elements, is in the experimental stage in a project of the Federal Rehabilitation Institute in Belgrade. Also outstanding among these projects are India's experimentation into methods of counteracting the effects of leprosy by surgical restoration and by integration of patients into employment and community life; its demonstration of ways to rehabilitate blind persons into agriculture; and its research into restoration of severely burned persons to employability.

Outstanding among Israel's many projects is one for development of methods for training blind persons in the use of textile machinery. Brazil has developed training methods for prosthetists and orthotists in fitting these devices, and methods of manufacture of prefabricated parts for them, to reduce costs. Other projects are related to heart disorders, cerebral palsy, severe burns, and mental retardation. Interchange of experts

Under the International Health Research Act of 1961, the VRA has made 60 awards for the interchange of experts in rehabilitation between the United States and the countries participating in international research. The disciplines involved include prosthetics and orthotics, psychology, counseling, plastic surgery, neurosurgery, and physical medicine, among others.

The first exchange visit was made by a group of U.S. specialists in plastic surgery who went to Vellore, India, to study the work among leprosy patients being performed under direction of Dr. Paul Brand. In 2-month rotation, experts from such schools as Harvard, Yale, Johns Hopkins, and the Universities of Pittsburgh, Kansas, Ohio State, North Carolina, and Pennsylvania, visited the Vellore hospital and brought back to the United States a wealth of information, not only on the treatment of leprosy itself, but on corollary methods of skin grafting and cosmetic restoration, useful in the medical and surgical aspects of rehabilitation in the United States. The interchange program also has brought many foreign experts to the United States to study its rehabilitation programs, particularly its organization and methods, as well as its research in relation to similar projects in their own country.

I. PROGRAM EMPHASIS FOR SPECIAL DISABILITY AND OTHER GROUPS

Companion to rehabilitation's key emphasis over the last decade on reaching the immediate goal of rehabilitating 200,000 disabled persons annually, has been the emphasis on extending rehabilitation to progressively greater proportions of the severely disabled. Most often this progress has been achieved by concerted drives to improve services to those in special disability categories, such as the mentally retarded, the mentally ill, the deaf and hard of hearing, the disabled youth group, the disabled aging, or those who receive public assistance.

In each such concerted effort, the full panoply of the program's resources is marshaled and drawn into the drive. The State vocational rehabilitation agency program is the focus, bolstered by special projects under the extension and improvement program, the research and demonstration program, and the training grants program, which also draw into the effort the talents of educational institutions and private rehabilitation groups and agencies.

The decade from 1955-64 was characterized by the development of new patterns of service not only for the rehabilitation of those already disabled, but for the broader purpose of early detection and diagnosis

of disabling conditions among those preparing for the world of work. Prevention of dependency through vocational rehabilitation measures a target in the attack on poverty-has become one of the strongest trends of the program. It extends through accentuation of youth programs, through the great volume of services for those disabled persons in their prime working years, and through the mounting total of older persons in our population beset by chronic illness and infirmities.

In this decade, there has been growing recognition of the total effect of disability on family units-on the added burden of handicapped children, on mothers unable to give proper care to their children, on fathers unable to provide for their families because of a vocational handicap. Measures were put into effect with cooperation of National, State, and local welfare organizations to hold these family units together while appropriate rehabilitation measures were taken. 1. Rehabilitating disabled youth

Vocational rehabilitation's concern with rehabilitation of handicapped youth, which goes back a good many years, has mounted to strong emphasis in recent years. As shown in figure 5, among the 120,000 rehabilitated in 1964, over 24,000 or 20 percent were under age 20. It is significant, particularly in light of the strong current focus on constructive, remedial action to help the mentally retarded, that 5,000 were mentally retarded individuals under age 20, and that of the 7,200 mentally retarded rehabilitated in this program in 1964, as much as 70 percent are under age 20.

Strong emphasis has been placed on the development of sound patterns for cooperative programs conducted jointly by State special education agencies and vocational rehabilitation agencies, mainly under the basic services program and the extension and improvement projects program. By spring 1965, at least 39 States-in nearly 400 individual school districts had special cooperative activities in the State programs for vocational rehabilitation. Also, as a major part of the series of prototype demonstration projects, the Vocational Rehabilitation Administration has issued three series designed to aid disabled youth. Two series demonstrate the values of introducing work training content and counseling services in school settings to facilitate the transition of retarded youth from school to work. Twenty-eight such projects are now active across the Nation, featuring coordinated services offered by special education and vocational rehabilitation.

VRA has also supported for some years a successful, groundbreaking series of occupational training centers for the retarded, serving mainly youth. Credited with pioneering in the demonstration of occupational training and work conditioning of the retarded, these projects supported by VRA reached a total of 46.

Other activities for disabled youth involve projects to help disabled selective service rejectees by providing counseling and referral services at Armed Forces examining stations in a number of States, under the aegis of the State vocational rehabilitation agency, and a special series of efforts to reach the youthful disabled public offender who is in prison or reformatory, or on parole or probation.

2. Rehabilitating the mentally retarded

The significant progress vocational rehabilitation has made in delivering services to increasing numbers of the mentally retarded is the

result of a combination of investments, going back to the midfifties. The resources represented by the various parts of VRA's authority have each been called upon to help.

From research and demonstration has come new knowledge and new techniques for serving the retarded, and knowledge of the key factors in their rehabilitation, such as family encouragement; and demonstrations, such as the nationwide series of projects to demonstrate the effectiveness of occupational training centers. Another series demonstrates the values of introducing work training content and counseling services in school settings to facilitate the retarded youth's transition from school to work.

Currently the largest single group of projects-SS or about 1 in 5 of all the research and demonstration projects-deals with the rehabilitation of the mentally retarded. Significant contribution can be expected from the special research and training centers for mental retardation at the University of Wisconsin and the University of Texas, started this year.

From the training grant program have come special efforts to train rehabilitation professionals in working with the mentally retarded, particularly for persons preparing to enter the rehabilitation counseling field and for counselors already in the employ of the State rehabilitation agencies.

From the varied State rehabilitation agency programs have come the development of new, active relationships and special projects conducted with local public education agencies to reach school-age mentally retarded youth as early as possible with vocational rehabilitation services in order to facilitate their entry into the world of work; the assignment of special counselors to work closely with the mentally retarded, often in the larger metropolitan areas; the establishment of rehabilitation facilities in State institutions for the mentally retarded; the establishment of halfway houses for the retarded similar to those for the mentally ill; and generally heightened activity to reach more of this comparatively neglected disability group.

The number of mentally retarded rehabilitated into employment in 1964 was 20 percent greater than in the previous year-about 7,200 against 6,000.

As a further reflection of the extensive activity in this field, the amount of Federal funds for services to the mentally retarded as part of the basic grants to States in 1964 was about $5.5 million, or more than 55 percent greater than the 1955 total.

Training grant funds for mental retardation programs rose in 1964 to some $800,000, about 5.5 times that of 1963. Grants in support of research and demonstration projects in this field increased from about $1.5 million in 1963 to $2.25 million in 1964.

These figures add up to a total of some $8.5 million expended by the Federal Government during 1964 for mentally retarded people served in the public program, an 80 percent increase over the $4.8 million of 1963.

The pace of research activity on mental retardation is made clear by the number of research and demonstration projects on this disability. The total of 65 projects in this area represents an intensive effort to move forward in the rehabilitation of these people. These activities were broadened in 1964 by a variation which combines classroom schooling with alternate workshop experience.

Many extension and improvement grants made to States have special provision for better services for the mentally retarded. Of the 123 such grants made to States in 1964, 17 had the specific purpose of serving the retarded.

The new program "Federal employment of the mentally retarded," sponsored by the Civil Service Commission in cooperation with the Vocational Rehabilitation Administration, has involved State rehabilitation agencies. At the end of fiscal year 1965, 117 retardates had been placed in Federal employment through this program. The State vocational rehabilitation agencies have had charge of evaluating and certifying the retarded clients for placement in suitable Federal job openings. A brief survey indicates they have filled such positions as: messenger, clerk, typist, janitor, key punch operator, laboratory worker, grounds maintenance worker, and mail clerk.

State vocational rehabilitation agencies have been active also in the conferences leading to formulation of comprehensive State planning authorized by the Maternal and Child Health and Mental Retardation Planning Amendments of 1963 (Public Law 88-156), and their programs integrated into the patterns of service proposed in the State plans.

The primary role of vocational rehabilitation in relation to planning for facilities authorized under the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1964 (Public Law 88-164), has been to insure coordination between the proposed university-based facilities and the programs for the mentally retarded operated by State rehabilitation agencies in the interest of fostering a comprehensive continuum of services.

3. The mentally ill

State vocational rehabilitation agencies have made substantial advances in rehabilitating the mentally ill. They are in varying ways and degrees providing vocational rehabilitation services to

Inhospital patients and posthospital patients who need rehabilitation services on the way to resuming work in the community, and

Mentally ill persons who are not and have not been hospitalized, but who need help to work in the community and stay out of the hospital.

In a majority of the States, the rehabilitation agency assigns counselors to State mental hospitals, on a full-time or part-time basis. Leading the way, some State agencies have moved to set up rehabilitation facility units within State mental hospitals. Others have taken steps to build a major program activity in this phase of rehabilitation, including employment of staff specialists skilled in psychiatric rehabilitation.

In 1964 almost 14,000 persons who have been mentally ill were rehabilitated into employment through services provided in the public program.

Many of them owe their rehabilitation to the results of rehabilitation research and training. The upsurge of interest in mental health in recent years has been in large measure responsible for well over 100 projects in this field, costing over $10 million, for halfway houses, work therapy, and screening of hospital patients for rehabilitation

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potential; outpatient counseling and hospital aftercare; and evaluation, training, and placement for emotionally disturbed persons.

The greatest obstacle to expanding services to the mentally ill is lack of specially trained personnel. One acute shortage is among psychiatrists. Considerably more hospitals have accepted the rehabilitation program. Many have used extension and improvement grants to expand their facilities and staff, and in a number of selected hospitals affiliated with medical schools, there are new academic and clinical courses on psychiatric rehabilitation. Training grants have also been used to support a variety of short-term training efforts for rehabilitation practitioners in rehabilitation of the mentally ill.

Since 1963 VRA has supported a psychiatric intern training program for counselors employed in State rehabilitation agencies. Three university departments of psychiatry associated with comprehensive hospitals have established training units. Almost 80 experienced counselors have had this specialized training since the program began.

4. Rehabilitating the blind

More than 5,000 persons were rehabilitated into employment in 1964 through the public program, only a small increase over the previous year, but a considerable accomplishment in view of the tremendous problems involved in the placement of blind persons in jobs.

Placement opportunities for blind persons in routine, repetitive machine operations once the mainstay of the program-are being reduced by automation. Counselors today must be prepared to help many blind persons into highly skilled and complex work, now widely available in many industries, but only for those who are well trained, adjusted to their disability, and flexible enough for adaptation.

One

Again, answers to these problems are being found in research. illustration of the methods being developed to help blind persons keep pace with the effects of automation is the VRA-grant support given to research at the University of Cincinnati to find ways for blind persons to participate in electronic computer operations, and to a private organization in Pittsburgh for development of techniques in applying such knowledge to actual operations.

The language program instituted at Georgetown University in Washington, D.C., a few years ago, to teach blind students Russian and German, has been highly successful, and a similar project is being estsblished at Occidental College in California to teach blind students to become linguists in Chinese and Arabic.

One important source of employment for blind persons is vending stands, operated in public and private locations under the general supervision of State rehabilitation agencies and the provisions of the Randolph-Sheppard Vending Stand Act.

The vending operation has grown consistently. In 1965 almost 2,600 stands on Federal, public, and private property did a gross business of about $60 million, with an average profit of about $4,700 to over 2,800 operators.

Another successful program for people with low vision, is the optical aids clinics in 20 States. These clinics provide services to scores of persons, whose low visual acuity has handicapped them for employment, by fitting magnification devices to increase their perception.