for Premature In- 30. Leny, S. and Perry, H. A.; Pertussis as a Cause fant Care", Dunham's Premature Infants, ed 3. of Mental Deficiency; Amer.J.Men. Defic. New York City: Paul B. Hoeber, Inc., Medical 52:217, 1948. Division of Harper and Brothers, 1961, chap. 25, pp 443-457. 31. White, R.; Finberg, L.; Tramer, A.; and Rodin, 17. Abramson, H.: "Recovery Nursery for Newborn M.; The Modern Morbidity of Pertussis in In- Infants", Resuscitation of the Newborn Infant, fants; Pediatrics 33:705, 1964. St. Louis: The C. V. Mosby Company, 1960, chap. 14, pp 188-196. 32. Rubinstein, J. H.; Role of the Diagnostic Clinic in the Care of the Mentally Retarded Child; Am. 18. American Academy of Pediatrics: Standards and J. Ment. Def. 66:544, 1962. Recommendations for Hospital Care of Newborn Infants, Evanston,Ill.,American Academy of 33. Barnett, C. D.; Anticipated Applications, Separa- Pediatrics, 1964. tions, and Bed Needs for Texas Special Schools, 1965-1969. Publication of Texas Board for State 19. A Guide for the Study of Perinatal Mortality and Hospitals and Special Schools, November 1, 1964. Morbidity, Chicago: A.M.A. Council on Medical Services, Committee on Maternal and Child Care, 34. Vowell, R. W.; Sloan, W.; Weir, H. F.; and Peck, revised, 1962. J.: The Waiting List in Texas; Am. J. Ment. Defic. 67:21, 1962. 20. Bo ldt, W. H.: Postnatal Trauma as an Etiological Factor in Mental Deficiency; Am. J. Ment. Def., 35. Bergman, J.;Bethel, J.;Pratt,R.; and Lavis, 53:247, 1948. L. W.; A Community Focused Institutional Ap- proach to Mental Retardation; Am. J. Ment. Def. 21. Rowbotham, G. F.; Maciver, I. N.; Dickson, J.; 67:94, 1962. and Bousfield, M. D., Analysis of 1400 Cases of Acute Injury to the Head, Brit. Med. J., 1:726, 36. Wright, S. W., Valente, M., Tarjan, G., Medical 1954. Problems on a Ward of a Hospital for the Men- tally Retarded; Am. J. Dis. Child, 104:64, 1962. 22.Byers, R. K.; Lead Poisoning; Pediatrics 23:585, 1959. 37. Menolascino, F. J.; Psychiatric Aspects of Mental Retardation in Children under Eight; Am. J. of 23. Ford, F. R., Diseases of the Nervous System in Orthopsychiatry 35:852, 1964. Infancy, Childhood and Adolescence, 4 Ed, page 417, 1960. 38. Mental Retardation: A Family Crisis-The Thera- peutic Role of the Physician; formulated by the Committee on Mental Retardation for The Group 24. Crome, L., Encephalopathy Following Infantile of the Advancement of Psychiatry, 104 East 25th Gastro-enteritis; Arch. Dis. Child. 27:468, 1952. Street, New York, New York,10010, Report Number 56, December, 1963. 25. Finberg, L., Pathogenesis of Lesions in the Ner- vous System in Hypernatremic States; Pediatrics 39. Stevens, H. A. and Heber, R.; Mental Retarda- 23:40, 1959. tion: A Review of Research, The University of Chicago Press, Chicago, 1964. 26. Vital Statistics of the United States, 1963. 40.Darrell, A. H., Cooperative Programs of Training 27. Texas State Department of Health, 1956-1960 and Research in Mental Retardation; A Survey Statistics. Study of Cooperative Relationships Established Between Residential Facilities for the Mentally 28. LaBocceta, A. C. and Fornay, A. S.: Measles Retarded and Colleges and Universities; The Encephalitis, Am. J. Dis. Child. 107:247, 1964. Antioch Press, Yellow Springs, Ohio, 1959.

36 .16...wwwwwwe ,nnwnmommonsw.01011111111,

4. EDUCATION AND TRAINING

The Texas Legislature in 1951 passed a law Adequate libraries and research projectsare authorizing special education classes for educable necessary to keep a forefront in the attack on educa- mentally retarded children who are unable to profit tional problems of the retarded. Studies of current from regular classroom instruction. In 1957, special procedures, programs, and activities will be required classes for the trainable mentally retarded were in- to keep these offerings up to date. These studies cluded. need to be designed with realistic solutions as goals.

In 1965-66, there were 1,895 classes for the educ- Itisimportant that evaluative techniques be able mentally retarded and 240 classesforthe regularly applied to educational programs for the trainable mentally retarded in Texas public schools. retarded in order to adjust and revise where services Parochial and private schools reported in 1964 that are of improper quality. It is equally important that they were conducting 402 classes for the educable correction of inadequacies be a direct result of the mentally retarded and 107 classes for the trainable evaluations. retarded.

Eighty-eight of Texas' 254 counties reported no INTERAGENCY COMMITTEE education services for the mentally retarded. Many of these counties were sparsely populated and services for the identification of the mentally retarded were Several State agencies now provide services of extremely inaccessible to them. However, a large some kind for the mentally retarded. It is difficult percentage of the mentally retarded were receiving for one agency to know what other agencies have services in special classes, according to surveys con- planned for a specific individual. Often there is a ducted during the planning study. duplication of services by one or more agencies, and at other times one agency does not act because the Comprehensive and quality educational services service appears to be within the jurisdiction of an- to the mentally retarded in Texas are dependent upon other agency. Consequently, the mentally retarded adequate identification, qualified teaching personnel, person may never receive the services which he needs. and a curriculum based on realistic objectives. To plan and to institute educational programs for the Furthermore, the retarded person is frequently unable to utilize available services without direction. presently known populationofretardedpersons would simply be a stop-gap measure. A primary goal Withoutcommunicationandplanningbetween is to operate and to maintain specifically designed agencies, there is little coordination of services. Thus, programs at a consistently high level, for the benefit it is important that action on behalf of the mentally of all mentally handicapped. retarded be formalized and coordinated on a statewide basis. All programs need thes :pport of education specialists and professions from many other specialty TERMINOLOGY areas outside the field of education. Another goal toward which those concerned with mental retardation can wor'c is to marshal community resources Each agency and discipline which have respon- for the educational benefit of the mentally handi- sibilities for services to the mentally retarded seem- capped and to make programs for the mentallyre- ingly have coined their own terminology, often using tarded an integral part of thetotaleducational some of the same words but with many different offering within every community. interpretations. The ability to communicate about

IIMOZWil11111111111.11.1.10.411ffiraallif needed services is dependentupon a language which 1. Amend the special education can be understood and applied. Therefore, the adop- unit allocation formula to ten pupils for eachunit. Allocate tion of standard definitions andterms relating to funds to local districts mental retardation is needed. on the number of pupils identified ( one pupil equal 1/10unit allocation). It is recommended thatState agencies providing 2. Provide for services to mentally retarded a uniform statewide curricu- persons adopt the lum which includes evaluativeworkshop activities definitions and terminologyof the American As- in public schools. sociation on Mental Deficiency, andthat these definitions and terminology beapplied uniformly 3. Provide for adequate facilities, by various State departments equipment, to determine eligi- and teaching suppliesto implement the curricu- bility of persons for availableservices. lum (financial support shouldbe shared by the local district, State and Federalprograms).

4. Finance adequatetransportation to assure MANDATED SERVICES pupil attendance andparticipationinspecial programs.

The present permissive 5. Provide for trained and certifiedpersonnel law for educatingmen- for each unit. tally retardedpersons in Texas public schools provides for school districts to establish classes whena suffi- 6. Provide for vocational rehabilitation cient number of eligible children livein that particular assis- district.The lawrecognizes tance to assure each mentally retardedindividual thattransportation, adequate and sufficient services. special facilities, teachingequipment, and supplies are a part of special services, butno provision has been made to finance these 7. Provideforindividualormulti-school extra items, over and district comprehensive educational above what is allocated for eachregular classroom units to serve teacher unit. the mentally retarded.

Since some districts have fewerchildren than required for establishinga class, and since no provision for transportation is madeto transfer children SPECIAL EDUCATION SERVICES to a district providing special education,many mentally retarded childrenare at a disadvantage. Other children are ata disadvantage because some districts There is presentlya lack of standardized, sys- do not have enough classes to establish a sequential tematic,evaluativeproceduresforevaluationof developmental curriculum. Teachersin a small pro- mentally retardedpersons and no provision is made gram are penalized because thereare too few to form for exchange of existing identifyingdata for mobile a group for in-service educationor plan conferences retarded persons. Thereare too few centers establish- relative to improved curriculum andprogram devel- ed where families with retardedchildren are able to opment. go for diagnostic services, comprehensive counseling, and/or referral to availableresources. To obtain these A need exists toassure comprehensive service to needed services, familiesmay travel long distances each retarded individual, regardlessof where his and are oftenunaware of nearby facilities or of pro- home is located, andto enable school districts to cedures required to obtainnecessary services. provide educational servicesto each identifiedre- tarded individual. Library materials, curriculum coordination,and opportunities for training and retraining of teachers It is recommended that the Legislature bere- in service are not readily available.Administrative, quested to study the need formandatory educa- consultative, and instructional servicesare not suffi- tional services for all eligiblementally retarded cient to provide quality educational individuals in the state. programs. Such Regional centers should provide,for the To insure comprehensive qualityservices to each retarded person and his family: (1)A systematic individual, irrespective of his homedistrict, it is be- screening and referral program;( 2) complete evalua- lieved that the following points shouldbe considered tion and diagnostic services; (3) family counseling; in such a study: ( 4) referral services for health, education,and wel- 38 fare; and (5) exchange of information from one mentally retarded have inadequate ancillarystaff. region to another for mobile students. Ancillary staff includes local program administration, supervision, and coordination, as well as sufficient Itis recommended that the Texas Education specialists in curriculum, medicine, psychology, social Agency establish area special education services work, public health, and recreation to assure quality for the mentally retarded to provide for:(1) of the programs. assurance of mandated educational services; (2) consultative service for school districts; (3) cur- It is recommended that the Legislature be re- riculum coordination; (4) materials centers and quested to amend the MinimumFoundation professional libraries; (5) in-service and retrain- School Program Law to provide adequate ancil- ing programs for teachers; (6) consultative serv- lary services that will assure a quality educational ices for the adult retardate programs. program for the mentallyretarded.

EXPANDED PROGRAMS COLLEGE STAFF AND CURRICULUM

The public education system in Texas provides In the optimum utilization of the program to for two groups of the mentally retarded from 6 combat mental retardation, college staffs face many through 21 years of age. One group, classified as problems related to pre-training and retraining of trainable, includes those with intelligence quotients professionalstaffpersonnel,keepingabreastof of 35 to 50. Another group, classified as educable, changing data, and maintaining an up4o-date level includes those with intelligence quotients of 50 to 70. of awareness. There is a need for better quality of It is recognized that present educational provisions educational pre-service training and retraining relat- for the mentally retarded are not adequate to meet ing to new programs, curriculum designs, and testing the needs of all retarded persons in Texas. of research results. Also needed is realistic design of research projects dealing with critical problems which it is recommended that programs for the mentally arise in day-to-day contact with retarded persons. retarded be expanded to include "borderline" Colleges and universities need to make additional mentally retarded pupils and additional services preparations and arrangements to train sufficient per- for the multiply-handicapped mentally retarded sonnel to staff the proposed programs. pupils. It is recommended that Texas colleges and uni- It is recommended that the Legislature be re- versities be encouraged to develop their profes- quested to enact new legislation to permit the sional training programs in such quantity and operation of educational programs for mentally quality as to assure a sufficient supply of trained retarded children with chronological ages under personnel as needed to staff comprehensive pro- 6 years. grams for the mentally retarded. It is recommended that the Division of Teacher Education and Certification of the Texas Educa- ANCILLARY PERSONNEL tion Agency have the responsibility and authority to administer and to insure the uniformity of modern professional training programs. Special education without ancillary services often is unproductive. Many educational programs for the

39 5. VOCATIONALREHABILITATION ANDEMPLOYMENT

Work is profoundly important to every person. 6. Supervised programs for on-the-job train- It is no less important because a personmight be ing of retarded workers. mentally retarded. Mental retardation, andthe en- forced absence from the labor force that itsometimes 7. Supervised living facilities while under- imposes, only serves dramatically tomake clear how going vocational rehabilitation services orwork- crucial is work and a vocation. Vocationalrehabilita- ing in sheltered employment. tion also becomes important for a personwhen his disability interferes with acquiring vocationalskills 8. Trained personnel to assist the mentally and a job. retarded in securing employment.

A wide array of vocational rehabilitationservices The recommendations presented below set forth for the retarded are available through privatework- proposals which would further enhance vocational shops,rehabilitationfacilities,State agencies, and rehabilitation services for the mentally retarded in the Division of Vocational Rehabilitation in the Texas Texas. Education Agency. Despite progress in the rehabilitation of the retarded, it is evident that an extensionof services should be provided to prepare moreretarded persons in Texas foremployment. SHELTERED WORK AND LIVING FACILITIES To establish a complete vocational rehabilitation program for the mentallyretarded, the following services must be made available. Sheltered employment and supervised living are essential elements in the rehabilitation of thementally I. Social,psychological, medical, and vo- retarded. Of the 53 Mayor's Commission reports cational evaluations. submitted, 29 cities recommended the establishingof sheltered workshops and 27 stated a need for super- 2. Counseling services to the mentally revised housing. Obviously, there has been a lag inthe tarded, and counseling services to their parents construction of such facilities. to provide them with an adequateunderstanding of the employment potentials and limitations of The complexion of society is changing fromrural their children. to urban, and more mentallyretarded persons are being trained and place.d in gainfulemployment. 3. School-work programs operated coopera- Mentally retarded individuals formerlyplacedin tively by the public schools and the Divisions of State Schools are being habilitated to alife in the Vocational Rehabilitation and Special Education community.It becomes increasingly necessary to of the Texas Education Agency. provide s"neltered training and employment aswell as supervisedliving for these individuals. Many re- 4. Employment training facilities for those tarded individualswillrequirelife-time sheltered who require further vocational preparation after employment and supervised living whileothers will completion of the public school program. need only temporary services fromsuch facilities. 5. Sheltered workshops for retarded workers It is recommended that shelteredworkshops and capable of productive work ina supervised half-way houses be made availablein each population to setting. metropolitan area having sufficient 0/41 support such facilities.(It is estimated that it mentally retarded include all community funds will take a population of at least 70,000people appropriated at the local level to assist in the to support adequately a shelteredworkshop or development of community facilities. half-way house.) It is recommended that the TexasEducation Itisrecommended thatshelteredfacilities, Agency request continued support of the Legis- whether private or community supported, be lature for increased general revenue funds to financially secure; and that the responsibility for match Federal monies available for providing financing these facilities be borne by the local rehabilitation services to the mentally retarded. community, the State, and the Federal Govern- ment.

It is recommended that sheltered work oppor- EMPLOYMENT tunities be extended beyond traditional workshop settings. (Many community and service activities could be performed outsideof a workshop through activities carried on under the profes- It has been vividly demonstrated that thc men- sional guidance of facility personnel.) tally retarded can be useful and productive employees if properly supervised. However, the majority of It is recommended that the traditional philosophy employers are not aware of the abilities of the re- of sheltered workshop operation be modified tardedafterthey have been adequately trained. whereby workshops would become an important Consequently, employers tend toresist employing training agency for future placement of retarded the mentally retarded. Since one of the goals of the persons in the community as well asproviding rehabilitation program is gainful employment, it is sheltered employment for life. important that every effort be made and all available services used in helping the retarded to find suitable employment.

It is recommended that the Texas Employment UTILIZATION OF Commission continue and intensify the use of its AVAILABLE FEDERAL FUNDS trained personnel to assist the mentally retarded in securing employment as an integral part of the Commission's program of service to the hand- Recent Federal legislation has made available icapped. additional Federal funds on a matching basis. Several phases of the Amendments to the Vocational Reha- It is recommended that consideration be given bilitation Act passed by the 89th Congress will affect to the placement of mentally retarded persons services to the mentally retarded. These Amendments in appropriate governmental employment. will provide the total rehabilitation program with additional case service funds through the utilization It is recommended that business and industrial of available State General Revenue appropriations. leaders be encouraged to employ the handicapped. A portion of these additional funds will be chan- It is recommended that the Governor's assistance nelled into the area of services to the mentally re- be requested to suggest to the mayors of Texas tarded. Also several provisions of the amendments cities which have Mayors' Commissions for Men- will make grants available to sheltered facilities on a tal Retardation Planning or local committees for matching basis. These grants will be for the improve- employment of the handicapped that these local ment of existing facilities and the construction of new committees emphasize, as a part of their overall facilities.Construction,renovating,staffing,and program, the employment of thementally re- equipping sheltered facilities will be involved. tarded.

It is recommended (in order to assure the State It is recommended that union leaders and mem- of Texas of the ft tll utilization of all Federal funds bers of joint apprenticeship training committees availablefort 9cationalrehabilitation)that beencoui aged teaccept mentallyretarded matching State funds for sheltered facilities and persons into their trainingand apprenticeship other vocational rehabilitation projects for the programs.

42 STATE SCHOOLS FOR It is recommended that on-campus living and THE MENTALLY RETARDED training programs such as the one established at Denton State School be established on State School campuses where such projectsare feasible. These projects would be primarily for boys and The six existing State Schools for the mentally girls from rural areas where training facilities retarded are presently operating withina philosophy sometimes are not available. conducive tovocationalrehabilitation. The State Schools presently have personnel assigned to work with all adult students for the purposes of vocational evaluationand on-campus placementinvarious ELIGIBILITY occupations within the institution. The students work under supervision and are continually evaluated for possible job placement in the community. The existing State and private agencies engaged in vocational rehabilitation of the mentally retarded The Texas Department of Mental Health and presently use various criteria for establishing eligi- Mental Retardation presently has working agreements bility for services. It must be recognized thatsome of with the Division of Vocational Rehabilitation, Texas the mentally retarded in need of vocational rehabilita- Education Agency, for that Division to assignre- tionwith proper counseling, training, and job place- habilitation counselors in four of the six existing State mentwill be able to function adequately in the Schools for the mentally retarded. Plansare being competitive labor market. made for assigning vocational rehabilitationcoun- selors to the other State Schools and anynew facilities However, a large number of the mentallyre- as soon as the need for vocational rehabilitation tarded in need of vocational rehabilitation services services is established in these institutions. will never be mature enough to function in thecom- petitive labor market. Many of these individualscan The vocational rehabilitation counselors assigned be productive and partially self-supporting in terminal to the State Schools work with eligible mentally re- sheltered workshops if vocational rehabilitationserv- tarded studentsafter their sixteenth birthday. In ices are available in their behalf. three of the State Schools, vocational rehabilitation counselors are directly responsiblefor on-campus Itis recommended that all State and private placement and vocational evaluation for all students aaencies enaaaed in the vocational rehabilitation over 16 years of age. of the mentally retarded recogn ize the feasibility of offering vocational rehabilitation services to In four of the State Schools, vocational rehabilita- any mentally retarded individual with the ability tion counselors are responsible forall off-campus to be productive; and that provisions be made to training and job placement of the students. When- include both the mentalk retarded capable of ever possible, the students are placed on jobs in their working in the competitive labor market and home communities. This requires makingarrange- those in need of terminal sheltered workshop ments for on-the-job training, counseling, supervision, employment. sheltered living, and transportation during training.

Itisrecommended that more pre-vocational DIAGNOSTIC AND EVALUATION CENTERS evaluationactivitiesbeestablished onState School campuses in order thata more realistic and practical vocational objectivecan be established for students with vocational potential. In order to offer a complete vocational rehabilitation program for the mentally retarded in Texas, it is necessary that early identification, early educational It is recommended that a realistic and workable placement, and early pre-vocational evaluation be plan be worked out for transporting students to made available for them. Adequate services of this and from training and employment while they type are available at present in the large metropolitan continue to live in the institution. areas; however, these facilities are almost nonexistent in the rural areas of the State. State and private Itis recommended that sheltered, (4f-campus agencies concerned with the vocational rehabilitation living facilities in the form of half-way housesor of the mentally retarded in ruralareas have difficulty foster homes be made available for State School getting proper information needed to serve retarded clients during and after rehabilitation. clients.

43 PUBLIC SCHOOL WORK-STUDY PROGRAM services to the mentally retarded in the rural areas has been difficult. The Division of Vocational Rehabilitation and Mentally retarded clients need close supervision Special Education of the Texas Education Agency in specialized facilities in order to be successfully designed and introduced a program to bridge the rehabilitated. Counselors serving the rural areas have gap between school and the worldof work for edu- been unable to provide close supervision because of cable mentally retarded persons. This is known as the large area they serve and the counselor-population the Cooperative Program. Local school districts may ratio. Evaluation, training facilities, and employment establish this program in their school by signing a opportunities are not readily available or accessible contract with the Division of Vocational Rehabilita- tion and Special Education of the Texas Education in the rural areas of the State. Agency. It is recommended that encouragement be given A rehabilitation counselor is assigned to the local to the developing and establishing of cooperative school district to work cooperatively with the special programs where they are feasible inrural areas. education teacher to evaluate the employment poten- It is recommended that the vocational rehabilita- tial of the mentally retarded, arrange for on-the-job tion counselor-population ratio be reduced so training, work experience training, job placement and counselors serving the rural areas can devote follow-up. The Cooperative Program has proven to adequate time necessary to effectively serve the be a successful method of rehabilitating the educable mentally retarded. mentally retarded; however, this program should be expanded to include all mentally retarded persons in It is recommended that bi-district or county-wide need of rehabilitation services. evaluation be established in training centers to serve the mentally retarded. It is recommended that the development of cooperative programs (school work-study) be en- It is recommended that provision be made for couraged in school districts where they do not day-to-daysupervisionofmentallyretarded exist. clients in on-the-job training stations in rural areas.(This possibly could be accomplished It is recommended that emphasis be placed on through volunteers from organizations and civic orientation programs for school administrators to groups.) inform them on implementation of these cooperative programs. It is recommended that workshops and half-way houses to serve clients from rural areas be ex- It is recommended that school officials be urged panded until such local programs can be &stab- to work toward developing and utilizing the lished. school facilities for developing the work experience phase of the public school program. Itis recommended that th.'re be established PERSONNEL adequate pre-vocational evaluation training programs on the junior high campus of cooperating Recent legislation expanding the scope of voca- schools. tionalrehabilitation and the President's War on Poverty Program has created a shortage of qualified It is recommended that programs similar to the vocational rehabilitation personnel to fill existing and cooperative program be established in schools anticipated vacancies. The responsibilities of reha- which do not have special education classes or bilitation personnel working with the mentally re- schools with small units which prevent the imple- tarded are so numerous and so widely diversified mentation of these programs. (This could be done that only uniquely talented persons can perform all on a county-wide or bi-district basis.) of them well. Personnel needs are critical. Itis recommended that ancillary positions be SERVING THE MENTALLY RETARDED established which would not require full professional preparation, but which are necessary IN RURAL AREAS in the rehabilitation process, such as job centers for placement counselors. One great need in Texas is to establish better vocational rehabilitationservicesfor the mentally It is recommended that professional personnel retardedinruralareas.Rehabilitation counselors such as psychologists, psychometrists and social presently are serving all 254 counties in Texas. How- workers be provided to enhance the rehabilitation ever, providing effective and adequaterehabilitation process.

44 6. SOCIAL WELFARE

SCOPE OF RETARDATION PROBLEM Despite the fact that these programs serve persons whose mental age may bechildlike, the programs IN TEXAS NOT REALLY KNOWN are not subject to Stateregulation because they serve "adults." These "adults" are sometimes easily led and It is recommended that State agencies which may have limited ability to reason ordo abstract servestudents,clients,patients,etc.,should thinking,acombinationofcircumstances which identify those who are retarded, tabulate any creates a fertile field for possible exploitation. Those data they have about these persons, and feed who pioneered services to the older employable re- this data into a central data system so that the tarded persons have been altruistic individuals, but State's knowledge about the scope and cost of the retarded teenager or adult with money in his mental retardation services in Texas may be pocket may be easy prey for unscrupulous persons. determined. It is recommended that the Legislature be requested to extend State agency regulation to NEED FOR REGULATION OF SERVICES include "half-way houses" and "sheltered work- NOT PRESENTLY SUBJECT shops." TO LICENSING Much concern was expressed about the obvious need for State regulation of many services to children FISCAL DEADLINE and handicapped adults which are not presently subject to regulation. Although the Texas Department of Public Welfare regulates child caring facilities In order for Texas to be eligible to receive and the Texas Education Agency regulates schools, Federal funds for Child Welfare services, maternal tbere are many programs in the "gray area" in be- and child health services, and crippled children's tween which should be regulated.Specifically, these services after July 1, 1975, these respective services are"nurseryschools,""kindergartens," and "day must by that date be available in all counties in the schools." These types of programs not only need to State and also must demonstrate reasonable progress be regulated for the protection of the children but toward these goals each year in the interim. This to assure parents who may be victimized by paying appears to have great relevance tothe development fees for erroneously labeled services of questionable of services for retarded children as these divisions of value. these State agencies have many of the same goals It is recommended that the Legislature be re- outlined in this and other sections of the Texas Plan quested to extend State agency regulation to to Combat Mental Retardation. include "nursery schools," "kindergartens," and "day schools." Another area which appears to need regulation TEXAS DEPARTMENT is that of "half-way houses" and "sheltered work- OF PUBLIC WELFARE (TDPW) shops." With the push to integrate into community life retarded persons who are able to work and manage their own lives under limited supervision, there TheTexasDepartmentofPublicWelfare have been developed various facilities to serve them, (TDPW) has great capacity and potential to offer such asvocationaltraining programs,supervised social services to the mentally retarded and their dormitories, half-way hduses, etc. families.

45 Expansion of TDPW Casework Services tiveness to find an escape from such exploitation. As retarded persons achieve gainful employment, they may be taken advantage of through excessive rent or As the TDPW is the only Stateagency with exploitative contracts and may need help in using services to people in every county of Texas considera- their earnings wisely. tion needs to be given to the feasibility of TDPW providing social services to the retarded in othenvise It should be emphasized that although Child unserved counties. It appears to be in order alsoto Welfare social services are available topersons up consider the feasibility of providing services to all to their twenty-first birthday and to unmarried par- economic groups, not just services andmoney grants ents of any age, the court may not declare a person for the indigent. dependent and neglected after his sixteenth birthday. It is recommended that TDPW, if requested, Itis recommended that TDPW be enabled, should serve the retarded and their families, through legislation and increased staff, to provide without a means test, in counties lacking other protective social services for persons over age social services, and should be enabled to accept 15 who are in need of such protection. A clarify- fees from persons able to pay for services. ing study should be made of laws related to auardianships for retarded adults, either through Whether or not the abovecourses are decided the State Bar of Texas or as a follow-up of the upon, constant attention to the quality of casework Texas Mental Retardation Planning Study. services is a necessity. Despite the frequently heard recommendation to lower caseloads, itisfelt that lowering caseloads will not initself improve the quality of casework. Research and Demonstration The reduced caseload will be effective only if the other improvementsare made. These include In recognition of the desire of TDPW to improve the appointment of qualified social workers andcon- its services to the needy, the 59th Texas Legislature tinuation of staff training and development by TDPW, included funds for research and demonstrationin its and: appropriation for TDPW. Large caseloads and lack 1. The availability and utilization of facilities of community resources in the past have hampered for diagnosis, treatment, care, and training. seriously TDPW's attempts to deal with the special 2. The exchange of knowledge andcoopera- needs of its clients who are retarded. Now thatcase- tion among agencies, institutions, and thecom- loads have been reduced, especially with regardto munities they serve. services for children, and as communityresources have and will continue to develop rapidly... 3. Increasedprofessionaland community awareness of mental retardation and the social ..It is recommended that TDPWuse some of problems it creates. its research funds to establish a demonstration project in intensive services toa selected group of retarded clients. Protective Services For Older Persons Special Liaison Needed Among TDPW, Mental Retardation Programs, Personnel Retarded adults who lack suitable homesor responsible parents or whose parentsare aged, infirm, or deceased, may have no one to turn to for protec- The launching of the Texas Plan to Combat tion, guidance, or training inways to manage their Mental Retardation willrequire specialattention own affairs. They may take pretty objects because f rom TDPW. they have never hadany training regarding property rights. They may produce children without knowing It is recommendedto facilitate the effectiveness the relationship betweensex acts and conception and of TDPW in the area of mental retardation without the capacity to support, supervise, and guide that the Department have astaffconsultant their children. The retarded girlmay be forced into and/or advisory committeeon mental retardation a range of deviant behavior but may lack the inven- to guide its services to the retarded; and that

46 the TDPW provide special training for field staff public subsidy of the facilities themselves, to enable regarding medical and social aspects of mental them to acquire additional and better qualified staff, retardation relevant to the clientele of the agency. or a public subsidy of families to enable them to pay the higher fees required to support upgraded services.

Licensing Program Foster Care Funds Are Scarce

Pressures sometimes have been exerted on State The therapeutic potential of foster care for re- legislators to abolish the licensing program of the tarded persons has been greatly overlooked. Because TDPW, which helps to protect children by requiring of the great demand for foster homes for homeless childcaring and child placing agenciesto meet children, the financial burden forfoster care of minimum standards. dependent and neglected children is already greater than many counties can bear. However, there are The licensing program of the TDPW, which retarded children whose special needs could be met helps to protect children by requiring child caring better in private residential care than in a State and child placing agencies to meet minimum stand- School. There are also retarded persons who do not ards, was endorsed by the Task Force on Welfare. require State School care who for various reasons cannot remain in their own homes. Further, tbere Itis recommended that local governments be are persons on the waiting lists of State Schoolswho urged tocontinuefullcooperation with the cannot remain in their own homes in the interim. TDPW licensing staff through fire,sanitation, and health inspections and consultations, and Itis recommended that State and/or Federal when necessary through legal procedures affect- child welfare funds be provided for the purchase ing substandard programs which are dangerous of therapeutic care, foster care, and day care for to children. exceptional children, and for professional homemaker services to improve their care in their The Task Force on Welfare questioned the own homes. merits of a suggestion that TDPW develop separate licensing standardg- for facilities serving mentally retarded children because it felt this would justify the proliferation of special standards for facilities serving SOCIAL SERVICES the crippled, ti.c cerebral palsied, the blind, the deaf, the emotionally disturbed, and the multi-bandicapped. Many communities have family and children's Instead, the Task Force agreed with the philoso- agencies, both public and private, which can be phy of TDPW of having licensing standards based attracted to the challenge of making social services on the needs of the "whole child" with additional available to the retarded person and/or his family requirements appropriate to meet tbe special needs at the time of diagnosis if they need help in under- of the handicapped children which a given facility standing the social implications of the diagnosis or serves. in coping with the family problems related to the retardation. The Task Force felt that all children, including those who are retarded, would benefit from upgraded minimum standardsforlicensing.Althoughthe TDPW can refuse licenses or revoke licenses when Casework and Placement facilities are dangerous to children, the objective of the licensing program is to help child care facilities to improve the quality of their services so that they Too often planning for care and training for can surpass minimum standards. retarded children is thought of as either home care or State School care without considerationof the At present, services to children outside their own many other types of care which mightbetter meet homes are in various stages of development and an the needs of the retarded person and his family. immediate raising of standards would force many existing programs to raise their fees and/or possibly Whatever seems the hest plan for the handicap- to cease operation. The only alternatives would be ped member, the family should consider the various

s possibilities, choose one, and be helped to live com- for a prolonged period such as for a serious illness, fortably with the decision. They also need to feel that (2) or when she is physically or mentally unable to no decision is for a lifetime and that it might be handle the full load alone, (3) or when she needs appropriate to have periodic reassessments of the help in learning better home management, (4) or to retarded person's situation and their own to determine learn techniques which will help her care for a mem- whether a new plan is indicated. ber of the family who has special problems such as PKU, diabetes, crippling conditions, etc. Homemakersareusuallyrecruited,trained, RESOURCES FOR CONTINUUM OF CARE placed, and supervised by welfare or health agencies. They may give special attention to the member of the family who needs extra attention, or may assist There '..,,.!eds to be a continuum of care resomces. the mother with excessive burdens of responsibility. These should be selected so as to help the retarded Consultant help in planning homemaker services is individual lead a near normal life, to develop his available from several national and state-level sources. level of self-help as well as other potentials including readiness for education or training and should also help the family achieve a well-rounded existence. Day Care, Night Care Families of the retarded need relief from their Or Weekend Care constant care and supervision even more than parents of normal children, yet there arevery few resources for substitute care. If they have to work outside the In some instances it is in the best interests of all home, the mothers of retarded children haveexcep- concerned for the retarded member to leave the home tionally limited resources for substitutecare. for care and training elsewhere a few hours each day or week although he continues to live in his own Itis recommended that a continuum of care home. Outside care can be especially helpful for the resources be developed or expanded to meet the retarded member whose family tends to underestimate needs of the retarded and their families. his capacity for self-help. It can be helpful to the family, especially the mother, in relieving her of the Some of these are described below, under the stress of his constant supervision and physical care. headings of child monitoring; homemaker service; Day care on a regular basis is an essential for day, night, and weekend care; short-termor emer- the retarded child of the mother who must work. The gency care; foster care, group care, half-way house, educational aspects of good care away from home and institutions. can be very important for the child who comes from a deprived environment. Other families may find that care away from home for the retarded member is Child Monitoring (Baby Sitting) more desirable at night or on weekends, similar to night hospitals which have been successfulas a means of treating mental patients. An available supply of carefully screened child monitors in a community would enablesome families to leave the mentally retarded member at home while they enjoyed activities outside the home occasionally. Short-term or Emergency Care Some families could manage with this service, leaving the more intensive and expensive services for families Families with retarded members have the same needing more help. A local organizationor agency unexpected crises other families have such as death, should take the initiative in recruiting andtraining such persons to hospitalization,seriousaccidents,orunexpected serve on a voluntary basis. The urgent business trips, and like other families they relevant experiences of United Cerebral PalsyAsso- ciation could be utilized. also need vacations from time to time. But unlike other families, these families find it difficult to leave the children with the neighbors or to find a sitter who will remain in the home continuously for several Homemaker Service days. Consequently, families with retarded members often suffer through a double crisis on these occasions. One family reported having to takeitsretarded Homemaker service providesa substitute mother member to a general hospital in order to leave town within a home when (1) the mothermust be absent two days for a funeral.

48 Group Care are just a step awayfrom being able to lead com- Foster Family Care and pletely independent existencesand for them the half- way houseprovides opportunities todevelop self- environment. In some instances it isbest that the retarded sufficiency in a somewhat sheltered person live awayfrom home either because ofhis owndevelopmental needs or becausehe and his family need to be completelyseparated from each other for a period of time.Also, some retarded per- Institutions sons do nothave suitable homes or parentswho can them, but do not need to be ininstitutions. care for Some handicapped personsneed intensive train- For these persons livingwith a substitute family may and close supervision and care. be best. Others who needless personalized relation- ing,or constant homes with others Others have physical conditionsrequiring medical ships may respond best to group It would probably be by house parents. attention or special equipment. like themselves, supervised unrealistic to assume that if acommunity had sufficient resources for careand training, there would be no needfor institutions. However, it isimportant to of institutions Half-way House remember that the modem concept is that althoughthey provide lifetime care for some, other persons enter themonly for a period of time the community or thefamily. Many young adult and olderretarded persons but may later return to

49 7. RESIDENTIALAND DAY CAREFOR THE RETARDED

considerationsshould include INTRODUCTION Basic day-care services which will strengthenthe family group and assist the retarded individual ineffectively utilizing him. In other planning: the resources that are available to Attention in this section was devoted to words, day-care services shouldenable the child to (1) For facilities and services to meetfuture popula- of his family and as a partici- (2) for ways to enrich grow up as a member tion and program needs, and pant in communitylife.2 the programs of present facilities and tomake maximum utilizationof existing residential and day-care resources, bothpublic and private. FEDERAL Throughout the United States, the residentialin- IMPLICATIONS: LOCAL, STATE, stitution traditionally has been thekeystone in the array of servicesdeveloped for the mentally retarded. assured that by In Texas, the State hasattempted to meet the Too frequently the public has been residential providing residential facilitiesit has discharged its needs of the mentally retarded requiring obligation to the retarded. The concept thatthe care bybuilding Special Schools. The Departmentof residential institution should be but one of anumber Mental Health and MentalRetardation administers been widely six Special Schools whichhave a combined capacity of coordinated services has not yet Schools for the Men- implem ented. of 11,500 beds. Three additional tally Retarded are under construction orin the plan- The Task Force on Prevention, ClinicalServices ning stage. These new schoolswill add approximately and Residential Care of the President's Panel on 2,900 beds to the present capacity overthe next Mental Retardation succinctly summed up thechal- three years. However, it is anticipatedthat the wait- persists, will continue to lenge to those who presently are engaged inplanning ing list, if the present trend activities. The group called for aphilosophy of care expand and will remain lengthydespite the opening that would demand a definite reversal of former at- of the new schools. Sustained expansionof residential titudes and practices. Retarded children havethe facilities ultimately will commit Texascitizens to a same needs as other growingand developing children, tremendous future tax burden. but they and their families also needspecialized with their Private residentialfacilidesserve arelatively services to meet the problems associated nevertheless, they particular handicap.1 small number of mentally retarded; play an important role in the arrayof available in- There should be a blending of services between stitutional services. As contrasted with thelarge State- installations often have the institution and resources in the community.There operated facilities, the private should be a systematic array of coordinated services better staffing ratios andthey have more flexible Usually, however, the fees for pri- designedtointegratethe retardateintosociety. program policies. Wherever possible the basic aim of the total program vate facilities arebeyond the financial capabilitiesof should be geared to keeping the retardedchild, most families of thementally retarded. especially infants and young children, with hisfamily Day-care resources arelimited in many Texas or else in fosterhome care. There is no substitute nonexistent in rural for family life. communities. They are almost

the Task 2LaCrosse, Edward L., Day-CareCenters for Mentally Re- iPresident's Panel on Mental Retardation, Report of for Retarded Children, Force on Prevention, Clinical Servicesand Residential Care, tarded Children, National Association 1962, Pages 1 and 2. Inc. ,0/51 areas. Undoubtedly many admissions to State resi- It is recommended that there be established a dential facilities could be averted if more resources network of regional centers for serving the men- for day-care services could be provided in local areas. tally retarded and their families. Community facilities, backed up by institutional resources, could make it possible for more mentally re- In addition to Legislative appropriations, maxi- tarded to remain with their families and, at the same mum utilization of local and Federal funds should time, relieve the institutions of some of the pressures be sought to finance these centers. Such regional for admission. centers should strive to dovetail with existing resources in the region and should be flexible in com- The new Federal program for cooperating with position so as to meet the unique characteristics of State and local communities in the construction of the region to be served. Chief goals of these centers community centers offersgreat promise for more should be the development of a continuum of care cooperative efforts among local, State, and Federal and the provision of continuity of services. resources for more appropriately meeting the needs of the mentally retarded closer to their homes. Applications for admission to Special Schools continue to be received by the Texas Department of Mental Health and Mental Retardation at a rate of 1,500-1,800 annually.Itis becoming increasingly SUMMARY: THE TEXAS CHALLENGE apparent that a sizeable portion of the applicants could and should be served locally or regionally if adequate resources are made available to the retar- It has been obvious that past efforts to meet the date and his family. varying needs of the mentally retarded in Texas have been discouragingly inadequate. This does notmean These new facilities should tie flexibly designed to decry the contributions of the many devoted in- so as not to duplicate existing resources in the area dividuals who have labored diligently to provide to be served and should complement the region so adequate services for the retarded. Conditions would as to provide the following basic services: (1) Diag- be in a deplorable state if it were not for the dedi- nosis and evaluation; (2) counseling for parents; (3) cated energies of those who have been providing care day care; (4) short-term residential care; (5 )shel- both in public and private facilities. However, far- tered employment opportunities and work evaluation; reaching changes are called for in the present mode (6) information, education, and referral; (7 )con- of service delivery. sultationtoregional agencies and institutionsof higher learning; (8) homemaker service; (9) foster Perhaps uppermost is the need for a change in home placement coordination; (10) halfway house attitude toward residential facilities. The public will operation and supervision; and (11) research and need to accept the philosophy that institutions should training, as appropriate. be used to meet the differential nee& of the retarded In remote areas, mobile service teams should be individual rather than primarily as a resource for the establishedand operate outofexistingregional community. Stated bluntly, the community should not centers and/or residential institutions. use the institution to meet a need that should be met by the community. This is a serious disservice to the Programplannersshould be cautionedthat retarded child and his family, and it is an abuse of categorical and a priori decisions that all centers limited residential resources. should be either separate or combined may lead to ineffective programs. The decision as to whether a Also impressive is the need for more coordinated given regional center should combine services for the planning among the many agencies, public and pri- mentally retarded with those for the mentallyill vate, in order to make maximum use of available should be based on several factors, including the resources. This need isparticularly urgent among characteristics of the region to be served, existing State agencies for statewide purposes and among services, availability of manpower, the need, local the many local groups at the community level. desire and interest, etc.

Whatever resources are developed in residential Itisi ecommended that empirically evaluated and day care for the mentally retarded, the resources demonstrations using both separate and joint in the institutions should blend with those in the centers in urban and non-urban areas be carried community. This is essential in order to promote con- out and that the Legislature be requested to tinuity of care and to assure the public that each appropriate funds to the Texas Department of retarded individual will have the opportunity to de- Mental Health and Mental Retardationfor velop to his full potential. establishing operational models.

52 Since the process of diagnosis and evaluation should be forthcoming to permit a broad-scale plan usually involves the same skilled professional man- of assistance to those local communities which dem- power in providing such services for both the men- onstrate interest and potential for assuming a larger tally retarded and mentally ill, and since manpower share of the responsibility for establishing effective is in short supply, there may be advantages to com- mental retardation services. bining mental retardation and mental health services Day-care service is a new and emerging pattern in a single regional center. of programming for the retarded in Texas which offers considerable potential for serving the retarded However,itisrecognizedthatprofessional specialization leading to competency in working with person within the context of his home and family. mentally ill adults may not automatically qualify the professional to work effectively with retarded children It is recommended that Special Schools, regional and youth. Further, Texas' experience in providing centers, and other service facilities as may be services of the type mentioned ineither joint or operated by the Texas Department of Mental separate centers is too limited to allow broad generali- Health and Mental Retardation offer day-care zations. Empirical investigations of the effectiveness training, as appropriate, to the retarded from a very early age; that the day-care function be an of services in both joint and separate centers should integral part of the continuum of services which be conducted. includes diagnosis, parent counseling, and refer- Where joint centers are authorized and operated ral services; and that the Texas Department of by the Texas Department of Mental Health and Men- Mental Heath and Mental Retardation in estab- tal Retardation, any advisory boards which may be lishing and operating day-care programs, should not duplicate existing services in the community. organizedorappointedshouldreflectanequal weighting of members having interest in each of the areas of mental retardation and mental illness. It is readily recognized that many families could care for their retarded familymember in the home The mechanism of Texas Department of Mental with appropriate supportive services. Day-care, in Health and Mental Retardation grants-in-aid to local which the retarded individual spends all or a portion communities is viewed as a basic and essential re- of the day in special training-care-supervision setting, affords him opportunities for growth development sourceforassistingcommunities and regionsto increasingly assume a greater share of the respon- and association with other persons of his age and ability level. At the same time, the parents are freed sibilityfor the development and coordinationof mental retardation programs. from supervision of the retarded child to pursue other duties relating to housekeeping, work, etc. It is recommended that the Legislature be requested to appropriate to the Texas Department Physical and mental strain are produced by the of Mental Health and Mental Retardation sig- constant supervision required by many retarded in- nificantly increased amounts of money to facili- dividuals. The day-care approach to assist in the tate the grants-in-aid program; and that priority alleviation of this problemisendorsed.Flexible in awarding such grants be given to projects movement of retarded individuals from day care to which have potential for demonstrating new and other existing programs ( e.g., education, habilitation, meaningful approaches to developing mental sheltered workshop, etc.) should be carrieg2 out as retardation case finding and diagnosis, care and the needs and circumstance warrant. treatment programs, and restoration or rehabilitation. It is recommended that the Texas Department of Mental Health and Mental Retardation be House Bill 12 (59th Texas Legislature) estab- authorized to establish new residential facilities lishesthegrants-in-aid mechanismtoqualifying as needed; that the location of any newfacilities centers. The goal of combined Federal, State, and be determined after a careful study of the need local fiscal assistance to communities to aid in the factors and resources in the geographical area development of mental retardation programs and to be served and that they adhere to the basic servicesis deemed essentialif maximum resource concept of proximity of care. utilization is to be realized. Specific future sites for institutions are not rec- The present Legislative appropriationtothe ommended, but priority of study should be given to Texas Department of Mental Health and Mental Re- a study of the residential need factors involving the tardation to implement the grants-in-aid program is El Paso area, the Rio Grande Valley area, and the viewed as token in nature. Increases in these funds northeast Texas area.

C integral part of the regional The importance of H.B. 41,which now permits be made available as an the TDMH/MR to establishthe sites of new Special center approach. Schools, is reaffirmed. Inaddition, the nature of the It is recommendedthat the Texas Department mental retardation problem inthe regions mentioned of Mental Healthand Mental Retardation de- above suggests the need forexpanded residential velop and establish realisticand practical guide- services in these areas. lines to be used by the StateSpecial Schools, and other State and localresidential facilities for the The sizes of residentialfacilities of the future mentally retarded, in providingadequate and should be planned so as toaccommodate effectively appropriate personnelstaffing patterns and op- their resident populations. erational standards. increaR^d attention be It is recommended thatthe Legislature be re- It is recommended that quested, on sound justification, toappropriate given to planning forsmaller living units (i.e., Schools: (1) dormitories or wards) to allow morehomogenous sufficient funds to enable all State increased amounts of in- To meet minimum staffing andoperations stand- groupings and permit populations and, dividual attention in care and training programs. ards to service the in-patient where appropriate, to assume theregional center role; and ( 2 ) to rai4e thesalary levels of child Study should be given to the meritsof special personnel in order to recruit residents are care and related purpose institutions( e.g., where all and retain high quality workers. bedfast, etc. ) and/or to the creationof special purpose units or sections( e.g., to serve the physically Assumption of the responsibilityfor caring for handicapped retardate, etc.) withininstitutions. large numbers of retarded Texas citizenscalls for an adequate professional staff to conductongoing eval- A 2,000-bed residentialfacility in or adjacent to uations of resident progress,implement leadership to a largemetropolitan area may be capable ofproviding nonprofessionals in training programsof various sorts, more effective servicesthan a 500-bed facility situated and communicate effectively andregularly to the in an area where professional manpowerand ancillary families of these individuals. However, the general services cannot be obtained. continue to principle that residential facilitiesshould also serve Appropriate ;tate agencies should and provide a broad array of provide programs to serve retarded personswho are as regional centers who have services to retarded residents inproximity to their blind, deaf, physically handicapped, or homes and families suggests that two1,000-bed in- other such disabilities in addition totheir intellectual stitutions will be moreeffectiveinfulfillingthis deficit. over-all responsibility than will asingle 2,000.bed Regional centers for certain disabilitygroupings facility. Cost comparisons betweeninstitutionsof and/or the operation of specialservice units within differentsizes must include considerationof the institutions should be initiated.Where indicated, magnitude and quality of out-patientservices as well State agencies should cooperatein joint planning, as thetraditional residential (in-patient ) serviceload. implementation, supervision, andevaluation of these endeavors. It is recommended that existingresidential facili- for the feasible, along Program planning and implementation ties, to the extent practical and multiply handicapped retarded childcalls for special- with all future new institutions,be converted or facilities and equipment. function; ly trained staff and unique constructed to serve the regional center Increased efforts should be made bythe State agencies that in the case of existing institutions,Legisla- serving these individuals, additional staff and to develop new programs tive support in the wwy of and to cooperate on basic programresponsibilities in facilities be authorized to facilitate conversionto the multiple problems the regional center approach in whichdiagnostic the non-retardation aspect of and evaluation services, along with abroad array represented. of out-patient and in-patient services,could be In the case of retardedresidents of Special provided. Schools, consideration should be given togrouping like multiple problems( e.g., blind retarded, deaf staff and retarded, cerebral palsied,etc.)from the Special As required, additional professional Frequently, it facilities should be made available to existingSpecial School network at a single institution. full range of is only in this way thatenough representatives of a Schools to enable them to provide a be amassed to justify the services to both in- and out-patients.Staff members given disability group can who can devote a portion of their time toconsultation specialized personnel and equipmentthat may be with correlated service agencies inthe field should necessary forsuccessful program implementation. 54 It is recommended thatin providing for a con- and studied in order to derive maximum benefits tinuum of cervices between the community and from their experiences. residentialresourceprovisionsbe madefor transitional types of services such as halfway It is iecornmended that the TDMH/MR streng- houses and group-living arrangements, off the then and broaden, in its various facilities, educa- campus of an institution. tion and rehabilitation services to the mentally retarded. Arrangements should be made for transportation for day-care and halfway house participants. A full range of services should be developed, including prevocational and vocational evaluation and It is recommended that the Legislature be retraining, sheltered workshops, residential supervised quested to authorize one or more demonstration employment aiid training, off-campus employment, units of this nature with the appropriate State halfway house place nert and employment, and com- agency exercising quality control of these pro- munity group living and working facilities and programs through licensing or some .9.!.railar vian. grams. Close cooperation should bemaintained with the Texas Education Agency in the planning, opera- As with the Community Mental Retardation tion, and evaluation of these various endeavors. Projects authorized by the 59th Texas Legislature, there is a need for demonstrating the potentials of A concept of rehabilitation should be adopted the halfway house and group living arrangement for which would promote the basic theme of permitting retarded persons as: (1) A deterrent to admissions each retarded person to develop to, and perform at, to Special Schools; (2) A means of assisting Special his full potential. Uang this approach, "being re- School residents with rehabilitation potential to make habilitatedorhabilitated" would notnecessarily the transition into either full or partial community involve the retarded person's return to the community. living; and (3) A model to give both the TDMH/MR The concept to be emphasized places the retardate's and communities knowledge about the effectiveness functional level in competition with his own poten- and potentials of such service units. In establishing tialnot his functional level against the functional and operating such a demonstration, close coopera- level of others in society. tion between the various State agencies having correlated responsibilities should be maintained. It is recommended that the Legislature be requested to appropriate funds to implement pre- It is recommended that the Legislature be re- viously passed legislation permitting remunerative quested to appropriate sufficient funds to each work assignments for the mentally retarded with- Special School and to each regional center to in the institution; that this provision also apply allow each of these facilities to establish and to regional centers operated by the TDMH/MR; operate foster home programs for the mentally and thatfunds .be made available .to .the retarded. TDMH/MR to increase the numbers of professionals supervising work and training assignments Sufficient staff and supportive services should be within the institution or center, establish work- made available to implement this recommendation. shops, obtain contracts, and, in general, coordi- Expenses to be covered include room and board, nate these and related activities. medical expenses, follow up, and other items necessary to the program's success. Close cooperation Proper safeguards should be included in these should be maintained between the TDMTINR and programs to insure that a continuing focus on training the Department of Welfare in implementing and and/or therapeutic activitiesis maintained. Special administering an overall foster home program for the Schools are currently authorized to pay working retarded. residents; however, funds have not been available for this purpose. The Mentally Retarded Persons' Act establishes the authority of the TDMH/MR to make foster home Work and compensation for work are corner- placements. Funds have not yet been available, how- stones of modern society. Work can be a motivating ever, to implement a foster home operation. Itis force in shaping behavior and preparing the mentally recognized that a rather sizeable proportion of Special retarded by ultimate return to society. A carefully School applicants and residents might be alternately planned system of work should be an integral part served by such a service. Other states which have of the programs of institutions, regional centers, and initiated programs of this nature have reported highly other service facilities which, may be developed by successful results. These programs should be visited the Department.

55 It is recommended that the TDMH/MR inven- The shortage of professional personnel is acute. Steps toryitsrecord-keeping procedures,especially sht uld be taken to upgrade the skills of existing those dealing with patient movement and serv- personnel in all fields and to insure a continuing flow ices, and implement new and/or strengthened of qualified personnel to staff new programs. record-keeping procedures as required. It is recommen1-1,3d that the TDMH/MR continue Much of the effectiveness of the total program, and strengthen its practice of utilizing volunteers existing and planned, will be evaluated through base to enhance its service programs. line and other records relating to populations served, types of services iendered, etc. Both research and The use of volunteers enables institutions to service programs will require accurate and efficient provide personal attention to residents, both material data input and retrieval systems. Cooperative under- and service in nature, not otherwise possible. In takings with other State agencies, including institu- addition, volunthers represent an important vehicle tions of higher learning, should be carried out to for transmission of information about mental retarda- establish such a record system. Close contact and tion and mental retardation programs operated by participation with national reporting systems should the Department to the public at large. Study should be encouraged. be given to new approaches in recruiting volunteers and to making their assignments more meaningful It is recommended that the Department expend and productive in scope. new efforts to identify and assist in the development of institutional staff members who demot.- It is recommended that the TDMH/MR strive strate promise as future administrators of Special to maintain flexible admission and service policies Schools, regional centers, and other service units at its various facilities; and that there be a per- which may be operated by that agency. Itis iodic review of all such policies. specificallyrecommendedthateachSpecial School be authorized to create the position of assktant superintendent to: (1) Assist the super- The exclusive use of court commitments to admit intendent with the administration and operation retarded individuals to the jurisdiction of the Board of an increasingly complex array of residential of Mental Health and Mental Retardation is undesir- and out-patient services andprograms; and (2) able. It is understood that the TDMH/MR iscurrent- give promising and capable individuals theop- ly in the process of abolishing court commitmentas portunity to gain valuable and broad training an absolute prerequisite for admission to a State experience in the st,,,rvision and administration School.Futureeligibilityn.ndadmissioncriteria of these endeavors should stress the continuity aild immediacy ofcare concepts. The future of mental retardationprograms in Texas resides in leadership. The TDMH/MR should Texas ranks high among the various states in the make every effort to identify and reward leadership total number of military personnel makingup its potential inits mental retardation programs. The population. example set in providing Assistant Superintendents for certain mental hospitals isa commendable pro- It is recommended that the TDMH/MRreview cedure and one which would be followed bythe itsadmissionpolicies and eligibilitycriteria Special Schools if a continuing flow of qualified ad- regarding these families; and that it explore with ministrators is to be maintained. Federal officialscooperative means toserve these often-transient families. It is recommended that the Legislature bere- quested to allocate increased funds to the De- Dependents of military personnel who qualify partment to be used to upgrade the training of as Texas citizens are eligible for Special School place- existing departmente7 personnel in all levels and ment. Non-resident families stationed in Texas, how- professional fields and to attractnew professional ever, do not qualify for TDMH/MR residential serv- workers into the system. ices. Recognizing that the basic concepts of proximity of care and residence with the familyare significant Review of the policies on theuse of these funds in conducting programs for the retarded,some means is recommended, the goal being to permit maximum should be worked out to provide comprehensiveserv- flexibility in assisting promising and qualifyingper- ices to the retarded dependents of military families sonnel to receive advanced training to better equip stationed in Texas. This includes residential place- them to contribute to totalprogram effectiveness. ment, if needed.

56 Concurrently evident is the potential influx of toassumethisresponsibility.Strengtheningthe large numbers of dependents of non-residents (non- knowledge, skills, and awareness of those professionals taxpayers ) whose families are then transferred else- now living and working in communities, relative to where, only to leave the retarded dependentas a mental retardation, should be a top priority in pre- burden to the TexaF taxpayer. This situation is to be paring the community for its new role in the treatment avoided. One possible solution :s the encouragement continuum. of the Federal Government to construct and maintain one or more residential institutions within the State It is recommended that the TDMH/MR assume for the benefit and use of its military personnel. a more active role in working with communities to establish effective recreational programs for It is recommended that the TDMH/MR's system the mentally retarded. of fee assessment to families of retarded children being served ininstitutions,regionalcenters, Such programs would serve both non-institu- and other facilities be continuously reviewed tionalized retardates as well as institutionalizedre- in order that fair and equitable charges be as- tarded persons on leave from the institution. These sessed for services rendered; that the TDMH/MR programs should focus on the development of activi- establish a formal appellate structure through ties which span week ends, evenings, and the summer which parents may make appeal if they feel months. Consultation from departmental staff should assessed charges are inappropriate; and that the be made available to community recreation programs. guidelines for fee payments established by the National Association for Retarded Childien be While a few communities have developed out- studied and implemented where possible. standing special recreational programs for exceptional persons, most cities and regions offer no special recre- The dependent retarded child may represent a ation resources of this nature. Recreation is viewed lifetime economic burden to the family. Fee assess- as both an adjunct to the social and physical develop- ments should be established in a flexible manner and ment of the retarded and as a valuable resource to should take into account multiple factors in the over- the family in making provision for a well-balanced all family situation, including income, commitments plan of care for the retarded ffidividual living at to other children in college, etc. Consideratim should home. be given to the desirability of limiting or significantly reducing payments after a dependent retarded child It is recommended that Special Schools, regional reaches his majority, or after a designated period centers, and other service facilities as may be during which the family has paid( e.g,, after "X" developed and operated byth,f3 TDMH/MR years). make provision in their programs for parent education (for the parents of both in-patients and It is recommended that the TDMH/MR embark out-perients) designe-I to better equip them to on an active plan of designing and carrying out care for their reMrded eiildren at home and in informational and educational workshops for key the cornmunity. professional groups in the various communities of the State,to eahance the knowledge and skills of these personnel to facilitate betterserv- As new information is generated by the TDMH/ ices to the non-institutionalized retarded and his MR anditsvariousservicefacilities,enhanced family. efforts should be made to impart this knowledge to parents in an attempt to upgrade their skills and Cooperation with other relevant State agencies competencies in dealing with their retarded children. in the funding, planning, and implementation of these conferences should be pursued. An example of the It is recommended that the TDMH/MR and the type of endeavor envisioned here would be a coopera- Texas Youth Council jointly formulate appro- tive undertaking between the TDMH/MR and the priate plans to study and meet the problem of the Texas State Department of Health to plan and imple- delinquent retarded child in Texas. As an interim ment a workshop for community dentists to better and supportive measure, it is recommended that acquaint them with the dental characteristics, needs, each State School be authorized to establish a and problems of the mentally retarded. small, special unit for delinquent defectives. The trend calling for increased community re- The advent of successful special education and sponsibility in serving the retarded in the home and rehabilitation programs at the community level can community must be accompanied by well-planned be expected to siphon off the more mildly retarded and meaningful efforts to strengthen local resources retardates. However, those retarded individuals whose

57 sociai behavior threatens program integrity at the quent, respectively, neither is adequately serving the community level are being referred in greaternum- defective delinquent at this time. Thea priori as- bers to the programs operated by the TDMH/MR sumption that the mental retardation component is and the Texas Youth Council. necessarily the underlying causative mechanism in the defective delinquent's antisocial behaviormay be While these two agenciesare responsible for fallacious and may lead toa failure to search out planning programs for the retarded and the delin- other relevant variables associated with the problem.

58 8. MANPOWER THE KEY TO PROVIDING MEDED SERVICES

OVERVIEW OF NEEDS A faculty member of the School of Social Work, AND RECOMMENDATIONS The University of Texas, has estimated from his own study of social welfare needs and from other sources, that more than 900 additional professionalsocial workers will be needed in Texas by 1975. He reported The manpower development section of the Texas that the Texas Department of Public Welfare alone Mental Retardation Planning Study was centered will require a minimum of 400 additional professional upon three basic tasks: social workers.

1. To determine how many people in Texas Other indications of future manpower problems now are working in the field of mental retarda- and challenges: tion services (prevention, treatment, rehabilitation, etc.). 1. The Texas State Department of Health, Division of Mental Health (now the Community 2. To ascertain how much service, both Services Section of the Texas Department of current and anticipated, must be provided from Mental Health and Mental Retardation)esti- the mental retardation manpower pool. mated in 1964 that an additional 161 professional social workers will be needed to staff community 3. To determine how to strengthen and in. clinics, centers and general hospitals by 1974. crease personnel in order to meet the needs of the mentally retarded and to make sure that 2. The director of special services for the comprehensive preventive services are provided Pasadena (Texas) Independent School District for high-risk groups. found that approximately 3,700 more special education teachers are needed now in classroom Authorities in the health disciplines have pointed units ( for mentally retarded children in Texas) out that there is a shortage of professional personnel which have been authorized but not activitated a manpower pool problemon most levels. Data because of a shortage of qualified teachers. which support this point of view were compiled dur- 3. Over and above this shortage of special ing the Texas planning study. education teachers is a shortage of vocational rehabilitation counselors. To serve the mentally For example, the director for personnel manage- retarded only, 10 positions were vacant at the ment of the Texas Department of Mental Health and time of the study, and were to be filled as soon Mental Retardation made an estimate ofmanpower as qualified counselors became available. It was needs in the State Schools for the retarded. He found predicted that, during the next three years, 120 (based on established standards of the American additionalvocationaladjustmentcounselors Association of Mental Deficiency)that the most would be needed. critical shortages existed in the following areas: 4. A consultant for the Division of Maternal 1. Medical doctors. and Child Health, Texas State Department of 2. Professional nurses. Health, stated:"Itisconservative to estimate that the general nursing staff in local health 3. Professionally qualified social workers. departments will need to be increased in che next 4. Psychologists. five years if nursing services used in combatting 5. Additionalstaff members adequateto mental retardation are to be improved and ex- meet supporting needs. panded."

59 5. A special report by a nutrition consultant retardation by encouraging staff research projects of the same department provided evidence ofa and work toward degrees and advanced college shortage in nutrition personnel, another segment attainment. of manpower considered to be an important part of the health team for the mentally retarded. It is recommended that the Legislature be requested to appropriate funds for State agencies 6. Reports from Mayors' Commissionson serving the mentally retarded, to be used for Mental Retardation in the 58 largest cliies in scholarships, stipends, and loans for the profes- Texas indicated deep concern regarding current sionaly education of staff members and prospec- and future staffing of community mental retarda- tive staff members in such fields as educational tion centers. psychology, special education, social service and counseling, speech and hearing therapy, medical Having confirmed that a shortage of mental and dental training, mental retardation planning retardation manpower is indeed a reality in Texas, and research, etc. the Task Force next considered the question: What can be done about it? The presentation following A comprehensive, professional study is needed consists of a series of recommendations, supported to identify tasks in the field of mental retardation by an elaboration on the need andreasons for the which can be performed by non-professionals, semi- remedies proposed. professionals and professionals.

Texas school children at an early age should be It is believed that such a study also wouldserve exposed to information about the "helping profes- as an extension of "retooling" efforts that are necessary sions," and what people in these professions doto if Texas is to establish the machinery for doing higher help the mentally retarded. quality work in the field of mental retardation. It is estimated thatthe comprehensive survey needed Itisrecommended that public and private would require a minimum of three to fiveyears. schools be encouraged to incorporate in their programs, from the first grade on, material that It is recommended that funds be requested to would provide knowledge and create interest in study and determine, with cooperation ofpro- the "helping professions." fessional workers in mental retardation, tasks which can be done by non-professionals, those For example, elementary school readers could which can be done by semi-professionals, and contain stories that broaden children's understanding those which must be done by professionals. and concepts of these professions. On the secondary education level, young people might be encouraged Continuing and expanding cooperation between to form organizations such as future nurses associa- facilities for the mentally retarded and the State's tions, future physicians groups, future psychologists institutions of higher learning should be encouraged. (including educational psychology) associations, future special teachers groups including special educa- It is recommended that all possibleavenues be tion for hearing and speech therapists, recreational openedtogreatercooperation between the therapists, ete,and future social workers organiza- facilities for the mentalhi retarded and the col- tions. leges and universities of Texas. Such cooper itive efforts should include making possible dualap- To these groups could come "visiting scientists" pointments of persons qualified to render service from the professional ranks of the mental retardation to both areas; utilizing teaching capabilities of faciiities toserve as lecturers and consultants. Sum- institutional employees in college classes and the mer work and participation programs for high school consultant services of college and universityper- and college students within the institutions andmen- sonnel in the mental retardation programs; pro- tal retardation facilities could and should be expand- viding office and work space in the schools for ed. Better communication is needed among people the retarded for university professors and stu- working in the field of mental retardation, particularly dents to conduct studies and research; encourag- in regard to attracting and placing personnelin ing thesis and dissertation efforts in the field of positions where they function most efficiently. mental retardation; entering into join: efforts for scholarships and training arrangements for in- The State should develop a means for keeping stitutional employees to get advanced college agency staff members and prospective staff members training; encouraging the holding of seminars abreast of the latest advances in the field of mental and training sessions for employees of depart-

60 ments and agencies dealing with the mentally evaluation ofallpositionsrelatedto mental retarded, to be conducted by personnel from the retardation in order to attract and retain quali- institutes of higher learning. fied personnel. Another important consideration for manpower 3. Providing for a salary increase for persons development discussed in the planning study was the completing recognized training programs design- need for a more flexible and functional State Employ- ed to increa se their proficiency and skills. ees Classification Plan. The very effective volunteer program and serv- Itis recommended that the State Employees ices provided by the volunteers in schools and centers Classification Plan be made more serviceable. serving the mentally retarded in Texas should be The following procedures are recommended: recognized and strengthened. 1. Authorizing employment above the start- It is recommended that the Texas Department of ing ( or minimum) salary step for persons who Mental Health and Mental Retardation initiate have broad experience, specialized training or studies aimed at strengthening the volunteer noted performance in their fields of work. program in all services to the mentally retarded and determining additional services which might 2. Providing for a general review and re- be provided by volunteers.

61 9. RESEARCH FOR BETTER METHODS OF PREVENTION AND CARE

OVERVIEW search that could well be implemented and expanded in the universities, agencies and service facilities of Texas. These included research on such subjects as Research implies change. To those who, in theirbasic behavioral development, communication, per- intellectual inquisitiveness, are eager for change andception, personality, motivation, latent ability mobili- who regard scientific inquiry a necessary process in zation, adjustment of adults, cross-cultural studies, society, the research method is logical and necessary. impact on families and community, and the whole To many, however, researchers are not appreciated, broad field of pre-school and school-age educational their services frequently omitted from long-range techniques. planning, and their methods of data-gathering at times even regarded as meddlesome. Those who tend to be satisfied with conventional methods are not inclined to support research endeavors. RECOMMENDATIONS FOR STATE COORDINATION OF RESEARCH Itis obvious, however, that research must be written into the statewide plan to combat mental retardation and must be pursued vigorously if imple- It is recommended that the State of Texas pro- mentation of the plan is to be realized. vide necessary funds specifically for research protects on mental retardation. The President's Panel on Mental Retardation in 1962 stated: "It is essential to support the foundation', In order to achieve the needed research in ade- of scientific research in all fields, and to stimulate the quate scope and with effective priorities, there must communication of both needs and solutions among be the proper combination of qualified people, co- investigators and clinicians working atevery level and ordinated agencies and dependable funding (men, in all phases of the field, including education, treat- machinery, and money). This would best be done ment, and care of the retarded." Amongrecommen- under the control of a properly qualified agency. dations made by this bodywere: (1) High priority given to developing research centerson mental re- It is recommended that the State provide the tardation at strategically located universities and in- leadership and the coordinating personnel to pull stitutions, (2) experimental research findings tested together researchers, State agencies and univer- in service agencies before widespread application, sities to obtain maximum use of research facilities (3) development of a comprehensive continuingpro- in mental retardation. gram for the collection and analysis of population statistics on the incidence, prevalence, and personal It is recommended that the proposed State Inter- and socio-economic characteristics of the mentally agency Covncil be requested to operate a clear- retarded (this referred toa Federal program, but the .ing house for research which would avail itself cooperation of states would be imperative), and (4) of published research reports from such sources provision for universities to offer opportunities for as the U. S. Department of Health, Education research training in several disciplines suchas educa- and Welfare: the National Association for Re- tion, psychology, sociology and physiology. tarded Children, the Councg for Exceptional Children, and similar sources, and Which would A subgroup of the President's Panel, the Task distribute these reports systematically to active Force on Behavioral and Social Research, reporting research centers inTexas. This Council also in 1964, spelled out some of the majorareas of re- should be requested to collect similar publications

63 from the Texas research centers and distribute tardation which are relatively unique to the them among the several centers in the State. State of Texas. Priorities recommended by the Task Force on Research were (1) Descriptive statistical data; (2) Education and treatment; (3) Preventive aspects of mental retardation;(4 ) CURRENT STATUS OF RESEARCH Subcultural, economic and ethnic factors in men- ON MENTAL RETARDATION IN TEXAS tal retardation; and (5 )Georgraphic problems. (More detail on each is presented below.)

During the course of the Texas Mental Retarda- 1. Descriptive statistical data. Epidemiologi- tion Planning Study (1965-66) a questionnaire on cal data and educational and treatment data on "Current Research on Mental Retardation in Texas" mentally retarded in Texas should be assembled, was sent to the presidents of Texas colleges and categorized and tabulated on computerized cards universities. Questions were asked concerning research for storage, retrieval and use by all agencies and projects starting in the near future. Respondents were research centers. Once assembled, these data asked to include the titles of research studies, amount should be kept current. The State of Texas should of funds involved, and names of sponsoring agents. maintain a staff to carry on this work within the framework of an existing agency ( e.g., the Texas The research questionnaire was sent to 84 col- Department of Mental Health and Mental Re- leges and universities and replies were received from tardation, Menta! Retardation Division ). 80 of those institutions. Seventy-one respondents indicated that they had no research on mental retarda- Such data should be compiled from all State tion in progress or proposed. Nine reported that they agencies handling retarded children and adults were active in one or more such projects, involving and from private facilities such as:parochial 142 researchers and a total cost of $1,287,087. schools, private schools for retarded, chapters of the Texas Association for Retarded Children, Higher education institutions and their branches Community Welfare agencies, community special conducting these projects were Southwest Texas State agencies and organizations, Goodwill Industries, College, San Marcos; The University of Texas South- crippled children's services, camps and summer western Medical School, Dallas; East Texas State recreation facilities and others. College, Commerce; Baylor University, Waco; Baylor Medical School, Houston; Vocational Rehabilitation An individual record on each retarded per- Regional Research and Training Center, The Univer- son should be submitted with data adequate for sity of Texas, Austin; Special Education Department computer treatment to include such items as: of The University of Texas, Austin; The University name, birthday, place of birth, race, address, of Texas Medical Branch, Galveston; Texas Woman's school district, type of handicap or handicaps, University, Denton. Current research on mental re- pa, ants' occupation, employment status of mother, tardation at the Houston State Psychiatric Institute number of siblings, test scores, prenatal, para- was also reported in this survey. natal and postnatal attention, midwifery delivery, age of mother at delivery, broken-home status, The questionnaire data indicated that the six and other data useful to teachers, therapists, State Special Schools currently have research projects rehabilitation counselors, health and welfare per- totaling $2,066,243in progress. Development and sonnel, and college researchers. training grants now in operation in the State Schools total $935,115. A clearing house, furthermore, should be established for amassing other significant data on mental retardation. The data should be derived SPECIFIC AREAS OF NAMED RESEARCH by well-controlled surveys and should include such factorsasincidence, according togeo- graphicareas,ethnicgroups,socio-economic Although some excellent research on mentalre- levels, and clinical types. tardation is being performed in Texas, itwas felt that much more research should be planned andcon- 2. Education and treatment. Research re- ducted on all significant aspects of mental retardation. lated to improved methods of education, including habilitation and treatment should be given It is recommended that priorities be established high priority. Studies on improved methods of for research projects on problems in mental re- educating, grouping, diagnosing and financing 64 are immediately needed. Research on improved "(b ) The Department may establish research treatment methods in and out of institutions institutes devoted to research and training needs to be expanded. in support of the development and expansion of mental health and mental retardt4- 3. The preventive aspects of mental retarda- don services in the State. The research in- tion. This includes genetic, prenatal, paranatal stitutes may be affiliated with major medical and postnatal causitive factors such as chromo- centers, medical schools and universities of somal abnormalities, consanguinity, maternal in- the State. fectious disorders, blood incompatibilities, infant and child care practices, postnatal infectious dis- "(c) The Department may accept gifts or grants orders such asencephalitis, toxic agents and of land and make contracts for the con- other factors causing brain injuries. struction of buildings and facilities at any site selected for the location of research 4. Subcultural, economic and ethnic factors institutes, or the Department may enter in mental retardation. These factors present num- into any contract or leasing agreement with erous problems unique to Texas such as those any Federal, State or local agency or with found in bilingual and migrant subgroups. Some any person or other private entity for the of the important problems needing investigation use of buildings and facilities. under this category are: effects of malnutrition and lack of environmental stimulation; the in- "(d) The Department may administer and op- cidence and effects of poor infant and child-care erate research institutes with funds donated practices, such as midwife delivery; effectiveness by Federal, State, and local agencies, and of preschool learning experiences; and methods by persons and other private entities and of increasing motivation or achievement drives. with any money that may be appropriated (These data might be obtained, in part, from by the Legislature." the Texas Mental Retardation Planning Study.) In keeping with these provisions of the Texas 5. Geographic problems. Research should be Mental Health and Mental Retardation Act,the performed in tbe State Gn problems unique to following recommendations are made: particular geographic areas. This would include the sparsely settled areas of west and southwest It is recommended that provisions be made for Texas and rural versus urban problems. the further strengthening and diversifying of research activity at the Houston State Psychiatric Institute, which already has been designated (in House Bill 3) as the official center for re- PROPOSED EXPANSION AND CREATION search and training for the Texas Department of OF RESEARCH INSTITUTES FOR Mental Health and Mental Retardation. RETARDATION It is recommended that provisions be made for opening a new institute for research of mental retardation and human development. Mental retardation research, as wellas mental health research, involves an extremely widerange of scientific disciplines, methods of investigation and It is recommended that provisions be made for points of view as to the nature of the problem. This the development of a center in a University in fact was borne out by the research committee which western Texas for research on mental retardation problems 3pecific to sparsely settled areas. producedrecommendationsforacomprehensive mental health program for the State of Texas,many of which were implemented in The Texas Mental Additional information concerning each of these Health and Mental Retardation Act, passed in 1965 recommendations is presented below. by the 59th Legislature. Under section 2-18 of this Act, entitled Research Institutes, it is stated that: HOUSTON STATE PSYCHIATRIC INSTITUTE "(a) The authorityforthe operation of the Houston State Psychiatric Institute for Re- search and Training is transferred to the Inasmuch as the research section of the Texas Department. Plan for Mental Health Services was prepared with

65 the fields of mental illness, mental health, and mental velopment for support of research centers on mental retardation in mind, it is felt that many of theareas retardation and human development. Construction of research in mental health would be similarto those money is available on a 75 per cent Federal, 25 per in mental retardation; therefore, the followingrecom- cent State matching basis. mendations of the research committeeon mental health are reiterated here: "The Research Task Force strongly recommends that the State establish additional research institutes similar in organizationto the Houston State Psychiatric Institute.It further PROPOSED INSTITUTE IN WESTERN TEXAS recommends that Houston Institute be substantially strengthened to take advantage of the excellent facili- FOR RESEARCH ON EXPERIMENTAL ties of strong nucleus of scientists now given joint PATTERNS OF PATIENT CARE AND appointments in Baylor Medical School and the In- stitute." MENTAL HEALTH SERVICES IN SPARSELY POPULATED AREAS The Houston State Psychiatric Institute should be strengthened and maintained inan atmosphere which is conducive to creative thought. The Institute should encourage activities throughout the broad As pointed out in the Texas Plan for Mental spectrum of research from basic research through Health Services, too often the researchprograms in applied research directly related to clinical problems. mental health neglect thespecial problems and unique opportunities that exist in ruralareas and smaller towns and cities. The kinds of mental health services and the patterns of patient care thatprove PROPOSED INSTITUTE FOR RESEARCH satisfactory in large metropolitanareas simply will ON MENTAL RETARDATION not work when transplanted to sparsely populated regions unless altered to fit the special needs of rural AND HUMAN DEVELOPMENT populations. A research institute should be established in western Texas to undertake research and demonstration projects evaluating new patterns of mental Funds now have been appropriated through the health and mental retardation services for sparsely National Institute of Child Health and Human De- populated areas.

66 10. TEXAS LAW AND THE MENTALLY RETARDED

Recommendations of the various Task Forces same needs, hopes and wants as normal persons. That which might require new laws or changes in present philosophy was endorsed by the Task Force on Law. laws are explained in some detail in this section. The recommendations of other Task Forcesmay require In every area of personal need for services and only adaptations or better administration ofprograms protection, thereisa higher degree of acuteness under present laws. These matters alsoare treated among most retarded persons because of their relative specifically. lack of capacity to cope with the activities and pressures required for existence and growth in modem society,particularlyinTexas' heavilyurbanized society. INTRODUCTION Principles. Careful consideration has been given tothe recommendations coming fromthelocal Background. Laws alone do not prevent mental Mayors' Commissions. This section also has benefit- retardation, diagnosecases, house, train or educate ted from the reports of the other Task Forces, aid patient-students; support research, or alwaysassure of the research staff, and free and frank discussions the proper handling of mentally retardedpersons among its members. accused of crime. If all of the recommendations andresponses are Law isslow to change, partly because the carefully sorted out in tenor and in substance, they enactment of new statutory law is a laborious process tend to cluster around two themes: and therefore the statutes remain relativelyrigid despite changed conditions, and because the development of case law by courts is the result of the applica- 1. Responsibility should be fixed. 2. Responsive solutions should be found. tionofstatutesto an almostinfinite varietyof situations, few of which can be chosen in advance to obtain a desired result. Thr-e two themes can be shortened to single words: Responsibility and Responsiveness. Neither is This slowness to change is mentioned because, a purely legal term. Insofar as possible, however, the report and recommendations of this sect'on will refer traditionally, abrupt and massive departures from to specific problem areas and the concept of desirable existing law are rare. Productive and worthwhile solutions in that frame of reference: Responsibility changes have tended to be evolutionary rather than and Responsiveness. revolutionary. Everyone interested in the well-being of mentally retardedpersons should know that the law changes slowly. This should be taken intoaccount in planning the best programs possible. Buildingon present law is usually much easier than boldnew WHAT IS INVOLVED departures. In meeting social needs, law is onlyone of three elements. To produce protection,or services to be rendered in the governmental sector ofour This section will not deal withevery problem society, the three essentials are L .v, funds and staff. posed by the large numbers of mentally retarded It takes all three to have program. persons. It is an acknowledged fact that these persons reside in almost every community in Texas. certainly Philosophy. The Task Forceon Welfare stated in every county. They have a spectrum of needs, and that it believes mentally retardedpersons have the in line with the two cardinal principles of Responsi-

67 bility-Responsiveness, it is felt that the following over- eral government aids the mentally retarded: research, all considerations are involved in the area of the law funding of PKU (Phenylketonuria ) testing programs, and the mentally retarded persons in Texas. aid to welfare programs, underwriting planning efforts in all states similar to the Texas Mental Retardation Individual responsibility. Individual responsibility Planning Study, etc. Because the Federal laws are, should be visited upon the mentally retarded person in general, outside the scope of this report, however, so far as he is capablebut no more. Actual mental they are not treated in detail here. Some recommen- retardationisa chronic and irreversible condition dations involving Federal Law and aid from the usually characterized by mental and social develop- Federal government are included, however, in the ment to a plateau of understanding and achievement endomement of S.J.R. 33 (59th Texas Legislature), somewhat below "normal." The responsibility of a to be voted on in November, 1966, as Proposition mentally retarded person in all civil matters should No. 15. track his respective mental capacity. What to do when criminal responsibility is involved is less clear. This entire area is treated at some length under Part 2, below, "The Mentally Retarded and the Criminal THE SITUATION TODAY: Law." TEXAS LAW AND THE MENTALLY RETARDED Familial responsibility. The family of a mentally retarded person shoulc: assume responsibility for him A one-word description of Texas law today with to the best of its capabilities, but not beyond those regard to the mentally retarded person is "spotty." reasonable for the family's resources and station in Many aspects of the law impinge directly or indirectly life.Texas laws require parents to support their upon the mentally retarded person. To deal with this children, and to support their mentally retarded problem in a meaningful manner, it is necessary to children in State Schools if able to do so. In cases categorize. The classifications chosen here are wholly of divorce, the father may be required by law to pay arbitrary and do not, of necessity, encompass all of for the support of a mentally retarded child without the problems or even every phase of every program, regard to the child's age. This is considered to be being more in the nature of examples. a wise provision. 1.Prevention: Texas now has a law making the Governmental responsibility. There isa wide testing of newly-born infants for PKU ( Phe- scope of governmental responsibility for mentally nylketonuria ) mandatory. (Art. 4447e.) retarded persons. The bulk of the services for mentally retarded persons in Texas comes from: 2.Education: Texas school laws define mentally retarded persons for special education pur- 1. The State Schools.(Texas Department of poses, and policy directives distinguish among Mental Health and Mental Retardation.) degrees of retardation.

2.Special education classes in public schools. 3.Guardiarship: Texas has no special laws for (Texas Education Agency.) the guardianship of mentally retarded persons. It is believed that the present guardian- 3. Aid to the totally and permanently disabled. ship laws, if rigorously and uniformly applied, (Texas Department of Public Welfare.) are adequate.

4. Cooperative programs for vocational rehabili- 4.Institutional Care: Texas law sets up several tation. (Texas Education Agency.) State Schools for mentally retarded persons and provides a general statute for their ad- Because local governments are creatures of the mission to those schools. This admission Law State and because some locial governments either may is Article 3871b. not do, or may hesitate to do anything in the way of governmental action without a specific enabling law, it seems thatlegally speakingthe key to helping the mentally retarded citizens of Texas lies in State RECOMMENDATIONS FOR IMPROVEMENT law and State-authorized financing. This reference would not be complete without The recommendations in this section are divided paying tribute to the many ways in which the Fed- into ;:wo parts. Part I is an item-by-item analysis of

68 some of therecommendations from the other Task accused of crime or delinquency. To some extent, Forces and the 58 Mayors' Commissions involving Part 2 will be repetitious of Part 1, in that it will be changes in the law. Part 2 is a consideration of prob- a summary of tho conclusions reachedby the Law lems revolving around the mentally retarded person Task Force.

PART 1: RECOMMENDATIONS INVOLVING CHANGES ;14 TEXAS LAW

TASK FORCE RECOMMENDATION LEGAL CHANGE REQUIRED

Education Preschool services needed. Could be done in special kindergarten, would be necessary to amend Art. 2919 now requiring an election toestablish any kindergarten.

Education Regional diagnostic and consultative agen- This might be possible by amendment cies for "spectrum" of services to the men- of the Rehabilitation District Law, Art. tally retarded. 2875k; otherwise by new legislation. 7.11 Education Allow allocation of special education co- By amending Art. 2922-13 and 2922-12. ordinators in districts with 10 to 21 special education teachers.

Education Amend the special education teacher allo- By amending Art. 2922, 2922-12 and cationformula toastraight classroom 2922-13. teacherunitfortenspecialeducation pupils; allocate funds on basis1 pupil equals 1/10th unit allocation.

Education Mandatoryparticipationofdistrictin By amending Art. 2922-11 or 2922-13. special education to assure services.

Education If local services not available, transporta- By amending Art. 2922-15. tion costs to be paid to district rendering services.

Education Special education teachers to be reimburs- By amending Art. 2922-14. ed on an eleven month basis.

Education Employment of education diagnosticians, By amending Art. 2922-12. 12 month basis to work with persons with learning difficulties.

Vocational Fu»ds should be made available for com- Amendment of Art. 2922-13 or 2922-15. Rehabilitation plete evaluation of all children in cooperative school-rehabilitation program.

69 TASK FORCE RECOMMENDATION LEGAL CHANGE REQUIRED

Vocational Transportation of mentally retarded clients Declaration of such transportation as a Rehabilitation to and from agency facilities. governmental function and appropriation of funds to a local unit of government for this purpose; or law plus funds to be used for contract services.

Welfare Amend Aid to Totally and Permanently Amendment ofeligibilityunderArt. Disabled to make payments to parents or 695a, and revision of the Constitution, guardians of mentally retarded persons Art. III, Sec. 51-a. who can remain in family setting.

Residential Possible establishment of institutions for Legislation establishing facility plus and Day Care multi-handicapped personsblind-retarded, appropriation. etc.

Residential Revisions in the Mentally Retarded Persons Amend Section 9 of Art. 3871b. and Day Care Act to permit non-judicial admissions.

Residential Purchase of care plans like Louisiana. Possible by amendment of the Mentally and Day Care Retarded Persons Act, Sec. 17, plusap- propriations.

Research State funds be provided for mental retarda- None. Added appropriated funds. H.B. 3 tion research. is sufficient authority.

The Law Task Force reported that itfelt the above recommendations are constructive. "(b ) State agencies charged with theresponsibility of providing services to those whoare Throughout the various sections, thereare at blind, crippl 3, or otherwise physicallyor men- least three central ideas: Planning, Coordination, and tally handicapped may accept money from pri- Financing. There seems to be littleor no division of vate or federal Sources, designated by the private opinion concerning the ultimate ends in view,or the or federal source as money to be used in and spectrum of needs of mentally retarded persons. establishing and equipping facilities for assisting "Who is to do the job?" and "Who will pickup the those who are blind, crippled, or otherwise physi- check?" seems to be the questions. Althoughan at- cally or mentally handicapped in becoming gain- tempt has been made here to state what legislation fully employed, in rehabilitating and restoring is necessary to authorize some agencyor level of the handicapped, and in providing other services government to do the job, the specific sources of determined by the stage agency to be essential financing are not recommended. Attention is called for the better care and treatment of the handi- to the provisions of S.J.R. 30, 59th Texas Legislature, capped. Money accepted under this subsection is proposing an amendment to Section 6, Article XVI state money. State agencies may spend money of the Texas Constitution. This amendment readsas accepted under this subsection, andno other follows: money, for specific programs and projects to be conducted by local level or other private, non- "Section 6. ( a ) No appropriation for private sectarianassociations,groups,andnonprofit or individual purposes shall be made, unless organizations,inestablishingandequipping authorized by this Constitution. A regular state- facilities for assisting those who are blind, crip- ment, under oath, and an account of the receipts pled, or otherwise physically or mentally handi- and expenditures of all publicmoney:iall be capped in becoming gainfully employed, inre- published annually, in suchmanner as shall be habilitating and restoring the handicapped, and prescribed by law. in providing other services determined by the

70 state agency to be essential for the better care stances, a few of the retardates will commit acts that or treatment of the handicapped. violate the penal code. When they do, examination discloses that there is set in motion a process which "The state agencies may deposit money ac- in Texas, is not altogether responsive to the needs ceptednder this subsection either in the state in the case. treasury or in other secure depositories. The money may not be expended for any purpose There is one school of thought that would allow other than the purpose for which it was given. the mentally retarded person to escape theconse- Notwithstanding any other provision of this Con- quences of his act by the applica .:on of a type of stitution, the state agencies may expend money "McNaughten 'e-for-the-retarded." That is some- accepted under this subsection without the neces- thing similar tk a defense of insanity in cases of sity of an appropriation, unless the Legislature, crimes among so-called normal persons. To move to by law, requires that the money be expended such a rule would not be responsive to the problem only on appropriation. The Legislature may pro- because the accused is not mentally ill although he hibit state agencies from accepting money under is mentally impaired. this subsection or may regulate the amount of money accepted, the way the acceptance and Such a rule would be hard to formulate and expenditure of the money is administered, and would solve no problems, for if sucha rule existed, the purposes for which the state agencies may and if it were used as a plea and if the merKally expend the money. Money accepted under this retarded jrason were acquittedsuch a verdict would subsectionfor a purpose prohibited by the not, in.ost cases, be responsive to his needs. There- Legislature shall be returned to the entity that fore, the methods described below for affording civil gave the money. rights to the mentally retarded are proposed.

"Thissubsection does not prohibitstate The new Texas Code of Criminal Procedures agencies authorized to render services to the (Art. 37.07) provides that ifa person is found guilty, handicapped from contracting with privately the judge is to assess the punishment unless the de- owned or looal facilities for necessary and essen- fendant asks that the punishment be assessed by the tial services, subject to such conditions, standards, jury. This Article also states: and procedures as may be prescribed by law." Regardless of whether the punishment be This amendment, to be voted on in November, assessed by the judge or the jury, evidence may 1966, is a vital ingredient to the upgrading of pro- be offered by the State and the defendant as to grams for the mentally retarded. It is believed to be the prior criminal record of the defendant, his a constructive amendment and its adoption is en- general reputation and his character. dorsed. It seems clear that at this time ( after verdict, before sentence) evidence could be introducea to show the actual intellectual attainments of the ac- PART 2: THE MENTALLY RETARDED cused, and it could be shown that he is mentally retarded. AND THE CRIMINAL LAW It is recommended that in those cases where evidence is intended to be offered to show that Of all areas involving the law and the mentally the accused is mentally retarded, either during retarded, the question of how to approaci many the trial or after the verdict has been rendered, problems incident to the criminal laware the most defense counsel be uniformly encouraged to file nettlesome. The principle of responsibility to the full- the requested sworn motion for probation in est extent of individual capabilitybut not beyond felony cases before the trial commences, as pro- is considered a workable standard. For this to bea vided in Art. 42.12 (b), and similarly in misde- workable standard, however, the mentally retarded meanor cases under Article 42.13 of the Code person's capabilities must be established ina manner of Criminal Procedure. which protects the civil rights of the retarded, the public from criminal acts, and the courts fromerror. Parenthetically, the Law Task Force felt that A pre-sentencing mental and physical evaluation and Mentally retarded persons, so faras possible, investigation, to deternOne the presence or absence should be taught to regard the police as friends and of mental retardation, should be within the discretion not as threats. But even under the best of circum- of the trial judge in every criminal case, whether the

71 issue of mental retardation is raised during the trial It is recommended that provision be madefor or not, or on the 'clearings after verdict and before adequate parole services for adult retardates sentence and judgment. If the judge is to hear the after released from department of corrections results of the evaluation, he could weigh them in installations or special facilities. assessing the penalties. The Law Task Force did not attemptto formu- One Mayor's Commission recommended that late a cost estimate for the, special facility for delin- funds be available for a thorough pre-trial examina- quent juvenile retardates or for suchan institution tion of the defendant at the request of the defendant's coupled with facilities for retardates whoare chrono- attorney or the attorney appointed to defend the logically adults and convicted for crime. accused to determine whether or not he is in fact mentally retarded.Thisisdeemed asuggestion Section 2.18 of House Bill 3, the Texas Mental worthy of consideration, provided that the results of Health and Mental Retardation Act (59th Legisla- the examination were made available equally to the ture) authorizes establishment of research institutes State and the defendant. in mental health and mental retardation. Sec. 3.13 of the same Act authorizes community centers tocon- It is recommended that provision be made for duct research in support of their programs and a pre-disposition mental and physical evaluation services. It is felt that a general statute permitting of every child handled as a delinquent. the Texas Department of Mental Health and Mental Retardation to engage in research would bea con- It is recommended that provision be made for structive measure. specialized facilities (a new institution or establishment of special wards at present institutions) for the handling of delinquent retardates or retardates convicted of crime.

72 11. LOCAL ACTIONAND PUBLICAWARENESS

Local communitiesofTexasshouldaccept 1. Local services increasing responsibility for are more effective and desir- identifying needs and able in most instances thanState institutional providing services in mentalretardation. Local action services. is the key to thesuccess of the Texas Plan to Combat Mental Retardaton.Responsibility for publicaware- 2. Avoiding ness should be shared at the State and or alleviating the problems ofre- local levels. tardation willpay, rather than cost, in the Coordination of efforts isessential. State-levelaction long run, is necessary tcencourage and assist localprograms. Conversely, local-level support and promotion isman- 3, Most retardedpersons can become assets datory for the implementationof statewideprograms, facilities and services. rather than liabilitiesto their communities. It is recommended thatlocal-level responsibili- Findings and recommendationsof various Task ties be shouldered by Mayors'Commissions on Forces in the Texas planningstudy pointup definite Mental Retardation, localunits of the Texas areas of responsibility which must beborne or shared Association for RetardedChildren, and other at the State and local levels. Theserecommendations interested groups andindividuals at the focal are adopted to the extent that: level. The Texas Mental Retardation 1.State-level workers should Planning Study inform local work- has demonstrateda need for concerted action in the ers of all of the recommendationsof the directions of: Texas Plan. (1) General pualicawareness; (2) community leadershipawareness, and (3) parent and 2. Local workers should special-interestawareness. These three categories of do everything possible public awareness needs willbe outlined below, with to assure the implementationof therecom- each divided into State-and local-levelresponsi- mendations. bilities.

Although the Texas studyindicated thatsome communities aremore advanced than others, itseems that none is assumingits full share of responsibility for combatting mentalretardation and helpingthe GENERAL PUBLICAWARENESS retarded.

It is recommended thatState-level responsibilities It is recommended thatthe target of actionfor outlined by this taskforce be assumed bythe general publicawareness be to inform the public appropriate State agencieswith responsibilities generally about the TexasPlan to Combat Men- in these areas. tal Retardation, thescope of the problem of mental retardation andwhat is being doneabout Local action and public it, and to createa climate of public understand- awareness are interlock- ing and support in which ing functions, but for thep1rpose of implementing the goals of the Texas Plan can bemore easily attained. the Texas Planto Combat MentalRetardation, specific goals can be set. In all endeavorsto attain It is recommended that these goals, emphasisshould be placedon the fol- State-level responsibilities lowing assumptions: for general publicawareness include the following activities:

73 1 Prepare new releases for the wire serv- especially in conjunction with National vices, (AP, UPI) and work with wire Retarded Children's Week. service newsmen on stories of statewide interest on mental retardation and the 4. Seek time on television and radio com- Texas Plan. munity service programs, usingState- prepared texts and adding local angles. 2. Prepare newsreleasesanddistribute them to local-level chairmen or repre- 5.DistributeState - prepared pocket - size sentatives. leafletswhenspeakingbeforelocal groups. a Prepare and distribute radio and television spot announcements. 6. Ask outdoor advertising firms to use pos- ters on mental retardation. 4. Prepare and distribute model scripts suitable for adaptation on community public 7. Arrangefor programs beforeParent- affairs programs, arid consider producing Teacher Association groups to give par- TV tapes which could be used "as is" or ents more awareness and und.erstanding enlarged upon for broadcast by local of retardation. stations over the State. 5. Prepare fact sheets of a broad, general nature about retardation and the Texas COMMUNITY LEADERSHIP AWARENESS Plan, and suggested speech outlines, and d L,tribute these to local-level chairmen. Consider producing film slides and mov- It is recommended that the target of action for ies suitable for presentation before or- community leadership awareness be to create ganizations. broad-based contributkns of volunteer time and money to projects aimed at benefiting the re- 6. Prepare a pocket-size leaflet giving cap- tarded. sule facts on mental retardation for distribution upon request from local author- It is recommended that State-level responsibilities ities. for community leadership awareness include the following activities: 7. Make availablebillboardpostersand other display materials promoting the 1. Ask local and county government officials fightagainstretardationandwork to perpetuate local Commissions on Men- through outdoor advertisers and local- tal Retardation. level workers in getting them used. 2. Prepare and distribute a priority list of It is recommended that local-level responsibilities goals set out by the Texas Plan, with for general public awareness include the follow- emphasis on what can be done at the ing activities: local level by clubs and individuals. 1. Make personal contact with executives 3. Contact State headquarters of civic clubs, and reporters for newspapers, TV and women's organizations, professional asso- radio stations. ciations, etc., to seek support of projects and to relate availability of speakers on 2. Adapt State-prepared news releases for mental retardation at meetings of the use at the local level and take them to club's local units. the media. ( See the "Fact Sheet for Pub- 4.Serve as a clearing house for the ex- lic Awareness" presented at the end of change of information on support which this section.) organizations over the state are giving to projects related to mental retardation. 3. Organize a Speakers' Bureau and seek appearances befor(ivic clubs and other 5. Create a State Speakers' Bureau for ap- groups, using State-prepared facts and pearances before State conventions or texts,and addinglocalangles.This professional associations and other gath- should be done throughout the year and erings, and seek sneaking dates.

74 It is recommended that local-levelresponsibilities 2.Distribute brochure and other informa- for community leadership awarenessinclude the tiontoministers,physicians,county following activities: judges, police, county and district attor- neys and judges and particularly in 1. Add a priority list of local goals to the smaller towns to home demonstration others State-prepared list. agents, school superintendents or likely to have professional contact with 2. Form a local Speakers' Bureau and pre- parents. pare speeches for civicclubs and other organizations to seek financial and volun- 3. Prepare news releases with specialized teer support of specific projects for new angles for publication in such professional Journal of or enlarged services.These speeches often journaias the Texas State may come as a resultof interest inspired Medicine and the Texas Bar Journal. by talks mentioned above, under "Gen- which eral Public Awareness." 4. Consider placing brochures, mothers might pick up, in oFhices of pe- 3. Keep the news media informed of any diatricians. planned speeches, organizational meetings, etc., and invite them to send their 5. Arrangeforspeechesbyrecognized representatives. authorities before State medical conventions and other professional gatherings. 4. Inform State-level authorities when any project is undertaken or when any club It is recommended that local-level responsibilities gives tangible support to services or proj- for increasing the awareness of parents and ects. special-interest groups among the public include the following: 5. Sponsor open houses at mental retardation facilities and arrange tours for special 1.In metropolitan areas, create a central groups. source to which parents orothers may turn for information when retardation is 6. Compile a list of existing mental retarda- suspected. tion services and facilities which need contributions of time or money, and ask 2. Sponsor speeches or seminars for meet- for support. ings of the local ministerial alliance to inform ministers about mental retardation and thus help them in counseling parents.

3.In larger cities, prepare a brochure on PARENT AND what services are locally available. SPECIAL-INTEREST AWARENESS 4.DistributeState-and locally-prepared brochures to appropriate agencies and professions. It is recommended that the target of State- and local-level action for parent and special-interest 5. Seek to interest newspapers and other awareness be to inform parents and those to media in human interest stories dealing whom they might turn for counsel, about mental with available services. retardation and the services available to them. 6. Organize university - supported seminars It is recommended that State-level responsibilities for public school teachers, welfare work- in increasing awareness of parents and special- ers and others to help them spotretarda- interest groups among the public include the tion and know where to send children following: and parents for help.

1.Prepare a brochure on what mental re- 7. Larger citiesshould make persons in tardation is, what services are available, smaller communities, who might be in and what to do and where to go when contact with parents of retarded children, retardation is suspected. aware of whateverdiagnostic and other

75 services might be available to them in 4. Send in consultants to help in setting up the metropolitan areas. new facilities or services.

It is recommended that local-level responsibilities for adding to, or improving, local facilities and LOCAL ACTION services for the retarded include the following: 1. Develop a priority list for establishing or While the increasing of publicawareness about improving local programs. mental retardation problems and services,as outlined above, is highly important, publicawareness alone 2. Form organizational boards for needed is not sufficient. facilities(diagnosticcenters,sheltered workshops, etc.) and seek out cc-, nmun- Local action to add services and facilities,to ity leaders to serve as board members. improve existing services and facilities, and to attain the Statewide goals of the Texas Planto Combat 3.Speak to groups which might support Mental Retardation is ofsupreme importance. Local- projects financially or in other ways. level support is essential to the attainment of State- wide goals; conversely, State-level assistance is needed 4. Keep news media informed of all such in meeting the needs of the retarded at thecom- efforts; consider appointing news execu- munity level. tives to boards.

Action to provide new or improved services for 5. Meet with officials of United Fund or retardates also will serve to generate publicaware- Community Chest to explain and coordi- ness, because it is news when people do things for nate efforts; seek to get persons sympa- the retarded, and because people learnmore about thetictothe needsoftheretarded mental retardation when they become involved withit. appointed to the governing boards of these agencies. 6. Ask larger churches to provide special ADDING, IMPROVING Sunday School classes for retarded children, and ask city recreation departments LOCAL FACILITIES AND CERVICES to offer special recreational programs. 7. Contact school officials and trustees to It is recommended that the target ofaction for urge implementation of recommendations local facilities and services be to fill existinggaps of the Texas Plan; seek to assure that in the opportunities available to retardates of all newer methods are used in the placing ages to make the most of their linuted abilities of students and in the instructionalpro- and to lead fuller lives. gram, and that special education teachers attend seminars or do summer postgrad- It is recommended that State-level responsibilities uate work to stay abreast of changing for adding to or improving local facilities and methods. services for the retarded include the following: 8.In communities having institutionsof 1.Distribute through the Mayors' Commis- higher learning, work through administra- sions, local units of the Texas Association tion and board members to implement for Retarded Children and otheragencies recommendations of the Texas Plan. information as to services and facilities recommended by the Texas Plan. 9. Report to the State levelon programs initiated or improved, and problemsen- 2. Serve as a clearing house for ideasput countered. into effect or considered by communities throughout the State. 10. Arrange for tours of mental retardation facilities for clubs or groups which might 3.Direct communitiesasto where help give financial or volunteer support. (financial, professional and otherwise)is available or might be secured. 11. Bring in authorities who might advise

76 how toestablishservicesor improve and senators to make sure they under- existing facilities or methods. stand, and to gain their suppert for, the recommended progiams. 12. Re-evaluate services available to retarded persons from the cradle to the grave in 3. In speeches before clubs and other groups a continuing effort tofill gaps in those (mentioned ear!idr) ask for support of services. needed legislation and financing. 13. Larger cities should move in the direc- 4. Make certain administrators and board tion of making services available on a members of schools and colleges are regional basis and inviting the participa- aware of recommended improvements; tion of surrounding counties and com- seek their positive support of same. munities in the establishment and financial support or needed services, thereby 5. Seek editorial support by Texas news- making services available to every men- papers of the Texas Planrecommenda- tally retarded person in the region. tions. 6. Arrange "Career Day" programs in the public schools, seeking to interest stu- ATTAINING STATEWIDE GOALS dents in careers of service to the retarded. 7. Make sure that local schoolo and other Itis recommended that the target for attaining agencies implement programs,services Statewide goals be to provide grassroots support and improvements authorized by State for services and facilities recommended for State- action. wide action in the Texas Plan to Combat Mental Retardation. STATE AGENCY ACTION It is recommended that State-level responsibilities for attaining Statewide goals include the following: A major objective during the next five years should be to create public understanding essential to 1. Develop a prioritylistof Texas Plan the establishment of community and regional mental recommendations for new and improved health and mental retardation centers which caa services and facilities. take over much of the information-education-referral functions. 2. Draft suggested legislation and work for its passage, keeping local-level agencies This will require additional staff and budgeted and supporters informed of efforts being funds. If the job is really to be done, and not merely made, results obtained, and how they can placed on the shelf and labeled the "good, hard work help. of many sincere people," staff and budget will be necessary. 3. Prepare and distribute news releases on these efforts. 4. Implement those recommendations which FACT SHEET FOR PUBLIC AWARENESS come within the realm of existingfinances and authority,and coordinateefforts among the various Statedepartments. A "Fact Sheet for Public Awareness" was prepared by the State Planning Office for use by chair- It is recommended that local-level responsibilities men of Mayors' Commissionsduring the time in for attaining Statewide goals include the follow- which those commissions were surveying their mental ing: retardation resources and unmet needs.

1.Familiarize all workers with Statewide It is recommended that this fact sheet for public goals. awareness and othersimilar directives deemed appropriate be prepared and distributed to 2. Work closely with State representatives groups and individuals atthe locel level.

77 Inkonwwwwwww... IMMO,

12. ORGAMIATION AND COORDINATION OF STATEWIDE AND COMMUNITY EFFORTS

GENERAL PRINCIPLES The planning study has revealed a pervasive interest and concern with the problems of mental retardation among the citizens of Texas. A network The development of mental retardation services of knowledgeable and ded,cated citizens who could is a multidisciplinary responsibility. Significant con- contributesignificantlyinfiloimplementationof tributions have been made by many professions, and mental retardation programs now exists, We urge, the Texas Plan to Combat Mental Retardation should therefore, the inclusion in the Texas Plan of strategies foster the fullest possible participation of all relevant to assure the continued participation and involvement disciplines. The planning study emphasized the im- of citizens at all levels of programming to the end portance of a multidisciplinary approach to mental that maximum contributions by these citizensto retardation and the necessity for administrative and mental retardation programs will be fostered. organization strategies recognizing the importance of this approach. Administrative and managerial posi- Recognizing thepotentialvalueofmultiple tions in mental retardation programs, for example, source financing for programming, maximum flexi- should be filled on the basis of administrative skills bility regarding budgeting of State funds should be and experience rather than on the basis of specific the rule, in order to allow the most effective use of professional degrees. such funds to match Federal and/or local fund% Flexibilityisparticularly desirablein community programs, where services to individual communities A great diversity of community needs and re- or regions must be adapted to the unique needs and sources exists throughout the State. Maximum flexi- resources of each area being served. The primary bility of approach, therefore, should be emphasized focus in programming should be on furnishing the so that programs will meet the individual needs of best possible services to the retarded, regardless of those citizens for whom they are designed. the source of financing. The mentally retarded person should be served, wherever he might be located. Since the great majority of retarded persons live in communities, and INTERAGENCY COUNCIL since prevention of institutionalizationisdesirable FOR MENTAL RETARDATION whenever possible, expansion of community programs is necessary. Texas should be concerned, therefore, with insuring effective coordination of community, The multidisciplinary responsibilities extant in regional and State programs through effective ad- the development of services for the mentally retarded ministration strategies. require the vital involvement of many State agencies. In order to provide for the efficient and orderly Mentally retarded Texas citizens are served by coordination and integration of services, to provide a number of public agencies, as well as by private for the evaluation and interpretation of mental re- programs. To insure maximum returns from existing tardation programs and needs to the citizenry and and future programs, it is imperative that programs to the State government, and to assure the proper complement each other and that they develop to implementation of existing programs, an official group meet the needs throughout the State. Effective ad- representing program interests in the field of mental ministrative procedures must be established to assure retardation should be established at State level. the fullest cooperation and coordination among all State and private agencies dealing with mental re- It is recommended that the Legislature be retardation. quested to establish by law a standing Interagen- 7g/79 cy Council for Mental Retardation composed of ggency Council for Mental Retardationinclude Representatives of all those State agencies having provision for the appointment of a policy-advis- a responsibility for any program involving serv- ory committee to be composed of six persons ices for the mentally retarded. with interests tn the field of mental retardation to render advice and to work with the Inter- The Interagency Council would be the primary agency Council on matters relating to major channel for coordinating communications regarding policy questions involving programs for the men- mental retardation programs among the State agen- tally retarded cies directly involved in providing services to the retarded. The Council would strive to minimize areas The Council should hold Periodic conferences of overlapping services and to meet needs for the with the Policy-Advisory Committee to stimulate development of services. direct communications betweeP the two groups. The Interagency representatives on the Council Ideally, to expedite the efficient coordination and should be the chief executives of each agency, acting integration of mental retardation activities considered ex-officio. The Interagency Council should have no by the Interagency Council for Mental Retardation, direct administrative authority over the various pro- the concept of regional or community counterparts grams represented among the membership on the of the State level Interagency Council should be de- Interagency Council. Council deliberations leading veloped. The Regional or Community-oriented Inter- toconsensusdecisions and recommendations for agency Council would foster the coordination and action, therefore, should be implemented through integration of programs below the State level in the appropriate administrative channels of the agency accordance with the actions of the State Interagency or agencies having a primary concern. Council. Open channels of communication among the programs serving the retarded at the Regional The Interagency Council should be served bya or Community levels should be maintained as they staff of salaried employees directed bya staff officer are maintained at State level through the Interagency directly responsible to the Interagency Council for Council. In those regions or communities where one Mental Retardation. An appropriate budgetto carry or more agencies have no regional representative, out the responsibilities of the Interagency Council the State agency may wish to send a representative should be provided. The offices housing staffper- from the State central office of the agency or from sonnel, equipment, and activities serving the needs an adjoining region or community to attend the of the Interagency Council for Mental Retardation Regional Interagency Council meeting. should be maintained separately from and removed from any State agencyor department represented A staff officer at Regional level may be appointed on the Council. or an employee from one of the agencies represented on the Regional Interagency Council may be designated to coordinate and work with the principal staff officer of the Interagency Council for Mental POLICY-ADVISORY COMMITTEE Retardationat the Statelevel. The Regional or Community level staff officer should work directly with and accept guidance from the principal staff The need for an advisory committeeon pro- officer of the State Interagency Council. grams of mental retardationisrecognized. The activities of such a committee to assist and advise Itis recommended that State agencies repre- the Interagency Councilinthe establishmentof sented on the Interagency Council for Menial policies in suchareas as terminology and definition, Retardation establish Regional Interagency Coun- research, manpower development, guardianships,and cils, composed of the regional counterparts of the like, can be of inestimable valueto the Council the State Level Council. in the interpretation of probable reactions andsenti- ment and in the representation of voluntary organi- It is recommended that Mayors, County Com- zations with primary interests in the field of mental missioners Courts or governing bodies of other retardation and related professionalprograms. Ade- appropriate political subdivisions be encouraged quate funds should be budgeted tocover consultant to appoint standing Local Commissions on Men- fees, travel costs andper diem expenses for com- tal Retardation. Commission members should be mittee members. selected so as to represent official mental retardation agencies and interests and specific Itis recommended that the statute providing voluntary agencies arid interests in the com- for the establishment by law ofa standing Inter- munity.

80 The efficacy of the Mayors' Commissions on Trustees of Mental Retardation and/or Mental Health Mental Retardation Planning in 58 cities throughout Centers, when such centers are included inthe Texas is recognized in the development of the Texas community. Itis expected that there will be an Plan to Combat Mental Retardation. The contribu- overlap among members of the Commissions and tions of the Mayors' Commissions for Mental Re- the boards of trustees of the Community Centers. tardation in the development of the plan recommend The boards of trustees will have administrativere- continued community leadership in this area under sponsibility for the Community Centers, according the chairmanship of a commission chairman to be to the provisions of the Texas Mental Health and appointed by thetitular head of the governing Mental Retardation Act (House Bill 3, 59th Texas agency. Legislature). The Commission should havean advisory function to the boards of trustees. Commissions should meet regularly with the Regional Interagency Council, such joint meetings The Commissions would keep leading citizens to be coordinated by the Regional staff officer as- vitally involved with local mental retardationpro- signed for this purpose. grams. They would facilitate communication among local agencies and local, regional and Stateprograms. Each commission should meet periodically with They could act in an advisory capacity to the Re- the Mayor, the City Council, and other community gional Interagency Councils and to the boards of officials to discuss mental retardation needs andpro- trustees of Mental Health and/or Mental Retardation grams and to stimulate communication and coordi- Centers. nation of efforts between State and local programs. It is recommended that all State agenciespro- Subcommittees may be appointed by the Com- viding services for the Mentally Retarded have missions to serve special needs, suchas the appoint- resources for program development that would ment of a subcommittee on employment of themen- allow them to take full advantage of funds that tally retarded. become available forresearch, demonstration projects and other services andprograms. The local Commissions should establish liaison and schedule regular meetings with the Board of

81 13. LEGISLATIONAND FINANCE

Combat Mental Retardation, today, may become sovictimized by rising and The Texas Plan to changing cost factors in the fluidmarket of rising presented in its entirety inthe preceding sections or contemplates a coordin- costs for manpower,equipment, and professional chapters of this publication, services, that a complete revisionof budgeted costs ated program ofintegrated services for thementally full spectrum and arrayof would become essential withinthe next year and retarded, recognizing a prior to the next sessionof the Texas Legislature. It services in the broad areasof research and preven- the would seem reasonable, therefore, towait as late as tion, care and treatment,and amelioration of legislative plan, taken Plan to Combat MentalRetarda- possible before structuring a problem. The Texas from the Texas Plan toCombat Mental Retardation tion envisions andrecognizes the need tostrengthen existing programs and toprovide for new and and contemplating financial support. in areas necessary servicesfor the mentally retarded The Task Force onLegislation and Finance where gaps now exist.Never before hasTexas of services suggests that there is aneed to take a good look at presented a more comprehensive program existing State legislationand financial data in the for the mentallyretarded, to provide for alifetime possible to their homes. total area of cost supportsfor mental retardation and continuum of care as near as recommends that further. study,during the period of A greater investment,therefore, must be made in made in order to only to correct inadequacies implementation of the plan, be existing programs, not provide for improvement inneeded and necessary and inefficiencies in currentactivities in the field of provide for innovation areas of legislationand financial support by the time mental retardation but also to the Legislature comes into sessionagain in 1967. and for new patterns of care. responsibility for meeting Careful planning for the purposeof strengthen- Although the primary costs of services for theretarded rests with the indi- ing existing programsand recognizing theneeds in research, prevention, care and vidual or his family, there mustbe recognition by expanding programs in the government of theresponsibility to discharge treatment, andamelioration in mental retardationis disproportion of inter- society's compassion by financingneeded care to the vitally essential to prevent a might be unable to pay forthat dependent services. To assumethat all services might extent that a person community benefit. be developedsimultaneously would be impractical, to say the least. Thetotal planning effort, requiring be aimed at the devel- The basic principle in aneffective comprehen- sound financial support, must for the mentally retarded priority and feasibilitybasis. sive program of services opment of programs on a is that the servicesoffered must bc geared to the needs of the individualand the community. The The fluidity and rapiditywith which the prob- of services can impart a lems of mental retardation are nowbeing resolved extent to which a program lagged so long precludes feeling of security andwell-being for our mentally in fields where progress retarded citizens can bemeasured by the develop- establishing a positive programfor the legislative and ment and provisionof adequate programs and cannot financialsupportofthe broad recommendations not" be measured in terms ofspecific dollar values. The extant in the TexasPlan. "What is" and "what is well as the personal be" in a moment. To recom- dividends to society, however, as become "what used to dividends rewarding theretarded make the chore mend positive legislativeneeds and positive financial support for a plan not yetin the implementationstage worth the effort. would be both impracticaland unrealistic. Positive for some of the Current programs in thefields of special educa- cost figures arefar from available training,as theyaffect the in prevention, care,treatment, and tion and vocational newer innovations mentally retarded, havealready proven beyond a amelioration; and eventhose costs, which are positive 83 reasonable doubt the efficacy of expenditures in these Although immediate andfutureneedswill areas, resulting in the prevention and amelioration require the financial assistance of all levels of gov- of retardation caused by culturaland economic ernment, every effort should be made to provide for deprivation, by disease, and by avoidable human community support of the mentally retarded, both suffering. for the purpose of maintaining ideological responsibilities and for control ot economic resources at the The Honorable Ben Barnes, Speaker of the Texas community level. For a community to abdicate this House of Representatives,addressing the annual responsibility would be to forfeit the right to those gathering of the Texas Social Welfare Association in democratic principles provided by our State and Houston in November, 1965, said, "I know that we, Federal Constitutions. as a people with a tradition of Christianity and humanitarian concern for the needs of the unfortun- The development of programs ot services for the ate, are committed to meeting these needs as best mentally retarded must be justified by the needs of we can." To meet these needs, closer coordination the individual in the community rather than to be and understanding among State agencies can result based solely on cost and on tbe availability of funds. in a more efficient development of programs of tax- supported services for the mentally retarded, avoid- The need for establishing closer working rela- ing duplications, and recognizing basic governmental tionships between the State and communitiesis responsibilities by departments. Certainly, the pos- recognized, and itis recommended that completely sibility of changes in laws and current practices open channels of communication become imperative might be necessary to provide for closer coordination in order to avoid overlaps, duplications of services, and for a more efficient expenditure of manpower and other costly and wasteful practicesaffecting and money at all levels of government. governmental expenditures. Within the communities themselves, care must be exercised to avoid duplica- Multi-source funding is, and will continue to be, tion of services for the mentally retarded to the a reality, involving the local, State, and Federal levels exclusion of other services which should be offered of government. Multi-source funding,it must be ht the community level but which are not because recognized, must be regulated to provide fora proper of the economics of supporting duplicate services. balance and to assure proper relationshipsamong the governmental agencies concerned. Selection of those services most practical and feasibleand most needed and necessaryfor imme- The Texas Plan to Combat Mental Retardation diate implementation ina comprehensive mental was built and developed on the concept of community responsibility and community planning. Each of retardation program requires flexibility of funding to provide for shifting program emphasis from one 58 Texas communities developed what, in effect,was an individual community plan to combat mental element of service to another and fromone location retardation. Each community determined thegreatest to another, as programs become more recognizable. needs of that community and which needs would The Task Force on Legislation and Finance, there- ultimately require the greatest expansion andstrong- fore, plans its greatest efforts during the implementa- est financial support. tion period in 1966.

84 APPENDIX

INTERAGENCY COL:NelITTEE ON MENTAL RETARDATIONPLANNING

Bill B. Cobb, chairman, Executive Budget Director, Governor'sOffice Richard L. Coffman, Administrator, Texas Employment Commission J. W. Edgar, Ed.D., Commissioner of Education, TexasEducation Agency Charles S. Eskridge, Executive Director, Regional Moital RetardationTraining Center, The University of Texas Jess M. Irwin, Jr., Executive Director, Texas Departmentof Mental Health and Mental Retardation J. E. Peavy, M.D., M.P.H., Commissioner of Health, Texas StateDepartment of Health James A. Turman, Ph.D., Executive Director, Texas Youth Council John Winters, Commissioner, Texas Department of Public Welfare

IMMISL

GOVERNOR'S ADVISORY COMMITTEE ON MENTAL RETARDATION PLANNING

Herman Jones, Chairman, Austin Ray C. Holbrook, La Marque Richard S. (Cactus) Pryor, Austin Mrs. Jack Allensworth, San kitonio Mrs. Merle Huston, Austin Mario E. Ramirez, M.D., Roma Byrnes Belk, Ph.D., Beaumont Mrs. Floyd L. Karsten, Houston Chester L. Reynolds, M.D., El State Sen. H. J. (Doc) Blanchard, Doman K. Kee le, M.D., Denton Paso Lubbock Mrs. Joe H. Lewis, Waco Philip Roos, Ph.D., Austin Frank Borreca, Houston Sam Loeb, M.D., Sweetwater Raymond Rude, Rosenberg John L. Clark, Jr., M.D., Odessa Mrs. Nancy Marcus, Dallas Israel H. Schuleman, M.D., George A. Constant, M.D., Victoria Wendell Mayes, Jr., Midland Houston W. C. Cunningham, Galena Park Charles Meisgeier, Ed.D., Austin Mrs. A. R. Schwartz, Galveston William S. Fields, M.D., Houston William J. McGanity, M.D., Mrs. E. E. Searcy, Fort Worth Shervert H. Frazier, Jr., M.D., Galveston Honorable Magus F. Smith, Austin John T. Miller, Jr., M.D., Lubbock Edinburg McIver Furman, M.D., Corpus State Rep. G. F. Mutscher, R. E. (Bob) Smith, Houston Christi Brenham Robert L. Stubblefield, M.D., Porter S. Garner, Sr., Laredo Mrs. W. C. Noel, Odessa Dallas Pete C. Palasota, M.D., Abilene Perry C. Talkington, M.D., Dallas Mrs. W. St. John Garwood, Jr., Fred Taylor, M.D., Houston Houston Faye Pannell, R.N., M.A., Denton Robert U. Parish, Houston Raymond W. Vowell, Austin Mrs. A. S. Genecov, Tyler George Parker, Fort Worth David Wade, M.D., Austin Harold A. Goolishian, Ph.D., John Peck, Ph.D., Austin Russell G. Walling, M.D., Galveston Hugh A. Pennal, M.D., Amarillo Texarkana Charles A. Guy, Lubbock Gus Pinkerton, D.D.S., Tyler Connie R. Yerwood, M.D., Austin Jack R. Hi ld, M.D., Houston (Deceased) Hull Youngblood, Sr., San Antonio

85 THE 12 STATE TASK FORCES

Health Services Peggy Sartain, M.D., Dallas Mrs. Frances Frizzell, Austin Richard L. Stafford, Ph.D., Galveston Mrs. W. St. John Garwood, Jr., Houston Members: Martha D. Yow, M.D., Houston Mrs. Giles( Janie) Harrison, Austin Mrs. Alice Nunn, Victoria Sam Nixon, M.D., Chairman, Floresville Chester L. Reynolds, M.D., El Paso Lewis Dodson, Amarillo Education Harold A. Gonlishian, Ph.D., Galveston Consultant: Jack R. Hi ld, M.D., Houston Me-nbers: William J. McGanity, M.D., Galveston Mrs. Eleanor Eisenberg, TDPW, Austin John T. Miller, Jr., M.D., Lubbock Richard H. Hungerford, Ph.D., Chair- Faye Pannell, R.N., M.A., Denton man, Victoria Mario E. Ramirez, M.D., Roma Sam Anderson, Big Spring Residential and Day Care W. R. Ross, M.D., San Antonio Aaron Armfield, Ph.D., Commerce Mrs. Ada Simond, Austin Byrnes Belk, Ph.D., Co-chairman, Members: Connie R. Yerwood, M.D., Austin Beaumont A. 0. Bowen, Bryan Mrs. E. E. Searcy, Chairman, Fort Worth Consultant: Mrs. William C. (Bessie) Bryant, San Mrs. Jack Allensworth, San Antonio Antonio Mrs. Louise Allison, Lubbock Paul Manning, TSDH, Austin Ray C. Holbrook, La Marque W. W. (Bill) Beaver, Lufkin Miss Jo Kelly, Co-chairman, Fort Worth Mrs. T. C. (Clara) Campbell, Abilene Hugh A. Pennal, M.D., Amarillo John L. Clark, Jr., M.D., Odessa Mrs. Jan A. (Dona) Ronk, Waco Charles Cleland, Ph.D., Austin Medical Aspects Richard Slater, Ed.D., Co-chairman, Mrs. S. E. (Lila) Thompson, Richmond Houston Members: Mrs. Dottie Stark, Irving Consultants: Roy Van Hoove, Austin Domin K. Kee le, M.D., Chairman, Mrs. Venedia Watkins, Longview Denton Charles D. Barnett, Ph.D., TDMH/MR, Austin Consultants: Louis E. DeMoll, TDMH/MR, Austin Group on Prevention: Don Partridge, TEA, Austin Reuben Adams, M.D., Dallas Carlton Wainscott, TEA, Austin Manpower Heinz Eichenwald, M.D., Dallas Jacob L. Kay, M.D., Dallas Members: Jim Lee, M.D., Dallas Vocational Rehabilitation Roy E. Moon, M.D., San Angelo George A. Constant, M.D., Chairman, Carl Moore, M.D., Austin Members: Victoria Sam A. Nixon, M.D., Floresville W. C. Cunningham, Galena Park Floyd Norman, M.D., Dallas Frank Borreca, Chairman, Houston Mrs. Tommye Frye, Pasadena Melvin L. Thornton, M.D., San Antonio J. Ed Bridges, Austin Richard D. Grant, Victoria William W. (Bill) Campbell, Austin Malcolm Lauderdale, Austin Group on Management: Tom Deliganis, Laredo Charles Laughton, D.S.W., Austin Porter S. Garner, Sr., Laredo James Moore, Austin Ira A. Budwig, M.D., El Paso Mrs. Joe H. Lewis, Waco Miss Alma Rollins, Austin Henry L. Burks, M.D., Galveston M. L. McDonald, Dallas J. J. Seabrook, D.D., Austin E. S. Cunningham, M.D., Fort Worth Shelley V. Smith, Abilene Miss Ila Fern Warren, Austin Albert McCulloh, M.D., Brady David Wade, M.D., Austin Theodore R. Pfundt, M.D., Houston John Weimer, Richardson R. L. Stubblefield, M.D., Dallas Mrs. Ovid Youngblood, Waco Research Fred M. Taylor, M.D., Houston Consultants: Members: Group on Research and Education: Max Arrell, TEA, Austin John Peck, Ph.D., Chairman, Austin Walter Dezelle, Ed.D., Port Arthur Arr Nell Boelsche, M.D., Galveston Louis Corenblith, TEA, Austin Doyle Wheeler, TEA, Austin William C. Ferguson, Ph.D., Edinburg C. W. Daeschner, M.D., Galveston William S. Fields, M.D., Houston Albert G. Randall, M.D., Edinburg Consultants: Welfare Services Ernest 0. Watkins, Ph.D., Denton William Wolfe, Ph.D., Austin Bill Caldwell, Ph.D., Galveston Wilfrid Calnan, Chairman, Corpus K. C. Haltalin, M.D., Dallas Christi Consultant: Edythe P. Hershey, M.D., Dallas Alan P. Bloebaum, Austin John D. Nelson, M.D., Dallas T. C. Calhoun, Austin Fred R. Crawford, Ph.D., TDMH/MR, Bobbye M. Rouse, M.D., Galveston Morris Craig, San Angelo Austin

86 Low Mrs. L. S. Vasbinder, Del Rio Finance and Legislation Wendell Williams, Ph.D., Denton Members: Consultant: George Parker, Chairman, Fort Worth State Rep. G. F. Mutscher, Chairman, Honorable C. L. Abernethy, Plainview Preston Clark, TMRPS, Austin Bill Anderson, Austin Brenham Jim ILnkerson, Austin Charles Meisgeier, Ed.D., Co-chairman, Pete C. Palasota, M.D., Abilene Austin Honorable Magus F. Smith, Edinburg Organization and State Rep. Don Cavness, Austin Robert L. Stubblefield, M.D., Dallas Coordination James A. Giddings, Houston Honorable Arthur Tipps, Wi. hita Falls State Sen. Charles Herring, Austin Members: Mrs. Merle (Dora) Huston, Austin Hull Youngblood, San Antonio Robert U. Parish, Houston Philip Roos, Ph.D., Chairman, Austin State Sen. Bruce A. Reagan, Corpus Local Action, Public Senator H. J. (Doc) Blanchard. Lubbock Christi Mrs. Nelda Coats, Lubbock Jack Y. Smith, Big Spring Awareness Vic Ehlers, Jr., Austin Raymond W. Vowell, Austin Miss Louise Evans, Amarillo Members: H. H. Meadows, Orange Mrs. Marilyn Schwartz, Chairman, Senator Walter Richter, Austin Galveston B. E. Rushing, Jr., Lubbock Honorable Ben Barnes, Speaker of the La lo Campos, Austin House of Representatives, Austin Jesse Garza, Austin Consultants: State Sen. Martin Dies, Jr., Luflcin James H. Higdon, El Paso Bob Johnson, Texas Legislative Council, Kenneth May, Lubbock Jess M. Irwin, Jr., TDMH/MR, Austin Austin Wendell Mayes, Jr., Midland Charles F. Mitchell, TDMH/MR, Austin Vernon A. McGee, Legislative Budget Richard S. (Cactus) Pryor, Austin James P. Oliver, Legislative Budget Board, Austin John Roper, Amarillo Board, Austin H. L. Menn, Ph.D., TDMH/MR, Austin

THE 58 MAYORS' COMMISSIONS ON MENTAL RETARDATION PLANNING

Much of the material which went into the Texas Plan was gathered inlocal planning studies in the 58 largest cities in Texas, by Mayors' Commissions on Mental Retardation Planning. These cities, their Mayors, theirCommission Chairmen, and membeis of their Commissions, are presentedbelow.

Mayor's Commission Chairman: Mr. Members of the Commission: Abilene H. H. Presnall, 1112 Arcadia Mayor: W. Lee Byrd, P. 0. Box 60, Mr. Robert R. Ashworth, 910 West 8th Members of the Commission: 79604 Mr. E. M. Blackburn, 315 East 5th, Box 70 Mayor's Commission Chairman: Mrs. Mr. Joe Besse, 3C0 East Main Mr. W. W. Farrar, 316 Craig Avenue Dr. James R. Carroll, 1100 Harrison T. C. Campbell, 1251 Elmwood Drive Mr. Alfredo Garcia, Jr., 808 South Dr. Joel Ray Coker, 1422 Tyler Members of the Commission: Cameron Mr. J. W. Collins, Vaughn Building Mr. George Kiser, P. 0. Box 189 Mr. S, T. (Bud) Curtis, 315 Van Buren Mrs. Ann Baker, 2241 South 19th Street Mr. Jack Linder, 713 Washington Mr. Manuel B. Edquist, Box 511 Dr. Verna Mae Crutchfield, 3665 Janice Mrs. Mildred Nun ley, 703 Jhn Wells Dr. G. Mason Kahn, 417 Austin Street, Dr. Charles Foster, 4601 Hartford Rev. Thos. H. Parsons, 1317 Northwood Box 1971 Dr. William N. Fryer, 2525 Rountree Mr. Gonzalo V. Trevino, 321 South Mr. Hugh H. Loewenstern, Sr., 415 Mrs. Claude Grant, 1201 Elmwood Wright West 10th Dr. Pete Palasota, 270 Leggett Drive Mrs. Leila Word, 1108 Hartwell Road Dr. A. B. Martin, 2201 Washington Dr. Robert Platt, 856 Highland Street Mrs. Frances Standifer, 3317 Green Mr. Samuel M. (Pat) Murphy, 517 Acres Road Amarillo Taylor Mr. Harry Walker, Box 993 Mayor: F. V. Wallace, 516 East 5th Dr. Hugh A. Pennal, 2209 West 7th Avenue, 79101 Dr. Jaime Quintanilla, 807-B Lamar Alice Mayor's Commission Chairman: Mr. Mrs. David Rasco, 2412 Travis Street Mayor: Cecil S. Carlisle, P. 0. Box 119, Lewis Dodson, 75 Hughea Street, Mr. Herbert 0. Willborn, 105 Houston 78332 P. 0. Drawer 1260 Street, Bol: 2089

87 Arlington Mr. Dan R. Elkins, Savings and Loan Building Bellaire Moyor: Tom J. Vandergriff, P. 0. Box Mr. Phil Wayne Evensberger, Radio Mayor: Robert D. Watts, 308 South 231, 76010 Station KWBA, Decker Drive Mr. Gary Garner, 2002 Washington Rice Avenue Mayor's Commission Chairman: Rev. Dorothy Harrison, 301 Tri City Beach Mayor's Commission Chairman: Gary D. Warren Neal, 1104 Lynda Lane Road Mr. W. E. Heaner, 707 West James Summers, 308 South Rice Avenue Members of the Commission: Mr. W. D. Hinson, Box 30 Dr. Louis B. Hughes, 414 Harold Lane Members of the Commission: Mr. A. N. Johnson, 2610 Virginia Mr. Milton Barrick, 1311 Hillcrest Mrs. A. H. Arnim, 5324 Braeburn Mr. Robert Burnett, 604 Waggoner Drive Mrs. Anna Johnson, 220 East Defee Mr. Ralph Bradley, 5101 Bellaire Mr. R. P. Campbell, 1519 Camellia Drive Mrs. Joan Johnson, 3012 Market Mr. Bob Kalbitz, 505 Williams Boulevard Mr. Ben Collins, 109 Parkview Drive Mr. Prather Brown, 125 Bellaire Court Mrs. Marvin Corder, 1511 Connally Mr. and Mrs. Walter Loflin, 713 Lloyd Lane Mr. W. L. Burns, 5573 Aspen Terrace Mrs. Lewis B. Coke, 5308 Pocahontas Dr. Doyle Lansford, City of Arlington Mr. Robert Mansker, 5310 North Redell Road Mrs. Reubin Coons, 4409 Holt Mr. Charles Merrill, 2706 Gilbert Circle Mr. Marvin Eaves, 308 South Rice Mr. Jim Neighbors, 603 Causley Mr. Clyde Messiah, Box 30 Mr. Pat Emmott, First State Bank of Mr. Ken Nowell, 728 Highland Mr. Dave Moore, 2 West Texas Avenue La Jean Morris, 209 LaFayette Drive Bellaire Shannon L. Morris, 1209 Decker Drive Mrs. H. H. Frisa, 5606 Whitehaven Austin Wanda Orton, Box 90 Mrs. W. C. Gardiner, 4990 Willow Mrs. Julia Pierson, Box 86 Mr. W. E. Hamilton, 308 South Rice Mr. E. L. Roberts, 2101 New Mexico Mrs. 0. A. Itria, 5324 Pine Mayor: Lester E. Palmer, P. 0. Box Mrs. Nancy Kirk, 4511 Holt 1160, 78701 Dean Walter Rundell, Box 818 Mrs. Don Teter, 5013 Glen Haven Mrs. G. A. Knudsen, 4811 Tamarisk Mrs. G. P. Kretzschmar, 4816 Welford Mayor's Commission Chairman: Mr. Audrey Tyer, Box 4, Mont Belvieu Mrs. Katherin H. Wood, 1302 Olive Mr. S. E. Lingo, 4923 Elm J. Ed Bridges, Box 3552 Mrs. S. E. Lingo, 4923 Elm Mr. John Woodard, Box 30 Mr. James C. McBride, 4525 Evergreen Members of the Commission: Mr. John A. Woodard, Box 30 Dr. Mary Magee, 5123 Evergreen Mrs. Roland Parker, 5211 Valerie Mr. Howard Barr, 4602 Ridge Oak Drive Dr. Tryon Robinson, 4700 Maple Mr. William W. Campbell, 4714 Frontier Beaumont Mrs. Frank Stamper, 110 McTighe Trail Mrs. G. 0. Summers, 5334 Braeburn Mr. Robert E. Canino, 8407 Sequoia Mayor: Jack M. Moore, P. 0. Box 2827, Mr. Jerome Toups, 4528 Oleander Mrs. Josephine Daniel, 2609 San Pedro Mr. William M. Tripp, 5315 Jessamine Street 77700 Mrs. J. W. Weems, 4413 Bellaire Miss Margaret Emswiler, 3805 Stevenson Boulevard Mr. L. Lee Hicks, 1600 Fairplay Ct. Mayor's Commission Chairman: Dr. Mrs. John J. Wheeler, 5333 Braeburn Mrs. Mary Holman, 201 West 33rd Monty Sontag, 5195 Oriole Drive Street Mrs. Charles White, 4537 Wedgewood Mr. Merle Huston, 1400 Lorraine Members of the Commission: Rev. Albert F. Jesse, 509 Carolyn Big Spring Mrs. Herman Jones, 3303 Greenlee Dr. Byrnes Belk, 3455 Stagg Drive Mr. A. A. (Bob) Ma llas, Jr., 703 Robert Dr. Harold Bevil, 3430 Evalon Mayor: George J. Zachariah, P. 0. Box E. Lee Road Mr. Frank Dover, 930 23rd 391, 79720 Mrs. Charles Meisgeier, 2703 Richcreek Mrs. Charles Foxworth, 1755 Bandera Road Drive Mayor's Commission Chairman: Mr. Dr. W. Richard Hargrove, Lamar State Jack Y. Smith, Box 1311 College Baytown Dr. E. V. Huffstutler, 820 Neches Members of the Commission: Mrs. V. E. Karnes, 1088 Amarillo Mayor: Dr. C. L. Liggett, (first part of Mrs. A. B. Marty,Jr., 3880 Holland Mr. Sam Anderson, Big Spring School study), Seaborn Cravey, P. 0. Box Drive District 6097, 77520 ( completion of study) Mrs. F. W. Morrison, Jr., 4460 El Paso Dr. Preston Harrison, Big Spring State Mr. John Neild, 2770 Fannin Hospital Mayor's Commission Chairman: Mr. Mr. R. A. Permenter, 1025 Woodrow Dr. C. D. Marcum, 901 Main Thomas M. Campbell, 509 Grantham Mr. William Phillips, American National Mr. Arnold Marshall, 1723 Purdue Road Bank Mr. Ray Nichols, c/o County Judge Dr. W. Pierre Robert, Jr., 1230 Long- Mr. R. W. Whipkey, c/o Big Spring Members of the Commission: fellow Drive Herald Mr. C. R. Shimek, 1580 Fairway Mr. Robert P. Beman, Jr., 1223 West Mrs. Albert Spahn, 3520 Wheat Drive Brownsville Defee Rep. Will L. Smith, 644 Avenue C Rev. H. 0. Bomhoff, 1706 Gillette Drive Mr. Arthur Stelley, 3895 18th Mayor: Antonio Gonzalez, P. 0. Box Mrs. M. M. Brown, Box 30 Mrs. Marjorie Wagley, Pietzsch Elemen- 911, 78520 Mr. C. G. Caldwell, P. 0. Box 425 tary School Mrs. Mary Clements Dr. Wilber S. White, 2487 Calder Mayor's Commission Chairman: Joan Mrs. H. J. Cornelius, 308 Burnett Drive Mr. Hugh Wright, 255 Clark Grotzinger, 1705 West Madison

88 Members of the Commission: Mrs. Alton Bowen, 506 Brookside Drive Corpus Christi Mrs. Mary Bradley, 2003 Vinewood Mr. Bruce Aiken, P. 0. Box 1749 Street Mayor: Dr. James L. Barnard (first part Miss Mary Bomaine, Crippled Children's Rev. Ray Brezna,St.Joseph Church, of study ), McIver Furman, M.D., 319 Clinic, Fort Brown 600 East 26 Furman Building( completion of Mr. Ben Brite, 245 Calle Cenizo Mrs. Travis Bryan, Jr., 612 South study ) Mr. Robert Brockman, 1623 Yale Avenue Hutchins Street Billie Burton, c/o Greater Brownsville Mr. Brooks Cofer, 721 Garden Acres Mayor's Commission Chairman:J. M. Commission, Market Square Boulevard Sloan, M.D. (first part of study ), Dr. Mrs. Lois del Castillo, 114 W. Park Mrs. L. P. Coffey, 2313 South College Helen Woods, 527 Gordon ( comple- Drive Avenue tion of study ) Miss Celeste Cavazos, 610 West St. Mrs. Thelma CoVan, 747 Rosemary Charles Drive Members of the Commission: Mr. Fred Celaya, c/o Texas Employment Mr. Marlon Crump, Edge Commission Mrs. Martha Culpepper, 4336 Culpepper Mr. Ted Abbott, Coastal States Gas Mrs. Emilio Colunga, 1624 West Drive Producing Company, Petroleum Tower Washington Mr. Jack Currie, 1901 Wayside Drive Mr. R. J. Brauer, Parent Child Guidance Mr. Cosby Contreras, 5160 Wilson Drive Mrs. Roland Dansby, 611 East 29th Center Judge Oscar Dancy, Cameron County Street Mr. Wilfrid Calnan, P. 0. Box 9217 Court House Mrs. Marty Easterling, 203 South Miss Aurora Cardenas, 4622 Green Mrs. Virginia Garcia, 43 East St. Coulter Drive Grove Charles Dr. Joe Geppert, 2011 Echols Mrs. Hugh Roy Cook, P. 0. Box 3625 Sister Mary George, Mervy Hospital, Mrs. Barbara Gerbert, 1-1-E Hensel Apt. Mrs. Gretchen Cullins, P. 0. Box 9217 1040 Jefferson Mrs. Carolyn Good, 1303 Milner Street, Mrs. Alton DeSha, 5630 Nelson Lane Mrs. Mary Helen Gonzalez, 504 E. C.S. Mrs. Pat Duaine, P. 0. Box 3025 Levee Mrs. Inez Grays, 404 North Reed Mrs. Bob Finke, 4838 Casper Mr. Tommy Graham, 1333 Old Port Avenue Dr. George Flood, 527 Gordon Isabel Road Dr. John J. Hall, 411 Brookside Drive Sister Francis, 901 South Alameda Miss Hazel Hawkins, 25 Honeydale Mr. 0. S. Hervey, 4012 East 29th Mr. Ralph Galvan, 316C Reid Drive, Mr. James "13.Holton, Jr., 1350 W. Mr. Art Herwald, 903 Mitchell Street Suite 4 Elizabeth Dr. Lannes Hope, 3309 Crane Street Mr. Don Hawkins, P. 0. Drawer 748 Mr. Gene Hooker, P. 0. Box 391 Mrs. Morris House, 2406 Kent Street Mrs. Evelyn Higgins, 4401 Kirkwood Mr. and Mrs. John Hunter, 1314 St. Mrs. Topaz Hughes, 711 South Coulter Mrs. R. N. Holden, 706 Monette Charles Drive Mr. Lee Howell, P. 0. Box 301 Mr. Myr lin Johnson, 717 Bowie Mr. Roger Jackson, 4101 Nagie Street Mr. Alexander W. Hueske, P. 0. Drawer Mr. Gus Krausse, 135 Alice Circle Drive Mrs. Mary Jernigan, 3210 Link Street 748 Mrs. Maude A. Lorance, R.N., Cameron Mrs. Mackin Jones, 1622 Oakview Street Mrs. Wayne Lundquist, 210 Wilshire County Health Department Mrs. Madelyn Klintworth, 1620 Ursuline Dr. W. R. Metzger, City Health Mr. Juan Lujan, 609 Rio Grande Bldg., Drive Department Harlingen Sister Regina Marie and Sister Lambert, Mrs. Mary Moon, 1810 Howard Mr. Arturo A. McDonald, c/o Boys Club, St. Joseph Hospital Dr. Christopher Morris, 261 Circle Drive 1103 E. Monroe Dr. Carlton Lee, 208 North Coulter Mr. John Nugent, 833 Wilson Building Mr. Gordan McIver, P. 0. Box 391 Drive Mrs. W. T. Nugent, 1525 Daytona Mrs. J. W. McMaster, 1165 Parkwood Mrs. Robert E. Long, 2005 Miller Street Mr. Adolfo Pesquers, P. 0. Box 9217 Place Dr. William McCulley, 203 Hensel Mrs. H. 0. Roberts, 320 South Morning- Dr. Horacio Mendiola, 105 W. Elizabeth Dr. Lamar McNew, 4004 Nagle Street side Mr. Robert Radius, 115 Holly Lane Dr. Chester Maineeke, 1304 Walton Mrs. 11. R. Robinson, 3509 Austin Rev. Harry Schuckenbrock, 1200 E. Drive, C.S. Mrs. Allie Roddy, P. 0. Box 1622 Lincoln Mr. Joe Salem, 302 North Chaparral Ruth Spooner, City Clinic Mrs. Curtis Mathis, 1401 Hoppess Street Dr. Nina Sisley, City Health Department Dr.J. Viada, 105 West Elizabeth Mrs. Charles Myers, 800 South Beck Mrs. Dorothy Watson, 2508 Morgan Building Street Mr. Ben Williams, 921 Bradshaw Mr. Moses A. Westbrook, 244 Fairfax Mr. Stephen Pearce, 207 Tee Drive Mrs. George Williams, 4202 Patrick Mr. Bert Whisenant, 24 E. Levee Mrs. Bookman Peters, 1110 Edgewood Dr. J. Zavaletta, 825 Palm Boulevard Street Dr. H. D. Pope, 204 Ehlinger Drive Corsicana Mrs. Elsie Ramage, 1618 Jersey Street, Mayor:R. G. Reading(firstpart of Bryan C.S. study ), David Campbell, M.D., 2010 Mr. J. 11. Reed, 700 Lawrence Street Mayor: Ronald C. Dansby (first part of Mimosa Drive ( completion of study ) study ), Jack Conlee, City Hall ( com- Rev. H. W. Reeves, 1300 East 31st pletion of study ) Street Mayor's Commission Chairman: R. L. Mrs. Mary Ritchey, 301 Hensel Drive Campbell, M.D., 1412 Oaklawn Drive Mayor's Commission Chairman: Mr. Mrs. L. E. Stark, 1104 Munson Drive, Alton 0. Bowen, P. 0. Box 953 C.S. Members of the Conanission: Mr. James Stegall, 901 Kasserman Street Members of the Commission: Mrs. Minnie Cooper, 1462 W. Third Dr. Walter Varvel, 511 Dexter So., C.S. judge Kenneth Douglas, Courthouse Mr. John R. Birkner, 2701 Kent, #9 Mrs. Harvey Watson, 3401 Sandra Drive Mrs. Irene Gardner, 1015 East Collin Mrs. Agnes Bowen, 802 East 25th Mrs. Doris Yancy, 900 West 18th Mr. Bill Hay, 2423 W. Eighth

89 0, E. Hendricks, 312 W. First Avenue Mr. John L. Ingle, 1367 Bar Harbor Mr. and Mrs. Christobal Aldrete, 217 Willie Hodge, TEC, 605 W. Seventh Drive Highland Avenue Mr. Henry Jacobus, Jr., 6119 Joyce Way Mrs. Eulalio Calderon, Jr., 313 E. Bean Dr. Andrew Megarity, 510 N. 25th Mrs. Elmer Krueger, 1924 Riverway Dan Cobb, 6006 Live Oak, Greenville Dr. Will Miller, 1405 Oak Lawn Drive Mr. and Mrs. Raul Dominguez, 1803 W. C. Onstott, City Hall Dr. Robert Leon, Southwestern Medical Avenue C Ned Polk, 1025 N. 24th School, 5323 Harry Hines Mr. and Mrs. A. R. Garcia, Bolner Lane Rev. Robert S. Potts, 2015 W. Park Mr. George Looney, County Juvenile Mr. and Mrs. Tom Gan .-At,101 South Mrs. Thelma Pryor, 812 W. Seventh Department, 4711 Harry Hines Broadview Avenue Dr. P. E. Luecke, 4105 Live Oak Mrs. Gloria Hermann, 105 Austin Courts Judge James C. Sewell, Courthouse Mr. M. L. McDonald, Caruth Rehabili- Mr. and Mrs. Hatton W. Honeycutt, 403 Mrs. T. M. Stokes, 1448 Elmwood tation Center, 7850 Brookhollow Stricklen Mrs. Mary Williams, 640 W. Fifth Dr. Harry Martin, Southwestern Medical Captain and Mrs. Robert Inderman, Avenue School, 5323 Harry Hines 9062 B Frazier, L.A.F.B. Dr. jack Martin, Southwestern Medical Mrs. John W. Keller, 1311 South Main School, 5323 Harry Hines Mr. and Mrs. J. R. Koog, 1704 Avenue D Dallas Mr. Juan Mason, Dallas Independent Mrs. R. B. Leathers, 1268 Quarry,irriagle School District, 3700 Ross Pass Mayor: Erik Jonsson, Main and Mrs. Sophia May, United States Public Mr. and Mrs. M. C. Locke, 209 North Hanvood, 75220 Health Service, 1114 Commerce Main Mr. Kenneth Mills, Caruth Rehabilitation Miss Lena McCue, 200 Broadway Mayor's Commission Chairman: Mr. Center, 7850 Brookhollow Chaplain Robert L. Merrill, 9086 Law- Charles G. Cullum, 2533 Hawes Street Mr. Joe Neuhoff, 2821 Alamo hon, L.A.F.B. Dr. Floyd Norman, 4143 Cole Mrs. James Murphy, 106 N. Broadview Members of the Commission: Miss Verlin Osborne, 7850 Brookhollow Mr. and Mrs. Bill Nixon, 703 Stricklen Mr. Price Parker, State Department of Mrs. J. B. Pena, 201 Waters Mr. A. J. Airoldi, P. 0. Box 35062 Public Welfare, Old Courthouse Mr. Leonard Reyna, Jr., 700 Rio Grande Mrs. Inez Anderson, Visiting Nurse Mr. W. T. Puryear, Dallas Independent Colonel and Mrs. Stuart Robb, 9127 Association, 2831 S. Ervay School District, 3700 Ross Brown, L.A.F.B. Mrs. Frank Austin, jr., 4009 Armstrong Mr. Glen Rollins, HEW, Mental Health Mrs. Stephen Ross, 410 Johnson Mr.Bill Baker, Buckner Baptist Services, 1114 Commerce Mrs. Carl Schorr, 222 Fox Drive Children's Home, P. 0. Box 18267 Mr. Philip Rushing, National Association Mr. and Mrs. Ted A. Small, 101 North Mrs. Margaret Beckner, Southwestern for Retarded Children, 202 S. Ervay Orbit Medical School, 5323 Harry Hines Mr. Edward J. Rydman, Planned Parent- Mr. and Mrs. Max Stool, 219 West Mrs. Jean Bentley, Children's Develop- hood, 3620 Maple Strickland ment Center, 3131 N. Pearl Mrs. Charles Sharp, 5227 Meaders Lane Mr. and Mrs. W. E. Stavley, 103 South Dr. Lawrence Claman, Child Guidance Mrs. Sam Shelburne, 5543 Waneta Broadview Clinic, 2102 Welborn Dr. Joseph H. Siegel, 2618 Oak Lawn Mr. and Mrs. Paul Tanksley, 254 West Albert Coates, 1720 Life Building Mrs. Charles L. Smith, 2806 Fairfax Strickland Glynne Coker, County Welfare Depart- Mrs. L. Storey Stemmons, 6246 Lupton Reverend Joe Walts, 509 East Losoya ment, 4917 Harry Hines Mr. Charles Storey, 2700 Republic Bank Mrs. R. D. Weaver, 100 Serafini Mrs. Margaret Cone, Day Nursery Building Association, 2017 South Ervay Mrs. Ted Strauss, 5100 Park Lane Denison Mr. W. H. Cothrum, 412 Lochwood Dr. Robert Stubblefield,Southwestern Village Medical School, 5323 Harry Hines Mayor: W. Worth Campbell, 108 West Mr. Earl Davis, United Cerebral Palsy, Mr. Jack Sudderth, Office of Vocational Main Street 801 Core Rehabilitation, 3515 Swiss Mr. Robert L. Dillard,Jr.,Southland Mr. Durwood Sutton, Grand Prairie Mayor's Commission uhairman: Mr. Center State Bank, 200 W. Main, Grand Fred T. Reeves, 1314 Lafayette Mr. Charles Edwards, 1501 N. Dallas Prairie Avenue Miss Kathleen Varner, Children's Devel- Members of the Commission: Dr. Heinz Eichenwald, Southwestern opment Center, 3131 N. Pearl Mrs. Paul S. Ague, 1108 Oakridge Medical School, 5323 Harry Hines Miss Thelma Whalen, Family Service, 2200 Main Mr. Wayne Dodson, 220 North Houston Miss Selby Fly, Hope Cottage, 2301 Avenue Welborn Dr. Wirt M. Wolff, 3503 Fairmount Dr. Don W. Freeman, 2301 South Aus- Mr. Peter Gaupp, Timber lawn Founda- Mrs. J. Lee Wood, 7011 Meadow Lake tin Avenue tion, 4645 Samuell Mr. George Wysong, Ttxas Employment Mrs. Wayne R. Howell, 711 South Fair- Mr. Bernard Goldstein, Jewish Family Conunission, 1206 Ross banks Avenue Service, 209 Browder, Room 403 Dr. A. 0. Jensen, 2301 South Austin Mr. James B. Goodson, Southland Life Del Rio Avenue Insurance Company, P 0. Box 2220 Mrs. C. B. Middleton, 1120 West Morton Mrs. Wesley Goyer, 5222 Wenonah Mayor: H. Conger Jones, 109 West Street Mr. Ludwig Guckenheimer, Bureau of Broadway, Drawer DD Family Service, 1114 Commerce Mrs. Gladys Overbeck, 1025 South Mr. W. B. Helton, Dallas Independent Maurice Mayor's Commission Chairman: Mrs. Mrs. Claude Rainey, 1225 West Gandy School District, 3700 Ross L. S. Vasbinder, 404 Stridden Avenue Street Miss Rose Lee Herring, City Health Mr. Norman Talley, 126 East Murray Department, 1936 Amelia Members of the Commission: Street Dr. Edythe Hershey, United States Mr. Everett Weldon, 7265 Lakeview Children's Bureau, 1114 Commerce Mrs. Angela Aguilar, 1206 Ave. B Drive

90 Mrs. W. E. Wilcox, 1201 Wood lawn Mr. Romeo Villarreal, 1332 North 14th Parker, 300 West Vickery Boulevard, Mrs.Charles W. Williams,Jr.,1515 Place Room 2096 West Hull Street Mrs. Bert Wolfe, 1034 Fairway Members of the Commission: Denton El Paso Dr. R. Earl Allen, 2524 Roosevelt Mayor: Warren Whitson, Jr., 221 North Dr. W. V. Bradshaw, 1800 University Mayor: Judson F. Williams, 500 San Drive Elm Antonio, 79900 Mrs. Earle D. Button, 3701 Wooten Mayor's Commission Chairman: Dr. Drive Mayor's Commission Chairman: Dr. Miss Mary Crutcher, 5th and Jones Ernest 0. Watkins, Drawer E, TWU Chester L. Reynolds, 1501 N. Mesa Station Joe Day, Jr., First National Bank Avenue Building Members of the Commission: Dr. Virginia Ellis, 1001 Montgomery Members of the Commission: Stanley Fish ler, Life of America Building Dr. Harold Craves, 3210 W. Lancaster Mr. Wayne Autrey, City Hall Mrs. Cara K. Adkins, 149 Raynolds Mr. Bill Bingham, Texas Technological John NV. Herrick, 1906 Fair Building Mrs. Lucy Baca, 4301 Nashville Richard Hill, 6266 Truman Drive College, Lubbock Mrs. Dorothy Ball, 616 North Santa Fe Mr. Joe Bowers, 610 Hillcrest H. F. Hopkins, 1000 Throckmorton Mr. Jesus Bonilla, 333 Cargill Brooks Keller, 400 \Vest Seventh Mr. R. L. Breckenridge, Denton State Dr. Ira A. Budwig, Jr., Suite 1-A Medi- E chool Miss Jo Kelly, 3210 West Lancaster Mrs. Margaret Clarke, 806 Greenwood cal Center, 1501 Arizona Avenue Dr. Stephen G. Maddox, 5216 West Mr. Laurence D. Cornett, 5441 Edmon- Freeway Mr. Emory Close, High School, Pilot ton Avenue Point Dr. C. 0. Terrell, Jr., 1000 Fifth Avenue Mrs. Wilma Daniel, Department of Mr. Jas. H. Daross, 6542 Mohawk Mrs. Lloyd J. Smith, 7428 Bridges Avenue Mrs. E. E. Searcy, 4028 Collinwood Education, TWU Mr. W. Keith Daugherty, 510 South Mr.J.K. Delay, Box 217, Lewisville Dr. E. N. Walsh, 1410 Pruitt Mr. J. A. Hillis, Vocational Rehabilita- Oregon Street tion Office, Fort Worth Dr. James F. Day, Texas Western College Mr. Reg Holland, 1421 Kendolph Mrs. Robert H. Given, 4935 Meadow Galveston Mr. Alonzo Jamison, 616 West Oak Lark Mr. Edwin W. Killian, Denton State Mr. J. H. Higdon, 9808 Daphne Court Mayor: Edward Schreiber, P. 0, Box School Mr. Jere Kennedy, 9507 Raleigh Drive 779 Mrs. Lennis McAdams, 824 Cross Mrs. Mildred Krauss, 118 W. Missouri Timbers Avenue Mayor's Conzmission Chairman: Dr. Mrs. Jane K. Maddox, Denton State Miss Amanda Lancaster, 1013 E San C. David Livingston, U.S.National School Antonio Avenue Bank Building, #419 Mr. Marion Shields, Argyle Public Mr. Jack McNutt, 8445 Valdespino Schools, Argyle Mrs. Margaret Murillo, 7514 Acapulco Members of the Commission: Mrs. Yvonne Mess ler, 2..02 North Locust Avenue Mr. Charles Morris, 200 South Locust Dr. James S.Nicoll, 100 West Rio Dr. Truman Blocker, 1422 HEr.borview Mr. W. C. Orr, First State Bank Grande Circle Mr. Barrett Reeves, Box 188 Mr. Robert H. Palm, 5023 Columbine Mrs. Wynnfried Braud, Third Floor, Mr. Mike Rummell, Shell Oil Company, Mrs. Louis J. Pepin, 5192 Jarman Road County Court House Highway 24 West Miss Champe E. Phillips, 2112 Erie Chief William J. Burns, Chief of Police, 18 San Jacinto Dr. Donald Ryan, 2521 Glenwood Avenue Dr. Paul Schedler, 1614 Scripture Mr. William B. Purse, Jr., 416 Cincinnati Dr. Robert L. Callison, City Hall Mr. Chester Strickland, Denton Indepen- Mr. J.K. Duncan, 824 Avenue D, Mr. Conrad Ramirez, 357 Ben Swain La Marque dent School District Drive Reverend Paul Young, 1915 Locks ley Dr. Morgan Evans, 10 Maple Lane Mr. Woody Richards, 920 North El Paso Judge Hugh Gibson, County Court Street Edinburg House Mr. John B. Rupley, Jr., 8208 Mrs. Dorothy Morris, County Court Williamette Mayor: Al Ramirez, 107 East McIntyre House Mrs. Edith Zanker, 3410 Morenci Road Mr. Richard A. Prets, 7117 Youpon Mayor's Commission Chairman: Dr. Mrs. Arthur J. Trimarchi, 1506 Avenue 0 NV. C. Ferguson, c/o Pan American Farmers Branch Rev. C. A. Tucker, 4419 Q-3i College Representative Ed J.Uarris,U.S. Mayor: A. A. Airoldi, P. 0. Box 14203 National Bank Building Members of the Commission: Miss A. V. Urquhart, 828 Avenue L Mayor's Commission Chairman: Mr.Leroy Eastin, Chief ofPolice Charles G. Cullum, 2533 Hawes Street Mr. John Gross, The Daily Review Garland Mrs. Gertrude Lake, P. 0. Box 990 Fort Worth Mr.Charles Pierce,1524 South 10th Mayor: Carl W. Cooper, 504 State Street Mayor: Bayar H. Friedman (first part Street Dr. Charles Queen, 113 South 10th of study), WillardBarr, 241 West Street 13th (completion of study) Mayor's Comission Chairman: Mrs. Mrs. David Smith, 609 South 9th Street Robert C. Parsons, 208 West Harvard Mr. Robert Thomas, 1016 West Schunior Mayor's Commission Chairman: George Drive

91 Members of the Commission: Miss Suzanne Aldridge, 2019 Park Mayor's Commission Chairman: Mr. Mrs. T. B. Aldridge, 2019 Park Stuart S. Jennings, 310 East Van Mr. Frank E. Amis, 1121 Lourock Mr. Paul Banner, 2501 Beverly Drive Buren Mrs. Wade Cloud, 824 Woodland Mrs. Nell Bearden, 1008 Wolfe City Mrs. W. A. Farr, 125 West Wanda Drive Drive Members of the Commtsdon: Mr. Kenneth Fuller, 3713 Darmouth Mrs. Claud Boose, 4013 O'Neal Mrs. Carol Harber, 265 East Garland Judge Lee Bostick, 3606 Bourland M:r. Howard Brawley, Jr. Avenue Mrs. T. A. Bouknight, Jr., 5504 Kayway Dr. J. C. Burkholder, 1724 Ed Carey Mrs. Nancy Iske, 4310 Windsor Mrs. ATMs Buchanan, 3903 Redbud Drive Leroyce Jones, 3110 Lakewood Drive Mr. and Ws. Ed Callahan, 2705 Dr. Jas. L. Childress, Cameron-Whiny Mrs. Elizabeth Merrill, 1620 Lakeside Stonewall Medical Society, 1710 Ed Carey Drive Mr. Robert Click, RFD 5 County Child Welfare Branch Office, Mrs. Nancy Mikkelson, 1602 Marion Mrs. Lettie Cobb, Ardis Heights 201 East Madison Drive Mr. Paul Coleman, Hunt County Court Rev. W. R. Eccles, 2214 East Grimes Mrs. Billie Mock, 4306 Tynes Way Ht.. ise Obelin Esparza, Juvenile Officer Mr. Gene Morrow, 4509 Windsor Dr. and Mrs. F. S. Corruthers, 3714 Lee Mrs. Helen Foehner, American Red Rev. Richard Nelson, 622 Wildgrove Street Cross, 118 East Tyler Drive Mr. Danny Darby, 2402 Avondale Mr. Antonio Garcia, LeMoyne Gardens Mr. and Mrs. Charles E. Nevil, 1725 Mrs. J. L. Davis, 1101 Commerce Drive Housing Office Crestridge Miss Lois English, 3910 Wellington Mrs. Dora Garza, Well Baby Clinic, Mrs. G. K. Quattlebaum, 2818 Honey- Mrs. George Evans, 4003 Western Circle Lon C. Hill Park suckle Mr. and Mrs. Hal Gammill, 2404 Royal Valdemar Gonzalez, P. 0. Box 268 Mr. Charles Smith, 410 East Monica Lane Mr. Darrell Hester, 318 East Van Buren Drive Mrs. Gracie George, 3004 Lark Strect Mrs. Billy Wagner, 1425 Nash Mrs. Arlo Grantz, 2309 Wesley Dr. John Huddleston, 506 East Van Mrs. James W. Whitworth, 1640 Mr. Danny Hearn, RFD 5 Buren Elizabeth Mr. M. L. Hulsy, 2604 Jones Mrs. Frances Hury, United Fund, Mr. Donald R. Willis, 2326 Nottingham Mrs. W. F. Johnston, 4105 Harris Harlingen National Bank Drive Mr. Jack Maxey, YMCA, 1915 Stanford Immaculate Heart of Mary School, 412 Mrs. Steven F. Wilson, 903 Carney Drive Captain and Mrs. David Mick les, 2315 South C. Street Wesley Mr. Ralph Jennings, Texas Employment Grand Prairie Mrs. C. R. Milam, 3016 Bourland Commission, 308 East Harrison Mr. and Mrs. Roy Milam, 3016 Bourland Mr. John Johnson, Licensing Worker, Mrs. Louise Miller, 3812 Wesley Mayor: C. P. Waggoner, 318 Main Street State Department of Public Welfare, Mrs, Virginis Moore, Hupt County Court P. 0. Box 1187 House Mayor's Commission Chairman: Mr. Ron Lairsen, 113 East Jackson Mr. J. Harris Morgan, RFD 5 Dr. Bert Levine, Clarke and Courts Mr. H. W. Van Pelt, 1817 Virginia Mrs. George Neal, 2509 Broadview Drive Building Mrs. W. J. Partin, 3901 Alpha Mrs. R. W. Liston, P. 0. Box 1905 Mr. Bill Pemberton, 5902 Stonewall Members of the Commission: Mr. Juan Lujan, 609 McKelvey Building Mrs. Dorothy Porter Dr.I. Magana, Harlingen State Adult Mr. Billy L. Arnold, 721 Egyptian Way Mrs. Nell Powers, 3500 Nashville Mental Health Clinic, P. 0. Box 268 Mrs. Gerald Ray, 5903 Stonewall Mr. John Morgan, 1409 East Harrison Dr. William L. Co lip, 300 N.W. Second Mrs. Med Rutherford, 5309 Wesley Street Dr. L. G. Muniz, 308 South 3rd Mr. Ed Travis, 6514 Flamingo Road Mist Margaret A. Murray, Harlingen Mrs. Pat Dantzler, 113 Byrd Way Dr. C. B. Weis, 2208 Park Mrs. Leroy Elton, Training Center, 613 State TB Hospital, P. 0. Box 592 N.W. Seventeenth Rev. Fred Wolf, 2309 Holsum Circle Mr. Menton Murray, 320 East Van Dr. Clyde L. Kresge, Jr., 909 Dalworth trs.Jerry Wooldridge, 2609 Highland Buren Mr. Arvin Myers, 622 S.E. Eleventh Mrs. Kurt Naumann, Welfare Family Street Halirii-m City Service, 210 South F. Street Dr. Lillian Solomon, 909 Dalworth Msgr. Victor Ralph,St. Anthony's Mrs. James Vecchio, 2322 Cypress Drive Mayor: Marvin L. Ward ( first part of School, 10th and East Harrison Mr. L. A. Vernon, 917 N.E. Fifteenth study ),VirgilDaniels,City Hall Mrs. Robert Ramert, Well Baby Clinic, Street (completion of study) Lon C. Hill Park Dr. John 0. Wilson, 649 Hinton Dr. Albert Randall, 186 North Sam Mayor's Commission Chairman: Mr. Houston, San Benito John P. Richards, 4928 Sabelle Mr. Ken Rockwell, 1114 East Taylor Greenville Mr. James W. Ross, City Hall Members of the Commission: Mr. John Rugaart, Jr., 2415 East Har- Mayor: R. L. Warren, Jr.,P. 0. Box rison 1040 Mrs. Fay Baker, 3629 London Lane Dr. Norman Schultz, M.D., 321 South Mrs. Sadie Duncan, 2301 Thomas Road 13th Mayor's Commission Chairmen: Mrs. John Coin, 4703 Fossil Drive St. Alban's School, 1417 Austin Mrs. Jay Adkisson, Box 846 0. B. Guynn, 2908 Carson Street St. Paul's Lutheran School, 313 East Mrs. James Rutherford, 2003 Walnut Mr. Buford New, 4500 Parrish Road Tyler Mrs. Frank Stinson, 714 Walnut Mr. Alan D. Sturm, Harlingen State Adult Mental Health Clinic,P.0. Members of the Commission: Harlingen Box 268 Mrs. Jane Taylor, 1910 Laurel Mrs. Nancy Adkisson, 2604 Jones Mayor: M. T. Hodes, P. 0. Box 232 Dr. John Tucker, 321 South 13th

92 Mr. Wally Van Wyk, 613 East Harrison Mrs. Roselle Lewis, 1018 Preston Street Members of the Commission: Dr. Ceorge Willeford, 1720 Ed Carey Mrs. Lee Lackard, 3800 University Drive, The ChiM,en's Clinic Boulevard Mrs. Alida T. Alaniz, 603 West Ella Mrs. McCorum, Harris County Proba- Mr. Joe Boring, 424 East King tion Department Rev. C. L. Branch, Military Highway Houston Dr. A. A. Mint; 7227 Holmes Road Mrs. Bill Gill, 625 West Richard Dr. andMrs.Alfred H. Moore, 4019 Mrs. Clyde Hai ley, 819 West Avenue I Mayor:Louie Welch, 000 Brazos, 77300 Fernwood Mrs. Don Hees, 732 West Alice Mrs. Virginia Norris, 3009 Southmore Mr. John Morrow, 1315 Angle Road Mayor's Commission Chairman:Mrs. Mrs. Alice Nunn, Houston Council for Mrs. Richard Roosa, 1912 Martin Avenue William H. Williams, 3318 North Retarded Children Braeswood Mr. Louis Peters, 1811 Lamar Dr. Theodore R. Pfundt, 6621 Fannin Laredo Members of the Commission: Street Dr. C. A. Pigford, Health Department, Mayor: J.C. Martin, Jr., 500 Flores Avenue, 78040 Mrs. A. S. Badger, 3212 Albans Road City Hall Mrs. David Pollan, 5926 River View Rev. J. T. Bagby, St. Martins Episcopal Mayor's Commission Chairman:Mr. Church, 717 Sage Road Mr. Curtis Posey, 3800 University Porter S. Garner, Station 1, Box 1607 Mrs. Robert R. Barr, State Department Boulevard Mr. Schoenbacher, Probation Depart- of Welfare Members of the Commission: Dr. Laura C. Bickel, 30 Oakdale ment, 61 Reisner Mrs. Margaret Booker, 9000 Westview Mr. EdwIrd Scurlock, Scurlock Oil Co., Mr. W. W. Allen, Laredo National Bank Mr. Frank Borreca, 3410 Montrose South Coast Building Mrs. John Beane% 710 Kearney Boulevard Dr. Richard D. Slater, 5723 Thrush Mr. Tom Deliganis, Laredo Junior Col- Mrs. Doris Brace, 7419 Haywood Mrs. Lester Smith, 6011 Deepwood lege Library Mrs. Leuelia Breedlove, 726 West 18th Drive Mrs. Lorraine Dickey, 500 Arkansas Street Mr. Paul E. Smith, 1500 Louisiana Mr. Richard Floyd, 2610 Musser Mr. Britton, Harris County Welfare Mr. Noah Sparks, Jr., 1500 Louisiana Mr. Mike Garcia, Laredo Junior f.lollege Department, 301 San Jacinto Mrs. Thane T. Sponse!, 3436 Meadow Library Mrs. Betty Cosey, Harris County Pro- Lark Mr. Jimmy Johnson, Texas Employment bation Department Dr. C. W. Thompson, 2117 Dowling Commission Mr. Ben Creath, 4396 Harvest Mrs. Torrence, e/o Jesse Jones Library Dr. Laura Montalvo, 1005 Washington Mr. Richard B. Cron, 2711 Main Building, Texas Medical Center Frances Quijano, 220 Hidalgo Mrs. Cunningham, State Department of Mrs. Ruth Urmy, 3726 Portsmouth M. J. Raymond, 420 Garfield Public 'Welfare, 1018 Preston Mr. D. D. Uzzell, 627 Euclid Dr. Jos. Schniedler, 806 Matamoros Mr. James Dannenbaum, Jr., 3915 Essex Rabbi Samuel Weingart, 3707 Link Dr. Murdina M. Desmond, Baylor Valley University College of Medicine, 1200 Mrs. Allen Weiss, 7710 Meadowshire Longview Moursund Mrs. Jane Williams, State Department Mrs. J. A. Elkins, Jr., 101 Farish Circle of Welfare Mayor:E. K. Bennett (first part of Mr. Paul Floyd, Melrose Building study), Tom Tilmoth, City Hall (com- Mrs. Everett Fulgham, 5604 Do liver pletion of study) Mr. J. Grimes, 1500 Louisiana Irving Mr. Frederick Grovberg, Tennessee Mayor'sCommissionChairman: Mr. Building Mayor: Lynn Brown, 835 West Irving D. A. Benton, P. 0. Box 1907 Mrs. J. D. Guidry, 1207 Maroby toulevard, 75060 Mr. Charles Hamilton, 712 Main Street Members of the Commission: Mr. James Hamilton, Department of Parks and Recreation, City Hall Mayor's Commission Chairman:Dr. Hon. John Allen, c/o Radio Station Miss Frances Heyck, 6621 Fannin Street Walter W. Barrett, 2120 McArthur KFRO Dr. Austin E. Hill, 1300 Capitol Avenue Boulevard Rev. Robert D. Bankes, 1303 South Dr. Reba M. Hill, 6720 Bertner Mobberly Avenue Mrs. N. D. Hines, 5507 Candlewood Membersofthe Commission: Judge R. E. Blount, Gregg County Court Mrs. Nola Hiskey, 12223 Overcup House Mr. Trick, Probation Department Mrs. Ann Brame, 914 North Glen Vista Mr. Bennett Cooksey, 515 North Court Dr. Richard E. Jennings, 6516 John Mr. Steve Fellows, 406 Little John Mrs. Clark Dingier, 1212 South Fre& nia Freeman Avenue Mr. Glenn Say les, 2117 Carpenter Free- Dr. Royce M. Floyd, 723 North 4th Dr. Francine Jensen, 1101 Elder way West Mr. Carroll Graves, Box 2304 Mr. Burton Jones, 3920 Mi;ton Mrs. Dohic Start, Board of Education Mr. J. W. Hagler, Gregg County Court Barbara Jordan, c/o Judge Elliott's Mr. Jim Weaver, 1709 Glen Brook House Office, Harris County Court House Mr. Donald Henley, 1103 Centenary Miss Frances Kelley, Mental Evaluation Drive Clinic, Texas Children's Hospital Mrs. Ruth Holt, 1503 Hughey Drive Mrs. W. H. Knight, 5809 Holly Kingsville Dr. Bill D. McKellar, 418 South Center Mrs. Dorothy Knowlton, 4002 Ella Lee Mr. Bob Maness, 1500 Berry Lane Lane Mayo). Dr. James A. Stockton, P. 0. Dr. Charles F. Mathews, 515 North Mr. Charles W. Leavens, Harris County Box 1310 Court Welfare Department Mr. Marvin Mikeska, 2201 Hughey Drive Rev. Lawrence Lee, 1111 Lovett Mayor's Commission Chairman: Mr. Dan Munteap, 110 Skyline Drive Boulevard Donald G. Haggerton, 415 Shelton Mr. Jake Reeves, 117 Peterson Court

93 Mr. Jere Ruff, First National Bank Mr. Steve Lewis, 2614 3Cch Judge 0. L. Hubbard, 405 Church Building Mrs. John Lott, 3214 44th Mrs. E. W. Leach, 906 Wildbriar Mrs. Joe Simpson, 523 Jones Mr. R. B. McAllister, KSEL Radio, East Mrs. Lynn Metteauer, 905 Markus Mr. Johnny Stone, c/o City Hall Broadway Mrs. James W. Peavy, 420 North Raguet Mrs. Venedia Watkins, P. 0. Box 5902 Mr. Kenneth May, Avalanche-Journal Mrs. William Sheehy, 1522 Turtle Creek Mrs. La Martha Wylie, 905 Delwood Mr. Alex Miller, Miller-Howard Office Drive Lane Supply, 1420 Texas Avenue Mrs. Ada B. Smith, 709 Markus Dr. John T. Miller, Great Plains Building Mrs. Lillie Smith, County Welfare Office, Mr. Jim S. Moore, Great Plains Building Court House Lubbock Mr. G. B. Morris, 1715 26th Mrs. Milton Smith, 419 North Raguet Dr. J. C. Morris, West Texas Hospital, Mrs. W. W. Trout, 450 Jefferson Mayor: Max Tidmore, 916 Texas Ave- 1302 Main Mrs. Jack H. Wade, 718 Frank nue, 79420 Mr. Tom 0. Murphy, Hub Motor Com- Mrs. J. B. Windham, 911 Markus pany, 901 Avenue H Mrs. Fred Woods, Route 5, Box 100 Mayor's Commission Chairman: B. E. Representative Bill J. Parsley, Citizen's Rushing, Jr., P. 0. Box 981 Tower Marshall Mr. C. W. Ratliff, KLBD-TV, Box 1507 Members of the Commission: Mrs. Reuby Rhodes, Lubbock Public Mayor: A. Weldon Webber, P. 0. Box Schools, 1715 26th 698, 75607 Dr. Erie Dell Adams, 3801 19th Dr. Roy Riddel, Jr., Great Plains Dr. Ted Alexander, 3405 25th Building Mayor's Commission Chairman: Dr. Mrs. Louise Allison, 1105 38th Mrs. Roy Riddel, Jr., 4707 22nd Waller Ethridge, East Texas Baptist Mr. Gene Anderson, Armstrong TrInsfer Mr. Jim D. Rosson, West Texas Adver- College(firstpart ofstudy),Dr. and Storage, 500 East 50th tis!ng, 1319 6th Robert W. Stagg, Department of Dr. Ted Andnychuk, Psychology De- judge Rod Shaw, Lubbock County Religion, East Texas Baptist College partment, Texas Tech College Court House ( completion of study) Mr. Kent Apple, Lubbock Chamber of Mrs. C. E. Smith, 2508 32nd Mr. J. W. Smith, Citizens National Bank Members of the Commission: Commerce, Box 561 Rev. William S. Smith, 3321 33rd Senator H. J. Blanchard, 1607 Broadway Mr. Robert L. Snyder, KCBD-TV, Box Mrs. Albert Agnor, Shreveport Road Mr. Clem Boverie, Furr Food General 1507 Mr. Bill Allen, 511 West Houston Office, 1708 Avenue G Mr. A. R. Soderstrom, 302 D. Sherman Mr. E. Dean Allen, 1707-A Elsie Dr. Travis Bridwell, Medical Arts Clinic, Avenue Miss Emma Mae Brotze, 513 West 1318 Main Mrs. James Spears, 5005 21st Burleson Mr. Dick Bunting, Texas Employment Mrs. Jack Strong, 3506 28th Dr. Norman Fromm, 502 Warren Drive Commission, 1602 16th Mr. Gordon Thompson, KFYO-Radio, Mrs. David Glenn, 2020 Turtle Creek Mrs. Bea Caddel, Evans, Pharr, Trout, 914 Avenue J Drive and Jones, Citizen's Tower Mr. Jack Thurman, TexasEducation Mrs. James Googe, 501 East Merritt Mrs. Cecil Cagle, 3506 43rd Agency, Great Plains Building Mrs. Joe Goulden, 706 Whetstone Mr. Owen L. Caskey, Texas Tech Mr. Roy Van Hoove, Lubbocic Public Mrs. Thelma Jarrott, 200 Brownrigg College Mrs. Julien Kennedy, 408 Henley Perry Mr. J. B. Cassel, 2114 Avenue Q Schools, 1715 26th Mr.Royce Vernon, TexasEducation Drive Mr. J. C. Chambers, 2302 Avenue Agency, Great Plains Building Mr. Glenn Kost, Marshall News Messen- Mr. Bill A. Chevalier, 2507 66th Mr. Charles T. Woodruff, Carroll ger, 309 East Austin Mr. William C. Clark, Lubbock National Thompson School, 14th and Avenue T Mrs. Orin Littlejohn, 1501 Wilson Building Mrs. Roy Lyle, Jefferson Highway Mrs. J. D. Donaldson, 3213 42nd Mrs. Otis Power, 309 Woodland Road Mr. Duncan Ellison, KLBK-TV, 7400 Mr. George D. Robins, 2709 South College Avenue Lufkin Mrs. Rodney Goebel, 2308 48th Garrett Mayor: Jim Waters, P. 0. Box 190, Mrs. Demar Therrell, Fern Lake Road Mr. Paul Graham, Paul Graham Com- Mr. Tom Walker pany, 1501 Avenue N 75901 Mrs. Lois White, 1602 East Bowie Alton Griffin, District Attorney, Lubbock Mayor's Commission Chairman: Mr. Mr. Paul Williams, KMHT Radio Sta- County Court House tion, Jefferson Avenue Mr. Charles A. Guy, Avalanche-Journal, S. H. Morrison, Jr., 1707 Allendale Box 491 Mr. Jerry Hall, Avalanche-Journal, Box Members of the Commission: McAllen 491 Miss Mary Hamlin, .City-County Health Mrs. L. 1, Arnold, I,21 Menefee Mayor: Paul G. Veale, P. 0. Box 220, Department, 1202 Jarvis Mr. W. W. Beaver, P. 0. Drawer 1508 78501 Dr. Ishmael Hill, Lubbock Public Mrs. Joe Beckham, 1106 Crooked Creek Schools, 1715 26th Drive Mayor's Commission Chairman: Mrs. Earl Hobbs, 3305 24th Mrs. Glenn Be Lisle, Route 6, Box 376 Verne Offerman, P. 0. Box 3606 Mr. C.J.Hollingsworth, West Texas Mrs. A. E. Broughton, 1408 Copeland Hospital, 1302 Main Mrs. Kenneth Childress, 207 Texas Members of the Commission: Dr. 0. Brandon Hull, 1907 Avenue Q Boulevard Mrs. Henry Huneke, 3508 52nd Street Mrs. Ernest Crain, Huntington, Texas Mr. Ted Clifford, Texas Employment Mr. Charles B. Jones, Citizen's Tower Mrs. A. E. Drew, 1302 Pershing Commission Mr. Charles R. Jones, 1715 26th Mrs. Murphy George, 202 West Dozier Mr. Ted Hinojosa, 413 North 14th Mr. Frank June 11,Citizen's National Mr. Robert D. Hamm, 321 Humason Mr. Albert Hughes, Mi. 24 N. and Mi. Bank Mrs. John Heyde, 1408 Betty 2 West

94 Dr. Dexter Jung, 1309 North 10th Gary Kelly, Gulf Oil Corporation Court House Mr. juan Lujan, 609 Rio Grande Mr. LaDoyce Lambert, Midland- Mr. Bill Butler, 17 West Colburn Building Reporter Telegram Mr. Walter E. Cobb, Jr., Chief of Police Mr. Jim Moffitt, 916 North 9th Street Mrs. Boyd Laughlin, 1703 North Main Mr. Frank Coffin, 213 Camellia Dr. Albert Randall, County Health O. A. Mc Brayer, 1701 N. Main Mr. Malcolm Dorman, 200 West Mon- Department James McClatchy, P. 0. Box 135 terrey judge Magus F. Smith, 1501 La Vista Mrs. Harry P. McClintock, 2200 Harvard Mrs. Jerry Fairchild, #7 Eads Mr. Calvin N. Snyder, 1113 North 2nd Mr. Charles McElreath, Midland Mr. George Fletcher, Jr., 628 Crept Street Memorial Hospital Myrtle Mr. Romeo Villarreal, South Texas Kenneth Scott, P. 0. Box 1230 Mr. Lawrence Gray, 306 West Joyce Habilitation Center Dr. and Mrs. R. Preston Shaw, 2109 W. Mr. E. M. Gutmann, 2598 North Street Mrs. Doris Williams, 100 North Closner Texas Mr. Carlton Harmon, 308 West Camellia Jean Starnes, 1603 North C. Street Mrs. Carlton Harmon, 308 West Mesquite I. B. Stitt, 801 Lawson Camellia Mrs. Bernice M. Swanson, 2006 Shell Dr. Key, City County Health Clinic Mayor: B. W. Cruce, Jr.(first part of Louis 11. Turcotte, 114 Capitol Menue Mr. Lee Nelson, 541 West Hydrangea study), George Boyce, Municipal Donald J. Vernon, 3703 Roosevelt Mrs. Bess Schofield, 2008 West Park Building, 75149 (completion of Harold Wallace, Chief of Police, Mid- study) land Police Department Jerry Ward, 4307 Country Club Pampa Mayor's Commission Chairman: Dr. B. J. Youngblood, 1802 West Wall Mayor: H. R. Thompson (first part of George Boyce study), Jim Nation, 2100 Mary Ellen Odessa (completion of study) Members of the Commission: Mayor: Preston Parker, P. 0. Box 3806, Mayor's Commission Chairman: Mrs. George Boyce, 1107 Gus Thomas- 79760 Mrs. Rufe Jordan, Court House son Road Mrs. W. T. Burns, 2636 Mark Drive Mayor's Commission Chairman: Members of the Commission: Carolyn Chesshir, 1420 Belt Line Road James Geiger, 3616 Bonham B. W. Cruce, 300 Riggs Circle Mr. Ronnie Cross, 403 West Atchison Ben Funderburk, 4232 Motley Members of the Commission: Mr. Tex De Wiese, 403 West Atchison David W. Goodwin, 3608 Hogan Mr. L. J. Edmondson, 126 West Francis Haynes Hanby, 305 Riggs Circle Miss Kay Clarke, 3800 Englewood Circle Mrs. Jack Foster, 1228 Williston Miss Reba Henry, 1718 Belmont Mr. Clint Dotaon, Ector County Court Mr. Warren Hasse, Hughes Building Larry Howell, Texas Mesquiter Mrs. Doris Fielden, 3209 East 31st Mrs. Willie Holmes, 523 Sloan Mrs. Dee Ingram Mr. Darrell Fishback, 316 Conet Mr. McHenry Lane, 1815 Williston Norma C. McGaughy, Recording Mr. John Candy, Jr., 2005 East 11th Mrs Nina Spoonemore, 1200 Hamilton Secretary Mr. Bob Harper, 305 East 35th Mr. Charles Vance, 823 West Francis Lois M. Nance, 1331 Tripp Road Mr. Bill Holm, 301 Monticello Mrs. Kay Veale, 2225 Mary Ellen Rev. A. R. Osborne, 1200 S. Galloway Dr. R. E. Johnson, 2200 West Illinois Mr. John Warner, 1308 Garland Mrs. Ray F. Owen, 809 Lakeside Mrs. T. W. Kane, 1203 East 11th Mrs. R. L. Wyatt, 1109 Sierra Dr. Joey Pirrung, 1123 Lakeview Rev. W. L. Lee, 3620 Melody Lane Ralph Poteet, Superintendent of Schools Dr. Carolyn Lewis, 3201 Blossom Lane Paris George R. Schrader, City Manager, City Mr. Jack Logan, 2904 Bonham of Mesquite Mr. Frank Maywald, 1101 Honeysuckle John Soward, 4400 Oleander Trail Mayor: V. E. Stewart, P. 0. Box 37, Mrs. B. J. Pierce, Cie lo Vista Apartments 75460 Mr. Jim Reese, 1504 Cumberland Midland Mrs. John Ben Sheppard, 3107 Windsor Mayor's Commission Chairman: Mrs. Mr. Bob Smith, 903 West 25th R. G. Coleman, 746 Church Street Mayor: Hank Avery, Jr.,P. 0. Box Mr. Walter Spence, 1511 Spur 1152, 79701 Dr. Charles Stephens, 3204 Blossom Members of the Commission: Lane Mayor's Commission Chairman: H. Wade Mrs. Walter Bassano, 2307 Hubbard Whiteley, 2211 W. Golf Course Road Street Orange Mr. Lester Crutchfield, 1878 Hubbard Members of the Commission: Street Mayor: James Neal Miller, P. 0. Box Walter Franklin, 963 - 23 S.E. Foy W. Aldrich, 3522 West Shandon 520, 77630 Mrs. W. H. Hale,Jr., 2930 Hubbard A. C. Ambler, P. 0. Box 1144 Street C. D. Bearden, 3006 Princeton Mayor's Commission Chairman: Mrs. Lawrence Mann, 3110 Dogwood Dr. Brent G. Blonkvist, 2005 West Wall H. H. Meadows, 611 7th Lane Dorothy E. Clader, 1416 Sparks Mr. Edgar Stone, 1873 East Washington Mrs. Christine Feagan, 238 Central Members of the Commission: Mrs. Bill White, 3171 Margaret Building Dr. John W. Foster, 1803 West Wall Mrs. N. J. Athas, 1 Sunset Circle B Mrs. Ray Greene, 4616 Storey Mrs. Peter Bedner, 31 Knotty Pine Pasadena Mr. John Gunter, Midland Tower Rev. Joseph 0. Berberich, 905 Cherry Building Mrs. G. W. Bird, 605 Elm Mayor: James L. Brammer (first part of Claudia G. Hazelwood, 2505 Cuthbert Mrs. W. J. Boyd, 2207 Westway study), Clyde Doyal, 1211 East Dr. R. E. Johngon, 3506 Louisiana Miss Maurine Buckner, 300 County Southmore (completion of study )

95 1

Mayor's Commission Chairman: Mrs. Shirley Brownlee, 1706 West 11 Mayor's Commission Chairman: William H. Wheeless, Sr., P. O. Box Dr. Mary Bublis, 1005 West 9th Robert W. Porter, 203 Lois Lane 3208 Mr. Roy B. Carnes, Plainview Schools, Box 1931 Members of the Commission: Members of the Commission: Mrs. Pauline Clark, 1006 Borger Hoyt Curry, Plainview Welfare Depart- Bill Blair, 851 S. Greenville Avenue Dr. George K. Alexander, 2302 Perez ment, Box 512 Earl Davis, 1119 Wisteria Way Jim Brammer, 1205 Monroe Rev. Arthur Digby, First Christian Dr. William Fackler, 203 W. Tyler Mr. Allan T. Brown, 235 Outlook, South Church, 910 Kokomo Mrs. Jo Hitt, 400 S. Greenville Avenue Houston Mrs. Hugh Etter, Welfare Office, Roger Kraus, 101 S. Sherman Mr. Bill H. Coyle, 1408 Acacia Courthouse Kerry R. Sweatt, 1013 Pacific Mr. Amos B. Culbreath, 2731 Hearne Ken Foreman Jack Sudderth, 3515 Swiss Avenue Drive Mrs. Delia Hall, Welfare Office, Mrs. George Engelbretson, 3521 Courthouse San Angelo Thornwood Mrs. Reba Hanna, Welfare Office, Mr. W. H. Ewing, 616 South Tatar Courthouse Mayor: Leon Abbott, P. 0. Box 1751, Mrs. C. A. Fort, 2120 Strawberry Mrs. Jackie Harder, 609 Denver 76901 Mrs. Tommye Frye, 3209 Albemerle Mr. Gifford Hodges, Plainview Schools, Mrs. Grace C. Grantham, 507 South Box 1931 Mayor's Commission Chairman: Main Jerry Huddleston Dr. D. D. Wall, 1434 Paseo de Vaca Mrs. L. G. Hancock, 2509 South Hous- Charles Lipscomb, 2209 Joliet ton Road Dr. Joseph Marshall, Plainview-Hale Members of the Commission: Mrs. Joe W. House, 1906 Jessie Lane County Health Unit Mrs. Jack Linn, 1808 Lillian Clifton Martin, Hale County Department Mr. George Barnes, 3122 Oxford Mr. John McGuire, 407 Cavalier of Welfare, Courthouse Mrs. G. L. Blaine, 2428 Greenwood Mrs. Audrey Martin, 712 South Main Tommy Montandon, First National Bank, Dr. Louis J. Broussard, 2708 Sherwood Mr. Dub Mays, Pasadena City H all Lockney Way Mrs. R. B. Meyer, 1506 Oaks Dri ve Jan Stanley, Child Welfare Services, Bishop Thomas Drury Mr. Bill Nunnellee, 9313 Lugary, Courthouse Dr. R. M. Finks, Clinic-Hospital Houston Dr. Ralph Thomas, 220 St. Louis Street Mrs. Marie Gabriel, 1930 St. Mary Mr. and Mrs. Reynolds Perez, 1202 Royce Vernon, Welfare Office, Mrs. Elsie Gayer, Baptist Memorial Madison Avenue Courthouse Hospital Mr. John H. Phelps, 2101 Strawberry Ralph Wayne, State Representative, 2005 Mr. Jess Gilbert Road West 5th Mr. J. M. Glasscock, 2525 Rice Mr. Weldon Phillips, 2007 Vince Charlie Young, Box 551 Mr. William Gorman, 3401 Oxford Capt. Harry E. Powell, 1203 Hart Street Mrs. Pansy Gross, 2544 Colorado Mrs. John Oswald, 2607 Shenandoah Port Arthur Mr. Dick Howard, City Hall Mrs. Mae Leah Reed, 403 South Walters, Mr. Don Hulse, West Texas Therapy Apt. 5J Mayor: Lloyd Hayes, P. 0. Box 1089, Center Mrs. Vernelle Roberts, 4038 Dumbarton 77640 Mr. Clarence Johnson, Edison Junior Mrs. Mary Sanderson, 2601 HunUngton High School Mrs. C. W. Seyer, 320 South Iowa, Mayor's Commission Chairman: Mrs. Elizabeth Jones, 1502 Kenwood LaPorte Walter Dezelle, Jr., Box 1309 Mr. L. W. Keilers, Texas Employment Mr. Levi Smallwood, 208 South Witter Commission Miss Sydney Stowe, 1107 South Witter, Members of the Commission: Mrs: Hilda Kirchman, 122 W. F irst Apt. 115 Lt. Neville Lawton, 214 Windham Mr. Warren Stutts, 208 East Curtis Raymond Armstrong, 4734 Redbird Miss Frances Lewis, Ceurthouse, Abilene Mr. George Thompson, 204 East Miss Pauline Bird, 530 Fifth Avenue Mrs. Beulah Livingston, 12 W. 34th Broadway Dr. Richard J. Bourgeous, M.D., 4359 Mrs. A. J. McDaniel, 1711 N. Magdalen Dr. Curtis Tomo, 1029 East Thomas Big Bend Drive Mrs. Joan McGee, 122 W. First Mr. and Mrs. Harvey Turner, 210 Tilden Mrs. Dorothy Spencer Gary, 2247 Fourth Mr. G. E. Neely, 5346 Fruitland Farm Mrs. H. G. Twaddle, 302 Dunwick Street Road Assistant Police Chief Doug Wilson, Box Mrs. Helen Glover, 4311 Big Bend 1026 Mr. D. Gabla Paddock, 2530 Honorable Roy D. Harrington, 4320 Guadalupe Twin City Highway Mr. H. E. Rader, State Department of Plainview Mrs. Thelma James, 3817 Seventh Public Welfare Rabbi Israel B. Koller, 3939 Third Street Dr. W. B. Rountree, 703 W. Washington Mayor: H. B. Hood, P. 0. Box 512, Honorable Carl A. Parker, 449 Trinity Drive 79072 Mrs. G. M. Sims, Sr., 3905 Fourth Mr. J. B. Strickland, First Savings Street Building Mayor's Commission Chairman: Mrs. Mark Smith, 2121 Lakeshore Drive Dr. Everett L. Sutter, 2719 W. Harris Elizabeth M. Grady, 912 Portland Col. Ralph Tolve, 3601 Platt Mr. Rama G. Sweet, 3217 S.A.C. Dr. R. L. Welch, 513 West Thirteenth v Members of the Commission: Honorable J. D. Weldon, 1937 Ninth Street San Antonio Judge C. L. Abernethy, Hale County Mayor: W. W. McAllister, Sr., P. 0. Courthouse Richardson Box 9066, 78200 Mrs. Barbara Allmon, 2006 Independence Riley Armstrong, 2000 West 17th Mayor: Herbert M. Ryan, P. 0. Box Mayor's Commission Chairman: Bob Brink, 1215 Smythe 309, 75080 Sam jorrie, 1315 San Pedro

96 Members of the Commission: Sam Farrow, 902 North 10th Mr. Leon Cox Dr. Joe Greenwood, 517 West Shell Rankin DeWalt Dr. Howard Britton, 3111 San Pedro Avenue Mrs. John Fox Avenue S. R. Greenwood, 112 North 6th Mr. Charles Hancock Miss Mary Louise DeLeon, Bexar County Dr. Thomas Hill, 3104 West Avenue T Mrs. W. R. Holmston Child Welfare, 3A Life Building Rep. Glenn Johnson, 601 West Zenith Mr. Jim Jackson Dr. Wayne Gill, 2310 Tower Life P. D. Johnson, 1432 East Avenue C Mrs. J. E. Jacobson Building Rev. Wilson Keenan, 2510 Bird Creek Dr. James E. Johnston Dr. Kenneth Kramer, c/o Psychology Drive Dr. J. M. McAllister Department, Trinity University Ray Martin, Brooklawn Drive Roland Matthews Mr. James Lewis, 401 West Nueva A. J. Mercer, Jr., 1505 East Avenue B Dr. Julian W. O'Bryant Street Mrs. H. T. Stewart, 3606 «Las Cienega Mrs. Julia Parks Dr. Robert Rast, 5800 South Presa Miss Olive Jane Strange, 804 North 13th Mrs. George Rasor Street William J. Valigura, Jr., 2505 Monticello Mr. Stan Sheppard Mrs. Rix Rutland, 932 Creekview Drive Road Mrs. Allen Sneed Dr. J.S. Weinblatt, 609 Fannin Loop Mrs. Max Willard San Benito Texarkana Tyler Mayor: Edgar Ogdee, P. 0. Box 1870, 78586 Mayor: Neal Courtney, P. 0. Box 1967 Mayor: Tom M. Clay, Peoples National Bank Building, Room 1010, 75601 Mayor's Commission Chairman: Mayor's Commission Chairman: John F. Barron, 500 North Dowling Robert W. Case, 3702 Ghio-Fish Mayor's Commisswn Chairman: Boulevard Robert L. Cook, 3204 Jan Avenue Members of the Commission: Mrs. H. H. Baker, 801 North Bonham Members of the Commission: Members of the Commission: Mrs. Chrissie Buck lin, Route 3, Box 130 Valdamar Garcia, 286 Victoria Circle E. 0. pone, Texarkana School System Mr. Dan Chamness Mrs. Nelson W. Haas, M.D., 505 South Mrs. Robert W. Case, 3702 Ghio-Fish Mr. A. M. Dullnig Boulevard Mr. D. K. Huffman Sam Houston Mr. E. C. Kennedy Pauline Pace, 1513 East Tyler, Harlingen Dr. J. W. Donaldson, 4006 Spring Lake E. D. Peek, Route 1, Box 43 Park Road Judge Harry Loftis Cliff Edwards, Texas Employment Mr. Clyde H. McLendon Commission Mr. Thomas Sproule Sherman Stern Feinberg, 3939 Ghio-Fish Boulevard Mayor: Ralph Elliott(first part of Dr. Lorie Hildreth, 17 Meadow Lane Victoria study), G. R. Stephens, 1427 North William Hughes, Texarkana City Police Woods (completion of study) Department Mayor: Kemper Williams,Jr.,P.0. Jack R. Martin, Wadley Hospital Box 1758, 77901 Mayor's Commission Chairman: Don R. Robert A. Martindale, Texarkana Shel- Logan, 515 North Wood Street ( first tered Workshop Mayor's Commission Chairman: part of study), Roger Harvey, 1806 Dr.J.E.Rorie, Collom and Carney George A. Constant, M.D., 306 North North Highland (completion of study) Clinic Moody Mrs. Harold Terry, 3424 Walnut Members of the Commission: Mrs. W. D. Thornton, 1201 Canadian Members of the Commission: W. T. Westbrook, Bowie County Health Mr. Lawrence Anderson Department M. E. Cerda, 3106 Cedar Rev. Stanley Hovatter Hon. R. H. Cory, 112 West Forrest Mr. Willie Jacobs Street Dr. Virginia Love Texas City Richard Danko, Devereaux School, Mr. Lloyd Perkins County Airport Rev. J. Allen Smith Mayor: Emmett F. Lowry, P. 0. Box Richard Grant, 1201 East Poplar Dr. Mary Jo Tonelli 2608, 77590 John Guseman, 105 North Bridge Street Mrs. Jennie Jo Hawkins, 2805 Meadow- Temple Mayor's Commission Chairman: lark The Rev. James R. Maples, Box 2788 Mrs. J. D. Howell, 512 West Colorado Mayor: Wilfred B. Pitts, Municipal Dr. Richard Hungerford, 1401 North Building, 76501 Members of the Commission: Glass Street: Mrs. Alice Kinchion, 602 East River Mayor's Commission Chairman: Mr. Wise Adams Street The Rev. James LeFan, Box 3764 Mr. Jack Alexander Mrs. Louis Kleinecke, 1908 East Mr. Art R. Anderson Crestwood Members of the Commission: Mrs. W. G. Bir Mrs. Mary F. McCall, Hopkins Elemen- Dr. Arr Nell Boelsche tary School Mrs. Hazel Bond, 1917 South 39th Mrs. Howard P. Broderson Sheriff Monte Marshall, Victoria County M. L. Brizendine, 912 Fannin Loop Mr. Otto Brotherton, Jr. Court House Dr. John Bryson, 509 South 9th Mr. Lester Burks Mr. Bob Martin, Radio Station KNAL Mrs. Ruth Cook, 1706 North 13th Miss Dianne Clamon Mrs. Thomas Martin, 3003 Bluebonnet Bill Elam, 216 West Avenue H Mrs. Joan Courtney Drive

97 Rev. Harold Pierson, First English Mrs. Frank Karaffa, 3021 North 43rd Wichita Falls Lutheran Church Mrs. Crawford Malone, 4308 Cedar Mr. Morris Roberts, 608 West Goodwin Mountain Drive Mayor: J. Winston Wallander, P. 0. Box Avenue Miss Pauline Reid, c/o Jefferson Ele- 1431, 76301 Harry Uthoff, 2504 Poplar Avenue mentary School, 315 Jefferson Mrs. Jan A. Ronk, 2208 Alexander Mayor's Commission Chairman: Arthur Tipps, 3200 Speedway Waco West University Place Members of the Commission: Mayor: Roger N. Conger (first part of study), Ernest Pardo, City Hall (com- Mayor: Du Pree Holman, 3800 Univer- Miss Patsy Haggett, County Courthouse pletion of study) sity Boulevard, 77000 Mrs. Thelma Fillmore, 2618 Bretton G. H. Kirby, 1105 Holiday Mayor's Commission Chairman: Mayor's Commission Chairman: Dr. Joe B. Mc Niel, 1105 Holliday Mrs. Sam Appell, 2605 Starr Drive Curtis E. Posey, 6340 Auden, Houston Dr. Charles Parker, Wichita County Health Unit Members of the Commission: Member of the Commission: Dr. Harlan Steph, Midwestern University Mr. John Weimer, 3401 Armory Road Mr. James C. Dalton, 1501 North 18th Mrs. Lee Lockard, 3811 Swarthmore, Mr. Frank Davis, 500 Valley Mills Drive Houston

CHAIRMEN, STATE AGENCY PLANNING COMMITTEES

Charles D. Barnett, Ph.D., Deputy Commissioner for MentalRetarda- tion, Texas Department of Mental Health and MentalRetardation Don Partridge, Director, Division of Special Education, TexasEduca- tion Agency Howard Masden, Assistant Director, Texas Youth Council Ted Mitchell, State Supervisor, Program of Services to theHandicapped, Texas Employment Commission Carl F. Moore, M.D., Director, and Paul Manning,Division of Maternal and Child Health, Texas State Departmentof Health Herbert Wilson, Assistant Commissioner,Texas Department of Public Welfare

STATE PLANNING OFFICE STAFF

Stuart C. Fisher, M.P.H., Planning Director Charles Meisgeier, Ed.D., Special Consultant John L. Jackson, Assistant Planning Director Preston Clark, Health Program Specialist Mrs. Elizabeth D. Bush, Secretary Mrs. Ruth Piper, Secretary Mrs. Avis Nissen, Secretary