Highlights of Georgia's comprehensive mental retardation plan

HIGHLIGHTS OF '
GEORGIA'S COMPREHENSIVE
MENTAL RETARDATION
PLAN
GEORGIA DEPARTMENT OF PUBLIC HEALTH
DIVISION OF MENTAL HEALTH
47 TRINITY AVENUE, S, W, ATLANTA, GEORGIA 30334

HIGHLIGHTS
OF
GEORGIA'S COMPREHENSIVE
MENTAL RETARDATION
PLAN
qEORGIA.DEPARTMENT OF PUBLIC HEALTH
DIVISION OF MENTAL HEALTH
47 TRINITY AVENUE, S. W. ATLANTA, GEORGIA 30334

INTRODUCTION
A Comprehensive Mental Retardation Plan for Georgia is a document which presents in detail the problem of mental retardation in Georgia, the existing and developing programs and services for the retarded in the state, and 134 recommendations for action which will make these programs and services truly comprehensive for all retarded citizens in the years ahead. The Plan was developed by the Georgia Department of Public Health after several years of intensive study in cooperation with other departments of state government, voluntary agencies and interested citizens.
This booklet is a summary of the major findings of A Comprehensive Mental Retardation Plan for Georgia. It presents briefly the highlights of each of the nine chapters. These include discussions on: Definition, Causes and Scope of the Problem (Chapter One); State Resources and Organization (Chapter Two); Prevention (Chapter Three); Community Services and Facilities (Chapter Four); Residential Services and Facilities (Chapter Five); Supportive Programs and Services (Chapter Six); Manpower (Chapter Seven); Research (Chapter Eight); and Legislation (Chapter Nine).
By 1970, it is estimated that Georgia will have approximately 142,000 mentally retarded citizens. Every year approximately 3 percent of the babies born within the state will be mentally retarded to some degree. Georgia will need an increasing number of both state and community services to help each of these achieve his maximum potential for living.
It is hoped that those who read this booklet will be stimulated to seek additional information in the larger volume. Copies of A Comprehensive Mental Retardation Plan for Georgia may be obtained from the Division of Mental Health, Georgia Department of Public Health, 47 Trinity Avenue, S.W. Atlanta, Georgia, or from any local health department.

MENTAL RETARDATION PLANNING PROJECT STAFF
John H. Venable, M.D., Director Georgia Department of Public Health Addison M. Duval, M.D., Director Division of Mental Health Larry D. Scott Project Director

Blount C. Ferrell Information Officer
Mrs. Charles D. Center Community Organizer
Judy Blair Stenographer

James D. Clements, M.D. Consultant
Thomas McConnell, Ph.D. Coordinator

This project was supported in part by a Mental Retardation Planning Grant awarded by Public Health Service, Department of Health, Education and Welfare.
11

GEORGIA STATE BOARD OF HEALTH

Chairman

- B. W. Forester, M.D. Macon

Vice Chairman - John M. Martin, M.D. Augusta

Secretary

- J. T. Mercer, D.V.M. Athens

Harrison W. Bray Manchester
Wesley A. Carr, D.D.S. Augusta
Lee Roy Claxton, R.Ph. Griffin
William A. Dickson, M.D. Hahira
P. K. Dixon, M.D. Gainesville
John E. Garner, Jr. Milledgeville
Roy L. Gibson, M.D. Columbus
L. H. Griffin, Sr., M.D. Claxton

John D. Marshall, R.Ph. Camilla
Earl T. McGhee, M.D. Dalton
W. Frank McKemie, M.D. Albany
Lamar B. Peacock, M.D. Atlanta
Carl E. Pruett Griffin
Richard H. Smoot, M.D. Decatur
A. C. Tuck, D.D.S. Thomasville

1ll

ADVISORY PANEL TO THE DIVISION OF MENTAL HEALTH GEORGIA DEPARTMENT OF PUBLIC HEALTH

Stanley Ainsworth, Ph.D. Chairman, Program for Exceptional Children University of Georgia Athens
Honorable Luther Alverson Judge of the Fulton County Superior Court Atlanta
Mrs. Carol Bush School of Nursing Emory University Atlanta
Rives C. Chalmers, M.D. Atlanta
Frank S. Cheatham, Jr. Attorney-At-Law Savannah
Dale Clark, Director Public Affairs and News, WAGA-TV Atlanta
John T. Doby, Ph.D. Chairman Department of Sociology and Anthropology Emory University Atlanta
J. W. Fanning Vice-President for Services University of Georgia Athens

Gerald H. Holman, M.D. Chairman and Professor Department of Pediatrics Medical College of Georgia Augusta
William S. Jackson, Dean School of Social Work Atlanta University Atlanta
Irwin J. Knopf, Ph.D. Chairman Department of Psychology Emory University Atlanta
The Reverend Robert E. Lee Lutheran Church of the Redeemer Atlanta
Oliver M. Littlejohn, Ph.D. Dean, Southern College of Pharmacy Mercer University Atlanta
W. Newton Long, M.D. Director, M & I Project Grady Memorial Hospital Atlanta
W. D. Lundquist, M.D. District Director of Public Health Chatham County Health Department Savannah
Robert A. Rainer, Jr., D.D.S. McDonough
Joseph S. Skobba, M.D. Atlanta

iv

CONTENTS

Chapter One

Definition, Causes, and Scope of the Problem

1

Chapter Two State Resources and Organization .

5

Chapter Three Prevention .

9

Chapter Four Community Services and Facilities

13

Chapter Five Residential Services and Facilities

19

Chapter Six

Supportive Programs and Services

23

Chapter Seven Manpower

27

Chapter Eight Research.

31

Chapter Nine Legislation

33

Recommendations for Action (All Chapters)

36

ACKNOWLEDGEMENTS
Appreciation is expressed to the following for photographs used in this publication:
The President's Committee on Mental Retardation The Atlanta Journal National Communicable Disease Center Housing Authority, City of Atlanta Atlanta Association for Retarded Children WSB-TV The Tulsa Tribune Smith, Kline & French Laboratories

v

chapter one

DEFINITION, CAUSES, AND SCOPE OF THE PROBLEM

The American Association on Mental Deficiency defines mental retardation as:
"Subaverage general intellectual functioning which originates during the developmental period and is associated with impairment in adaptive behavior."
Very simply stated, mental retardation means that sometimes before, during or after birth something so interfered with the normal development of the individual that his learning ability, or ability to adapt, was permanently impaired. Mental retardation is usually broken down into several categories or levels of functioning. The American Association on Mental Deficiency recognizes four such groupings of retardation-mild, moderate, severe, and profound. The vast majority (88.9%) of the retarded are classified as mildly retarded. A much smaller percentage (6.2 %) are described as moderately retarded. Fewer still are categorized as severely retarded (3.5 %) and the remainder (1.5%) are profoundly retarded. Table 1 shows the maximum levels of social, educational and vocational attainment that ordinarily can be expected of retardates with different degrees of handicap.
CAUSES OF MENTAL RETARDATION The causes of three-fourths of the cases of mental retardation are unknown. Although information about the etiology of mental retardation is incomplete, a great deal is known about some factors which have a definite bearing on retardation.
Genetic Causes
Since all living organisms are the product of their genetic makeup, any alteration of the normal genetic information stored in the body's cells can have a profound effect on the development of the individual. Such alterations may cause what is described as "inborn errors of metabolism" in which the individual cannot metabolize specific foods in a normal fashion. Examples of such genetic disorders are phenylketonuria (PKU) and galactosemia. Other genetic disorders may not always be manifest, but may exist in a carrier state, so the

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disorder may be transmitted to succeeding generations as a recessive gene. Some nineteen different biochemical disorders have been associated with retardation. It is believed that at least 30 percent of those individuals whose retardation is due to medically related factors suffer from specific genetic disorders or chromosomal aberrations.
Obstetric Causes
Mental retardation resulting from damagy to the growing fetus, or newborn, can usually be related to at least one of several obstetric factors. Some of the obstetrically related causes are: poor maternal nutrition, poor or inadequate prenatal care, maternal diseases, drugs, excessive exposure to radiation during the early months of pregnancy, incompatibility between the blood cells of mother and infant, respiratory insufficiency in the infant, disturbance in the infant's blood glucose, calcium, or sodium levels, intrauterine anoxia, birth injury, and premature birth.
Pediatric Causes
Mental retardation which occurs during the later developmental period between infancy and adolescence also can be associated with several factors. Among these are mental retardation which

1

TABLE 1* Developmental Characteristics of the Mentally Retarded

Level of Retardation Mild (I.Q. 5569)
Moderate (I.Q. 4054)
Severe (I.Q. 2539)
Profound (I.Q.0-24)

Preschool Age 0-5 Maturation and Development
Can develop social and communication skills. Minimal retardation in sensorimotor areas. Rarely distinguished from normal until school age.
Can talk or learn to communicate. Poor social awareness. Fair motor development. May profit from selfhelp training. Can be managed with moderate supervision.
Poor motor development. Speech is minimal. Generally unable to profit from training in self-help. Little or no communication skills.
Gross retardation. Minimal capacity for functioning in sensori-motor areas. Need nursing care.

School Age 6-17 Training and Education
Can learn academic skills to approximately 6th grade level by the teens. Cannot learn general high school subjects. Need special education.
Can learn functional academic skills to approximately 4th grade by late teens if given special education.
Can talk or learn to communicate. Can be trained in basic self-help skills. Cannot learn functional academic skills. Can profit from systematic habit training.
Some motor development present. Cannot profit from training in self-help. Need total care.

Adult 18 and over Social and Vocational Adequacy
Capable of social and vocational adequacy with proper education and training. Frequently need supervision and guidance under social or economic stress.
Sometimes capable of self-maintenance in unskilled or semiskilled occupations. Need supervision and guidance when under mild social or economic stress.
May contribute pa,rtially to self-support under complete supervision. Can develop self-protection skills to a minimally useful level in controlled environment.
Some motor and speech development. Totally incapable of self-maintenance. Need complete care and supervision.

*A dapted from Sloan and Birch, American Journal
of Mental Deficiency. 60:262, 1955.
2

results from an infectious disease such as rubeola, commonly called red measles; accidents such as falls or automobile injuries which can cause brain damage; ingesting certain chemical substances such as lead, carbon monoxide, arsenic and a wide variety of other intoxicants can cause permanent damage to nervous tissue and subsequently cause mental retardation; sensory defects such as defective vision or hearing may cause a child to function as a retardate; and there is an increasing body of research that indicates that malnutrition may also cause permanent mental retardation.
Socio-cultural Causes
The majority of the mentally retal jed-perhaps three-fourths of them-seem not to suffer from gross organic impairment of the nervous system. Their retardation seems to stem from cultural deprivation. Damaging environmental influences are thought to include: interferences with normal stimulation during early infancy, traumatic emotional experiences in early childhood, and lack of normal experiences during the developmental pe-

riod, parental neglect, and social and economic deprivation.
SCOPE OF THE PROBLEM
In the United States
In the United States, there are approximately six million mentally retarded. At least 672,000 of these are so retarded that they cannot profit to any degree from public school programs, and the remainder will need specialized educational placement to achieve their maximum potential. Based on current birthrates, nearly 110,000 mentally retarded infants will be born each year for the foreseeable future. Mental retardation strikes twice as many individuals in the United States as blindness, polio, cerebral palsy and rheumatic heart disease combined. Only a small percentage of the retarded, however, require residential care. A 1964 census of state institutions indicated that nearly 200,000 retardates are now being served in these facilities at a cost exceeding 350 million dollars per year.
In Georgia
It is estimated that today about 130,000 persons -3 percent of the state's population-are mentally retarded to some degree. Most of these-89 percent-are classified as mildly retarded. A much smaller percentage-6 percent-are classified as moderately retarded. Fewer still-about 3~ percent-are described as severely retarded, and a very small percentage-l ~ percent-are classi.tied as profoundly retarded. By 1970, it is estimated that there will be 142,000 mentally retarded individuals in Georgia, with varying degrees of mental disability. Of these:
126,000 will be mildly retarded. They can learn to do productive work. Most can learn elementary school subjects.
9,000 will be moderately retarded. They can learn to care for themselves and do simple, routine tasks.
7,0.0~ will be severely a~d profoundly retarded.\ ThIS IS the group who Will require constant care and supervision.
These figures show the magnitude of the problem -one of the foremost health, social, and economic problems in Georgia.

3
\

chapter two

STATE RESOURCES AND ORGANIZATION

Three departments of state government are more actively involved in providing programs and services for the mentally retarded: the Georgia Department of Public Health, the State Department of Education, and the State Department of Family and Children Services. In addition, the state's volunteer associations for retarded children-most of whom are members of the Georgia Association for Retarded Children-play an important role in providing and obtaining services for the mentally handicapped. In several areas of Georgia, chapters of the Georgia Association for Mental Health have also assisted in providing community services for the retarded.
The Georgia Department of Public Health
The Georgia Department of Public Health was designated by Governor Carl Sanders as the responsible agency for the development of A Comprehensive Mental Retardation Plan for Georgia. This came about as a result of President John F. Kennedy's President's Panel on Mental Retardation, which in 1962 issued a report emphasizing the responsibilities of the states for the implementation of an effective national program to combat mental retardation. In 1963 legislation was passed by the Congress that, besides authorizing the various state governors to designate agencies to create mental retardation plans, also appropriated over two million dollars to be used by the states for such planning. In Georgia, the State Health Department vested its planning responsibility in its Division of Mental Health. The Division of Mental Health has three branchesthe Community Services Branch, the Hospital Services Branch, and the Training and Research Branch. Their responsibilities are outlined below:
The Community Services Branch develops, promotes, and coordinates community mental health and community mental retardation services. Future plans call for similar responsibilities in alcoholism programs. The Hospital Services Branch coordinates and develops residential facilities for the mentally retarded and the mentally ill. Residential facilities under this Branch include Central State Hospital, Gracewood State School and Hospital,

Southwestern State Hospital, and the regional hospitals presently under construction and to be constructed throughout the state. In the future it will also have responsibilities for residential programs in alcoholism.
The Training and Research Branch is responsible for those facilities with programs that are primarily concerned with manpower training and development as well as research. Residential care is also included in these programs. Included in this Branch are the Georgia Mental Health Institute and the Georgia Retardation Center.
The Division of Physical Health has six Branches, two of which have programs related to mental retardation. These are Health Conservation Branch and Dental Health Branch.
The Health Conservation Branch's Maternal Health Service, recognizing that high maternal and infant morbidity and mortality rates and high premature rates can be associated with mental retarc4tion, assis~ in red~cing th~se hazards by helpin~ establIsh family planrung services and maternal clinics in county health departments.
The Branch's Child Health Service prom~tes
well-child clinics in county health departments, provides consultation in PKU screening programs, conducts hearing and vision screening tests in schools and similar activities designed to improve the health of all children.
The Dental Health Branch is concerned with the prevention and treatment of oral disorders. Dental health education programs are directed toward a number of groups including educators, dentists, parents, community organizations, and school children, including the mentally retarded.
A recent survey conducted by the Branch revealed that Georgia dentists feel the need for special training in dentistry for the mentally retarded and generally feel they do not' have the proper facilities in their offices for serving this group at present.
The Division of Medical Care Administration has three Branches, one of which is the Medical Assistance Branch composed of Crippled Children's Service and Medicaid Service.

5

The Crippled Children's Service provides medical, nursing, social and psychological aid through clinics. for children who have a variety of crippling conditions, some of whom may be mentally retarded.
Medicaid Service is responsible for administering the Medical Assistance Program, a federal! state funded program to insure that medical care of high quality is readily available to those Georgians unable to pay for it. Eligible mentally retarded individuals in nursing homes or stateoperated institutions can have part of the cost of their care paid through Medicaid.
The Health Department's Division of Epidemi-
ology has two Branches-the Epidemiologic In-
vestigations Branch and the Laboratories Branch.
Each has limited responsibilities in the area of
preventing mental retardation.
The Division's Epidemiologic Investigations Branch is concerned with the occurrence of epidemic diseases of all kinds. The Branch studies outbreaks of diseases like German measles and red measles, both of which have been associated with mental retardation.
The Laboratories Branch analyzes blood and fluid specimens for local health departments in such areas as Rh determination and tests for syphilis. These procedures help identify patients who are in high risk groups in terms of conditions which may lead to the birth of a mentally retarded child.
The Department's Office of Local Health, which
coordinates the work of regional, district and
county health departments throughout the state,

plays an important role in making public health services available to all citizens. Many community programs, like those for the retarded, receive state funds through these local health departments.
The State Department of Education
The State Department of Education is the official state agency responsible for planning public school special education programs and vocational rehabilitation services. Within the Department, the Division for Exceptional Children and the Office of Vocational Rehabilitation ServiceS have staff members with responsibility for developing and coordinating education programs for the mentally retarded. The Departmental objective is to provide a public educational program for every handicapped school-age child, whenever his needs cannot be met within the framework of the usual school program. This includes children who suffer from mental retardation, physical disability, emotional disturbance and communicative disorders. Vocational rehabilitation is a program designed to restore people to their maximum physical, vocational, social and economic' usefulness. Mental retardation usually constitutes a vocational handicap that makes the individual eligible for vocational rehabilitation services. In Georgia, vocational rehabilitation is administered by the Assistant State Superintendent of Schools for Vocational Rehabilitation Services. This agency's Division of Spec.ial Disabilities has

:~:
6

a responsibility in the areas of mental illness, behavioral disorders, and mental retardation. The Division assigns staff members to school systems, institutions, and facilities, where they work with the teenage and young adult mentally retarded. General counselors also work with the mentally retarded who are not in specialized programs.
The State Department of Family and Children Services
This Department, through its Division of Social Administration and Division for Children and Youth, provides services which affect the lives and well-being of many retarded children. The Division of Social Administration promotes throughout the state the Food Stamp Program, which provides food for needy families at low cost. The Division for Children and Youth implements a number of statewide programs which may also benefit the mentally retarded, including: protective services for neglected, abused or exploited children; licensing services for day care centers; homemaker services; foster boarding services; adoptive services for children whose normal parents are deceased or unable to care for them; court services for young offenders; and services for unmarried mothers. The Department also administers Youth Development Centers for juvenile offenders across the state.
The Georgia Department of Labor
This Department's Employment Security Agency, in addition to administering a program of job insurance for unemployed workers, administers job placement programs for youth, handicapped, and older workers. The Agency works with the Office of Vocational Rehabilitation Services to place retarded adults in suitable positions.
The State Board of Corrections
Correction programs must necessarily take into account the fact that many inmates in the state prison system function in the retarded range of intelligence. Because of this, the Georgia Industrial Institute, a facility for young criminal offenders at Alto, Georgia, operates a program which includes screening, testing and work evaluations for a limited number of inmates. The service is provided in cooperation with the Office of Vocational Rehabilitation Services. Other diagnostic facilities are being developed to allow more accurate control and preJiction of the inmate's

rehabilitative program.
The Georgia Association for Retarded Children
This voluntary association is dedicated to improving the general welfare of all retarded children and adults. Local units of this voluntary association are active in providing services to the retarded in many communities. Although the stated philosophy of both the National Association for Retarded Children and the Georgia Association for Retarded Children is to obtain rather than to provide services, it has been necessary to do the latter in many instances. Of the 41 existing community training centers serving the retarded, most of which are affiliated with G.A.R.c., only two receive substantial support from public agencies.
The American Association on Mental Deficiency
The most important and best known professional organization primarily concerned with the field of mental retardation is the American Association on Mental Deficiency. This is a multidisciplinary organization whose membership represents many professions working with the mentally retarded. The Association holds annual conventions, sponsors special conferences and publishes the American Journal of Mental Deficiency and Mental Retardation. These publications carry professional articles on topics of current interest and report research activities in mental retardation. The Southeastern American Association on Mental Deficiency is the regional affiliate of the parent organization and includes Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, Puerto Rico, South Carolina and Tennessee. The SEAAMD has a membership of over 800 persons.
Need for Interagency Coordination
A successful campaign to combat mental retardation in Georgia is the responsibility of every citizen. In order to create the proper environment for the completion of the many tasks outlined in this summary and A Comprehensive Mental Retardation Plan for Georgia, coordination of responsibilities and efforts must be established. This coordination must include all state and local agencies as well as private and volunteer groups-indeed all Georgians. There is a great need for a coordinating body, such as an Interagency Council on Mental Health and Mental Retardation, which could coordinate every phase of programming in the field of mental retardation among all interested groups.

7

chapter three

PREVENTION

In some instances, mental retardation can be prevented. Some experts estimate that about half of all new cases of mental retardation each year could be prevented, if existing preventive measures could be applied to the entire population. The following are some of the ways mental retardation could be prevented with existing knowledge.
Prevention of Genetically Related MR
Mental retardation due to genetic disorders such as phenylketonuria (PKU) can be prevented by the use of screening techniques employed soon after birth. If PKU is detected at birth, a corrective diet can be prescribed for the infant; irreversible brain damage can then be prevented. In Georgia, a state law passed in 1966 requires that every newborn be given an appropriate screening test for PKU no sooner than 48 hours after milk feeding has begun and no later than 30 days after birth. At present, it is estimated that only about 60 percent of all newborns are being tested. However, this activity is expanding rapidly, and. proper dietary control to prevent this form of mental retardation probably will be possible with all neonates within the next few years. Mental retardation due to defective genes can also be prevented, in theory at least, by genetic counseling. At present, facilities for this sophisticated service are very limited; in the future this service is expected to become more available for parents of a retarded child who want to assess the danger of having another child who might also be retarded.
Prevention of Obstetrically Related MR
Many cases of mental retardation associated with prematurity, damage to the fetus or the newborn could be prevented by careful obstetric care, before, during and after birth. Every expectant mother should receive good general prenatal care by a physician throughout her pregnancy with close attention to such factors as nutrition, drug therapy and exposure to irradiation. The services of a hospital should be utilized for delivery.

Prevention of Pediatrically Related MR
Some cases of mental retardation occuring during the later developmental period between infancy and adolescence can also be prevented. Retardation resulting from the complications of certain communicable diseases, such as red measles, can be prevented by immunization of the entire susceptible population against this disease. A measles eradication project is currently being conducted by the Georgia Department of Public Health throughout the state. Since this project began in 1966, about 200,000 preschool-age children have been vaccinated by public and private health services. Another 100,000 preschool-age children have already contracted the disease and, therefore, require no immunization. An additional 280,000 children in this age group, and up through the second grade, should be immunized. The project, hopefully, will help to accomplish this task over the next year.

9

Intensive accident prevention programs could dramatically reduce mental retardation due to brain damage resulting from accidental poisonings. Children frequently ingest a great variety of common household cleaning products or large quantities of drugs with disastrous results. Permanent damage to nervous tissue may result from lead, carbon monoxide, arsenic and many other intoxicants. The primary source of lead poisoning

is dried paint, often found peeling off walls, doors and window sills in deteriorating houses. Children sometimes chew and digest this peeling paint causing both mental and physical harm. Educational programs to alert parents to these dangers are urgently needed. Another preventable cause of mental retardation is accidental head injuries which cause brain damage. About one-third of all persons injured in accidents are children under 15. About 17 million children are accident victims each year in the United States. Many of these injuries are to the head, especially those which occur in an automobile accident. These could be largely eliminated if every automobile were equipped with seat belts for every passenger, adults and children. Functional retardation-retardation that apparently has no basis in nervous system defect-is sometimes caused by defects in vision or hearing. This kind of retardation can be prevented by examination of young children who appear to be retarded to determine if they are able to see and hear normally. Proper nutrition should be available to every expectant mother and growing child. ~xpectant mothers need to eat the proper food to insure that the growing fetus is properly nourished; the growing child needs good nutrition to assure the proper growth of his nervous system, and to give him resistance to debilitating childhood diseases.

10

Prevention of Socio-Culturally Related MR
Mental retardation can be caused by unstimulating environments which do not provide children with learning experiences. For example, children who grow up in a home where the use of language is minimized tend to enter school with a verbal handicap. Socio-cultural retardation is especially prevalent in slum neighborhoods where the general level of education is low and where children have few, if any, experiences which stimulate or develop their mental capacity. If Georgia is going to prevent retardation caused by inadequate environments, it will first have to win the battle against poverty itself. This is a worthy aim, for it is estimated that three-fourths of all cases of mental retardation originate in disadvantaged neighborhoods.
It is important that every child be wanted by his parents and not viewed as a burden to the family. Family planning programs are expanding rapidly in Georgia through the joint efforts of both the Georgia Department of Public Health and the Department of Family and Children Services. Efforts are being made to provide parents with a better understanding of sexuality and the role of reproduction in married life. Moral considerations are struggling to keep pace with technical progress in birth control. Few disagree, however, that family planning, particularly among the indigent, can play a part in preventing the birth of children who through deprivation and social rejection may become retarded. Because early stimulation is important to later development, another measure which would reduce socio-cultural mental retardation is the upgrading of staff and programs in existing day care centers for normal and mentally retarded children. A program that is well planned is more than a baby-sitting service and should provide stimulating experiences, group activities, training in simple skills and supervised recreation. An expansion and upgrading of the programs in these centers in Georgia is very much indicated. To provide stimulating environmental experiences for culturally deprived children, the Federal Government through the Office of Economic Opportunity sponsors Operation Head Start, a national project aimed at preschool-age children from the lower socioeconomic classes. The program is massive in scope, attempting not only to educate children but also to meet special needs in areas of

health and social services. In Georgia, during the summer of 1967, 33 communities enrolled 13,649 underprivileged children in Head Start. Evaluations of this program have been encouraging and indicate that the intellectual achievements of deprived children may be increased by these preschool training programs. The State Department of Education believes that the establishment of kindergartens in every public school system would also have a marked effect in reducing mental retardation due to social and cultural factors. They are working actively to include kindergartens as a part of the educational program for all Georgia children.

11

chapter four

COMMUNITY SERVICES AND FACILITIES

Community services for the retarded include all specialized services of a non-residential nature, that is, services which are provided primarily during the day and do not require a retardate to live away from home. Such services help the family maintain its unity and capitalize on the availability and affection of family members to assist in training and supervision. For the majority of the mentally retarded, community services are more appropriate forms of treatment than longterm institutional care. It is estimated that no more than 5 percent of the mentally retarded in Georgia are in need of institutional services. The other 95 percent probably can be served best by a variety of community programs providing a continuum of care and service. Based on an estimated 142,000 retarded in Georgia by 1970, nearly 135,000 could benefit from one or more community service programs during their lives. Most of this number, about 125,000, will be mildly retarded and could profit from appropriate special education and vocational rehabilitation programs. Other needed community programs include day care and training programs, adult activity centers, sheltered workshops, family counseling services, and diagnostic and evaluation services.
Special Education in Public Schools
As public schools are presently organized in Georgia, their primary educational responsibility is for children between the ages of six and seventeen. Total educational planning for the mentally retarded, however, should include programs at the preschool and postschool ages as well.
Preschool Educational Programs
Based on population estimates, there will be approximately 17,100 preschool-age mildly retarded children in Georgia by 1970. Like normal children this age, these children need such things as exercise, group stimulation, language instruction, affection, success experiences, training in social habits, appropriate toys. and opportunities to satisfy normal curiosity about nature and the environment. Preschool educational programs should

be designed to meet the individual needs of each child. School Age Special Education Programs Special education programs in the public schools reach a larger number of retarded persons who have the potential for becoming responsible citizens and engaging in productive employment than any other single service. By 1970, Georgia will have approximately 30,200 school-age educable mentally retarded children and 6,050 trainable mentally retarded who could benefit from special education classes. Programs for the educable attempt to provide basic educational and social adjustment skills in the early years with increasing emphasis on vocational training as the child grows older. For the trainable child, emphasis centers around instruction in oral language and communication, sensory and physical development, selfcare, social adjustment and economic usefulness. During the 1966-67 school year, Georgia's public school system provided 657 special education classes for the educable mentally retarded and 28 classes for the trainable. By 1970, the state will need 2,500 classes for these mentally retarded. Currently, Georgia is meeting only about onethird of the need. One important factor limiting the growth of special education classes has been the shortage of trained teachers and administrative personnel. There is also a critical need for coordinators and consultants for state and local mental retardation programs. School psychologists are limited too, and even though there will be approximately 60 of these specialists throughout the state by 1970, the demands for their services will far exceed the supply. Postschool Age Special I:<Iucation Programs Beyond the age range served by the public schools, educational programs should be developed to as'sist the mentally retarded adult throughout life. Vocational and educational demands will change and the mentally retarded will need opportunities to learn new skills and relearn old ones. Cooperative planning between state and local agencies will be needed to assist the retarded through these periods of transition.

13

Vocational Rehabilitation Programs
Public school special education programs go hand in hand with programs of vocational rehabilitation. The State Education Department's Division for Exceptional Children and the Office of Vocational Rehabilitation Services sponsor cooperative programs with local school systems through which educable mentally retarded in secondary classes participate in work-study curriculums. This program includes adjustment training in various jobs at school or in the community for a portion of the day. Upon completion of the program, students are given assistance in finding full-time employment.
In addition to the public school program, the Office of Vocational Rehabilitation Services serves

the mentally retarded through a variety of other programs. These include vocational appraisal clinics, work laboratories, pre-vocational centers, training stations, workshops, rehabilitation residences and foster homes. A number of other vocational rehabilitation programs are conducted in institutions, such as their cooperative program for residents at Gracewood State School and Hospital. During 1966-67, more than 5,000 mentally retarded were assisted by the Office of Vocational Rehabilitation Services and 691 became gainfully employed. By 1910, the number of mildly retarded adults in communities throughout Georgia will reach approximately 77,400. A substantial number of these will require vocational rehabilitation services if they are to function in a relatively independent fashion in the community.

14

Day Care and Training Services
Day care and training programs are designed to serve the severely retarded school age child who cannot be included in a public school educational program. They also serve other retarded children whose emotional, physical or sensory handicaps make them ineligible for special education classes. Emphasis in these programs is not on learning academic materials, but on self-help skills needed in everyday living. Community training centers of this type will be needed for approximately 600 severely retarded school-age children by 1970. There are approximately 41 community day programs for the retarded in Georgia today. These programs serve about 1,000 individuals and include day care and training services, adult activity centers, and sheltered workshops. Most of these programs were begun by volunteer groups of parents who were unable to obtain public services. The majority of these centers have been in operation less than a decade, function with limited professional consultation or guidance, and often without adequate funds. In general, 'while the staffs are extremely dedicated, they lack adequate training for their jobs and standards for operation of these centers are not specified. It is estimated that these centers are serving only a small percent of the total number needing this community service. Adult activity centers, for instance, are badly needed to serve an estimated 1,600 severely

/ retarded adults who are capable of sheltered community living. Programs in these centers focus on teaching simple skilIs appropriate to adult behavior. They can be most effective in delaying institutionalization. Even if residential care is finally necessary for these teenagers and adults, their experiences in these activity centers can help them receive the maximum benefits available from institutional life.
Sheltered workshops-protected work settings designed as places of non-competitive employment for the moderately and mildly retarded adultsare also needed in Georgia communities. In such programs the retarded learn simple, repetitive

15

skills which are applied to practical production tasks. Usually they are paid a wage for their labor, a factor which proves to be highly motivating. Georgia currently has only five such workshops, but by 1970 it is estimated that some 4,300 moderately retarded adults could benefit from relatively permanent placement in this community activity.
Family Counseling Services
Another community service which should be more generally available to the parents of the retarded is family counseling. Discovery by parents that their child is not developing normally and is not progressing at the rate of other children is usually a shocking and frightening experience. Counseling can assist the family in facing their situation and in coping with the problems involved. They need psychological support and reassurance. They need guidance and help in understanding the diagnosis, the kind of training program best suited for their child, and the importance of family support for his maximum development. Community oriented family counseling services are most important to parents of preschool age moderately and severely retarded children and to parents of profoundly retarded individuals of all ages. By 1970, communities will have approximately 1,800 retarded persons in these groups. In general, counseling services should be rendered by an experienced person such as a physician, psychologist, social worker, teacher or nurse. The sooner this servic~ can be given, the more likely it is to be meaningful and long lasting.

Diagnostic a"d Evaluation Services For each mentally retarded person in Georgia to have the opportunity to develop his maximum physical and mental potential, it is essential that his mental retardation be diagnosed as early as possible. Early identification should be not only the responsibility of the family, but also the responsibility of all public and private agencies and professionals rendering services to children. This particularly applies to those who deal with preschool children. Under ideal conditions, it probably would be useful and desirable for every retarded individual to be evaluated thoroughly from three to five times during his lifetime. This ideal probably will not be attainable for many years to some. A more practical approach would probably be to begin planning these services on the basis-of the number of retarded being born each year. While this approach disregards the backlog of cases needing service, it appears to be the only way to make long-range planning feasible. Based on the 1966 birthrate, approximately 94,500 live infants will be born in Georgia in 1970, of which 3 percent or about 2,800 will be mentally retarded. If each of these will require a minimum of three evaluations during his lifetime, the total annual caseload will be approximately 8,500. Diagnostic and evaluation centers should be planned to meet this need. It is estimated that a minimum of 10 to 20 diagnostic and evaluation centers are needed to meet the minimum need for this service. Only three diagnostic and evaluation clinics are now in oper-

16

ation in Georgia financed by federal funds from the Children's Bureau of the U. S. Department of Health, Education, and Welfare. These were developed by the Maternal and Child Health Servicc of the Georgia Department of Public Health. They are located in Muscogee County, DeKalb County and Chatham County. Each serves the retarded from several counties, but the services are limited to certain age groups and are not available to all who need them. In addition to these clinics, the Evaluation and Rehabilitation Center at Gracewood State School and Hospital performs evaluations for retarded outpatients from all over the state. Central State Hospital also provides evaluation for its residents, some of whom are mentally retarded. Other existing sources for these services include limited psychological testing through county health departments, general hospitals, universities, mental health clinics, local associations for retarded children and psychologists in private practice. To meet the need for additional diagnostic and evaluation services for the mentally retarded, the Georgia Department of Public Health has developed plans for the construction of additional facilities. Three types of clinics are envisioned: 1) community based clinics operated within a comprehensive system of community mental health services; 2) clinics which would be operated as part of the regional state hospitals, generally for preinstitutionalization programming; and 3) specialized clinics for the most complex cases operated in conjunction with the state's two medical schools. In this category, one such center is already in operation at Gracewood State School and Hospital and is affiliated with the Medical College of Georgia. The Georgia Retardation Center being constructed in the Atlanta area will be affiliated with Emory University School of Medicine. Programmed in the Center are extensive facilities for diagnostic and evaluation services. Other Services Although the Department of Family and Children Services is not charged with any specific respons:bility for providing services to the mentally retarded, a number of their services often involve them with the mentally retarded and their families. These include: protective services, day care services; homemaker services; foster boarding services; adoption services; juvenile delinquent services and the services of the Youth Develop-

ment Centers. Protective Services-Protective services are defined as those specialized social services in the interest of children who are neglected, abused or exploited. The mentally retarded often live in families in which there are feelings of hostility and frustration due to a lack of understanding of their special needs and limitations. Casework services can help families understand these problems and their reactions to a retarded child or sibling. Guidance can also be given to community resources to help them deal with their situations. Day Care Services-Licensing day care centers for children is a n;sponsibility of the Department of Family and Children Services. They also inspect and license day care and training centers for the mentally retarded when these centers apply to the Georgia Department of Public Health for participation in their purchase of care and services plan. Foster Boarding Services-Foster boarding service is given by foster parents on a cost-of-care basis to children who are unable for some reason to live in their own homes. While there are no foster homes expressly selectcd and approved for retarded children, the Department of Family and Children Services has been successful in placing many children with l.Q.'s of 70 or less needing this specialized service. Adoption Services-Both public and private agencies are finding it difficult to locate prospective adoptive parents for retarded children. However, the Department of Family and Children Services is now conducting a special project to locate permanent homes for children with a variety of handicapping conditions including mental retardation. Juvenile Delinquent Services-As of July, 1967, 157 counties in Georgia had staff available to make social studies to aid the juvenile court in making decisions and plans for youthful offenders. Many of these young people are the mentally retarded who have been led into delinquent acts by others or who live in communities where supervised leisure time activities are limited. They often are referred to the Youth Development Centers by the juvenile courts when they become community management problems. Youth Development Centers-The services of the Youth Development Centers, administered by the Department of Family and Children Services, are discussed in the chapter "Residential Serviccs and Facilities. "

17

chapter five

RESIDENTIAL SERVICES AND FACILITIES

Residential services and facilities are designed to provide 24-hour care and training for retardates who need certain specialized services that cannot be provided in the communities in which they live. The following is a brief description of existing and developing residential facilities operated by the Georgia Department of Public Health, private residential programs, and the need for improved services for the mentally retarded residing in correctional institutions. Gracewood State School and Hospital Gracewood State School and Hospital is at present the only publicly supported residential facility designed specifically to serve Georgia's mentally retarded. The institution provides care and training for nearly 2,000 mentally retarded individuals from all over Georgia, and employs a staff of approximately 1,100. Routine medical and dental care, psychological or psychiatric consultation, academic or educational services, and recreational and religious programs are available to residents. Vocational rehabilitation programs are provided through a cooperative agreement with the Office of Vocational Rehabilitation Services. These represent only a few of the many programs now in operation. In addition to services available to residents, limited out-patient services, such as diagnostic, evaluation and rehabilitation, are being provided through the Evaluation and Rehabilitation Center. Gracewood also provides a variety of educational and training programs for its employees, medical and nursing students, and other special interest groups as well as information programs for the general public. The professional staff at Gracewood is actively engaged in a number of research projects related to the training and rehabilitation of the retarded. A number of them have published scientific articles concerning their work. Because of serious overcrowding at Gracewood, future plans call for reducing the number of retarded served by this institution to about 1,400. This action cannot be taken, however, until about 1970 when additional residential facilities become available.


Central State Hospital Central State Hospital at Milledgeville, the largest of the state's tax-supported institutions for the care and treatment of the mentally ill, also cares for about 1,750 mentally retarded individuals. The hospital has admitted through the years a number of individuals who were either mentally retarded or were suffering from a combination of mental retardation and emotional disturbance. In 1965, the hospital population was grouped into treatment units to provide a higher quality of services. Patients were grouped in one of several waysby geographical areas of county residence, by chronic illness, and by mental ability. The present program of services being developed for the hospital's retarded patients is similar to that offered residents at Gracewood State School and Hospital. Southwestern State Hospital Southwestern State Hospital is made up of two units, one at Thomasville and another at Bainbridge. Each is providing services for both the mentally ill and the mentally retarded. The Thomasville facility is being used for ambulatory mentally ill and mentally retarded patients between the ages of 18 and 60 who appear to need longterm care. The Bainbridge facility is serving residents between the ages of 25 and 55 who require

19

only supervised living facilities. Although the residents are classified as chronically mentally ill and/ or mentally retarded, stress is being put on reevaluation, retreatment, resocialization and rehabilitation. The hospital's two facilities now serve about 400 mentally r,etarded patients. When in full operation, it will serve approximately 520 mentally retarded in a total population of some 1,200. Georgia Retardation Center The Georgia Retardation Center, now under construction in DeKalb County, will provide residential care for 1,000 mentally retarded. It will have a 40-bed branch at the University of Georgia in Athens. In addition to residential care, this facility will serve as the state's primary location for training of professional personnel and research in mental retardation. It will be affiliated with five colleges and universities and 28 departments within these institutions to provide clinical experience for stu-

dents recelvmg academic training in mental retardation. Construction was begun in the fall of 1966. It is scheduled to admit patients in the fall of 1969. Regional State Hospitals Regional state hospitals, now under construction or being planned, will also provide residential care in some cases for the retarded. Each of these hospitals will provide services for mentally ill adults and children, individuals suffering from alcoholism and other addictions, geriatric patients and mentally retarded individuals from a specific geographical area. Now under construction are hospitals in Atlanta and Augusta. Funds have been allocated for construction of a third hospital in Savannah. Tentative plans are in progress for construction of hospitals in Gainesville, Columbus, Albany, Rome, and Macon. The Georgia Regional Hospital at Atlanta will have 120 beds for non-ambulatory severely and profoundly re-

20

- . ~ ..~ .
,..., .... ,

tarded. The Georgia Regional Hospital at Augusta, because of its proximity to Gracewood, will not offer services to the retarded. Each of the other regional hospitals will have 60 beds for the retarded.
Other Residential Facilities
Private Residential Facilities-There are only three known facilities in Georgia providing private residential care for the retarded. All three are located in the vicinity of Atlanta and serve a relatively small number of individuals. Nursing Homes-The number of mentally retarded persons in private nursing homes in Georgia is not known. A 1963 survey of 167 nursing homes indicated that 77 admit mentally retarded patients and 69 do not. Twenty-one homes did not respond to the survey questionnaire . Correctional Institutions-A percentage of Georgia's mentally retarded can be found among alcoholics in city and county jails, among the inmates of correctional institutions, and the Youth Development Centers. No significant study has been made concerning the extent of mental retardation among chronic alcoholics. However, a few years ago, the Emory University Department of Psychiatry conducted a research program involving 6,000 chronic alcoholics. The incidence of mental retardation was ascertained along with other factors in a 10 percent sample. Some 50 percent were found to be mentally retarded. No effort was made to determine whether the retardation was due to organic factors or resulted from cultural deprivation. In 1965, a survey was conducted among the 3,000 adult male offenders at the Georgia State Prison at Reidsville to determine how many inmates were

mentally retarded. A 10 percent random sampling of the population was administered individual psychometric tests. The survey seemed to indicate that about one-third of the total prison population functioned in the retarded range, possibly due to lack of intellectual and environmenal stimulation during the developmental years. A similar survey was conducted at the Georgia Industrial Institute at Alto, a correctional institution for juvenile offenders. From the 10 percent sampling, it was estimated that one-third of the Caucasians and one-half of the Negroes in this institution also function in the retarded range of intelligence. Georgia also has Youth Development Centers for juvenile offenders administered by the State Department of Family and Children Services. These are located in Atlanta, Augusta and Milledgeville. Plans are being made for six additional regional centers to be located in Waycross, Sandersville, Rome, Augusta, Gainesville and Albany. These new centers will be designed to accommodatein addition to regular juvenile offenders-mentally retarded adolescents who have become community management problems. Group intelligence tests were administered in the three existing Youth Development Centers to determine the extent of the mental retardation problem. Some 748 young offenders participated in these tests. Results indicated that 419 (56%) had normal intelligence (LQ. above 80); 283 (38%) were mildly retarded or borderline (LQ. between 60 and 80); and 46 (6%) were found to be retarded to an even greater degree (LQ. below 60). These figures indicate the seriousness of the retardation problem in these Centers and emphasize the need for special programs.

21

chapter six

SUPPORTIVE PROGRAMS AND SERVICES

Although the foundation of a comprehensive plan for the retarded must be based upon the development of adequate community and residential facilities, such programs must also be augmented by a variety of supportive services and activities. Three such supportive programs are public information and education; recreation, physical education and leisure time activities; and spiritual guidance. Public Information and Education Well-planned programs in public information and education can accomplish a great deal in creating public understanding and awareness of the needs of the mentally retarded. These programs can take many forms, each designed to reach a particular audience. For example, in attempting to inform the public as a whole, media such as newspapers, radio or television would probably be the most appropriate. In other instances, face-to-face communications through seminars, panel discussions and the like are more appropriate. Still other groups can best be reached through printed materials such as pamphlets, brochures, and articles in professional journals. The most effective public information and education programs are those which have been carefully planned as to the goal to be attained, the audience to be reached, and the best methods to reach them. Information on mental retardation and the various programs and services being provided for the retarded can be secured from many agencies of state government and from the voluntary agencies as well. The Georgia Department of Public Health, the State Department of Education, the State Department of Family and Children Services, the Georgia Recreation Commission and the Georgia Association for Retarded Children all have informational materials available and can provide speakers for groups interested in the details of existing and planned service programs. Each has organizational units in communities throughout the state for easy accessibility in acquiring information. Since the ultimate success of mental retardation programs depends upon public awareness of the needs, legislative interest in providing

funds and professional cooperation in providing services, it is vitally important that concerned public and private agencies in Georgia organize and execute public information and education programs about mental retardation.

23

Recreation, Physical Education and Leisure Time Activities The mentally retarded have the same needs for recreation and physical education as normal people. Because they have more leisure time than most individuals, supervised, well-planned recreation programs are essential in the development of comprehensive state and local services. The activities making up a broad recreational program will vary in complexity with the level of retardation of the participants and will take into consideration the presence of other physical handicaps as well. The importance of these services is underscored by the need to help the retarded learn to use their leisure time wisely and in socially accepted ways. Unfortunately, many public recreation agencies have been slow to include the retarded in their programs because of inadequate staff preparation and lack of experience in working with the mentally retarded. To help correct this situation, the Georgia Recreation Commission has conducted a number of statewide training programs to assist recreational personnel and others working with the retarded in planning and conducting programs to include this group. Since these training programs were initiated, several local recreation agencies have begun activities for the mentally retarded.
~~~

Spiritual Guidance Religious groups can provide some of the most important community programs for the mentally retarded. Many of these groups sponsor day care and training services for the retarded, while others provide recreational programs or special classes in religious instruction for the retarded. Religious groups can help create community awareness of the problems and needs of the retarded. They also can be a vital source of volunteers to work in community programs. In addition, pastors, priests and rabbis can offer moral support to families of the retarded and sometimes can advise them on problems related to retardation. Information and education programs on the role of religious organizations in serving the mentally retarded should be promoted through national, and state religious organizations as well as through local congregations. Many of these groups are already developing programs and materials for the retarded. Similar activities need to be fostered among each of the religious faiths.

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chapter seven

MANPOWER

Programs for the prevention and treatment of mental retardation have been seriously limited over the past decade by a shortage of trained professional manpower. Three major factors have contributed to this shortage: 1) increased demand for professional services in retardation, 2) a lack of available training facilities, and 3) limited student interest in working in this field. Just as in every other state, Georgia is faced with a shortage of personnel which can hamper seriously the expansion of existing programs and the development and implementation of new programs. This manpower situation is likely to become more critical in the immediate future and will remain severe for some time. The problem is accentuated further by the general lack of training facilities within the state, and the total absence of facilities for training in some specialties. Existing educational facilities are currently inadequate to supply the needs of the state for professionals in the field of mental retardation. Priority should be given to expanding present training programs and developing new programs where none exist.
Physicians
The number of physicians needed to meet the increasing demand for services throughout the country is extremely low. In Georgia, there are 107 physicians per 100,000 persons; this compares unfavorably with the national average of 142 physicians per 100,000 persons. Since the need for physicians in all specialties continues to grow, there is little likelihood that the physician-citizen ratio will become more favorable in the near future. On the other hand, despite its general standing in relation to physicians as a group, the state is slightly above the national average in the number of pediatricians and only slightly below the national average for obstetricians and gynecologists. These specialties are closely involved in the prevention and treatment of mental retardation. Alleviating the shortage of medical personnel will take a number of years. Future planning may see the development of programs to train paramedical personnel to assume some of the tasks now being performed by physicians. Certainly the state's

two medical schools-Emory University School of Medicine and the Medical College of Georgiawill not, in the immediate future, be able to supply the demand for doctors; neither school is able to admit but a small fraction of the total number of applicants to the freshman class annually. The Medical College admits 100 students each year from a total of 300 applicants; Emory's medical school admits 72 students annually out of some 900 applicants.
Psychiatrists
Psychiatrists also are scarce in Georgia. The state's ratio of psychiatrists to population is about one to 30,000; the national average is closer to one for every 11,000. The state's five facilities offering residency training programs, most of which have developed during the past 15 years, already have made a significant contribution to the number of Georgia psychiatrists. These facilities are the Medical College of Georgia in Augusta, Emory University School of Medicine in Atlanta, the Lenwood Division of the Veterans Administration Hospital in Augusta, Central State Hospital at Milledgeville, and the Georgia Mental Health Institute in Atlanta. Training will also be available at the Georgia Retardation Center.
Psychologists
There are presently some 228 psychologists employed in Georgia. Approximately half are functioning in a clinical capacity and a majority are located in the larger metropolitan areas. It is estimated that by 1970, the Georgia Department of Public Health alone could utilize about 135 fulltime psychologists as compared with the 95 presently employed. There are now ony five certified school psychological workers employed by public school systems in the state and the need will increase to 95 by 1970. In view of the growing need for services andAhe expanding mental health and mental retardation prozrams in the state, training facilities for psychologists are seriously inaqequate. Emory University, The University of Gtorgia, Georgia State College and Atlanta University offer training pro-

27

grams through the doctoral level. Approved internships and post-graduate training in psychology are being provided through Central State Hospital and the Georgia Mental Health Institute. The Georgia Retardation Center, when completed, will also offer training in psychology. However, these training facilities still will not be able to meet the demands for psychologists in the foreseeable future. The pressing needs suggest that it may be desirable to train and utilize personnel below the master's and doctoral level to perform some of the less complex functions of the psychologist. Social Workers Social workers often can assist retardates in their everyday social interactions by serving as intermediaries and by counseling with the mentally retarded and his family. With the more severely retarded, the social worker can facilitate the adjustment of all the retardate's family. Social workers may also participate in diagnostic and evaluation studies; serve as liaison between institutions for the retarded and home communities; offer consultation with agencies and groups working with the retarded; and plan programs to provide treatment services and placement for the retarded. Georgia's two schools of social workat The University of Georgia and Atlanta University-graduate about 110 social workers each year. These graduates can fill only a small fraction of the state's total needs. It is estimated that by 1970, the State Health Department alone could utilize the services of nearly 400 master's level social workers. When completed, the Georgia Retardation Center, along with the existing Georgia Mental Health Institute, will offer practicum training programs for social workers. Nurses Nurses have a vital role to play in providing care and services to the mentally retarded in hospitals, clinics, training centers, schools and in the home. Shortages of nursing manpower exist throughout America, and in Georgia the nurse-citizen ratio is less than one-half the minimum desirable ratio. There are three classifications of registered nurses: professional and graduate nurses who have earned a baccalaureate degree from a school of nursing; diploma nurses who are trained in programs managed by hospitals; and associate degree nurses who are graduates of a nursing school affiliated with a two-year college program. Only one Georgia institution currently offers a graduate degree in nursing; three of the state's institutions prepare pro-

fessional nurses at the baccalaureate level; 14 Georgia hospitals provide training for diploma nurses; two of the state's colleges grant associate degrees. The public health nurse is especially important in rural and urban areas of the state. In 1967, the State Health Department employed 673 nurses throughout the state; it is projected that by 1970 the Health Department could utilize the services of nearly 1,400 persons in this profession. In addition to their regular training, specialized training in mental retardation is important for nurses planning to work in this area of handicap. Gracewood State School and Hospital offers a fiveday orientation program for public health nurses. In addition, students from six schools of nursing spend time at GracejVood during their courses in pediatrics, psychiatry, or public health nursing. Central State Hospital offers an affiliation course in psychiatric nursing to students from various Georgia schools of nursing. The Georgia Mental Health Institute also offers training programs for nurses, as will the Georgia Retardation Center. In view of the increasing demand for nurses and the inability of present training facilities to meet the need, it would seem desirable to develop specialized programs to maximize the use of professional manpower. As an example, there is one program of limited enrollment in the state which prepares nurses for more specialized maternal care. Licensed practical nurses, as well as delivery room and delivery floor technicians could be trained to handle some of the duties now being performed by registered nurses. Special Education Teachers Special education teachers playa vitally important role in preparing large numbers of educable and trainable mentally retarded for future life. Quality education often can make the difference between a retardate who is capable of self-support and one who will need residential care. The need for teachers trained and certified in this area of handicap far exceeds the supply. At present, there are five academic training programs in Georgia which prepare teachers and leadership personnel to work with the mentally retarded. These are The University of Georgia, Atlanta University, Georgia State College, West Georgia College, and Georgia Southern College. The Georgia Retardation Center, when completed, will provide clinical experience for special education teachers.

28

Vocational Rehabilitation Specialists Vocational rehabilitation specialists often can help adult retardates adjust to community living and thus prevent institutionalization. These specialists work throughout the state in a variety of community and institutional programs. The needs of society as well as those of the retardate are served when the retardate can learn to be self-supporting. At present, both The University of Georgia and Georgia State College have master's level training programs in vocational rehabilitation counseling. In addition to these training sources, special classes are available for persons who have already earned undergraduate degrees and who wish to take limited coursework in vocational rehabilitation. However, since only a small portion of these graduates will be working with the mentally retarded, present training capacity does not appear to be adequate.
Adjunctive Therapists Adjunctive therapists - including occupational therapists, physical therapists, speech therapists, and recreational therapists-have important parts to play in the overall treatment programs in both community and institutional settings. In all of these therapies, the state is faced with acute shortages of qualified specialists. Conditions are further complicated by the lack of training facilities for these disciplines; no school in Georgia offers training in occupational therapy or physical therapy, although Emory University, Georgia State College and The University of Georgia have plans for establishing such programs. When completed, the Georgia Retardation Center will offer training and experience in occupational therapy, physical therapy, recreation and physical education, and music therapy.
Chaplains Religious leaders are playing an increasingly important role in stimulating the growth of mental retardation services and in ministering to the spiritual needs of the mentally handicapped. Within the general training of the ministry, clinical chaplaincy is a specialty which provides clergymen with experience in working with the mentally disturbed and their families. Although there are nine facilities throughout the state where clergymen may receive clinical training, none include instruction in retardation. The Georgia Retardation Center, when completed, will include a training program in mental retardation for theology students

who wish to understand the needs of the retarded and their families. Until other such specialized training is available to Georgia's religious leaders, short-term workshops on mental retardation probably will be the most desirable alternative.
Other Needed Personnel
Two other groups who work closely with the retarded, and who receive very little formal training, are institutional attendants and the staffs of day care and training centers throughout the state. It is the attendant who lives and works with the retardate from day to day. No other staff person has as great a potential for influencing and training the retardate; no other staff person has less formal training in retardation. They need, more than any other staff group, to be taught the procedure, techniques, skills, and attitudes necessary to deal effectively with the retarded. Gracewood State School and Hospital has two training programs in operation for attendants and supervisors. One of these focuses on the skills needed by the attendant in caring for the more severely and profoundly retarded, most of whom are bedfast. The other is concerned with teaching skills in caring for ambulatory residents.
For the foreseeable future, Gracewood probably has the capacity for training sufficient attendants to meet its own needs. As other residential facilities are opened, however, it will become necessary to train attendants in other locations throughout the state. It seems likely that both the Georgia Retardation Center and the regional state hospitals will play important roles in this area. Day care and training center staffs attempt to teach and train retarded children with only sporadic exposure to short-term retardation workshops and sometimes with no preparation. There are no programs in Georgia to provide systematic training for the directors and staffs of these centers-which include activity centers for the older retardates and sheltered workshops. The State Health Department plans to initiate such a program in the future. Although inservice training programs for day care and training center staffs are lacking, The University of Georgia is developing a training program to prepare students for working in retardation centers. The Athens Branch of the Georgia Retardation Center, to be constructed on the campus of The University of Georgia, will serve as the training facility for this program.

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chapter eight

RESEARCH

Man's best hope for eliminating or reducing the impact of mental retardation lies in researchthe search for knowledge, new facts and unknown answers. Research activity takes many forms. It may involve studying the effect of a new drug on a disease process, evaluating the usefulness of a new teaching technique, or analyzing the effects of poverty and malnutrition on future intellectual growth. Because research is performed does not always mean that answers have been found; mental retardation is a complex phenomenon which usually does not lend itself to simple solutions. So little is known and understood about some aspects of mental retardation that scientists have only scratched the surface in finding the answers.
Research Discoveries
Although many research projects on mental retardation have not been fruitful, some have had a profound effect on our understanding and treatment of the mentally retarded. The cause of phenylketonuria-a metabolic disorder-was discovered through research. This condition, which can cause mental retardation, can now be treated through diet control. It was through research that behavior modification techniques were explored and refined. These procedures are contributing significantly to new training approaches with the retarded. Researchers discovered that chromosomal abnormalities were present in retardates diagnosed as mongoloid; it seems possible that this discovery may lead to the prevention of mongolism in the future.
Research Support
One of the most serious stumbling blocks to research in mental retardation is the lack of support for such programs in the actual working situation. The pressing demands for service impinge upon physicans, psychologists, social workers, nurses, therapists and educators alike. To a large extent these needs are real and cannot be ignored. On the other hand, new answers cannot be found by doing more of what we have done already.

Financial support for research is needed from both state and local governments, as well as from private foundations and the Federal Government. Attitudes toward the support of research activities seem to be changing, but funds for personnel and facilities are still minimal in Georgia. Research Centers The Georgia Retardation Center will become in a few years the state's primary facility for mental retardation research. This activity will be in addition to the role of the institution in training professional personnel and providing residential care. In cooperation with Gracewood State School and Hospital and Central State Hospital, this facility will do a great deal to stimulate and increase'research activities in Georgia. A great many research programs directly and indirectly related to mental retardation presently are under way in Georgia, mostly at colleges and universities. Research in certain areas is also being carried out at Gracewood State School and Hospital, Central State Hospital and the Georgia Mental Health Institute.
Research Communications One important problem which is interdisciplinary in character and national in scope is the difficulty in communicating research findings efficiently among scientists engaged in research activity. There is always a lag between research discoveries and their communication and implementation. The problem of communication, coordination and continuity of research efforts in mental retardation faces Georgia as it does the nation. Efforts should be directed toward improved communications perhaps through joint conferences or newsletters to those doing research in retardation.
Research Personnel Georgia faces a critical lack o( professional personnel in all areas. This shortage extends to both academic and institutional settings, so that those who have the interest, knowledge and ability to do research related to mental retardation are few in number. As facilities for training personnel in retardation expand, it can be anticipated that research output will increase as well.

31

chapter nine

LEGISLATION

Order and predictability of life in society would not be possible without a firm foundation of legal sanctions and prohibitions. In the United States no man is considered to be above the law, and he is entitled to pursue his owns goals as long as his actions do not interfere with the rights of others. The menally retarded because of the unusual nature of their disability are singularly affected by the law. The law must take into account the chronic character of mental retardation, along with the disparities in abilities displayed by variou;; retardates. This variability has long been understood by those who: work with the mentally retarded; unfortunately while legal authorities have not been ignorant of this variability, the law itself has tended to deal in absolutes. Before the law, the retardate is either competent or incompetent, committed or freed. The defendant is either responsible or not responsible, triable or not triable, punishable by ordinary standards or subject to exoneration. With the development of new alternatives in treatment, attempts are being made to overcome certain rigidities of the law to help the retarded benefit from modern knowledge about his growth and development. There is a need to minimize mandatory legal requirements wherever voluntary compliance can be obtained. The better the services available to the retarded and those concerned with his welfare, the less the need for coercive intervention to provide care. Although formal, mandatory, and coercive legal action toward the retarded should be kept at a minimum, the law must also protect the rights of the retarded; it cannot rely exclusively on the good intentions of those who manage institutions and other programs.
Civil Law and the Retarded The fact of retardation should never be considered an adequate reason for removing the ciVlI rights of the retarded. Any circumstances which may seem to justify any departure from these basic principles should be the subject of judicial review in each individual case. On the other hand, many of the retarded definitely are at a disadvantage in

recoglllzmg and asserting their rights; for these people, society should provide additional protecttive services. If a state agency should be assigned responsibility for these services, it should not only serve in a liaison capacity between the retarded, his parents or guardian, the public and the courts on social and legal problems, but also should be concerned with scrutinizing the application of any laws and administrative procedures which adversely affect the retarded. Guardianship Guardianship has important legal implications for the mentally retarded. At present, under Georgia law, only one type of guardianship is possiblethat delegating responsibility for both the estate and the person of the retarded individual. Guardianship of the property of the retarded person should be clearly differentiated from the guardianship of the person. There may well be need for the former in cases where the latter is unnecessary, and vice versa. Where guardianship of any kind is required, it should be carefully adapted to the specific requirements of the case. For some of the retarded, a comprehensive guardianship will be needed, but it is important that mentally retarded adults be allowed freedomeven freedom to make mistakes. There should be a periodic review by the courts of the need for continuation of any form of guardianship. In particular, the status of guardianship of any retarded person should be reviewed when the ward reaches the age of 21. While the courts generally consider family members first in appointing a guardian, the protection of guardianship should not be denied where there is no suitable relative or where funds are inadequate to compensate a private guardian. One solution would be the establishment of a public guardianship program, possibly through a state agency. Although guardianship might be vested in the agency, actual duties would be carried out by staff members. Institutional Commitment Laws have generally distinguished between "voluntary admissions" to mental institutions and

33

"involuntary commitments"-with judicial intervention required only for the latter. In general, society can rely on the discretion and professional judgment of superintendents of facilities for the retarded to accept as "voluntary" admissions only those retarded adults who are themselves capable of making such decisions. The judicial hearing which should be held for all admissions which are not voluntary should provide for the protection of the rights of the retarded. There should be regular judicial review of the need for continued institutional care for all retarded adults, especially when he has reached the age of 21, regardless of the original type of admission. Sterilization Sterilization of the mentally retarded has been a controversial issue for many decades. Sophisticated current research indicates that causitive variables other than heredity can cause mental retardation, and that genetic factors play a much smaller role than previously suspected. In the past, sterilization of the retarded has been practiced more widely than is true today, and the eugenic value of such operations is no longer unquestionably accepted by physicians and behavioral scientists. On the other hand, in some instances sterilization may be appropriate, particularly where the placement of an unmarried female retardate of childbearing age in a community setting might reasonably be expected to result in illegitimate pregnancy. Since 1937 Georgia has had an involuntary sterilization law which created a State Board of Eugenics and authorized the involuntary sterilization of the feebleminded, mentally ill, sexual deviant, habitually criminal, epileptic, and physically defective. Unfortunately, the law, which is still on the books, does not adequately protect the physician performing the operation from civil liability or criminal prosecution by retardates or their families. Although no physician has ever been sued in Georgia for performing this operation, protection should be established by appropriate amendment to the 1937 law. In 1966 a statute was passed legalizing voluntary sterilization and setting forth conditions under which the operation is authorized in the case of consenting persons. This law does provide protection from civil action for physicians and other persons participating in such sterilization operations.

Criminal Law and the Retarded Legal Confessions Recent U. S. Supreme Court opinions have emphasized that mental retardation is an important factor in determining whether a confession is truly voluntary. Under the Constitution, only voluntary confessions may be used at the trial of the accused. The police should be warned of the inherent unreliability of confessions by the mentally retarded. They should be urged to adopt strict standards in questioning people whom they have reason to believe may be mentally retarded. Confessions by the mentally retarded should be accepted only with the greatest caution-if at all.
Competency for Trial
The mentally retarded are sometimes automatically committed to institutions when they are found incompetent to stand trial. A critical review should be made of such procedures. The court should be able to choose from a range of alternatives, depending on the facts in the case. Following a finding of such incompetence, the retarded defendant should also be allowed to raise at a judicial hearing any defense on the facts or the law, other than a defense based on mental disease or defect precluding responsibility. The indictment might even be dismissed based on the facts or the law.
Criminal Responsibility
Traditional tests of criminal responsibility have resulted in the conviction and punishment of many mentally retarded defendants. Informed lawyers, judges, physicians and laymen in the different jurisdictions should reconsider the many issues involved in assessing the criminal responsibility of the mentally retarded defendant, all of whom need therapeutic treatment or training. The extent to which this training is available in our prisons and mental institutions should be reexamined. The type of control and treatment needed by many retardates may not be available in these institutions today.
Other Areas of Legislative Concern
Abortion Georgia has a new abortion law, enacted by the 1968 General Assembly, which declares that an abortion can be performed under hospital conditions if three qualified physicians and a hospital staff committee agree that continued pregnancy would cause "irremedial damage" to the physical

34

or mental health of the mother or child. It further allows abortions for rape victims if they desire. This modernization of the law will prevent many cases of mental retardation each year. Prior to this year, a woman could seek a legal abortion only' if her life were threatened by a continuation of the pregnancy. However, there are many other circumstances where abortion is advisable. For example, a number of drugs taken during certain stages of pregnancy have been implicated in the birth of infants with mental or physical defects. Mothers who become seriously ill during pregnancy and require extensive medication for a variety of reasons also have a greater likelihood of bearing a defective child. German measles, if it occurs during early pregnancy, can cause defective mental and sensory functioning in about 20 percent of resulting births. Abortion is also indicated to prevent the birth of a child to a mentally retarded mother who would be unable to care for her offspring. Georgia can be proud that it is among the first of the 50 states to recognize the need for a modern approach to therapeutic abortions. Interstate Institutional Transfer Provisions for interstate institutional transfer of patients is a legislative action sorely needed in Georgia. Existing laws require a Georgia resident in an out-of-state institution applying for admission to a Georgia hospital to first be delivered to his home county where standard commitment procedures are carried out. This procedure has caused hardships on the patient and his family as well as

the agencies involved. A procedure has been developed which allows direct transfer of patients from out-of-state institutions to Georgia institutions, and vice versa. This transfer method, called the Interstate Compact on Mental Health, has been adopted by 35 states. Services to Georgia's mentally retarded, both within and outside the state, would be improved by Georgia's participation in this interstate compact. Cost of Care The cost of keeping a retarded person in a state institution has almost doubled during the past seven years. Medical, educational and professional services are increasingly expensive and equipment and material costs have risen sharply. To assist in paying for this care and training, the Georgia Department of Public Health is charged with collecting fees from institutionalized patients, or persons legally responsible for their support. These funds cover only a small portion of hospital operating costs. Payment is based on a graduated scale according to income. The existing state law, which defines financial ability to pay, uses as a criterion gross income as defined by Georgia income tax laws plus income from other sources, such as veteran's disability payments, pension payments, social security benefits, insurance payments, inheritances and gifts. Legislation is needed which will allow the state to charge reasonable per diem fees based on criteria other than gross income, such as the principal of estates and trusts. A legal mechanism for effective enforcement of these procedures is also needed.

35

RECOMMENDATIONS FOR ACTION
The following recommendations for action must be implemented to aid in the prevention of mental retardation and to develop comprehensive programs and services for Georgia's mentally retarded. Implementing these recommendations will require the continuing efforts not only of those who contributed to the development of the state plan, but many others as well. Translating the plan into action will require the continuing support of every Georgian.
CHAPTER TWO-STATE RESOURCES AND ORGANIZATION
1. That an Interagency Council on Mental Health and Mental Retardation be established. This Council should be composed of the chief executive officers of such agencies as: The Georgia Department of Public Health, the State Department of Education, the Department of Family and Children Services, the Board of Regents of the University System, the Georgia Department of Labor, the State Pardons and Parole Board, and the State Board of Corrections. Consideration also should be given to the inclusion of representation from the Georgia Municipal Association, the Association of County Commissioners, the State Merit System, Georgia Association for Retarded Children and the Georgia Association for Mental Health.
2. That the State Department of Education establish an Advisory Committee on Mental Retardation with representation from appropriate state agencies, colleges and universities with teacher preparation programs in mental retardation, psychologists and local school personnel to provide continuing direction and supervision in the implementation of these recommendations.
3. That an Advisory Committee on Maternal and Child Care be appointed to assist the Maternal and Child Health Service of the Georgia Department of Public Health in the implementation of the recommendations in this Comprehensive Mental Retardation Plan and that consideration be given to the appointment of similar local Advisory Committees.
CHAPTER THREE-PREVENTION
4. That the Georgia Department of Public Health investigate the need for the establishment of genetic services within the Department. Responsibilities in this program might include: (l) counseling parents and prospective parents; (2) developing training programs for both medical and non-medical personnel; (3) organizing a high risk registry of specific genetic disorders and congenital abnormalities; and (4) the establishment of statewide chromosomal laboratories for studies in connection with counseling services.
5. That nursery provisions as established by the American Academy of Pediatrics be instituted as nearly as possible in all hospital nurseries.
6. That standards be developed concerning satisfactory anesthesia coverage in hospital delivery units especially for use in the proper management of obstetrical complications as approved by the professional staff and governing body.
7. That routine testing of the cord blood of all infants for red cell isoimmune antibodies by an approved method be done to detect unsuspected ABO incompatibilities to prevent the occurrence of mental retardation due to Kernicterus and the Rh blood testing of the mother prior to delivery be encouraged and expanded.
8. That the Georgia Department of Public Health take appropriate steps to implement the testing of all newborns for PKU and other inborn errors of metabolism.
9. That a program be instituted to educate physicians and the general public concerning harmful effects of drug administration during pregnancy.
36

10. That the Medical Association of Georgia through its appropriate committee undertake an educational program for physicians and the public on genetics and family planning and on the urgent need to improve the care of expectant mothers and infants in Georgia.
11. That irradiation of individuals, both male and female, be strictly monitored through the cooperative effort of physicians, hospitals, clinics and public health agencies.
12. That adequate communicable disease control programs be established to identify and prevent the spread of certain viruses and other communicable diseases which might result in mental retardation and other disabilities.
13. That the Joint Commission on Accreditation of Hospitals be urged to recognize as credited autopsies those fetal autopsies performed by hospitals so that much needed information about the cause and prevention of fetal deaths can be obtained.
14. That a statewide perinatal study team be established by the Medical Association of Georgia to assist hospitals and related community organizations in establishing perinatal mortality and morbidity studies using statistical techniques.
15. That the Georgia Department of Public Health study methods and make recommendations concerning: (l) recording at the time of birth confidential medical information about prenatal and postnatal reproductive problems and congenital abnormalities which could be used in the establishment of a "high risk" register of infants who might become mentally retarded; (2) methods for disbursing such information through medical rather than legal channels; and (3) to whom such information should be directed for use in follow-up preventive and treatment programs.
16. That every effort be made to investigate, identify and correct factors which lead to premature birth and that special attention be given to the identification of "high risk" pregnancies to assist in the prevention of premature births.
17. That a statewide intensive care program for "high risk" infants, with emphasis on the premature, be established in regional centers in hospitals throughout the state.
18. That referral centers for medically indigent expectant mothers with special pregnancy complications be established at the Medical College of Georgia in Augusta and Emory University School of Medicine in Atlanta and that consideration be given to the planning of other centers throughout the state.
19. That every expectant mother be provided adequate pr.tnatal care throughout her pregnancy by qualified medical personnel and that the Georgia Department of Public Health, the local health departments and the medical profession share responsibility in overcoming factors which prevent meeting this need.
20. That every expectant mother should have the opportunity for hospitalization for prenatal complications, labor, delivery and postnatal care and that the provisions of Act #397, Georgia Laws 1957, which provide hospital care for the indigent be expanded to include these services as well as others necessary for complete hospital care for the indigent and that adequate funds be appropriated for implementation.
21. That the pregnant, unwed mother be recognized as having special problems in maternal and infant care requiring environmental, social and economic rehabilitation and that she be given a high priority for services.
22. That efforts by the State Department of Family and Children Services to increase the aid to unwed expectant mothers be supported.
23. That efforts by the State Department of Family and Children Services to increase aid to expectant mothers in its Aid to Families with Dependent Children Programs by eliminating the "substitute father" regulation be supported.
24. That the program, budget and staff of the Maternal and Child Health Service of the Georgia Department of Public Health be expanded and enlarged to administer an adequate program of obstetric, infant, child and adolescent care for the indigent throughout the state.
37

25. That county or district maternal clinics be established for those localities needing such services and that they be staffed by obstetricians where possible and adequately trained paramedical staff. In some instances, traveling clinics may be needed.
26. That well-child or developmental clinics be established for counties or districts without these services by the state and local health departments. All such clinics should be staffed, where possible, by physicians with pediatric training and qualified nurses. Where counties lack population to make such clinics feasible, clinics serving several counties should be established.
27. That the Georgia Department of Public Health provide vitamin and mineral supplements as needed to clients in both maternal and well-child clinics.
28. That the State Department of Education provide a school breakfast program using Commodity Surplus Foods for indigent children to help each child function at his maximum potential.
29. That the Georgia Department of Public Health consider using Commodity Surplus Foods as an inducement for better attendance at both prenatal and postnatal clinics.
30. That both the Commodity Surplus Food Program administered by the State D~partment of Education and the Food Stamp Program administered by the State Department of Family and Children Services be expanded.
31. That adequate nutrition and nutritional instruction be emphasized as important factors in prenatal care and in the growth and development of children.
32. That a full and complete program of voluntary family planning be implemented throughout the state and made available to every citizen, both male and female.
33. That the effects of socio-cultural factors on the quality of human reproduction be considered in the design and development of maternal and child care programs.
34. That both private and public agencies working with expectant mothers attempt to identify and alleviate those environmental factors which might cause cultural mental retardation in a child born into an adverse social environment.
35. That sex and family life education courses be included in the curriculum of elementary and secondary schools with special emphasis to reach the dropout group by the ninth grade, and that other health programs for children and adolescents emphasize nutrition, preventive medicine and emotional preparation for parenthood.
CHAPTER FOUR-COMMUNITY SERVICES AND FACILITIES
36. That the Georgia General Assembly provide adequate funds, as determined by needs and specified by the Department of Education, for a quality public school educational program for the mentally retarded.
37. That the State Board of Education conduct a study to determine the most equitable formula for the allocation of funds for the financing of programs for exceptional children.
38. That the Division for Exceptional Children of the State Department of Education advise School Plan Services of the State Department of Education concerning appropriate construction and equipment needed for the mentally retarded with multiple handicaps, so that recommendations may be made to the School Building Authority for its approval.
39. That the State Board of Education provide incentive grants to cooperating multi-county school systems for the purpose of establishing regional psycho-educational service centers which would offer evaluation and instructional services for all children who experience learning difficulties and for whom such services are not available locally.
40. That these psycho-educational service centers be located in the proximity of and function cooperatively with existing and proposed facilities administered by other state agencies such as mental retardation clinics, mental health clinics, public health clinics, and clinics operated by university training centers.
41. That the State Department of Education explore ways for the school psychologists, counselors, visiting teachers and school social workers to be more fully utilized in programs of education and vocational rehabilitation for the mentally retarded.
38

42. That the Division for Exceptional Children of the State Department of Education in conjunction with local school systems implement a variety of extended school programs such as summer programs, Saturday programs, etc., utilizing state and federal funds.
43. That the State Board of Education encourage the establishment of pre-school and kindergarten programs as a part of Georgia's educational plan.
44. That the Educational Television Services of the State Department of Education provide staff assistance and program time for developing and transmitting programs relating to the education of the mentally retarded.
45. That the Adult Education Services of the State Department of Education provide educational programs for adults who are mentally retarded.
46. That the Division of Vocational Education of the State Department of Education devise vocational education experience for the mentally retarded, making these available where possible through existing vocational education facilities, sheltered workshops and regional centers.
47. That initially the amount of not less than $200,000 be appropriated, and increasing amounts as needs indicate, to provide for the education of multi-handicapped children when appropriate services in local public school programs or in state-supported facilities are not available.
48. That the State Board of Education make a study of the transportation needs of the mentally retarded and that these findings be reported to the General Assembly so that appropriate legislation can be enacted.
49. That the Office of Vocational Rehabilitation Services conduct studies to explore ways to improve the efficiency and effectiveness of the vocational rehabilitation process.
50. That the Office of Vocational Rehabilitation Services establish an adequate number of vocational appraisal clinics over the state to insure that such services are readily available to all mentally retarded persons who can benefit from such service.
51. That the Office of Vocational Rehabilitation Services assign counselors to the proposed regional diagnostic and service centers to provide consultation in the area of vocational rehabilitation as well as insuring proper referral for services.
52. That the Office of Vocational Rehabilitation Services extend services under the cooperative Vocational Rehabilitation-Special Education Program concurrently with the development of certified units in the various school systems.
53. That the Office of Vocational Rehabilitation Services establish work evaluation laboratories in those schools with sufficient prevocational classes to make such laboratories economically feasible.
54. That the Office of Vocational Rehabilitation Services establish prevocational training centers wherever appropriate to provide work adjustment training to pupil-clients enrolled in prevocational classes.
55. That the Office of Vocational Rehabilitation Services assist in the development of sheltered workshops geographically located over the state to insure that such services are readily accessible to all mentally retarded persons requiring such service.
56. That the Office of Vocational Rehabilitation Services expand services for the mentally retarded who are on probation.
57. That the Office of Vocational Rehabilitation Services expand services for the mentally retarded who are federal offenders.
58. That every community establish a comprehensive Health Planning Council with broad community representation to study health needs and determine methods for implementing programs, services and facilities to meet these needs.
59. That case-finding services be expanded to include all individuals and agencies competent in the early identification of the mentally retarded.
60. That consultation on request be provided by the Georgia Department of Public Health, State Department of Education and/or other appropriate state agencies to communities throughout the state for the establishment of diagnostic and evaluation clinics.
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61. That additional diagnostic and evaluation clinics for the mentally retarded be established throughout the state as rapidly as possible.
62. That special diagnostic and evaluation clinics for neuro-sensory disease be established at the Medical College of Georgia and the Emory University School of Medicine to serve as consultants to the well-child or developmental clinics, coordinate therapy for children with complex medical problems and give specialized training to both medical and paramedical personnel.
63. That diagnostic and evaluation clinics serve the mentally retarded of all ages and not be limited to special age groups or particular types of mental retardation.
64. That both private and public day care centers for the mentally retarded be developed throughout the state as rapidly as possible to meet existing needs. The possibility of increasing state financial support for these day care centers should be considered.
65. That "Standards and Guidelines for Day Care Centers for Mentally Retarded Children" as developed by the Georgia Department of Pu blic Health be followed in inspecting and approving existing and future public and private day care centers for the mentally retarded.
66. That the Georgia Department of Public Health in cooperation with other appropriate agencies provide training opportunities for the staffs of day care centers for the mentally retarded in order to upgrade the quality of services.
67. That the Georgia Department of Public Health and the State Department of Family and Children Services jointly study the feasibility of developing (1) homemaker services for families of the mentally retarded, (2) foster boarding care for the mentally retarded, and (3) adoptive homes for the mentally retarded throughout the state.
68. That the Georgia Department of Public Health, the State Department of Family and Children Services, and the State Department of Education plan and develop services needed for Georgia's mentally retarded juvenile offenders.
CHAPTER FIVE-RESIDENTIAL SERVICES AND FACILITIES
69. That all facilities providing residential services for the mentally retarded meet and maintain current program standards as recommended by the American Association on Mental Deficiency (Standards for State Residential Institutions for the Mentally Retarded).
70. That separate residential units for the mentally retarded be provided in each regional state hospital. Such units will provide comprehensive services including pre-hospital evaluation and planning with families of the retarded. No residential unit for the mentally retarded should exceed a 500bed capacity.
71. That Gracewood State School and Hospital and Central State Hospital's Mental Retardation Unit continue to serve the mentally retarded of the state until additional facilities are available. At that time, these two institutions will continue to share in the total residential care program.
72. That the State Department of Education assume responsibility for providing educational opportunities for the mentally retarded in all state-supported residential facilities.
73. That the Office of Vocational Rehabilitation Services provide or extend vocational rehabilitation services in cooperation with the various state institutions for the mentally retarded to the extent that each institutionalized mentally retarded person found eligible for vocational rehabilitation services can be assured of receiving prompt and maximum legally constituted services.
74. That the Georgia Department of Public Health on a consultative basis should cooperate with the State Board of Corrections; Office of Vocational Rehabilitation Services, State Department of Education; and the Division for Children and Youth, State Department of Family and Children Services to establish in the State Prisons and the Youth Development Centers comprehensive services to identify the mentally retarded within these institutions and to develop education and rehabilitation programs especially for this group. Attention should also be given the mentally retarded alcoholics in correctional institutions and in the community.
75. That the Office of Vocational Rehabilitation Services expand services for public offenders who are mentally retarded and incarcerated in the various institutions administered by the Department
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of Family and Children Services and the State Board of Corrections. These institutions would include Youth Development Centers at Adamsville, Augusta, and Milledgeville; Georgia Industrial Institute at Alto; Georgia Development and Training Center at Buford; Classification Center in Butts County; State Prison at Reidsville; and county work camps.
CHAPTER SIX-SUPPORTIVE PROGRAMS AND SERVICES
76. That the Governor through an Interagency Council on Mental Health and Mental Retardation consider the establishment of identical geographical districts for all state agencies.
77. That the Governor's Interagency Council on Mental Health and Mental Retardation assist in coordinating and improving information programs on mental retardation within the departments of state government responsible for services to the mentally retarded.
78. That the Georgia Department of Public Health establish a position for a Public Information Officer to be permanently assigned to the Division of Mental Health with specific responsibilities in the field of mental retardation.
79. That the Georgia Department of Public Health establish an office of Public Information and Education in each state hospital under its jurisdiction.
80. That the Georgia Department of Public Health assume responsibility for the preparation and promotion of both public and professional educational materials concerning mental retardation.
81. That the Georgia Department of Public Health, in cooperation with the Georgia Association for Retarded Children, encourage the use of volunteers in mental retardation programs.
82. That the Georgia Department of Public Health work closely with professional and lay organizations in the development of mental retardation programs.
83. That the State Department of Family and Children Services and the State Department of Education, Division for Exceptional Children develop information programs to include pertinent materials on mental retardation for use by their own staffs and in the presentation of their programs to the general public.
84. That the Georgia Recreation Commission, the Georgia Department of Public Health and the Georgia Association for Retarded Children cooperate in the distribution of information about recreation programs for the mentally retarded to agencies and organizations serving this group.
85. That professionally trained and certified recreation personnel be employed to direct recreation programs within state-operated facilities and institutions for the mentally retarded.
86. That colleges and universities in the state providing training programs in the field of physical education and recreation include instruction and training in physical education and recreation for the handicapped including the mentally retarded.
87. That the Georgia Recreation Commission in cooperation with appropriate state and local agencies conduct statewide and regional workshops for recreation personnel in planning and conducting programs for the mentally retarded.
88. That the Georgia Recreation Commission encourage local recreation departments throughout the state to work with day care centers and other agencies for the mentally retarded in the development of recreational programs.
89. That theological seminaries throughout the state provide instruction and clinical experience in mental retardation for their students.
90. That the Georgia Association for Pastoral Care be encouraged to conduct a survey to determine the present participation of religious organizations in the state in programs and services for the mentally retarded and their families.
91. That on request, the Georgia Department of Public Health provide information concerning mental retardation to state and local religious organizations to encourage more active participation of these groups in providing space for day care centers, classes for religious instruction and recreational programs for the mentally retarded.
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CHAPTER SEVEN-MANPOWER

92. That all professional disciplines concerned with mental retardation be represented when desirable on state, regional and local interagency councils on mental retardation.

93. That the Georgia Department of Public Health provide consultation in mental retardation to all

professionals working with the mentally retarded and those involved in prevention and early

detection programs.

94. That emphasis be placed on better employee utilization through careful and continuing job

analysis to assure as nearly as possible that non-professional duties are not assigned to profes-

sional personnel. The professions themselves must of necessity participate in this continuing

evaluation.

95. That positions be created for auxiliary personnel without professional training in order to support

and extend the skills of professional personnel to the greatest possible degree.

96. That, where possible and feasible, intensive inservice training programs be instituted in order

to develop employee skills to the utmost. Present employees should be expected to perform at the highest skills of which they are capable and they may well be the best source of talent available.

97. That increased emphasis be given to active, continuous recruitment campaigns, and these pro-

grams be designed to:

place Georgia's needs and professional growth opportunities before the appropriate people

throughout the country;

attract into employment skilled personnel in health related fields who presently, for one rea-

son or another, are not in the labor market; attract retiring military personnel who may have skills useful in the field of mental retarda-

tion, and incidentally, in other health areas as well;

coordinate needs with special Federal programs now operating, as the Manpower Train-

ing Program, the Neighborhood Youth Corps, and other similar programs;

develop opportunities to use part-time, seasonal, and student personnel;

develop opportunities to use middle-age unskilled personnel in institutional and other set-

tings to aid in the socialization of the child; encourage the use of volunteer personnel wherever possible in order to extend patient care

services and to introduce people to the field of mental retardation.

98. That a centralized recruitment effort to reach students early in high school be established in order

to influence them to prepare themselves for professions working with the mentally retarded, and

that concerted efforts be made to induce high school students to enter pertinent areas of college

training. 99. That a more comprehensive and intensive public information program be developed in order
to make careers in the field of mental retardation more appealing to young people and other

prospective applicants. 100. That there be an expansion of the state scholarship program to provide more adequate stipends,
additional levels of study, and a broader range of academic disciplines related to the field of

mental retardation. 10 I. That project grants be sought to support manpower research in the field of mental retardation. 102. That continued study be given to salaries in order to establish and maintain comparable salaries
'with other employees in all occupational areas. 103. That state and regional retardation centers establish salaries, job descriptions, and personnel
policies to attract qualified personnel in all disciplines. 104. That the unequal distribution of the physician-population ratio be improved by increasing the
incentives for medical practice in problem areas.

105 . That the present below average physician-population ratio in Georgia be improved by increasing

.~ ,.f . theslze...,of graduating classes from each medical school in Georgia and/or by the establishment

..

of a third medical school in the state.

!.

,.

i;

42

j~

106. Tnat added emphasis be given to undergraduate medical trammg programs in maternal and infant care and that the present residency training programs in obstetrics, gynecology, pediatrics and psychiatry be expanded, improved and properly supported to provide a greater source of trained and qualified personnel.
107. That the Georgia Department of Public Health in cooperation with the state's two medical schools, the Medical Association of Georgia and the Georgia Hospital Association establish and support a training program to provide physicians with a combination of obstetric and public health training for indigent maternity care programs in Georgia.
108. That additional short-term medical student fellowships be made available by the Georgia Department of Public Health for studies in maternal and infant care programs.
109. That the Medical Association of Georgia recommend a proper scale of compensation for physicians' services in public health care programs.
110. That the number of public health nurses employed in local public health programs be increased until the desired ratio of one public health nurse for every 5,000 population is reached.
111. That a state nursing committee on mental retardation be established including representation from public health, maternal-child health and psychiatric nursing. Sponsorship might be through the Georgia State League for Nursing, the Georgia State Nurses Association, or both.
112. That university schools of nursing be encouraged to strengthen mental retardation content and clinical experiences in undergraduate and graduate curriculums. Learning opportunities provided by state and regional retardation centers should be utilized to the fullest.
113. That the Georgia Department of Public Health in cooperation with the schools of nursing work to increase the number of qualified public health nurses with at least a baccalaureate degree in order to more effectively implement the preventive, therapeutic and habilitative aspects of mental retardation programs.
114. That the Georgia Department of Public Health in cooperation with the Georgia State League for Nursing and the Georgia State Nurses Association provide continuing education programs for all levels of nursing personnel to (1) stimulate interest and change attitudes about mental retardation, (2) increase skills in the care of the mentally retarded and (3) learn new knowledge and concepts in mental retardation.
115. That the Medical College of Georgia, Emory University, and Georgia State College after consultation with the Georgia Department of Public Health establish training programs for nurses, assistants and technicians in maternity care to provide nursing and paraobstetrical personnel for indigent maternity care programs in hospitals, out-patient clinics, and health departments.
116. That the State Department of Education intensify its recruitment program through all possible means such as enlarging the Georgia State Teaching Scholarship Program, providing recruitment personnel, and increasing salaries.
117. That the Teacher Education Services of the State Department of Education establish criteria pertaining to staff qualifications, facilities, laboratory space, and curriculum content for those colleges and universities which provide a teacher preparation program for teachers of the mentally retarded.
118. That funds through the Grant-in-Aid Program of the State Department of Education be provided for in-service education programs through the school year as well as in the summer.
CHAPTER EIGHT-RESEARCH
119.
120.

121. That continuing careful studies and evaluations be made of groups and agencies interacting with the mentally retarded or involved in programs relating to mental retardation to provide coordination and continual upgrading of these programs.
122. That the Division for Exceptional Children of the State Department of Education seek funds to research and investigate more varied teaching methods and curriculum designs for the mentally retarded.
123. That a Branch of Training and Research should be established in the Division of Mental Health of the Georgia Department of Public Health to be administratively responsible for facilities and programs operated by the Division of Mental Health, designated as training and research facilities and/or programs.
124. That the Georgia Retardation Center be established as a multidisciplinary development and behavioral research center.
125. That each residential facility for the mentally retarded operated by the Georgia Department of Public Health have a director of research.
126. That the Georgia Department of Public Health develop a statement of policy regarding human research in accordance with the recommendations of the Surgeon General, U.S.P.H.S.
127. That there be established research, diagnostic, and treatment centers in the Department of Pediatrics at both medical schools.
128. That colleges and universities, official and private agencies provide additional scholarships and fellowships at the predoctoral, doctoral, and postdoctoral levels for those interested in research related to handicapped children and adults for the training of administrative, technical, and nontechnical supportive personnel for research programs.
CHAPTER NINE-LEGISLATION
129. That existing guardianship laws be amended to allow flexible, more limited guardianship of property or person according to the needs of the retardate.
130. That an appropriate state agency be assigned the responsibility of developing and coordinating guardianship services for the mentally retarded.
131. That the 1937 Georgia law concerning sterilization of nonconsenting persons be amended to protect physicians and other medical personnel from civil or criminal action brought against them by other persons except for negligence or maleficence.
132. That therapeutic abortions be legalized under limited circumstances as follows: a. when a continuance of pregnancy would endanger the life or would gravely impair the physical or mental health of the pregnant woman, or b. when the fetus most probably would be born with a grave and irremedial mental orr physical defect. Legislation should provide appropriate protection for medical personnel and facilities involved.
133. That Georgia participate in the Interstate Compact on Mental Health. 134. That financial ability to pay for state institutional services be more broadly defined to allow the
use of other financial criteria besides income. The Cost of Care Act as amended in 1966 should be further amended: a. The revised statute should specify in detail those persons who are legally responsible for
the cost of care of patients. b. The revised statute should provide an effective enforcement procedure to assist the Georgia
Department of Public Health in collecting payments. c. The revised statute should make patient income from trusts, estates and funds assessable for
cost of care purposes. Under some circumstances, the principal of such trusts, estates, and funds should be made assessable also.
44