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 .. .. , ~,-' .- lit' I \:' . J -,., ~ ... I I " ,. -I' ., ~IA .., 4!f I 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: