Highlights of the Second Report of 

The President’s Committee on Mental Retardation

THE REPORT: 

Documents significant changes in the field of mental retardation 

Describes a long-range trend toward including mental retardation services in programs for all 

handicapped persons 

Makes recommendations in three major need areas—residential care for the retarded, manpower 

for mental retardation programs and mental retardation in poverty neighborhoods. 

AMONG THE RECOMMENATIONS: 

Residential Care (page 11)

 Improve standards and develop a national system of accreditation 

 Expand the Hospital Improvement Program 

 Establish a program to relocate and rebuild obsolete facilities 

 Develop an insurance system to give parents a free choice in selecting residential 

services 

 Bring mental health authorities into more active participation in developing programs for 

the retarded who are emotionally disturbed 

Manpower (page 15)

 Increase grants and awards to attract top professionals into the mental retardation field 

 Develop grants for the training of desperately needed supportive personnel 

 Make grants to develop statewide volunteer service programs 

 Develop in-service training and education programs for employee improvement and 

advancement 

Deprivation (page 19)

 Make health and education services available to every child from birth as his right 

 Enact the proposed 1968 maternal and child health legislation 

 Develop community and neighborhood health and education centers to give preventive 

health care and screening, early education and day care 

 Develop fixed facility and mobile health, education and social service programs for rural 

areas 

 Expand career planning in supportive health, education and social services in low income 

areas 

 Form a service group to teach and demonstrate home and health skills in low income 

neighborhoods 

 Urge youth organizations to undertake large-scale membership and voluntary service 

program development in poverty areas 

 Extend voluntary family planning services to all Americans 

 Include the needs of the retarded in model cities planning 

 Intensify research into the cause of mental retardation associated with social and cultural 

deprivation 
The 

Edge of Change

THE PRESIDENTS COMMITTEE ON MENTAL 

RETARDATION 

A REPORT TO THE PRESIDENT ON MENTAL RETARDATION PROGRAM 

TRENDS AND INNOVATIONS, WITH RECOMMENDATIONS ON 

RESIDENTIAL CARE, MANPOWER, AND DEPRIVATION 
We cannot rest as long as WE there is one child 

who becomes retarded through our neglect, one 

individual who lacks the care he needs because of 

our indifference, one person who fails to reach 

his potential ... no matter how limited. 

-LYNDON B. JOHNSON 
President Committee on Mental Retardation 

Washington, D.C. 20201 

Dear Mr. President: 

I have the honor to transmit the second report of the President's Committee on Mental Retardation. Although 

I have assumed the chairmanship of the Committee too recently to participate in the development of the report 

and the recommendations, I nevertheless urge fullest consideration for its recommendations on the part of all 

concerned government and private agencies. 

During its second year, the Committee has continued its studies in the 10 priority need areas identified in 

its first report. Work has focused on three of those areas—residential care, manpower needs and mental 

retardation in poverty neighborhoods. Reports and recommendations in those three areas, together with an 

assessment of trends that are working basic change in mental retardation programs, make up this report. 

Individual members of this Committee, Mr. President, are eminent in their fields and leaders of many 

years' standing in the Nation's endeavor to make progress in serving human and social service needs. 

We can look to the future with confidence as Long as distinguished citizens such as the members of 

this Committee give of their experience, knowledge and vision to help the Nation chart its progress for the 

common good. 

The Committee is deeply grateful for the encouragement and guidance that you have so fully and 

unstintingly given. Your informed, continuing interest in the problem of mental retardation inspires 

us in our belief that the national effort to deal more effectively with mental retardation will ultimately be 

achieved. 

Respectfully yours, 

Chairman 

The President 

The White House 

Washington, D.C. 

The Edge of Change 

THE enduring change that brings new directions and meanings into life comes on like a new 

day: not all at once, but in a growing definition of shapes, a stirring as men awake, and finally 

a growing fullness of light and movement. 

Thus has basic and meaningful change been coming into the lives of the nation's millions of 

mentally retarded in this decade. 

There is a long way to go and much to do before the new day for the retarded is full. But 

the dawn is now far enough advanced to distinguish much that is new and many of the 

directions that progress must take. 

Three developments are bringing on the new day for the retarded: 

 POPULAR AND PROFESSIONAL ACCEPTANCE of the mentally retarded as human 

beings who can grow and learn to make the most of their abilities. 

 AGENCIES' REAPPRAISAL of their missions and methods in light of new and different 

human needs to be served. This reevaluation, often painful, is bringing new patterns of social 

action and citizen participation in community affairs. 

 RECOGNITION OF MENTAL RETARDATION PROGRAM DEVELOPMENT AS AN 

INESCAPABLE PART OF THE RESPONSE TO CRITICAL NATIONAL ISSUES such as 

poverty and deprivation, city planning and renewal, manpower training and use, education 

policy, population study and human resources planning. 

Ushering in the new shape of life for the retarded are hundreds of programs and projects. 

Federal government programs grounded in landmark legislation enacted by Congress during 

your administration, President Johnson, have brought major program advances in a field of 

human need seriously neglected before. This federal action—such as construction of 

university-affiliated training facilities, mental retardation research centers and community 

mental retardation service facilities—has spurred important beginnings nationwide in meeting 

the evident needs of the mentally retarded. 

As a result, social action, career and research possibilities never before available have 

opened up. 

And mental retardation has been brought into the mainstream of citizen concern as a national 

problem that every American can help meet in his own community. 
Real change announces itself in new ways of tackling problems and needs at the 

grass-roots level. There are now hundreds of such new-look activities throughout the 

country. The following pages present a sampling. 

Diagnostic, Study, Treatment: A Problem of Availability 

Interest and expertise in mental retardation are still scarce in health, education, social 

work, psychology and other professions. As a result, competent, helpful guidance for 

retarded children and their families continues to be a desperate need. 

Progress is coming as specialists recognize that mental retardation is a many-sided 

problem and that its "cure" comes only in the fullest possible development of individuals' 

particular abilities. Prevention demands massive public education and public involvement as 

well as top professional work. These needs are now producing such innovative programs 

as: 

 DIAGNOSTIC, STUDY AND TREATMENT CENTERS. These 

bring together teams from many fields. The U.S. Children's Bureau has 

taken the lead in starting a national network of such centers. Some 

states are now building their own. The aim of these centers is to put 

comprehensive diagnostic and study centers within reach of every 

family. 

 REGIONAL SERVICE PROGRAMS. Here the aim is to make 

care, education, training and other service programs for the retarded 

conveniently available to every family. A few states now have a 

network of such centers. 

 COMMUNITY CENTERS. These are on the front line of 

community health and social services. Some serve only the retarded, but 

increasing numbers work with all handicapped conditions. Their 

sponsorship and patterns of operation differ. Some are under-one-roof 

cooperatives of community public and private agencies. Others coordinate the efforts of 

groups of agencies. 

 SPECIAL MEDICAL AND ALLIED PROGRAMS. Of many kinds, these seek to 

meet specific needs that—usually—have been overlooked before. Examples: 

 A southwestern city's mouth care training and dental treatment program for every 

retarded child in its area. 

 Mobile unit diagnostic programs in some rural areas. 

 Trained home health aides to relieve mothers of severely retarded children of their 

constant care. 

 Homemaker services for families with a retarded infant. 

 PUBLIC INFORMATION PROGRAMS. The great number and variety of these 

highlights the widespread public interest generated by the problem of retardation. 

The 3-year public service campaign on mental retardation coordinated by the Advertising 

Council brought over $30 million in contributed space and- 
time from newspapers, magazines, radio and television stations and display advertisers. 

State and community campaigns to spur public awareness of retardation and its causes have 

been conducted in nearly every state by such groups as the U.S. Jaycees, Civitan International, 

United Commercial Travelers, women's club federations, service fraternities and sororities. These 

activities have often been tied to measles vaccination campaigns, better nutrition drives and other 

mental retardation efforts. 

Residential Care: A Road to Main Street 

Everybody's picture of the "bad old days" in mental retardation is the large warehouse giving 

custodial care to the forgotten retarded. That picture, tragically and disgracefully, is still true 

about many of the nation's public and private institutions for the retarded (see special report 

beginning on page 11). 

At the same time, however, dedicated staffs, imaginative 

state leaders and federal encouragement for innovation are 

spurring the development of institutional programs of 

startling freshness and vision. 

 COMMUNITY GROUP LIVING PROGRAMS. These 

are making it possible in some states to move significant 

numbers of people out of institutions and into community 

living. Making the move are two kinds of institution 

residents—trained workers starting on jobs in the 

community and semi-independent persons able with 

minimum supervision to live in the community. This trend 

has brought major growth in community foster care programs 

for the retarded. 

 BEHAVIOR MODIFICATION. Improvement in the 

hyperactive, sometimes self-destructive behavior often 

found in the severely retarded has made learning and 

social growth possible for the first time for many retarded 

persons. These capabilities in the severely retarded were 

undreamed of even by most experts until recently. 

 "SPECIAL PEOPLE" PROGRAMS. These bring the 

care, compassion and hope of concerned citizens into the 

lives of individual retarded persons. They are vitally 

important, effective programs that operate on small budgets. 

The Foster Grandparents Program gives this service 

opportunity to the elderly. High school and college students take part through the Student Work 

Experience and Training (SWEAT) Program. (Unfortunately, both these programs have been 

curtailed by budget cuts this year.) 

Some institutions give service-and-training opportunities to VISTA volunteers. At least one 

institution has formed a Neighborhood Youth Corps unit of retarded residents. 

Nearly every institution in the country has a group of community volunteers. These groups 

increasingly include high school and college students. 

 INNOVATIVE RESPONSE-TO-NEED PROGRAMS. These are of many kinds. For example: 

Residence ward nurses in a midwest institution learned speech and physical therapy techniques in 

order to supply steady reinforcement to therapists' work during residents' on-ward hours. . . . A 

southern institution fitted a bus as a mobile classroom so that field trip experiences could be discussed 

on the spot before returning.... A west coast institution- 

uses behavior-modification to teach one group of residents 

how to work with another, more severely retarded group to 

improve the latter's behavior. . . . An occasional 

community is now developing programs to meet the special 

needs of the adult retarded, a group often overlooked. Also 

being tackled in some programs are the needs of the multiply 

handicapped retarded individual. . . . A community service 

group in one eastern state works with mentally retarded 

offenders committed to the state penitentiary. (A national 

sample of 90,000 prison inmates was recently found to 

include nearly 8,600 mentally retarded persons.) 

Education and Day Care: More, Earlier, Better 

Discoveries of far-reaching significance have been 

made in recent years in the field of learning. 

Studies have found that the period of most rapid 

learning comes years before school begins. The range 

of an individual's intelligence is largely set in earliest 

childhood. It can be blunted in those same early years 

by a limiting, harsh, negative environment. 

It has also been found that traditional education 

methods faced many children with problems that their 

special learning handicaps make difficult or impossible for 

them to surmount. 

Education and day care for the intellectually 

handicapped have thus grown up as innovation-minded, 

probing fields. Some of the new-look programs now 

under way in these fields include: 

 PRE-SCHOOL CLASSES. These aim to give the retarded child a running start when his 

potential for learning is highest. Another goal is to prevent functional retardation. Programs range 

from infant stimulation projects to school-entrance readiness classes. 

 MACHINES, SPECIAL MATERIALS AND TECHNIQUES. Samples: 

 A multi-station electronic laboratory gives programmed instruction to varying-sized groups 

simultaneously. An aide supervises each group. Teachers concentrate on children needing 

individual attention. 

 Audio-visual presentations and role-playing supplement field trips in a western program that 

helps retarded children build a sense of self-worth. 

 A reading readiness program built on picture-word associations produces results even with 

severely retarded pupils. 

 A community center produces film strips on personal hygiene and grooming for the trainable 

retarded. 

 A state university produces an educational television series for the retarded in every 

primary and intermediate class in the state. 

 A private organization center devised simple pre-primers which retarded children in a reading 

readiness program compiled from their personal experiences. 

 SPECIAL INSTRUCTIONAL PROGRAMS. These are as varied as the needs that imaginative 

special educators see. A midwest public school system teaches concepts of language and systematic 

thinking to pre-school children- 
who have language difficulties. Aim is to overcome retardation caused by social 

deprivation. . . . Several urban school systems have driver education programs for the 

educable mentally retarded. . . . Another midwest system provides a "continuum of care" 

curriculum that begins in the pre-school years and continues into adulthood for both 

educable and trainable mentally retarded. 

 DAY CARE TRENDS ARE TOWARD MORE PROFESSIONAL PROGRAMS, away 

from babysitting and "just play." Among developments: 

 One western state has developed an accreditation program to upgrade the competence 

of day care center administrators, staffs and aides. Three universities cooperate by offering 

classes. 

 Public health nurses in a southern state give school health services in day care centers for 

the retarded. 

 The office of mental retardation in an eastern state aids voluntary organizations' inner city 

day care activities to help counter functional retardation. . . . An institution in the same state 

offers summertime enrichment programs for the children of migrant workers. 

 SPECIAL EDUCATION INSTRUCTIONAL MATERIALS CENTERS. 

Established by the U.S. Office of Education in cooperation with universities, these centers spur 

a flow of information and guidance to special education teachers of the retarded and other 

handicapped. Fourteen centers are in operation. 

Vocational Training, Employment: People and Jobs Fitted Together 

Vocational training and employment of the retarded have 

proved out in dollars and cents as well as in the intangibles of 

pride and dignity. 

Lifetime incomes of vocational rehabilitation trainees, 

according to a Department of Health, Education, and Welfare 

study, average 16 times the cost of the training. 

The nearly 5,000 mentally retarded workers in 40 federal 

government agencies receive a higher percentage of outstanding 

performance ratings than any other government workers. 

A national food service company that has employed retarded 

workers for more than 5 years found in a comparative 

performance study that retarded workers stay in their jobs over 

twice as long, do their jobs well three times as often, and get 

along with co-workers far better than non-retarded workers do. 

Every achievement, however, reveals new needs to be met, 

new horizons to be explored. Among new-look programs are: 

 JOB SIMPLIFICATION AND REDESIGN. These are now 

making it possible to train retarded workers as data processors, 

electronic component assemblers, bank clerks and offset press 

operators. 

 INTENSIVE JOB PREPARATION AND PLACEMENT 

PROGRAMS. One midwest state's program joins five agencies in 

an 8- to 9-month- 
preparation of long-time institution residents as nurse's 

aides, housekeepers and food service workers, finds homes 

for them in communities and places them in jobs. 

 SPECIAL RESIDENTIAL TRAINING PROGRAMS. 

These programs offer Monday through Friday residential 

center training opportunities to retarded persons who cannot 

conveniently take training on a day basis. 

Planning, Programming, Manpower Development: What Makes the Action Go 

Forward 

Until recently, the design and administration of programs 

for the mentally retarded was largely confined to programs in 

residential institutions. 

The emergence of community-based services during the past 

decade has radically altered old patterns. Today, the 

planning and administration of up-to-date programs for the 

retarded is a highly complex activity that reaches into every 

area of community endeavor. It joins many kinds of resources 

to bring better service to the retarded and is highly innovative. 

Among examples of new-look program design, 

administration and resource development activities in the 

retardation field are: 

 A midwest state's interagency case information service, tied 

into state university computer center. 
 A cooperative planning and programming project for a 

sparsely settled area of thousands of square miles, being 

carried out by four western states. Communications heart of 

the program is a network of intensively trained citizens whose 

strategic locations make them logical referral and feedback 

resources. 

 A central state's interagency retardation planning group 

has developed and begun implementing detailed service 

planning models for work with the socio-economically 

disadvantaged teenaged girl, the pregnant woman in a poverty 

area and the pre-school child in deprived areas. 

 The National Association for Retarded Children 

established during the past year the first national organization 

of youth united to serve the retarded. State units are being 

organized rapidly. 

 A Midwest city's association for retarded children and antipoverty program jointly planned and developed a center for 

handicapped children in low income neighborhoods. 

 Workshops, training institutes, information exchange and 

other in-service developmental activities are becoming 

widespread. Growing numbers of programs use closed circuit 

television for staff training as well as case study. . . . A 

southern region wide program spurs training and experience 

exchange among retardation specialists and institution staffs. . 

. . An eastern state institution offers a course to qualify attendants for high school equivalency 

certificates with resultant job advancement and increased pay. 

 Aiming for one-to-one staff-patient ratios in programs for the retarded and other 

handicapped, an eastern state trains supportive workers to assist specialists, thereby freeing the 

specialists to concentrate on the major concerns their training has qualified them to handle. 

What the New-Look Programs Mean 

Citizen action to focus attention on a specific health or social problem has been a potent 

force behind dramatic advances in American health, education and social services. 

Such action has led in two generations' span to almost total conquest in the United States of 

tuberculosis, polio, diphtheria and measles. It has spurred wide popular participation and 

technical progress in overcoming mental retardation, mental illness, heart and circulatory 

disorders, crippling neurological conditions and cancer. It is now awakening the nation to the 

profound interrelationships of man and his environment. 

Almost everything we have been learning in this explosive century, however, has shown us that 

no problem exists in a vacuum. 

Solutions to Problems A and B may be found in a study of-apparently unrelated Problem C. 

Effective diagnosis, study and treatment of any condition now requires the cooperative 

knowledge and skills of many people from many fields. 

At the same time, our communities' health, education and social needs—particularly in low 

income areas—have become so great, and the resources to meet them so inadequate in their 

present applications, that fundamental- 
revision in the delivery of community services has become a critical necessity. 

Leaders in the field of mental retardation must face up to this challenge. The campaign to 

prevent mental retardation and help the mentally retarded utilize their abilities fully is entering a 

new phase. 

Because resources of money and people are short and because human needs are so deeply 

interrelated, people and organizations interested in specific handicapping conditions will need 

to work together increasingly. 

The development of all-inclusive approaches to handicapping conditions will promote more 

effective services for retarded individuals than can be found in most communities today. 

Such approaches would end the tragic limbo into which the emotionally disturbed retarded 

have so often fallen. 

They would end the frequent neglect of individuals having unusual retardation-allied 

conditions such as autism. 

Comprehensive approaches would particularly make it possible to tackle the awesome 

amount of mental retardation that has social and environmental causes. This retardation is 

frequently neglected in today's largely biomedically oriented research and treatment programs. 

The time has come for workers with the retarded to surmount their fears of submergence 

and neglect in comprehensive programs for the handicapped. Substantial grounds have often 

existed for such fears. . . . and still do in many programs. But important changes in knowledge 

and attitudes about the retarded are combining to make enlightened action possible. 

The mistaken notion of retardation as an irreversible, unchangeable condition is at last giving 

way in a score of fields. Replacing this long-frozen view of retardation is a mounting 

involvement and excitement among scientists, health specialists, educators, psychologists, 

social workers and therapists. 

This new attitude is bringing attention, respect, and action programs to the field of mental 

retardation. If wisely cultivated, it will assign retardation as important a priority in 

comprehensive service planning and programming as that given to any other handicapping 

condition. 

The protection of the interest of the retarded over the next decade, then, will probably be a 

matter of two related endeavors. 

We will need to cultivate the excitement about the possibilities of making important 

progress in preventing and overcoming human functional disorders. 

And all groups and individuals concerned about such disorders will need to insist that every 

handicapped individual get all of the help he needs to grow to the fullest realization of his own 

abilities and potential. 

Last year, this Committee pointed out 10 areas in which major action in furthering the national 

campaign against mental retardation was needed. During the year since submitting its first 

report, the Committee has focused major effort on studies in three of those areas—residential 

care of the retarded, manpower for programs working with the retarded, and poverty-linked 

retardation. Reports with recommendations in these areas follow. 
 
PRIORITY 

REPORT: 

Residential Care for the Retarded 

MANY of the nearly 200,000 residents in state institutions for the mentally retarded live in disgraceful conditions that the states' own regulatory agencies would not tolerate in privately 

operated facilities for anyone. 

Moreover, the facilities in which these retarded persons live are in many cases in a state of 

decay. 

The average age of institution buildings is 44 years. Some have reached the century mark. At 

least 50 percent are functionally inadequate for the care, growth, learning and rehabilitation 

programs that can be successfully carried out with the retarded. 

The reasons are not hard to find. 

Many states' institutions are administrative stepchildren. They are often located in remote 

places, far from population centers, according to a long-prevailing view of the retarded as 

mistakes of nature to be put out of sight. 

They are poorly budgeted: the national average expenditure per person per day—with all costs, 

both direct and indirect, figured in—is just $7.60, and actual amounts range down to just over 

$3.00 in some states. 

Staffs are often underpaid, under qualified and without reasonable hope of having better 

working conditions or career advancement. Institution locations and pay scales make recruitment 

of trained manpower difficult. Archaic, uneconomical administrative practices, born of the lowbudget necessity to "make do," have hardened into tradition at many institutions. 

Seen in this perspective, the accomplishments of some institution administrators and staffs in 

developing fresh, innovative programs (see page 3) appear near-miraculous. 

The closest approach to development of standards for residential facilities for the retarded 

has been made by the American Association on Mental Deficiency with its institutional evaluation 

program. The AAMD effort, helpful though it has been in guiding many institutions' 

improvement activities, chiefly covers the traditional large, hospital-oriented type of residential 

program, however, and contains little guidance on day-to-day care. 

Taxpayers pay over a half-billion dollars a year to operate these so-often-inadequate 

facilities for residential care of the retarded. In all too many cases, it is half a billion dollars paid to 

perpetuate outworn, inhumane warehousing of human beings. 

The dilemma of how to improve the nation's institutions for the mentally retarded is a tough 

and tangled one. The essence of the problem is what to do about buildings, budgets, programs and 

populations that have existed in neglect and decay for many years with little or no thought being 

given to their needs by either state officials or the public. 

Renovation of existing buildings is often too costly to undertake. But states hesitate to 

abandon such buildings because of the investment put into them. Finding another use for them is 

usually difficult because of their isolated location. 

A look at institution budgets can be like an expedition into a hidden land that time forgot. 

Needs that were great in 1930 may not yet have been constructively studied and responded to. The 

hundred different ways of using residents' unpaid labor to flesh out penny-pinching personnel 

budgets would appall labor and management specialists. 

Housed in inadequate buildings and chained by inadequate budgets, many institutions, 

moreover, cannot control the size or kind of population they must care for. Nationwide, there are 

thousands of mildly retarded individuals, "behavior problems" and "slow learners" in 

residential facilities for the retarded who should not be in these institutions. 

Thousands of severely retarded individuals are on waiting lists trying to get in. Institutions' budgets, 

administrative channels and ties with other agencies are too often insufficient. 

The need is now too great and too long neglected to be solved by the states alone. Massive federal intervention 

to spur the improvement of present facilities and the development of new, up-to-date self-renewable systems for 

the residential care of the mentally retarded is imperative. 

The recommendations that follow offer a program for beginning the job in a constructive way that will make 

as much use as possible of existing facilities and resources. 

1. Control of the quality of public, non-profit and private residential care for the retarded is essential. 

We recommend, therefore, that the appropriate professional and voluntary organizations, with support 

from the federal government, take immediate steps to improve the standards for residential care of the 

retarded and simultaneously develop a system of accreditation of residential care programs and facilities 

for the retarded. 

2. The federal government's Hospital Improvement Program has elicited imaginative new approaches to delivering 

residential care in state institutions. 

We recommend that this program now be expanded to effect major change by: 

A. Greatly increasing funds, with the provision that every state institution for the retarded have 

opportunity to participate. 

B. Making awards on the basis of a state plan for bringing present institutions up to acceptable 

standards and the development of community-based residences as alternatives to institutions. 

C. Relating awards to the size, budget, and needs of the institution. 

Particular effort in this connection must be made to meet the unmet needs of the severely and 

profoundly retarded. Accommodations and care for them are inhuman in many institutions. 

3. The use of outmoded, mass-housing buildings must be ended. Industry has rarely hesitated to abandon and 

replace obsolete plants; states should be no less firm in developing up-to-date facilities. A new geographic 

distribution of modes and forms of residential care services—including group homes, residential vocational 

training centers, nurseries and specialized nursing homes—is badly needed. 

We recommend, therefore, that a new part be added to Public Law 88-164 to establish a construction 

program for relocating and rebuilding obsolete residential facilities. 

Safeguards must be included to insure that future institutions do not perpetuate the mass housing and programming 

patterns of the past, and that the construction be planned for easy modification as new techniques and needs are 

found. The planning should be carried out in consultation with architects, urbanologists, demographers, community 

developers and other specialists in environmental sciences. 

4. Hospital In-Service Training Program grants should be greatly increased to include significant 

training for both leadership and direct service personnel in residential care facilities. 

5. Public and private social services for children and adults are related to residential care for the retarded in two 

ways: one, they can suggest alternatives to residential care; two, they have the competency to counsel families 

during their times of greatest stress—such as the time of deciding to seek a child's admission to an institution, 

or that of returning a retarded person to community living. 

We recommend that federal, state and local welfare agencies, both public and private, clearly identify 

a portion of their resources for welfare services to the retarded and their families. 

Such services include casework, adoption, homemaker services, foster care and day care. 

Immediate strengthening of child welfare services to the retarded through expert staffing, consultation and 

training is an essential component of this recommendation. 

6. We recommend that a federally supported insurance system be established to enable a free choice 

in selecting residential services. 

The exercise of free choice in the selection of an institutional home for a retarded individual will bring to the 

residential care field the improvement motivation of free, competitive enterprise. 

7. In order to provide a viable choice, we further recommend that a system of loans or grants be 

developed to assist private non-profit and proprietary organizations to establish alternative forms of 

residential care for the retarded, such as hostels, group homes, nurseries, residential vocational training 

centers, nursing homes and extended care facilities. 

8. State and local mental health authorities and the National Institute of Mental Health should 

take active leadership in developing services and programs for emotionally disturbed retarded persons in 

residential care or community programs. 
PRIORITY 

REPORT: 

Manpower To Serve the Retarded 

c action to overcome chronic shortages of trained persons to 

wor

he schools, too few therapists to work with them in community and residential care 

pro

ts and cottage parents, too 

few ers. 

THE time has come for systemati

k with the mentally retarded. 

The shortages are felt in every kind of program for the retarded. 

There are too few physicians, nurses, social workers and psychologists to give needed 

diagnostic and evaluation services. There are too few teachers trained to work with the 

retarded in t

grams. 

Less heard about, but equally critical, there are too few attendan

 foster grandparents and student workers, aides, too few volunte
Every kind of worker with the retarded is in short supply. 

At the same time, however, there is too much hand-wringing in the mental retardation field 

about specialist shortages and too little being done to find and develop supportive staff members 

to a

alists' efforts through the imaginative use of trained supportive 

man

findings about the increasingly 

mo

tunity to tap this resource through bold new programs of training and neighborhood 

invo

 make the following recommendations 

 Welfare grants, 

nnovative uses of specialist manpower in serving the 

 social casework and family services aides, and attendants in mental 

l education classes) and centers 

ed only refresher training or slight retraining to return 

therapists, teachers and other professionals who are 

xtend professional acceptance to 

specialists' functions with a view to transferring as many of those functions as possible to 

ssist specialists. 

The manpower problem in mental retardation is thus a double-barreled one. More workers, 

both specialists and supportive personnel, are needed. But also needed are searching studies to 

develop ways of extending speci

power in all program areas. 

Long a neglected career area, the mental retardation field is now erupting with interest and 

challenge. Findings in human learning problems have pushed special education to prominence 

and challenged the interest of students and teachers. Discoveries in genetics and biochemistry are 

making retardation research one of the brightest new frontiers of scientific exploration. Work 

simplification and job redesign studies have been spurred by 

re significant jobs that trained retarded workers can handle. 

Meantime, large numbers of unskilled or semiskilled persons are entering the U.S. work 

force and the mainstream of the nation's economic life for the first time. Supportive service 

occupations offer an ideal route for many such workers into prideful and important careers. The 

nation's service organizations and agencies, including those working with the retarded, should not 

lose the oppor

lvement. 

In the broad context of a great need for the services of many people and great opportunity for 

career growth in work with the mentally retarded, we

directed to manpower planning, development and use. 

1. We recommend that increased effort be made to attract scientists and professional specialists 

in education, the medical and behavioral sciences and related fields into research and service in the 

field of mental retardation. U. S. Department of Health, Education, and

scholarships and awards should be greatly expanded in support of this effort. 

Private organizations and foundation sources of support should also be sought and involved, particularly in researching and developing i

retarded and other handicapped persons. 

2. To increase supportive service personnel in mental retardation programs, we recommend that 

existing grant programs such as the New Careers and Neighborhood Youth Corps Programs be 

expanded and new grant programs be made available through the Departments of Labor and 

Health, Education, and Welfare to recruit, train and place supportive workers such as teacher 

aides, nurse’s aides,

retardation services. 

These grants should be administered primarily as work training and employment grants and should be 

made particularly available to low income applicants. The place of training and employment should 

preferably be clinics, schools (including public school specia

serving the needs of the retarded in the trainee's neighborhood. 

3. We recommend a sustained effort on the part of all agencies operating programs 

for the retarded and other handicapped to attract into work with the retarded those 

qualified workers who may ne

to work in service professions. 

A great potential in this area exists in nurses, 

not working during their family-raising years. 

4. To expand mental retardation services with existing and potential manpower resources, we

recommend that professional groups recognize and e

supportive personnel who work with their members. 

We also recommend that professional specialists and their associations evaluate 
trained supportive workers. 

We further recommend that professional groups reassess in light of the preceding 

any restrictions which they now place on the use of nonprofessional support personnel 

and reduce those restrictions to a minimum. 

We urge in this connection also that higher education institutions review curricula to assure that 

courses reflect current thought on specialist and supportive staff duties and responsibilities in services 

for the retarded. 

5. To improve utilization of adult and youth volunteers and to develop volunteer service as a 

major mental retardation manpower resource, we recommend that a Department of Health, 

Education, and Welfare grant program be made available to each state to set up, expand 

or modify a volunteer service program available to both tax-supported and private 

programs for the retarded.

6. We recommend that institutions, schools, centers and other facilities offering 

services to the retarded develop employee education and training programs for employee 

self-improvement and upgrading. The Departments of Labor and Health, Education, and 

Welfare should collaborate in helping make such programs possible through grants 

and development of training models. 

We also urge that supportive occupations in service to the mentally retarded be 

recognized as career opportunities, with adequate remuneration, on-the-job and other 

opportunities for learning new skills, and predictable lines of advancement and 

promotion for qualified aspirants. 

7. To permit a wider sharing of knowledge and experience in the field of service to the 

retarded, we recommend that the federal government develop and fund a program 

through which clinics, schools, residential care facilities and agencies could exchange 

specialist and supportive workers for mutual program benefit.

8. To establish a common terminology for jobs and positions in programs serving the retarded, we 

recommend that occupations serving the handicapped be defined in the Department of 

Labor's Dictionary of Occupational 

Titles and that the dictionary’s 

definitions then become standard 

reference for workers serving the 

mentally retarded.

In developing these definitions, the 

Department of Labor should also identify 

nonprofessional duties that have 

accumulated in the work of professional 

workers with the handicapped and suggest 

possible new service and support 

occupations in which these duties could be 

combined. 
THE EDUCABLE MENTALLY RETARDED 

IN URBAN AND SUBURBAN AREAS 

Black outline indicates poverty area 

Map indicates percentages of total school enrollment in classes for the educable retarded in 

metropolitan St. Louis as determined by child's place of residence rather than where attending school. 

There are more children classified as educable mentally retarded living in urban poverty areas than 

there are living in the suburban sections. This pattern of poverty and mental retardation is repeated in 

map data prepared on Bridgeport, Los Angeles, Harrisburg and Seattle, and would be expected to be 

true of other major urban centers.16

Map developed by President's Committee staff, using school enrollment data 

supplied by school systems, 1968. 
ITY REPORT: 

The Retarded Victims of Poverty 

FACT: 

Three-fourths of the nation's mentally retarded are to be found in the isolated and impoverished urban 

and rural slums. 

FACT: 

Conservative estimates of the incidence of mental retardation in inner city neighborhoods begin at 7 

percent. 

FACT: 

A child in a low income rural or urban family is 15 times more likely to be diagnosed as retarded 

than is a child from a higher income family. 

FACT: 

Forty-five percent of all women who have babies in public hospitals have received no prenatal care. 

Avoidable complications of pregnancy, which are often the harbingers of crippling conditions in children, 

soar in this group. 

FACT: 

Incidence of premature births (among whom neurological and physical disorders are 75 percent more 

frequent than in full-term babies) is almost 3 times as great among low income women as among other 

groups of women. 

FACT: 

The mortality rate of infants born to low income mothers is nearly double that of infants born to mothers 

in other income brackets. 

FACT: 

The children of low income families often arrive at school age with neither the experience nor the 

skills necessary for systematic learning. Many are found functionally retarded in language and in the 

ability to do the abstract thinking required to read, write and count. An appalling number of these children 

fall further behind with the passing of each school year. 

FACT: 

Students in the public schools of inner city low income areas have been found in numerous studies to be 

from 6 months to 3 years behind the national norm of achievement for their age and grade. About three times as 

many low income children as higher income children fail in school. The child whose father is an urban 

laborer has only one chance in 3,581,370 of being named a National Merit Scholar; but the child whose 

father has a professional or technical position has one chance in 12,672. 

FACT: 

The rate of Selective Service System rejections for intellectual underachievement is 23 percent nationally 

and soars to 60 percent and more among groups whose members are largely from low income areas. 

Mounting evidence is pointing to an intimate relationship between diet and mental and nervous 

disorders. Low incomes, economic stagnation, high rates of malnutrition and high incidence of disease, health 

problems and mental retardation are all found together in the nation's poverty neighborhoods, and even though 

they cannot yet be directly linked, more than coincidence is obviously at work. 

To those of us with responsibility to advise on measures to combat mental retardation, the meaning of the 

known and apparent facts is clear: the conditions of life in poverty—whether in an urban ghetto, the 

hollows of Appalachia, a prairie shacktown or on an Indian reservation—cause and nurture mental 

retardation. We believe that attack on the fester points of poverty will also hit the causes of retardation in the 

nation's rural and urban slums.
We therefore support and urge all 

speed in the war on poverty at all levels, 

by both the public and private sectors of 

American life. Within that framework, 

and with a focus on preventing mental 

retardation as well as other handicaps, we 

make the following specific 

recommendations. 

1. Since mental handicaps afflicting 

millions of Americans stem from 

neglect, deprivation and lack of 

stimulation during infancy and early 

childhood, we recommend that all service 

agencies, both public and private, act now to 

make health and education services available 

as the right of every American child from 

birth. 

 The need for such action presents 

itself in every part of our communities. It 

has

f the Union Address to assure prenatal care to mothers and first-year medical 

car

today, nearly 

irre

education centers located for convenient access by all. These centers would initially furnish 

pmental handicaps in children from birth 

en. 

and 

social development from infancy onward and aiding parents to encourage each child's growth as an individual. 

CHILDREN UNDER AGE 17 WHO HAD ROUTINE PHYSICAL EXAMINATION DURING A 12-MONTH PERIOD, 1962-63 

 reached crisis stage in the nation's low income areas. 

We recommend passage and full funding of the maternal and child health legislation which you, President 

Johnson, proposed in your 1968 State o

e to children in disadvantaged areas. 

We also urge all necessary steps to assure systematic attention to the medical screening, health care and 

developmental education of children prior to school-entry age. In the absence of such attention 

versible perceptual and learning handicaps become deeply rooted in great numbers of children. 

We recommend that the needed services be made available in urban and suburban areas through community 

and neighborhood health and 

three kinds of services: 

A. Preventive health care and systematic screening for health and develo

to school-entry age; prenatal care and counseling for pregnant wom

B. Early developmental education beginning in the child's first year. 

C. Day care for all children who need it, with the aim—as in Project Head Start—of promoting mental 

 

 Urban Rural Under $2,000- $4,000- $7,000 Over 

 $2,000 4,000 7,000 10,000 $10,000 

erished family is likely to miss 

examination. Handicapping conditions will therefore go undetected.13

Sources: Inside backcover

Mental retardation and other handicapping conditions are often found through physical examination in 

childhood, but the isolated rural child and the child in the impov
POVERTY'S CHILDREN: AN EXAMPLE OF EDUCATIONAL 

ATTAINMENT: 

NATIONAL LEVEL VERSUS APPALACHIA 

ON THE NATIONAL LEVEL: 

For every 10 pupils in first grade: 6 graduate from high school; more than 2 go to college; more 

than 1 finishes college. 

BUT IN APPALACHIA: 

For every 10 pupils in first grade: fewer than 4 graduate from high school; just over 1 goes on to 

college; fewer than 1 finishes college.14

Sources: I inside back cover 
These centers would be financed cooperatively by the federal government, states and localities. 

We do not minimize the great practical problems involved, but we believe that a network of centers in 

the highest-need areas can be started quickly. First requirement is a wholehearted commitment by community 

leaders, public and private agencies, professional groups and civic organizations to provide health and 

education services to infants and children as a first-priority investment in the nation's long-term health. 

Representatives of the population living in the area to be served should be involved in the planning and 

leadership of each center so that the program meets area needs and continues to do so. 

2. The problems of the handicapped in rural America urgently require special attention. 

In our preoccupation with urban needs and problems, we have overlooked a crisis in rural health, social 

service and education that has been steadily growing more acute. This crisis was documented recently in 

the report of the President's National Advisory Commission on Rural Poverty, The People Left Behind. 

The basic fact is that people in most rural areas are too few, too scattered and often too poor to 

support adequate services. 

This problem needs to be attacked on a regional basis. As in the cities, existing resources should be 

brought together and applied. 

We recommend that county governments, school districts, public health districts, medical and 

other professional societies and voluntary organizations (including such major rural forces as the American 

Farm Bureau Federation, the National Farmer's Union, the National Grange and other groups) pool their 

resources to plan regional health, special education and social service facilities and programs that can 

handle the unique problems of specific rural areas through a combination of fixed-facility and mobile 

services.

State and federal resources should be applied on a supplementary basis to assure adequate facilities 

and services in areas unable to finance or maintain them entirely. 

We suggest that the United States Department of Agriculture's Extension Service, the Partnership for Health 

Program and the Comprehensive Rehabilitation Planning Program take leadership in promoting and 

coordinating the development of these regional programs. The population of each region to be 
served should be represented in planning and operational groups. 

3. The soaring incidence of mental retardation in the nation's disadvantaged areas calls for continued and 

intensified programs of education and rehabilitation for all persons whose skills and self-reliance could be 

improved. 

We recommend, therefore, that federal assistance to state and local educational agencies for programs 

of education and rehabilitation serving those areas at all age levels be increased and significantly expanded. 

4. The continuing national shortage of health, education and social service specialists makes the development 

of large numbers of supportive workers as "expanders" of specialists' efforts a crucial need. 

We therefore urge that public and private agencies aggressively promote and develop career 

planning and opportunity in supportive health, educational and social services as an aid in supplying 

trained manpower for low income area programs, including those for the mentally retarded. Agencies' 

promotion of these opportunities should support adequate remuneration, on-the-job training activities and 

chances for advancement and promotion as part of supportive service occupation planning. 

Potential supportive manpower resources abound in the low income areas themselves. These resources 

should be tapped to the fullest possible extent. 

As part of this effort, we urge agencies and private industry to devise and conduct work training 

programs through which low income area residents can conveniently acquire the skills to work in 

supportive service positions. U.S. Department of Labor, Department of Health, Education, and Welfare 

and Office of Economic Opportunity grants should be available to assist in the development of these 

programs. 

Built into the training programs should be services that will help make it possible for interested 

persons to be trained. Temporary child care, for example, should be furnished. 

We also urge the formation of a community living service modeled on the U.S. Agricultural 

Extension Service. 

The job of this service would be to recruit, train, assign and supervise highly skilled men and women in 

instruction and demonstration activities in homemaker, community hygiene and personal health skills in low 

income neighborhoods. A significant proportion of the service members should be from low income 

areas. 
We suggest that the service be established as a federal government program so that uniform 

national standards and a pride in nationwide membership can be attained. 

In addition, existing supplementary manpower programs that bring special groups into work 

with the handicapped should be expanded. Among these are the Student Work Experience and 

Training (SWEAT), the Foster Grandparent, and the Volunteers in Service to America 

(VISTA) programs. These low-budget projects have produced spectacular results both for those 

served and for their participants. 

5. To help free young minds from the shackles of poverty and futility, we urge the nation's 

voluntary and service organizations for children, youth, students and young adults to come 

to the aid of young people in low income areas, both urban and rural.

Youth membership organizations such as the Boy Scouts and Girl Scouts, Campfire Girls, 4-H, 

Future Homemakers, Future Teachers, Future Farmers and religious youth groups might seek 

massive increase in members in low income neighborhoods. Leaders from those neighborhoods 

could be trained in hurry-up courses and modifications in membership qualifications and fees made 

as necessary to increase participation. 

Volunteer service organizations for youth such as the newly formed and promising youth arm of 

the National Association for Retarded Children, Red Cross Youth and the various hospital youth 

auxiliaries could make major expansion of their activities into low income areas. These groups could 

make an especially critically needed contribution by furnishing the trained volunteer aides needed in 

neighborhood health and social welfare agencies, public health clinics, schools, day care centers 

and Head Start programs. 

Such organizations should aggressively seek to involve civic and service organizations as cosponsors 

SUB-EMPLOYMENT RATE FOR SLUM SECTIONS FOR EIGHT METROPOLITAN AREAS 

 

(Subemployment includes unemployment, underemployment and subminimum earnings.) 

One out of every three slum residents who was already a worker, or who should and could become a 

worker with suitable help, was either jobless or not earning enough for living above the poverty level. 

The mentally retarded make up a significant proportion of the slum population, as demonstrated by the 

map on page 18. The mentally retarded are therefore strongly affected by such conditions as subemployment and unemployment.15

Sources: Inside backcover 
in these activities, especially to assure that such program needs as volunteers' transportation, needed uniforms and 

meals are furnished. 

We also suggest that the voluntary service organizations for youth redouble their efforts to recruit low income area 

young people into community volunteer work, and that these organizations further work with the schools to develop a 

system through which junior and senior high school students could receive educational credit for volunteer service in 

the community. 

6. A key factor in the futility of life in poverty is the accumulation of mischance and unwanted event. 

One of the points at which the treadmill of futility can be stopped is in helping low income men and women 

plan the size of their families. 

We recommend that family planning services and voluntary birth control assistance be made 

available through poverty area and other community agencies to help lower the alarmingly high 

rates of unwanted children and infant mortality in low income areas. We support your 1968 Health 

Message proposals on this subject. 

We also recommend that the nation's schools promptly develop and offer a top quality program of 

instruction, beginning in the early elementary grades, in human biology and education for parenthood. 

Over-all goal of this instruction would be to raise the quality of child and family life as well as arm young 

people with mature views of their future roles as responsible individuals, parents and heads of families. 

7. Among the most difficult problems facing U.S. communities today are the elimination of slums, the design and 

construction of attractive low cost housing, and the planning and delivery of community health, education and 

social services. 

We recommend that responses to the needs of the mentally retarded be incorporated in model 

cities and other programs that seek to improve present communities and design the communities of 

the future. 

We also recommend that labor, industry and commerce be involved on a larger scale in the 

development and redevelopment of our communities to assure adequate standards of living and 

community human services for all citizens. 

8. Ninety-five percent of the existing community facilities for the mentally retarded constructed under Public 

Law 88-164, Part C, are located in middle income neighborhoods. 

We recommend that Congress amend P.L. 88-164, Part C, to give the Secretary of Health, Education, 

and Welfare authority to see that the facilities are located for best service to all of a given 

community's mentally retarded. 

Requirements for matching funds should be made more flexible so they can be related to a 
community's average income or even eliminated in very deprived areas. 

9. Results are now beginning to come in from early childhood research and education programs 

being conducted throughout the country by universities, foundations and research laboratories. 

Without exception, their findings are that childhood programs can have long-term effect in 

preventing mental retardation linked to environmental lacks. 

We therefore recommend intensification of research in the social and other behavioral sciences 

with the aim of isolating and defining the so-far unidentified social, environmental and 

cultural factors that cause or contribute to mental retardation. 

10. Not all of the answers needed about the bonds between deprivation and retardation can be 

found through studies of human beings, however. 

There is in existence a national network of centers developed for the purpose of man-related 

research which cannot be carried out in studies directly involving human beings. We recommend that 

this network, the regional primate research centers, undertake major inquiries into the 

relationship to mental development of nutrition, infant stimulation, success-failure patterns and 

similar topics.
Mr. President: 

DURING the coming year we shall continue our studies of the three critical program need areas 

on which we have made recommendations in this report: residential care for the retarded, 

manpower development and use in mental retardation programs, and the mentally retarded 

victims of poverty and deprivation. 

We expect to have further recommendations in these areas as our studies of programs, needs 

and trends progress. 

We plan also to launch a major inquiry into the area of education for the mentally 

retarded. 

In addition, you will be receiving special reports and papers on progress and needs in research 

on mental retardation and on a national information center. The latter is planned to bring together 

research and program information in the mental retardation field and to make that information 

conveniently and uniformly available to researchers and program planners nationwide. 

Also directed to your attention will be a comprehensive monograph on the history, 

development, status and needs in residential care of the retarded. This monograph is the chief 

supporting document for the recommendations on residential care made in this report. 

We will report to you from time to time on progress in several continuing studies. 

One of these studies is attempting to define the economic impact and cost of mental 

retardation. The aim of this study is to develop a body of economic information through which 

cost factors in mental retardation may be established for the guidance of agency planners, valid 

cost comparisons made, and viable program projections made. 

Another study is developing guidelines for the use of model cities planners in incorporating 

designs for mentally retarded persons living and working in communities of the future. 

All of these areas were identified in our 1967 report as having critical needs. Our work 

during the past year has carried forward from general description of - 
those major need areas into the deep and detailed studies whose 

outcomes are reported in these pages or will reach you in later 

papers. 

This 1968 report, as did its predecessor, suggests actions to 

combat mental retardation that can and should be taken at all 

levels of the nation by both public and private agencies. 

Retardation is a problem that can strike any family in the 

nation. Every individual, every agency can help to do something effective about the problem. Our fundamental belief is that 

the nation's ultimate success in the attack on mental retardation 

will be won by a broad cooperative effort in which professional 

specialists and citizen volunteers work together to combat 

retardation and its causes through programs in health, 

education, rehabilitation, community planning and 

organization, social service and research. 

The field of mental retardation, with your steady support, 

President Johnson, has crossed the threshold of major change 

and advance. Some ways to foster growth and learning in even 

the most severely retarded have been found. The human cell's 

secrets of programming for the unborn are being pried out. The 

most critical period for learning has been found to be years 

before the time when formal education of children begins. Developing successful instruction for 

the retarded has enabled us to discover steps in the learning process that were unsuspected 

before. And analysis of work and work patterns in order to train retarded workers has shown 

that these workers can do more than previously thought and that the elements of even complex 

jobs can often be rearranged for effective performance by retarded workers. 

It is crucial, therefore, that the momentum of interest and action developed in the problem of 

mental retardation in this decade be held and intensified. 

We are grateful, Mr. President, for your continued personal inspiration and guidance to us 

and to the many others who are working on behalf of the retarded. The support of your Office 

is a key force in helping the nation bring on the new day when most mental retardation can be 

prevented and the remaining retarded individuals can be helped to be contributors to the 

common good. 

Sources 

1, 2, 3, 4 Adapted from Mental Health Statistics, 1968, a report by the National Institute 

of Mental Health. 

5 Adapted from Patients in Mental Institutions, Part I, Public Institutions for the 

Mentally Retarded, 1965, a report by the National Institute of Mental Health; and from 

Charges for Residential Care of the Mentally Retarded, 1963, a report by the National 

Association for Retarded Children. 

6 Adapted from data from (1) Interstate Clearinghouse on Mental Health, Council of State 

Governments: Arizona, California, Florida, Georgia, Illinois, Indiana, Kansas, Missouri, New 

Mexico, New York, Ohio, Oregon, Pennsylvania and Texas; and (2) Social Policy for the 

1970’s, from Indicators, May 1966, a publication of the U.S. Dept. of Health, Education, and 

Welfare. 

7 Adapted from Mental Health Statistics, 1968, a report by the National Institute of 

Mental Health; and from Indicators, 1966, a publication of the U.S. Dept. of Health, 

Education, and Welfare. 

8 Adapted from survey by American Association on Mental Deficiency, April, 1968; and 

based on rated bed capacity as reported by the institutions. 

9 Adapted from Report on Allied Health Professions and Services, 1967, a report by the 

National Advisory Health Council. 

10 Adapted from Report of National Advisory Commission on Health Manpower, 

1967. 

11 “Services Required” figures computed from Standards for State Residential Care, as 

established (1964) by American Association on Mental Deficiency; and “Services Available” 

figures computed from staff census of Patients in Public Institutions for the Mentally 

Retarded, 1965; A report by the National Institute of Mental Health. 

12 Adapted from The South’s Handicapped Children, a report of the Southern Regional 

Education Board, 1967. 

13 Adapted from The People Left Behind, 1967. The report by the President’s National 

Advisory Commission on Rural Poverty. 

14 Adapted from Education Advisory Committee Interim Report, 1968, Appalachian 

Regional Commission. 

15 Adapted from Manpower Report of The President, 1967. 

PHOTO CREDITS 

Central Wisconsin Colony and Training School, Madison, Wis.*John F. Kennedy Center, 

Kalamazoo, Mich.*Mansfield Training School, Mansfield, Conn.*The Shield Institute, Bronx, 

N.Y.*David Warren*Jim Wells