For nearly 25 years I have devoted my professional life and most of my other hours to the problems of disability and how they may be reduced or eliminated through better rehabilitation programs. In doing this I, have had inspiration, support, and encouragement from many, many sources-not the least of which has been the sustained interest of the chairman of this committee.

Over those years, the remarkable changes that have been wrought in the concept and practice and results of rehabilitation can scarcely be understood by anyone who has not been engaged in this work over a long period of time.

We see this change, for example, in the public program of vocational rehabilitation, both in the Federal direction in Washington and in the elevation of the work being done in the State vocational rehabilitation agencies. Our public programs not only are doing a better job but they are doing a great deal more of it-which means that thousands more disabled people are being rehabilitated and placed in useful employment, with the dignity and self-reliance which go with it. In New York State we are proud of the progress being made in the vocational rehabilitation program under the able leadership of Mr. Adrian Levy. Last year more than 8,000 disabled people were rehabilitated into employment through the State program, ranking second among all the State programs.

For much of what has been accomplished we are all deeply indebted to the vigor, the imagination and the administrative skill of Miss Mary E. Switzer, Commissioner of Vocational Rehabilitation. She has demonstrated quite clearly her capacity to administer a Federal law with competence and do it in such a way that it invigorates the entire rehabilitation movement in this country.

I think this is an important point to consider, since the Congress is now being asked to give additional authority to the distinguished Secretary of Health, Education, and Welfare, Mr. Celebrezze, and to Miss Switzer. I can assure you, Mr. Chairman, of my complete confidence in their ability to administer this law soundly and for the benefit of the American people.

I am particularly sensitive to the importance of one of the provisions of S. 2515. As a physician I know quite well the difficulty of making early predictions about what a disabled person can or cannot do. I have told audiences all over this country that there is one maxim in rehabilitation which must never be violated: Never tell a disabled person he cannot do something without first giving him a chance to do it.

Yet under our present Federal law, we are asking the rehabilitation counselor in the State agency to make an initial prognosis about a disabled person which nobody should be asked to make. He is expected, after initial diagnostic workup, to decide whether or not the person will be able to get and hold a job at some time in the future when the rehabilitation program has been completed. For literally thousands of disabled people, who are the victims of serious disabilities plus many associated difficulties, it is simply impossible to make this kind of prediction at that very early stage. Because of this, large numbers of severely disabled people who might be helped must be turned away by the State vocational rehabiltation agencies before they even begin a program of rehabilitation services.

I strongly recommend the committee's support for this amendment which would authorize services up to 6 months for those disabled people whose prognosis is hard to determine. This would bring into the picture an immense number of disabled people, most of whom will ultimately go to work, and the remainder would be able to function at a much higher level, with an increased interest in life and a decrease in the burdens they present to their families.

The bill proposes a system of construction grants to increase the number of rehabilitation centers and workshops for restoring the disabled. Let me assure the committee that this is one of the very great needs at this stage of development. I have been engaged for nearly 20 years in the direction of the Institute of Physical Medicine and Rehabilitation in New York City, a modern rehabilitation center which operates as an arm of the New York University Medical Center. At this institute we are concerned daily with the most severely disabling conditions that exist among our people. In fact, our patients also include seriously disabled people from abroad who come to us seeking the benefits of modern restorative methods. As you might expect, we are in close touch with dozens of other rehabilitation centers engaged in dealing with the same problems.

Many of the centers such as our institute have already benefited from the assistance provided through the rehabilitation facilities provisions of the HillBurton Act. I hope the chairman of this committee, as a coauthor of that historic piece of legislation, realizes how deeply his foresight and understanding are appreciated by the many medical types of rehabilitation centers which have been made possible by that law.

We have reached a point now where the urgent unmet need is for centers and workshops whose main objective is vocational evaluation, training and preparation for work. When we concern ourselves with the disabled in workshops, we are talking about a group of people whose disabilities usually are extremely serious and difficult to overcome. The resources for training them in ordinary schools and training institutions are exceedingly limited. Therefore, we have had to rely on vocational types of rehabilitation centers and some of the more modern workshops, where the whole environment as well as the staffing is based on this specialized work for a very special group. The bill includes a provision for initial staffing of such centers and workshops, so that when a facility is con-structed or expanded, the sponsors are encouraged to properly staff for modern professional and training services. This is needed in nearly all cases and will contribute greatly to getting these new centers and workshops started on a sound basis.

S. 1525 gives further attention to the developing need for more and better workshops for the disabled. It is obvious to me that the establishment of a National Policy and Performance Council, as suggested in the bill, will do much to elevate the standards and the effectiveness of our workshops. The proposals for a system of Federal support for training services in workshops, for technical advisory services, and for workshop improvement grants will strongly supplement this effort to produce the kind of workshops we must have during the next few years in this country.

I was pleased to note the proposal to establish a 3-year National Commission on Architectural Barriers to rehabilitation of the handicapped. In our work at the institute, we experience frustrations that have nothing to do with the success or failure of our own work. The cause of this frustration is the inaccessability of the vast majority of our buildings, public and private, for so many disabled people who have been successfully rehabilitated and are functionally able to move about with great freedom in our society. Yet, because we continue to build unnecessary steps, design narrow doors, provide restrooms with impossibly small cubicles, put water fountains and telephones out of the reach of the disabled, we unintentionally place an endless series of obstacles in the path of these people. I have been particularly involved with this problem for several years in a series of cooperative efforts with professional and industrial groups. Great national organizations, like General Electric and others, have helped us devise special kitchens for the handicapped housewife where the equipment is modified for ease of operation from a wheelchair. In cooperation with prominent builders, we have designed homes with all the essential features for successful living by handicapped people. In the process of doing these things we have learned how relatively simple it is to make the needed changes. In public and other buildings, the problem is essentially the same.

Most of the technical design work has been completed already to master this problem. What is needed now is a massive and intensive program of education and collaboration, so that the building industry, the National, State, and local governments, and the professional groups can jointly prepare an organized plan to see that new construction is designed for accessibility by the handicapped and that existing buildings are modified to make them usable.

S. 1525 contains another proposal which can contribute as much to the advancement of rehabilitation as any single suggestion made in recent years. I refer to the provision for establishment of an information service. This plan, if approved and carried out, would enable the Vocational Rehabilitation Administration to establish a central source of data service, using modern computer systems, as a service to all organizations and individuals concerned with rehabilitation. We have a very great need for this; and the need becomes greater each day. We can The day of the computerized information system is already with us. scarcely afford to permit rehabilitation work to move into the larger dimensions which are required without assuring ourselves that the increasing flow of information is collected and made promptly available to researchers, program directors, and the many others who constitute this growing field. There is a growing insistence on the part of governmental and other leaders for a better method of collecting, storing, analyzing, retrieving, and disseminating the findings of research. This is one of the important ways in which such an automated data system would be not only helpful but essential. I hope the committee will approve this pro

vision.

Related to this is a proposal for a modest program of intramural research to be conducted by the Vocational Rehabilitation Administration. I believe this is an important step which should be taken promptly. I have been engaged in and

concerned with research in rehabilitation for several years. We now direct at New York University one of the several special rehabilitation research and training centers which have been supported by the Vocational Rehabilitation Administration. We are in close collaboration with other research activities in the rehabilitation field. It is my conviction that there are and will be numerous situations in which the Vocational Rehabilitation Administration should undertake some special types of research on its own, as a service to the research community that is growing in rehabilitation now.

I have noted the several other provisions of S. 1525 which are designed to make improvements of various kinds, some of them administrative, some technical. I wish the committee to know that the proposals have my support.

As a final note, I wish to bring to the committee's attention the fact that S. 1525 will carry out the legislative proposals in vocational rehabilitation that were contained in the report of the President's Commission on Heart Disease, Cancer, and Stroke. I had the privilege of serving as Chairman of the Rehabilitation Subcommittee of that Commission, under the able leadership of Dr. Michael DeBakey. It is interesting to note that, while there was a Subcommittee on Rehabilitation, all units of the Commission took an active interest in the need for better rehabilitation research and services for the disabled victims of heart disease, cancer, and stroke. It was for this reason that the Commission made such clear and strong recommendations to make improvements in the Federal law governing vocational rehabilitation, as well as to expand the level of financing for several of the on-going programs.

Therefore, Mr. Chairman, if you enact S. 1525 you will be aiding the President in a very specific and important way in his plan for a Great Society; you will be carrying out the recommendation of the President's Commission on Heart Disease, Cancer, and Stroke; you will be earning the profound gratitude of rehabilitation workers throughout the United States; and you will be fashioning better lives for hundreds of thousands of disabled people, not only in this generation but in the generations to come.

I thank you most sincerely for all you have done in the past and I respectfully urge that the committee report S. 1525 favorably.

The CHAIRMAN. We certainly want to express our appreciation to you. You have been with us a good many times in the past. You have always been tremendously helpful. You have always given a very fine forward and challenging statement. We could not have a better statement that you have given this morning. We are deeply grateful to you not only for the help that you have given us through the years, but also for the tremendously fine and great work that you do. Dr. RUSK. Thank you very much.

The CHAIRMAN. We will now hear from Dr. A. P. Jarrell, president of the National Rehabilitation Association and director of Vocational Rehabilitation in the State of Georgia; accompanied by my old friend, Mr. E. B. Whitten, the director of the association. You have been with us in the past and we welcome you back this morning. We are very happy to have you here.

Dr. JARRELL. Thank you very much. It is a pleasure, Mr. Chairman, to be here and to have Mr. Whitten with me. You have before you the comprehensive statement prepared by the National Rehabilitation Association for the record.

The CHAIRMAN. We will put that into the record in full at the conclusion of your remarks. (See p. 98.)

STATEMENT OF DR. A. P. JARRELL, PRESIDENT, NATIONAL REHABILITATION ASSOCIATION, AND DIRECTOR, VOCATIONAL REHABILITATION, ATLANTA, GA.; ACCOMPANIED BY E. B. WHITTEN, DIRECTOR, NATIONAL REHABILITATION ASSOCIATION

Dr. JARRELL. Senator Hill, I will present the summary and I shall attempt to emphasize the principal problems faced by those who engage in rehabilitation activities today and to point out how the proposed legislation will help to solve these problems.

In the first place, let me say that the National Rehabilitation Association is supporting S. 1525 wholeheartedly. It embodies many of the concepts and programs we have been working for a long time. We believe that the passage of this legislation will provide a new benchmark for measuring the progress the Nation is making to provide equal opportunities to its physically and mentally impaired citizens.

As you know, Mr. Chairman, the problem of disability in this country is an enormous one. The best estimates we have indicate that there are at least 3 million severely handicapped individuals in this country who could profit from rehabilitation services and who would accept such services if they were available.

It is further estimated that this number is increasing at a rate of not less than 300,000 per year. The increase is not surprising when we consider that advances in medical sciences have not only saved many lives, but have frequently left individuals with severe disability. For instance, the paraplegic at one time lived only a few years. Now, with modern treatment, his life expectancy may be almost normal. The problems of rehabilitation are also compounded by the advancing age of our people.

Problems in connection with disability must be attacked on many fronts. Expanding programs of research will reveal many yet unknown facts about the origin of the disability and possible ways of prevention and treatment. Every possible effort must be made to increase the numbers of people competent to work effectively with handicapped individuals. We need many more well equipped and staffed rehabilitation facilities. Some of the needs of disabled people may be met in whole or in part by programs serving the general public, including basic programs of health, education, welfare, and employment. There are certain needs of the handicapped, however, that continue to require specialized professional services which we call rehabilitation. This legislation is directed principally toward expanding and improving these professional rehabilitation services. Considerable progress has been made in rehabilitating the handicapped since the passage of Public Law 565 in 1954. The number of persons rehabilitated has more than doubled and rehabilitation agencies are providing more comprehensive services to a more severely disabled clientele. This is indicated by the increasing numbers of the mentally ill, mentally retarded, cerebral palsied, epileptic, and other groups of severely handicapped individuals who are being served and rehabilitated. Those of us who are actively engaged in the provision of services recognize, however, how far we must go before we can say we are providing a comprehensive, high quality

service for even a majority of our handicapped citizens who need them. For a few minutes I would like to discuss some of the problems we face in the rehabilitation movement.

In the first place, we need more personnel; not just any kind of personnel, but personnel highly trained to perform professional and related functions in the various areas of rehabilitation. We need people of the established professions such as counselors, social workers, physicians, psychologists, and therapists to provide day-to-day services for the handicapped. We also need increasing numbers of people in less well-known occupations such as vocational evaluation, workshop production, research, training, and facility consultation.

We recognize that substantial progress is being made in providing additional professional personnel with Federal assistance and the contribution this committee has made to this progress. We want

to call attention, however, to the fact that these programs must be continually expanded if we are to meet our personnel needs.

The CHAIRMAN. Do you think that we can meet these needs as we go forward with these programs?

Dr. JARRELL. Right. That has been well demonstrated.

Another serious problem is the dearth of vocationally oriented rehabilitation facilities. We are not implying that we have by any means enough facilities providing high quality medical services for handicapped individuals, but it is undoubtedly true that medical rehabilitation facilities have developed far more rapidly than those whose principal concern is vocational adjustment, vocational training, and placement. The workshop, for instance, is at about the same stage of development in this country today that the medical rehabili tation center was approximately 10 years ago. Although there are exceptions, workshops are generally poorly housed and equipped and inadequately staffed and financed. Pioneers in this field have demonstrated clearly what good workshops can do to make rehabilitation a reality in the lives of many severely handicapped individuals. Wẹ now need more better housed and equipped workshops, more personnel specifically trained to work in workshops, and better organized professional services in workshops. We also need numerous additional comprehensive rehabilitation facilities, providing a full range of services, but with emphasis upon vocational adjustment and vocational training.

Next, the State-Federal program of rehabilitation needs a broader legal base to enable it to provide services more effectively.

For instance, the present definition of diagnostic services discouraged the comprehensive kind of evaluation which is required for many of the severely handicapped people who are coming to the vocational rehabilitation agencies. At the present time, these agencies are expected to determine the rehabilitation potential of the individual applicant upon the basis of a general medical examination and other short-term evaluation procedures. This is not sufficient for many clients, particularly the severely disabled client, including the mentally retarded, the emotionally ill.

It is frequently necessary that a handicapped individual be evaluated by experts over a protracted period of time before any reasonable determination can be made as to his rehabilitation potential. Currently, in Georgia, we are in the process of establishing an evaluation center, to be used in Metropolitan Atlanta, in which we shall attempt