Georgia State Plan for Child Development [1971]

GEORGIA STATE PLAN FOR COMPREHENSIVE CHILD DEVELOPMENT
1971
EUREAU OF STATE PLANNING AND COMMUNITY AFFAIRS

GEORGIA STATE PLAN FOR CHILD DEVELOPMENT 1971
Bureau of State Planning and Community Affairs

3Hmml! <!Indtr
GovERNOR

1f~~t'u.titt~ ~~.partut~nt
J\thtttht SUSS4
April 2, 1971

~nmi1tun 3Jurhnn
EXECUTIVE SECRETARY

The Executive Committee The Appalachian Regional Commission 1666 Connecticut Avenue Washington, D. C. 20235
Gentlemen:
I am pleased to endorse for your review Georgia State Plan for a Comprehensive Child vevelopment Program. This Plan was edited and assembled by the Bureau of State Planning and Community Affairs under the direction of my Inter-agency Task Force on Child Development. This Task Force is a part of my Inter-agency Council on Human Resources and was established by Executive Order on August 28, 1970.
The purpose of the Task Force and the purpose of this Plan is to enable the State of Georgia to systematically address all of the problems confronting our children.
I am requesting that you process this Plan in the most expeditious manner possible so that we may immediately address the problems related to child development.

JC:gdw

TASK FORCE IN EARLY CHILDHOOD DEVELOPMENT

Mr. H. Herschel Saucier, Chairman Deputy State Director State Department of Family and
Children Services State Office Building Atlanta, Georgia 30334
Dr. Russell S. Clark Director, Division of Planning
Research and Evaluation State Department of Education State Annex Building Atlanta, Georgia 30334
Mrs. Mary Gordon, Consultant Early Childhood Education Curriculum Development Division state Department of Education state Annex Building Atlanta, Georgia 30334
Miss Ruth Melber Senior Consultant Nurse Georgia Department of Public Health 47 Trinity Avenue Atlanta, Georgia 30334
Mr. Melvin T. Solomon Manpower Program Coordinator State Labor Building, Room 178 254 Washington Street, S.W. Atlanta, Georgia 30334
Dr. D. Keith Osborn College of Home Economics Dawson Hall University of Georgia Athens, Georgia 30601
Dr. Joanne R. Nurss Department of Early Childhood
Education Georgia State University 33 Gilmer Street, S.E. Atlanta, Georgia 30303

Mr. William T. Levins State Office of Economic
Opportunity 101 Marietta Street, N.W. Atlanta, Goergia 30303
Mr. Herbert D. Nash Associate Director Division of Special Education State Department of Education State Office Building Atlanta, Georgia 30334
Miss Audrey Lane Chief, Licensing Section State Department of Family and
Children Services 18 Capitol Square, S.W. Atlanta, Georgia 30334
Miss Beverly Poth Consultant Federal Programs for Exceptional
Children Division of Special Education State Department of Education State Office Building Atlanta, Georgia 30334
Mrs. Winifred Gerhardt Consultant, Day Care Services state Department of Family and
Children Services 18 Capitol Square, S.W. Atlanta, Georgia 30334
Dr. Homer Coker Director, Child Development
Program West Georgia College Carrollton, Georgia
Mr. Joseph R. Wynn Coordinator 4C Program Community Council of Atlanta 1000 Glenn Building 120 Marietta Street, N.W. Atlanta, Georgia 30303

PREFACE
Human resources are Georgia's greatest asset. Implicit in this viewpoint is the goal of developing every individual to his maximum potential.
Recognizing that development of those human resources which influence the lives of the general public. from the beginning to the end are essential to an orderly society, the Governor of Georgia in August of 1970 issued an Executive Order creating and establishing the Governor's Interagency Council on Human Resources. Among other duties, this Council was assigned the responsibility of planning and coordinating all programs dealing with the development of human resources, and encouraging appropriate State agencies and organizations to assume responsible roles in program development and implementation.
In order to carry out these responsibilities, the Council was charged with the establishment of Task Forces to assist in planning social programs which will serve the needs of Georgians; the Task Forces to include, but not limited to, family planning, child development, youth development, manpower development, education, health, and drug abuse; and to consist of experts from Federal, State and local governments, private agencies, and interested citizens.
The Task Force on Child Development consists of State specialists in the fields of education, health, welfare, and labor, as well as representatives from the University of Georgia College of Home Economics, the State Office of Economic Opportunity, the Community Council of Atlanta, and local Community Action Agencies.
This document represents the initial effort of the Task Force on Child Development to prepare a comprehensive overall plan to develop and coordinate services for quality child development programs in the State of Georgia, and particularly for the Appalachian region of the State, which has been designated a demonstration area for such programs.
Concepts and standards of childdevelopment,and overall goals and components of a comprehensive Child Deve.lopment Program are set forth in Chapters I through IV. Chapter V defines the boundaries of the Appalachian demonstration area ,describes theorgani.z.a.tional framework for program administration, and lists resources and existing services upon which child development staff can draw for program implementation.
Chapter VI lists projects which have been selected as priorities for 1970-1971 funding; and significant issues which will be considered in next year's Child Development Plan are set forth in Chapter VII.
It is hoped that this document, in describing the interrelationships existing among various agency responsibilities in child development, will stimulate many recommendations for better coordination of programs, services and training, and will lead to specific guidelines and procedures for local organizations within the near future.

TABLE OF CONTENTS

Page

List of Maps, Charts and Appendices

1. Concepts of Child Development ...................... p. 1

II. Standards for Child Development

p.2

III. Overall Goals for Comprehensive Child Development PrograIll .................................. p.3

IV. Components of Comprehensive Child Development PrograIll ............................................ p. 6

A. Educational Services for the Child and Parent ..... p.7

B. Health Services

p.10

C. Social Services and Counseling .................... p. 19

D. Chi ld Care Services..................................... p. 20

E. Manpower Education and Training .................... p.20

F. Evaluation

p.24

G. Coordination of Existing Services .................... p.25

V. Demonstration Area

p.26

A. Definition and Boundaries ..................... p.26

B. Eligibility

p. 28

C. Planning and Administrative Organizations ......... p.28

VI. Summary of Proposed Projects for Implementation of PrograIlls .................................... p.3l

VII. Planning for the Future ............................ p.32

Appendices

"

"

p.33

LIST OF MAPS, CHARTS AND APPP"t\'lHCES

Page CHART I: Suggested Flow Systems Scheou:\tic DIagram,.", " , . " " . , 15

:HAP I: Appalachian Child Development Demonstration Areas . . . , ..... 27

APPENDICES:

APPENDIX T: Data on Georgia Ch]] dIen " .".' ... ,.,

" .. . 33

APPENDIX II: Directory of Vocat onal-Technical Schools, 1970-1971 " .

APPENDIX III: Georgia. Ed '.lea t ion" 1 PtJg r,im~' Rel'i t i ng
Child Deve 1GP;U~IH.

APPENDIX IV: Standards for Maternal and Child Health Care

5L

APPENDIX

V: Immunization Schedule Recommended for County

Health Departments in Georgia

.

APPENDIX VI: Social Security Act, Title IV-A, Funding of

Family and Children Services

,

. 59

APPl:~rmIX VII: Resources and Exist ing Services.. . .. , ,,, .... ,,.. . 6LL

I. CONCEPTS OF CHILD DEVELOPMENT
Recent research in human development has dramatically demonstrated that to produce optimum outcomes~ it is necessary to provide a stimulating environment for the very young child. InfDrmation showing the negative effects of a deprived environment has been collected in institutions and orphanages where understaffing and shortag-e of facilities produced severe deprivation for infants housed there (Dennis and Najarian, 1957; Goldfarb~ 1955). There seems to be some similarity in conditions found in the disadvantaged home and those found in the institution. When Pavenstedt (1965) studied lo.ver class homes~ her observations led her to conclude that there is a lack of interest or concern for other than the barest physical needs of the infant and that this lack of concern remains as the child reaches the more independent stage of "toddler".
In view of the effects of deprivation on the satisfactory development of the child and in view of the degree of deprivation of language and intellectual stimulation in lower class homes~ it seems imperative that child development programs assume the role of active interventionists. It is clear that thinking in the child does not simply emerge but is a function of events surrounding the child. Piaget (1952) has suggested that cognitive development proceeds through a series of stages which involve the integration of previously organized behaviors with subsequent behavior. As mental structures are modified to adapt to new inputs from the environmental deprivation~he further suggests the importance of maintaining a stimulating environment for the pre-schooler.
The effects of a stimulating environment can only be felt if the child is otherwise well and free from physical abnormalities and deficiencies. It goes without saying that the physical needs must be met so that health is preserved; then a pre-school environment which provides an active learning curriculum can produce optimum advantages for the youngster.
REFERENCES
Dennis~ W. and Najarian~ P., "Infant Development Under Environmental Handicap." Psychological Monographs, 1957.
Goldfarb, W.~ "Emotional and Intellec.tual Consequence of Psychological Deprivation in Infancy; ARe-evaluation." P. Hoch and J. Zubin (Eds.), Psychopathology of Childhood~ New York: Gruse and Stratton~ 1955.
Pavenstedt, E.~ "A Comparison of the Child-Rearing Environment of UpperLower and Very Low-Lower Class Families." American Journal of Ortho Psychiatry, 1965.
Piaget, J.~ The Origins of Intelligence in Children. New York: International Universities Press~ 1952.
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II. STANDARDS FOR CHILD DEVELOPMENT From the Concepts of Child Development as outlined above, it becomes readily apparent that the central strategy or theme for a State Child Development Plan must be one of maximum utilization of existing resources and expertise. The Child Development Task Force serves as an umbrella for drawing together the many diversified efforts within the State that ultimately and jointly relate to the total development of the individual child. It is recognized that much has been accomplished by various State and Federal agencies over a period of years in the field of child development. Thus, in many programs, explicit detailed child development standards have already been developed to insure maximum utilization of public funds and benefit to the child. (See Appendix VI for Title IV-A, Social Security Act, Criteria for Funding of Day Care Programs.) It is not the intent of this program to further complicate the implementation of child development programs by unnecessarily and arbitrarily establishing additional program standards. Such action would not be in the best interest of the program, the applicant, or the child. Therefore, the quality standards that will apply to any individual child development project will be those standards adopted by the basic grant agency and other official standard-setting agencies for that particular project, provided such action is consistent with the requirements of DHEW and the Appalachian Regional Commission. In those instances where there is no basic agency participation, the applicant will recommend quality standards to be adopted and these standards must be accepted by the Georgia Task Force on Child Development, DREW, and the Appalachian Regional Commission. After the first full year of operation careful analysis will be made regarding this policy, and any changes deemed necessary to ensure the most effective system of operation will be considered for possible implementation.
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III. OVERALL GOALS FOR COMPREHENSIVE CHILD DEVELOPMENT PROGRAM
The principles of free government promoted in the Preamble to the Constitution of the State of Georgia imply that it is intended for the State to upgrade the quality of iife and social environment for all citizens by improving the State's human resources.
Georgia's early childhood development efforts in the past have been fragmented and uncoordinated in the areas of health, welfare, and education. To fulfill the State's primary obligation to improve its human resources, a comprehensive child development program is being developed.
A comprehensive child development program should include the following goals:
A. GENERAL
1. To improve and promote the health and well-being of children from conception to six years of age.
2. To provide direct services to help strengthen and improve family life, including parental functioning, parent-child relationships, family planning, health services and educational opportunities.
3. To provide direct services through child care programs so as to supplement parental functioning, to improve the care and supervision of children, to provide educational stimulation and opportunity for the child and to safeguard his physical well-being.
4. To encourage the creation of services required for quality child development programs in the State of r,eorgia that transcend the boundaries of various State agencies and assist in planning for child development throughout the State.
5. To encourage public and private institutions and promote policies in the State of Georgia designed to meet the medical and dental health, educational, nutritional and social needs of children in the face of a changing national society.
6. To coordinate public and private regionwide programs for children to allow for better use of available resources, and to provide more and better services for these children.
7. A major objective of the plan is to integrate the various components of child care services into a total, well-organized program, with all phases of child development placed in perspective.
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8. To develop a joint training program for child development personnel: to include parents, para-professionals, and professionals.
9. To encourage expansion and development of comprehensive child care centers throughout the State.
10. To provide technical assistance to all communities, organizations and persons in the State of Georgia seeking to develop new programs or to improve existing child care programs.
11. To encourage State legislation which will better coordinate and expand State activities and expenditures for children.
B. SERVICE DELIVERY
1. To insure that service delivery systems provide for the following four general areas of need in child development, whether the service is directed toward health, education, mental health/special education, vocational education or child care. These four areas of concern are:
Programs for parents (actual and prospective) Programs for children (0-3 years) Programs for children (3-5 years) Programs for training adults to work with child development
programs
2. To encourage the development of components that would provide for the following needs within the bounds of the four areas of concern.
Programs for parents - Positive programs of family planning, necessary medical services, nutritional training and parental educational programs.
Programs for Children (0-3 years) - Medical, psychological and social/emotional evaluations with appropriate followup action.
Programs for Children (3-5 years) - Medical, psychological, educational, and social/emotional evaluation with appropriate follow-up action with emphasis on developmental programming.
Programs for Training Adults - Educational and training programs which will insure an adequate supply of professionals, para-professionals, aides and other adults to provide the services needed in a comprehensive child development program.
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C. EVALUATION
Promote methods whereby the effectiveness of the total program maybeevaluated~ with the objective of utilizing the evaluations as a basis for program reorganization and improvement.
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IV. COMPONENTS OF COMPREHENSIVE CHILD DEVELOPMENT PROGRAM
INTRODUCTION
Child development services are defined as including children from conception through age 16 with particular emphasis on the preschool child. This does not exclude any child between these ages and should make provision for children with special problems such as behavioral disorders, learning disabilities, retardation, severe crippling, or disability, etc. Research findings indicate that social intervention in behalf of the child must begin with prenatal experience and extend upward if we are to offset the effects of poverty and deprivation on the child's future development.
Families usually provide for the safety, physical well-being and health of children, as well as provide opportunities for children to acquire the social and intellectual skills and competencies which make it possible for the children to do well in school and to participate fully in our society. Many families do not have within themselves, nor are they able at present to find in the community, the resources to make these provisions for their children.
The purpose of this plan is to design a program that will provide for any family in the State who needs them, those services necessary to supplement and strengthen parental functioning to assure optimum development of the children.
Such a program will need to include a variety of kinds of child development services and make provision for providing this service in many different ways. No single service~ no single model will suffice in meeting the need.
In a region as diverse as the State of Georgia, many kinds of needs will present themsel~es. In some sections, women work in industry; a day care center and family day care home are needed. In others, women are home but school records show that their children are likely to fail in first grade; a half-day program is desirable. Some children who are characterized by severe poverty live in isolated rural areas -- a mobile program that can meet once or twice a week at some central place to provide an enrichment program for children and training for parents would be advantageous. Homemakers and baby sitters are necessary adjuncts to the child development program. Children with special needs may do best in a day care home; and when families are in serious trouble, foster homes or emergency care may be necessary. In many areas mobile units will need to go into small rural communities (to a church or school) and conduct oneday or two-day a week programs. They will need to train mothers to provide preschool education and provide them with the necessary toys, games, etc. on a lease basis. Each of these programs should be center-based and the center may consist of a social worker, a child growth and development specialist, an aide or a nurse, and a mobile unit.
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Components of this comprehensive program will provide for development, i.e., health, mental health, education, welfare and nutrition. These components include:
1. Education services for a. The child, and b. The parent
2. Health Services a. Family planning b. From Conception - 16 years for the child c. Family
3. Child Care services - child care to all ages including exceptional and physically handicapped children.
4. Education (training and manpower) - for professionals, paraprofessionals, volunteers.
5. Social services and counseling - in all areas of the program.
6. Research and evaluation.
The need may be for services as comprehensive as foster care or full day care, or it may only be necessary to provide a preschool enrichment program which will enable children to acquire the social-personal, cognitive and physical motor skills upon which a successful school experience depends and which will serve as a vehicle for dealing with children's health problems.
A. EDUCATIONAL SERVICES TO THE CHILD AND PARENT
1. Objectives:
a. Strengthening family functioning is a major goal of this program. Many kinds of educational experiences will be provided parents to accomplish this goal. Parental involvement and the parent education are essential for this program. The program for the children will succeed and its effects will persist through the growing up process only to the extent that parents have be~n involved and as they have acquired skills and knowledge which will enable them to participate actively and positively in the growth and education of their children.
In order for these programs to have maximum impact, parents will be encouraged to participate in programs which will enhance parental functioning, programs which teach parents how to reinforce and extend the benefits of the children's program, family planning classes, consumer education, homemaker skills, etc.
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b. Education for young children from birth to school ages should encompass the following aims:
1. To foster security with adults.
2. To encourage self-liking, self-confidence and selfunderstanding.
3. To recognize reasonable limits and to influence growth toward self-discipline.
4. To promote health, physical growth and motor development.
5. To increase independence in meeting and solving problems
6. To stimulate a liking for children of different ages and backgrounds.
7. To promote the language skills.
8. To help children to observe, investigate, seek and acquire information'
2. Problems and Needs:
The years before six are the most crucial period of a child's growth and learning. If this critical ueriod of growth is neglected,. it is virtually impossible to make up the deficit in later years. The homes of disadvantaged children are usually lacking in the experiences that promote optimum intellectual growth. It is obvious, therefore, that provisions for care of young children before school age need components that provide educational stimulation.
3. Proposed Programs for Meeting Needs:
a. The Child from Infancy to 3 years
It is desirable in most instances for very young children to be at home with their mothers. Realistically, it is an accepted fact that many mothers must leave their very young children in child care centers.
The workers for these children are charged with a double responsibility. They need to be substitute mothers as well as teachers. They must provide warmth and love as well as intellectual stimulation. There will need to be enough adults present to give much individual care and provide interaction on a one-to-one basis.
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Equipment that provides visual and tactile stimulation should be provided to promote intellectual growth. A variety of materials must be available with which the children may interact with the help of conforting adults. The design and arrangement of rooms to eliminate over-crowding of the smaller children is extremely important, and the teacher should be highly competent and devoted to young children.
b. Education of Children from 3-5 Years:
No child care center should be developed without a strong component of educational stimulation for the preschool child. these educational programs must be based on sound child development programs and be consistent with the policies of the State early childhood education guide.
The preschool program should be neither a rigid course of study nor a permissive "waiting for something to happen" procedure. As in all good curricula, the program must be based on what is known about child growth and learning theory and the foundations of subject matter suited to the child's level of understanding. It is based on the needs of young children: The need for physical movement; the need for trust and understanding; the need for experiences to extend their knowledge and concepts, and the need for develping a sense of selfworth and inner-controls. The selection of curricula and program material for nursery and kindergarten children should be drawn from concrete experiences that are selected to interweave intellectual, physical and socio-emotional development. These are arranged by competent teachers prepared to take the child from where he is at the present time and guide him toward his potential.
c. Special Education:
Special education components are designed to be separate entities; thus, they could be incorporated into any existing program or established as separate programs.
1. Programs for Parents
a. Counseling for parents of handicapped children and helping them to adjust to the child's handicap in the home.
b. Helping parents understand the nature of handicapping conditions.
c. Instructing parents in ways to help the child compensate for the handicap.
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d. Providing opportunities for parents to observe the child in a learning situation so the parents might better assist child at home.
e. Providing training services to parents so they can relate to their child's specific handicapping condition, and so they will have opportunities to work with other handicapped children.
f. Providing prospective parents with instructional and medical services for prenatal and postnatal care.
2. Programs for Handicapped Children
a. Providing appropriate educational programs for both mentally and physically handicapping conditions.
b. Demonstration Centers
These centers could function independently or be included in an existing facility, but in either case should provide for medical, pyschological and social/emotional evaluation with follow-up prescriptive programs. Demonstration classes in all identified areas of exceptionality could serve also as training facilities for professional, para-professionals and aids who will be working with handicapped children.
B. HEALTH SERVICES
1. Objectives
To ensure that every child is a wanted child and as free as possible from the handicaps of prematurity, congenital manformations, and other conditions related to mental, physical and social growth and development.
The plan of comprehensive health care for children is strongly oriented toward a program for seeking and maintaining health, beginning with prenatal care and following the child through his early years. While there is provision for diagnosis and treatment of illness, the major focus of the plan is directed toward maintaining a maximum level of health for each child.
a. The basic health needs of the child, including the prenatal child, must be met; dental services, medical correction and treatment, as well as nutrition services, must be provided. If the family is to function adequately, the health needs of parents must be met.
The growth and development of a baby depends largely upon the health and well-being of his mother before conception as
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well as during pregnancy, as well as upon being a wanted child.

The medical supervision of the mother while she carries her child is of great importance for the child's normal growth and development. Her diet must contain the proper nutrients for the baby's growth. Prevention of pregnancy complications must be attained, because growth and development of a baby is inseparable from the health and well-being of the mother. An inherited disease, a chronic illness, and an acute infection, or a complication of pregnancy may result in the death of the baby before birth, abnormalities of his organs, or his premature birth.

Recent advances show evidence that birth injuries, cerebral palsy, mental retardation, and congenital malformations can be decreased. Such factors as virus infections, ionizing radiation, maternal medication and dietary deficiency require more attention during the unborn baby's life, because these events can produce defects in the baby, crippling him for his lifetime.

b.

Most of the services needed for comprehensive child health

care are available, at least in some parts of the State. A

vital part of the plan is to increase the accessibility of

these services throughout the State (with primary emphasis on

identified poverty areas) and to improve the patterns of

communication and referral among the various units of the health

care system.

The Health Department's cooperation will be sought in setting up prenatal clinics and education programs, well child health clinics, adult clinics, dental clinics, treatment centers, and in providing mental health resources. Provisions will be made to purchase these services from private sources in the event of the unavailability of Public Health~sources. Provisions will need to be made for transportation to facilities, purchase of medication and medical and dental appliances, follow-up visits, care for children if parent is hospitalized, in-home care of sick, etc.

2. Problems and Needs

The major problems in the improvement of child health care are:

a. Shortage and poor distribution of professional health manpower.

b. Lack of coordinated health services.

c. Limited transportation facilities.

There is strong indication that comprehensive health maintenance services for children could reduce demands upon physicians and other health professionals for minor problems and allow for more effective

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utilization of existing manpower. Consequently, the plan proposes use of individuals with minimum preparation required for each function in the health maintenance spectrum, particularly for preventive, observational, and instructional functions.

3. Proposed Programs for Meeting Needs

The following health care system is described as a proposed plan of care for the health care of mothers and young children (0-5 years).

General Overview:

The Comprehensive Health Plan will be a coordinated funding effort between public health departments and financial effort on the part of agencies concerned with the delivery of comprehensive health services.

The health care system will be a group of coordinated health facilities and services to provide for various levels of care for mothers and children. Such facilities or services should include connnunity satellite health centers for family health maintenance, a central health center for diagnosis, evaluation and treatment for mothers and children, and a hospital for in-patient care and maternity service.

Plans are that existing facilities, services and resources will be utilized, as well as services of private physicians. All appropriate on-going programs will be utilized.

Components of service for the health care plan could encompass screening and counseling, diagnostic and treatment services, hospital delivery, rehabilitation-restorative services, and coordinative record service. Such components will include the following areas:

Health Maintenance

Logical Location

Screening and Counseling

Satellite Connnunity Center

Diagnostic and Treatment

Satellite Connnunity Center Central Health Center Hospital

Restorative and Rehabilitation

Hospital, Home Care Services, Crippled Children's Services, Mental Health Centers, other agencies

Coordinative Record Service

Computer Center and/or record referral

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Service Provision Family Planning
Prenatal Care
Postpartum Care
Delivery
Children 0-3 Years Infant and Toddler Health Care
Immunization Services Referral and Caring for Identified Problems

Activities Involved
Casefinding and family planning counseling, medical evaluation and treatment, instructions, nutrition assessment, counseling and parent education.
Casefinding, medical and obstetrical evaluation, treatment with hospitalization as indicated, health maintenance to include physical, developmental, nutritional assessment, counseling and teaching.
Medical evaluation/treatment, family planning evaluation/treatment, nutrition counseling, child care instructions. Hospitalization as indicated.
Hospital obstetrical services for labor, delivery, postpartum (includes physical and emotional care, counseling, teaching and assistance in newborn and high risk infant care).
Activities Involved
Casefinding. Assessment: physical, developmental, vision and hearing, nutritional; screening and counseling, Medical diagnosis, treatment and therapy. Parental instruction; accident prevention, signs of illness, child care.
According to immunization, cummulative record referral.
Referral for physical corrections, rehabilitation services, instruction and counseling. Supportive care of both parents and child. Notification of appropriate resources: crippled children's service physicians, specialists or health centers. Referral for emotional and/or behavioral problems to community mental health.

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Children 3-5 Years Child Health Care
Dental Health Handicapped Children

Activities Involved
Casefinding. Assessment: Physical, developmental, vision and hearing, nutritional; screening and counseling. Medical diagnosis, treatment and/or therapy. Referral. Immunization. Parental instruction: Accident prevention, signs of illness, child care.
Notification of appropriate resources ; crippled children's service physicians, specialists or health centers.
Dental Screening, evaluation and treatment. Parental instruction dental care.
Activities Involved
Notification of appropriate resources: Crippled children's service physicians, specialists or health centers. Referral for emotional and/or behavioral problems to community mental health. Early identification of handicapped children. Referral, home care followup as indicated, parental emotional support and counseling. Medical and surgical intervention as indicated. Immunization. Social-psychological evaluation to identify immediate and future educational needs.

The following schematic diagram, with accompanying explanation,outlines a suggested flow system coordinating community programs and services with agencies which can implement them.

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SUGGESTED FLOW SYSTEMS SCHEMATIC DIAGRAM
Central Health Center Concentrated Medical Sers. High Risk Factors Chronic/Acute Illness Physical/Mental Treatment/Therapy Screening/Counseling Record/Referral

Satellite Community Center Screening/Assessment Immunization Home Care Counseling: Nutrition Drug Abuse Clinics: Dental Adolescents Family Planning Prenatal Child Health Health Ed./Exhibits

Records

..

&

..

Referral

Extended Care Services Hospitals Private Clinic Integrated Facilities:
Special Laboratories Radiotherapy Intensive/Acute Care Crippled Children Mental Health

Service Agencies Education Manpower Community Action Agency Model Cities F.A.C.S. (Welfare) Emergency and Family Assistance, education, employment, child care, transportation, housing

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CENTRAL HEALTH CENTER
1. Will be a stationary facility ideally located in the vicinity of hospital and medical centers.
2. May be an organized composite of well coordinated services that will ultimately achieve preferred medical care.
3. Provide complex, concentrated medical services to mothers and children for conditions such as those designated as high risk factors, chronic or acute illnesses, physical and mental disabilities.
4. Provide treatment or therapy.
5. Provide screening for problems needing correction and counseling services (for both parent and child).
6. Referral to Satellite Community Center hospital and other agencies as indicated.
7. Maintain central records service. Referral to hospitals, Satellite Community Center and other related health agencies.
8. Provide referrals (for parent and/or children): a. Care during pregnancy. b. Labor and delivery. c. Sterilization and abortion. d. Medical and surgical conditions which may require hospitalization. e. Acute, chronic or handicapping conditions which may require hospitalization.
Standard Requirements of Care:
1. Written policies, procedures and regulations for the conduct of the center.
2. Reference to Standards for Maternal and Child Health care.
Staffing (as applicable):
The Center Physician and Center Administrator should have primary responsibilities in the operation of the health center as categorically indicated.
Center Physician: Responsible for health orientated activities.
Medical Specialist Dentist Nurse Specialist/Public Health Nurse/ Licensed Practical Nurse Nutritionist X-ray/Laboratory Personnel
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Health Program Representative Social Worker Patient Coordinator (for follow-through or patient referral)
Center Administrator; Responsible for center coordination and administration.
Central staff (operative) Liaison Fiscal Records Librarian Clerks Outreach workers Maintenance/housekeeping personnel
SATELLITE COMMUNITY CENTER
1. Will be stationary and/or mobile clinics located in neighborhood areas.
2. Provide corrective screening services plus follow-up; Physical, developmental, nutritional assessment and counseling of mothers and children.
3. Provide clinical and dental services related to health maintenance.
4. Provide treatment of minor health complications (parasites, colds, impetigo, low hemoglobin).
5. Provide home care services for health maintenance to include rehabilitation and restorative care.
6. Provide limited laboratory services such as urinalysis, hematocrit, tests for pregnancy, serology and pap smear.
7. Refer laboratory specimen to Central Health Center, specified pathologist or licensed laboratories, as indicated.
8. Provide counseling related to nutrition (demonstrations as indicated).
9. Provide immunization and maintain record system.
10. Provide family planning services.
11. Referral to Central Health Center (conditions requ1r1ng physician supervision may be delegated to a registered nurse).
12. Referral to other health related agencies as indicated.
13. Provide health services to day care nurseries and kindergartens.
14. Maintain records and refer copies to the Central Health Center.
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15. Maintain and distribute educational material in coordination with community agencies.
16. Provide patient coordinator (establish linkage with existing agencies). 17. Should be the central area to elevate community involvement.
Standard Requirements of Care: 1. Written policies, procedures and regulations for the conduct of the center. 2. Refer to "Standards for Maternal and Child Health Care". (See Appendix
IV. ) 3. Medicaid, Medicare and medical treatment services must be supervised by
a physician. 4. Centers must meet all local and state health standard requirements.
Staffing (as applicable): The House Specialist and Center Director should have primary responsibi-
lities in the operation of the clinic. Dentist Nurse Specialists Public Health Nurse Registered Nurse Licensed Practical Nurse Aide Health Program Representative Patient Coordinator (for follow-through of patient referral) Clinician (part or full-time physician)
Center Director: Responsible for satellite coordination and administration. Clerical Aides Outreach Transportation
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C. SOCIAL SERVICES AND COUNSELING
The social worker's task is to identify problems and to bring her own special skills, the community resources, and the program's resources to focus upon the solution of the problem. The social worker is the family's advocate in the community. A social service program should help parents and children with problems that affect their relationship with each other, with problems related to the changes in today's society, with problems associated with the bearing and rearing of children (both in wedlock and out of wedlock) and with decisions related to the parent's plans and goals for their children.
In working with child care program staff, the social worker must contribute an understanding of the dynamics of human behavior and family relationships, and must also assist with the problems that arise from the sick or handicapped child, from separation of the child and parent (even for a brief time) and help with other problems that arise from a change in the family due to placement of the child, from the mother working outside the home, etc.
It is recognized that persons who have been seriously deprived may find it difficult to use services even though they know services are available. They may need support to place their children in a setting which will enhance the children's lives, or to recognize that the child may be in need of specialized help such as counseling, medical care, etc. It may be difficult for these persons to actively seek help when they themselves need it.
Many kinds of services will need to be secured or developed on behalf of the child and the strengthening of parental functioning. Programs should include services such as:
1. Services to the unmarried parent.
2. Family life counseling.
3. Diagnostic services.
4. Supportive services in family planning.
5. Services to the child.
6. Supportive services to the child's family.
Social workers should be used:
1. Do case finding and screening.
2. Provide counseling services.
3. Provide information regarding community services and resources.
4. Make appropriate referrals.
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5. Serve child case program staff -- to broaden and strengthen the understanding of the dynamics of behavior.
A social service program should be available to all projects. In the initial phase of this child development program, provisions for social service staff should be a part of each proposal submitted for funding. Later, as funds become available, the Department of Family and Children Services may provide this service either through contractural arrangements or through direct employment and supervision of staff.
Social services should be available to clients, and consultation should be available to the agency staff.
D. CHILD CARE SERVICES
Children in their early stages of development need a variety of stimulating educational experiences in order to develop to their full potential. Many families without help from the connnunity are unable to provide these experiences for their children. Many connnunities in this region are unable to provide the opportunities necessary for children to acquire the social and intellectual skills and competencies which make it possible for them to do well in school and develop to their maximum potential. It is estimated that there are approximately 25,000 children in the Appalachian Region of Georgia that are in need of some form of comprehensive child care service.
A comprehensive child care program should include prov1s1on for day care programs, both in group centers and family day care homes, for homemaker service, in-home care, foster care, emergency care, part day programs, and a mobile program which can be taken to the child and his parents. It should provide service for both the "normal" and the exceptional and physically handicapped child.
The Department of Family and Children Services plans to operate or contract with local groups in providing as many as possible of the services listed in the above comprehensive child care plan.
Programs will be designed to maximize the child's potential socially, personally, intellectually and physically. This program planning will involve the local connnunity to develop the kind of program needed by children and families of that connnunity.
E. MANPOWER EDUCATION AND TRAINING
While there have been programs for young children for many years. it has only been recently that great interest has been shown by the public to provide comprehensive child development programs.
Unfortunately, the interest in, and the establishment of, day care programs has exceeded the supply of trained personnel available. Also, the provision of services to mothers and children has been hampered by a shortage of health and social services professionals, and allied professionals. As
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a result, child development programs have either gone wanting, or administrators have filled positions with unqualified personnel. In these situations, children and families suffer via non-existent or inadequate programs.
In order to effect a good comprehensive child development program which will provide for educational stimulation in an acceptable psychosocial environment as well as provide services to attain and maintain health and well-being of children, two priorities emerge:
1. To provide additional qualified child care personnel in these areas:
a. Teachers and supervisors for child care centers.
b. Social workers, physicians, nurses (including nurse specialists), and other allied health and social welfare personnel.
2. To provide a strong program of in-service and pre-service training. The purpose would be to up-date trained personnel and up-grade untrained personnel.
The educational preparation and training of local people to implement a good child development program will enable programs to be adequately staffed, will provide for employment of many persons with limited formal education and limited resources for meaningful employment, and should enable the community to continue the program after federal funds are reduced.
Professional education will include:
1. Educational preparation of teachers, physicians, dentists, nurses, social workers, nutritionists, and other professionals in accredited schools of education. The latter includes universities, senior and junior colleges, schools of nursing and vocational-technical schools.
2. Existing Georgia schools and scholarship programs should be utilized as far as possible.
3. The career ladder concept will be encouraged, thus allowing upward advancement through additional educational preparation.
Trainin~ programs will include:
Extensive in-service and pre-service training will be provided both for persons who will work with children and for those who will work in the community. Such training should, whenever possible, take place in a setting where trainees can work with good models and can be supervised while working. In addition, such training will be specific for a given program with on-the-job supervision. Training programs will be evaluated
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in termsoT the trainees' performance on the job and will be based upon a careful consideration of the skills and competencies involved in the task for which the person is being trained. A provision for group meetings with trained leaders should be an ongoing part of the in-service program.
Training programs should be provided for:
1. Volunteers - These will be encouraged to work in the programs, but they should participate in a training program prior to working in a project.
2. High school students - Schools will be encouraged to offer to high school students courses related to parental and family functioning; those students having participated in a training program could work with children to acquire firsthand knowledge of child growth and development.
3. Teachers of Young Children - As child development centers are established, extreme care should be taken to select teacherg that can foster child development. Not every person is suited to the care and handling of very small children. As child care centers are charged with a double responsibility of being parents and teachers, personnel should have very special training. Each teacher in the program should have a certificate in early childhood education. All persons working with babies should have pre-service training and courses in child growth and development. There should be para-professional personnel available for specialized work and these should be trained under available programs in the vocational schools.
4. Parents - Training programs should be provided parents in areas of learning how to reinforce and extend the benefits of the children's program, family planning classes, consumer education, homemaker skills, child care, etc.
5. Professional and Para-Professional Service Staff (social service health, nutrition, dental) - In-service education should be provided to upgrade educational preparation, to provide information about current trends in child care, and to provide information pertaining to parent-child relationships and the effects of service intervention. Programs will be directed toward upgrading the quality and coordination of services to mothers and children.
Suggested Model for Child Care Centers:
Child care centers are of special importance for child development and require trained personnel.
The effects of deprivation in the early years upon health, social relationships, intellectual development and emotional stability is a major national concern today. Society, on behalf of its future citizens, owes to the nation the best possible child care centers for its young so
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as to off~set the effects of impoverished environments.
The following model is suggested for an instructional team which is multi-leveled, interdisciplinary, and differentiated in roles, yet coordinated in function. This model should be implemented wherever possible:
1. Teacher trainer - PhD level.
2. Coordinators/Supervisors - Ed. S. level.
3. Lead Teachers - Ed. S. level or M. Ed. level.
4. Teachers - M. Ed. level or B.S. level.
5. Assistant Teachers - B.S. Level.
6. Teachers Aides (Post-secondary) - A.S. Level.
7. Other Aides (Pre-secondary).
Input into this model is received from other college and technical school personnel and from other community and state resources.
In areas where training resources are not readily available, mobile units could be utilized. Existing library and other instructional materials for early childhood education could be used for stocking these units, which would then remain in communities for several weeks at the disposal of training teams.
Also, regional centers could be established to serve as satellite training units. Universities and vocational schools could assign students to these centers for an internship/practicum experience. During their term of service, students would act as trainers for other personnel in the centers.
In addition, child care workers should be encouraged to participate in workshops, seminars and institutes sponsored by professional organizations and other groups, the Department of Family and Children Services, Vocational Technical Schools, and the University of Georgia.
Proposed Model for Training in the State of Georgia
Training needs to include pre-service and in-service training for paraprofessional and professional staff o Resources of schools, colleges, and other teaching institutions need to be combined to effectively produce the needed training programs. Programs should be planned to include a career development component.
Training is conceived of as a program to include all persons involved in the child care area, including health, nutrition, social services, and education. Special training programs should be made available to personnel working with children and their families. The following recommendations
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are made for such training:
1. Professional Training
a. Provide scholarships for attending state colleges/universities offering programs in the area of early childhood education and service to children.
b. Provide funds so that off-campus courses in early childhood education and services to children may be offered in local areas.
2. Para-professionals
a. Provide funds to implement local training programs fer paraprofessionals and aides to work with children.
3. In-Service Programs
a. Provide funds for continuous in-service training of personnel to insure quality educational programs and to foster professional growth within professional and para-professional ranks.
F. EVALUATION
Programs in the areas selected for demonstration will be subjected to complete evaluations prior to, during, and following implementation. The evaluation will consist of a series of measurements and observations reflecting changes resulting from the intervention programs. An evaluation plan will be developed utilizing appropriate standardized instruments.
Evaluation of the effects of social services and counseling can probably be most adequately accomplished by detailing services rendered and the recipient's reaction to those services. An interview schedule will be developed for use by an independent party for purposes of evaluating those services.
Evaluation of the health service component will reflect changes in the health status of children resulting from project intervention. Data will be used to compare project impact on child health problems described in the project as well as vital statistics for the specific area.
Evaluation services provided by the State Health Department will be utilized to determine changes in the number of mothers and children reached .compared to the possible target population. Included will be family planning services and child care services; such as health supervision, early detection and treatment of health problems and immunizations. Vital statistics will reveal changes in the percent of live births to the mothers less than 18 years of age, premature births, and neonotal and maternal mortality.

Evaluation of the prov~s~ons of the comprehensive child development program will be based upon the continuity of services and the involvement and interrelationship of agencies -- welfare, social service, education and health. G. COORDINATION OF SERVICES
Plans are currently being devised to insure the coordination of efforts in the provision and delivery of child care services. As new programs and resources are developed, they are coordinated with all relevant existing private and public services, to assure maximum utilization of mutually supportive programs.
In addition to the above effort to maintain coordination of existing services with new resources, data is being compiled to provide more complete information of all services available in the regions designated as Local Development Districts. As the data is compiled, it will permit optimum elimination of overlapping and duplicative services through complete coordination of resources.
All Child Development construction projects will conform to the A-95 Project Notification and Review System.
This coordination effort will assist the State agencies and regional planning agencies in identifying problems, avoiding duplication, and insuring the prudent use of public funds.
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v; CHILD DEVELOPMENT DEMONSTRATION AREA

A. DEFINITION AND BOUNDARY

The Child Development Demonstration Area in Georgia will encompass all 35 Appalachian counties. The Interagency Task Force decided that no single demonstration area be established as was done for the Commission's Health Demonstration Program. The Interagency Task Force believes that the Appalachian Child Development Program should be available to all of the children in the Appalachian portion of Georgia, and that a designation of a single demonstration area now may eventually preclude assistance to those areas outside such a designated area. However, the Interagency Task force specified that the Appalachian area should be divided into four distinct physical areas. These four areas are as follows:

1. The Coosa Valley Area Planning and Development Commission:

(Member Counties)

a. Bartow b. Catoosa c. Chattooga d. Dade e. Floyd

f. Gordon g. Haralson h. Paulding i. Polk j Walker

2. The North Georgia Area Planning and Development Commission:

(Member Counties)

a. Cherokee b. Fannin c. Gilmer

d. Murray e. Pickens f. Whitfield

3. The Georgia Mountains Area Planning and Development Commission:

(Member Counties)

a. Banks b. Dawson c. Forsyth d. Franklin e. Habersham f. Hall

g. Lumpkin h. Rabun i. Stephens j Towns k. Union l. White

4. The Lower Appalachian Region:

Atlanta Region Metropolitan Planning and Development Commission:

(Member Counties)

a. Douglas b. Gwinnett

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APPALACHIAN CHILD DEVELOPMENT DEMONSTATION AREAS I. COOSA VALLEY APDC 2. NORTH GEORGIA APDC 3. GEORGIA MOUNTAINS APDC 4. LOWER APPALACHIAN REGION
, -".. -:::-----_l_ _-L-. ----J_ _
F _ORIDA
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Chattahoochee-Flint Area Planning and Development Commission:
(Member Counties)
a. Carroll b. Heard
Northeast Georgia Area Planning and Development Commission:
(Member Counties)
a. Barrow b. Jackson c. Madison
The reason for consolidating the three Area Planning and Development Commissions above is that the majority of their member counties lie outside of the Appalachian portion of the State. Joint cooperation between two different Child Development Demonstration Areas in the planning and administration of projects will be coordinated through the Administrative Office.
B. ELIGIBILITY
Participation in the comprehensive child development program will be voluntary and individuals may seek services at any time, Persons who are otherwise not eligible by criteria listed below may receive services by paying an established fee in accordance with a sliding fee scale (where applicable).
Persons or families in the following categories will be eligible for participation in the program:
1. Those who are eligible for medical assistance as medically needy persons, under the State's Title XIX plan.
2. Those who meet the definition of former and potential recipients under the State Welfare Plan.
3. Those who are at, or near, dependency level, including those in low-income neighborhoods and among other groups that might otherwise include more AFDC cases, where services are provided on a group basis.
C. PLANNING AND ADMINISTRATIVE ORGANIZATIONS
The Interagency Task Force will be composed of State agency personnel, qualified professional child development experts, and local consumer parents who shall be selected from their peers at the local level. Provision will be made by the end of the first operating year for representation from local communities. An Administrative Office shall be established by the InterAgency Task Force. This 'Administrative Office will be staffed with qualified

personnel who will implement the Plan under the policies of the Interagency Task Force.
The main functions of this Administrative Office will be as follows:
1. Administer Program at State level under the direction of the Task Force.
2. Coordinate field staff.
3. Develop and finalize the Child Development State Plan.
4. Review submitted Child Development applications.
5. Recommend Child Development applications to the Interagency Task Force.
6. Perform other duties assigned by the Task Force.
The Administrative Office will have field personnel assigned to specific areas within the Georgia Appalachian region. The field personnel will be responsible for the following:
1. Assisting the local communities, C1V1C organizations, regional State agencies, etc. in the planning and development of projects.
2. Selecting projects at the regional level, developing applications, and recommending applications to the Administrative Office for consideration.
Once the program is implemented, the Bureau of State Planning and Community Affairs, hereinafter referred to as the Bureau, will act as a liaison-technical advisory office between the Interagency Task Force and the Appalachian Regional Commission.
The Bureau's responsibilities will include the following:
1. Act as the State Clearinghouse for the A-95 reviewing of applications involving construction.
2. Assist the six Appalachian Area Planning and Development Commissions with the regional clearinghouse review of applications where applicable.
3. Review the Task Force Child Development Plan for accuracy, completeness and compliance with ARC criteria, and transmit Plan to the Appalachian Regional Commission.
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4 . . Review applications forwarded from the Task Force for accuracy, completeness and compliance with ARC criteria, and transmit applications to ARC by endorsement of the State Representative. Existing procedures between the State's Representative and the ARC (as in other program areas)will apply to Child Development Projects.
5. Assist the Interagency Task Force with technical interpretations of ARC policies, criteria, and guidelines, and any other similar related functions.
6. Develop fiscal guidelines for the program.
An advisory committee system will be established at the local level in each area of the region. Membership in the local advisory committee will consist of consumer parents, professional personnel (concerned with service delivery), public officials, and concerned citizens in the area. The percentage of consumer parents will conform to the requirements of funding sources.
The local advisory committee will participate in program planning, and work towards a comprehensive plan for child development as well as delivery of services. The advisory committee shall recommend approval or disapproval of projects of local programs, both new and previously funded.
From the local advisory committee, members will be selected to serve on the Interagency Task Force.
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VI. SUMMARY OF PROPOSED PROJECTS FOR IMPLEMENTATION OF PROGRAMS

The initial projects selec~ed by the Task Force on Child Development were in the following counties:

Douglas Paulding Haralson Walker Dade Catoosa

Stephens Banks Cherokee Dawson Fannin Franklin

Chattooga Polk Carroll Forsyth Townes Floyd Gilmer

Habersham Lumpkin Pickens Rabun Union Whitfield v.1hite

The types of programs selected included:

(24) Day Care Centers

(1) Comprehensive, Service, Training, Diagnostic and Treatment Center

(2) Maternal and Infant Care Projects (Serving a total of 20 counties)

(1) Unwed Mothers Services

(1) Mobile Toy Lending Library (with parental involvement)

(3) Dental Care Projects

(1) Prenatal Comprehensive Health and Medical Project

(33) TOTAL

These project proposals were judged to be in such a state of readiness and/or completion that they could be submitted to the Appalachian Regional Commission by April 1, 1971.

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VII. PLANNING FOR THE FUTURE This plan constitutes Georgia's initial effort for a Statewide comprehensive Child Development Plan. Any weaknesses of this first endeavor will be corrected as experience is gained in the future implementation of the plan. This plan is to be considered a working draft and will be replaced next year by a more detailed strategy for Comprehensive Child Development. The current plan provides the necessary foundation required to gain 2xperience and expertise necessary for the preparation of a truly comprehensive Child Development Strategy in the near future. It is anticipated that the plan for next year will emphasize the identification and relationships of existing programs at local, state and federal levels. The plan will work towards a strategy for the implementation of a system which maximizes the interrelationships of existing programs such that the pyramiding effect is realized. For ex~mple, it might be possible for a mother to place her child in a child development day center, thus gaining the necessary time to receive additional training or counseling which will result in her being a better mother to her child, (or, she could attend a nurses training facility while her child attended the center, thus benefiting not only her own child, but also other children in the community). Next year's plan will outline the staff structure necessary for carrying out additional interagency coordination and communication, as well as Task Force responsibilities. Also, a strategy will be developed and included in the plan for making projects self-sustaining when federal support for individual projects is no longer available. Finally, next year's plan will address those areas identified by the Appalachian Regional Commission as being deficient or absent from this plan.
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APPENDIX I
DATA ON GEORGIA CHILDREN
The following data are presented as major indications of unmet needs in the delivery of health and welfare services to children in the State of Georgia. Separ2te data on Georgia Appalachian children are also included.
Tables 1 through 5 and Figure 1 were taken from "Georgia Vital and Morbidity Statistics 1969" published by the Georgia Department of public Health, Atlanta, Georgia. The terms used in the column headings are discussed below:
Live Births
A live-born infant is one who shows any evidence of life (breathing, heart beat, or movement of voluntary muscles) after complete birth.
In 1969 there were 90,193 live births, an increase of 2,873 over the 87,322 occurring in 1968. All of the increase occurred in the white births while the nonwhite decreased by 65.
The white and nonwhite birth rates for 1969 are 17.8 and 24.1 per 1,000 population, respectively. (See TabJ e 1, page 35.) The Georgia total rate for both races is 19.4 compared to the U. S. rate of 17.7
In 1969, 96.0% of all live births (99.7% of the white and 88.1% of the nonwhite) occurred in hospitals. This represents an increase of 1.5% over the corresponding percentage for 1968 and can be largely attributed to the increased percentage of nonwhite births occurring in hospitals.
Maternal Deaths
The term "maternal death" describes a death resulting from complications of pregnancy, childbirth or the puerperium. There were 29 such deaths reported for Georgia in 1969, a decrease of 1 from 1968.
Infant Deaths
An infant death is any death occurring during the first year of postnatal life. There were 2,060 infant deaths recorded in 1969, with a white rate of 17.3 per 1,000 live births and a nonwhite rate of 34.6. The Georgia total rate in 1968 was 25.5 compared to the u.S. rate of 21.7.
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APPENDIX I (Cont'd)
Fetal Deaths
A fetal death is defined as a product of conception of any length gestation that shows no sign of life after complete birth. Prior to 1954, only fetal deaths of "20 or more" weeks gestation were recorded, and were classified as stillbirths.
In 1954, a new procedure was initiated in which all products of conception, regardless of length of gestation, were recorded and classified as fetal deaths and grouped according to length of gestation.
Inunature Deaths
An immature birth is defined as the birth of a live born infant with a weight of 5 1/2 pounds (2500 grams) or less. If weight is not specified, a live born infant whose length of gestation is less than 37 weeks is considered immature.
There were 8,375 immature births recorded in 1969, compared with 8,261 in 1968, with a change in rate from 94.6 per 1,000 live births in 1968 to 92.5 in 1969. This was a total increase of 114, the white increasing by 45 and the nonwhite by 69.
Births to Unwed Mothers
The total rate of 112.9 births to unwed mothers per 1000 live births in 1969 represents a decrease of 2.1 from 1968 with the'individual rates being 34.9 for the white and 280.5 for the nonwhite.
Neonatal Deaths
A death occurring during the first 27 days of life is classified as a neonatal death. The 1,435 neonatal deaths reported for 1969 comprise 69.7% of the total infant deaths for the year and show an increase of 3.4% over the 66.3% in 1968.
Deaths in this age group in 1969 show a decrease in number and in rate for both white and nonwhite. A 2.6% decrease in neonatal deaths from the 1968 total was the consequent result. Approximately 52% of all neonatal deaths occurred to infants under one day of age.
The Georgia total rate in 1968 was 16.9 compared to the U.S. rate of 15.8
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TABLE 1

- SUMMARY OF SELECTEj~' VITAL STATI.<"'l'lCS, GEORGIA, 193.'5, 1940, 1945 - 1969

--- -"_. -

---- -- "---t-

-- ~~~~l;~.II~i:;~~~~e1 Whitei:~~~e ---Number

-Year Total +-~--
1935 63,29( 1940 64,69 1945 74,99, 1946 85,69 1947 94,311

White
----
37,34 38,91 47,42 227,572 56,354 29,345 62,394 31,917

24.011
27.4 I'
29.2 '!

23.3 27.8 29.2

1

Number

Tot"1 1
23,6\34,313 18,6771 15,636 23.832,296 17,321tl 14,972 25.4 28,456 16,310 12,146 27.027,405 16,1601 1\ ,245 2J.2128.n~nl17.022 11,758

Totsl
11.3 10 ,3
9.1 8.8 H.9

_~
NC'n-
White white
9.7 14.2 8.5 13.8 8.0 11.2 7.9 10.4 8.0 10.8

----HaLe.rOJ'] Deatbs*

-- ---

- Number Non

Ratto

Ii

i Non-

1 Total White wh it-. 'I:<>_t_al Wh it. white

458

230

2<8 72.41 61.6 87.9

342

146

196

37 5 76.0

250

102

148 5332..391 21..5 53.7

229

85

1f.J/.j. 26.7 15.1 49.1

247

107

14( 26.2 17.1 43.9

1948 91,604 58,60l' 33,003 28.611 27.7 31J.-1129,309117,0831 12,226

9.2

8.1 1:.3

208

~ ;~:~:: ;::~ ;~:~ 1949 93,557 58,65
1950 92 ,099 57,00

I,

32.2 29'537 1 17,}01 12,186 31.6 130,416 '118,00511 12,411

9.2 8.8

8.1 11. 3 7.7 11.2

185 150

1951 95,161 59,285 35,876 1952 97,130 61,439 35,691

26.711 24.1 27.3' 24.9

32.6130'~021118'161 12,641 33.0 30,6221 18,310 12,312

8.6 8.6

7.4- 11.5 7.4 11. ...

143 128

78

130 22.7 13.3 39.4

71

114 19.8 12.1 32.7

55

95 16.3 9.6 27,1

46

97 15.0 7.8 27.0

36

92 13.2 5.9 25.8

1953 1954 1955 1956 1957

97,421 00,191 00,295 02,643 01,882

61,67 1 35,750
64,39 21 35,799 64,238 36,057 65,642137'001 65,412 36,470

~6871 H:H: 1958 99,780 64 ,09
1959 99,458 64,04 1960 1)9,707 64,41 1961 00,444 64,31 36,128 1962 99,047 63,77 35,269

1963 1964 1965 1966 1967

99,360 00,581 94,336 89,376 86,469

64,57 65,09 60,22 57,85 57,03

34,785 35,488 34,110 31,521 29,438

27.0 27.3 I 26.81
I 27.1
26.4

24.5 25.C 24." 24.6 23.9

~H ~U I'!
25.1 22.4 24.2 21. 7

2233..88 \
21.6
20.0 i
19.2

2\.8 21.5 19. ? 18.1 17.7

32.91 3o '751I[lf'521 1 l::\~J1 3,.7130,5>5 10,863 11 ,692 ,
1
32.21 3o ,"38!119,;361 11,7021 33.0! .'!1,:>821, 19,830 11,752

32.2 , 3),421'1 <0,"19 1 17,492
i Jl.~133.249il 21,044 11,2C5
30.7 33, 376:1 21, '''.7 1 '2,329

31.3 i35'324'11111"26: 12,798'

31.7,34,367 22,320 , 12,047

I 30.b~3S,051 23,5041 12,547

I

I

iU1: I 29.0137,696,124,5941
2.6137,5l2:' 24,607!
L.5!38,J04Ii 25,1411
"".9.38'465 iI 25'74\'\ 12,120

1,.Oi38,'-'48\i 26,125 12,323

8.5 H.3 8. ] H.3 8.6
8.5 8.4 8.9 8.6 8.8
:;II
8.6, 8.51

7.4 11. 3 7.3 10.7 7.3 10.4 7.4 10.5 7.7 11.0
7 . 5 10.7 7.4 10.' 8.0 11.4 7.8 10.6 8.0 10.9
:: I tU
8.1 10.0 8.1 1 9.6

116

39

106

31

99

38

95

36

82

23

64

16

69

li7

60

12

52

19

48

19

H 18 22 13

41

20

28

10

]:::~:1 [-,--_1~9_'_4 58,61 61,50

28,706

19.1

-".3 i/.8

-'--

~:..2Ij41._Dii-:' 27.t:S551 13,4761 9.0

8.2111.4

30

nnl'L"~OB I L4.11L.l.18.d 27.fl701

,

II

Li _~'LIi

I
!

9 11

77 11.9

75 10.9

61

9.9

59 9.3

59 8.0

48 6.4 52 6.9 48 6.0 33 5.2 29 4.8

35 5.3 35 5.7 36 5.2 21 4.6 18 3.2

21 3.4 18 3.2

6.3 21.5 4.8 21.0 5.9 16.9 5.5 15.9 3.5 16.2
2.5 13.5 2.7 14.7 1.9 13.6 3.0 9.1 3.0 8.2
2.8 10.1 3.4 9.9 2.2 10.6 3.5 6.7 1.8 6.1
1.5 7.3 1.8 6.3

~ I I -THoo- ~[.{~;~~ Year

= "N"= 'u=m= "'b""= .r=--= Inf= an_t= _D_e= a_t~= h_s = ~ =~.

F"~~=O~O~'_
Fetid Deaths
~----Number

NonTotal White w.~~_~_~~.-+~t81 Wh~ei

Ratio Non-
White white

I 3'981111'~1212'455 I 193514,316 2,227 2,089' 68.2\ 5~.~ ~~.~i

TO. tal} 63.0 41.0 94.6

19403,737 1,851 1,886 1945 3,181 1,728 1,453

57.8 42.2

47.6 73.11 3.078,.ll.32fl 1,752 36.4 52.7 2,208111,036 1,172

47.6 34.1 1 67.9
29.4 .\ 21.8 ! 42.5

1946 3,068 1,694 1,374

35.8

30.0 46.81 2.421 II 1,161 1,260

28.3

20.6 42.9

1947 1 3,239

1948 1949 1950 1951

3,150 3,093 3,081 3,256

1,771
l,66J 1,668 1,518 1,548

1,468
1,489 1,425 1,563 1.708

34.3
34.4 33.1 33.5 34.2

28.4
28.3 28.4 26.6 26.1

46.0 2, 457 11 1 ,174

45.1 1

I! 2/.08i:

l~ll"

40.8 2, :78 ,I

44.5 1 ~. 02', ";':13';

47.61 2,091

I 1,283
!
1 99 1, tOe, 1." 1 1,1'3

26.1 II
,I
Ii il

18.8 40.2
18.9 39.4 16.6 34.6 15.5 32.5
, 16.4 1 31. 3

1952 3,158 1,567 1,591

32.5

25.S 44.0\ 1,992

J ,139

13.9 31.9

Immature Births Number

NonTotal White white Total

I

I

NOT AVAILA B L E

I

5,738 1
6,508 6,557 &,645 7,355 7,683

3,614
3,870 3,738 3,697 4,079 4,202

2,124
2,638 2,819 2,948 3,276 3,481

60.8
71.0 70.1 72.2 77 .3 79.1

195343,051 1954 3.155
1955 2:985 1956 3,087 1957 3,099
1

1,469 1,562 1.456 1,478 1,482

1,587 1,593 1,529 1,609 1,617

31.3 31.5 29.8 30.1 30.4

23.8 24.3 22.7 22.5 22.7

i 44.3 1,067
44." 3,950 '~2.4 /+,lfi1
43.5 ':J,''jiJ. 44.3 3,(,J3

867 2,239 :':,2 1.. 5 2,065 2,080

; ,100 1,711 i.910 1,669 1,558

il 20.2
,9.4

,i

il 1.. 1. ':>

36.4

35.7 I!

14.1 34.8 34.9 31.5 31.8

30.8 47.8 53.1 45.1 42.7

7,673 8,382 8,572 8,662 8,752

4,224 4,641 4,499 4,412 4,441

3,449 3,741 4,073 4,250 4,311

78.8 83.7 85.5 84.4 85.9

1958 3,103 I' 1,510
I' 1959 13,233 1,555
1960 3,282 1,582
II 1961 1,950 1,389
1962 12,986 1,418

II 1%3 ,3,084
I' 1964 '2,932

1,482 1,426

i:~~ ;:~6~ 1965

2 734 1 1,294 1,180
I!,. 1,137

1968 2,223 1,138

,~" 1,068

""

II

1,593 1,678 1,700 1,561 1,568
1,602 1,506
1 ,f+ -is
1,319 1,165
1,085 992

31.1 32.5 32.9 29.4 30.1
31.0 29.2 :9.0 28.0 26.6
2.3.5 22.8

23.6 24.3 24.6 21.6 22.2
23.0 21.9 21.6 20.4 19.9
19_4 17.3

44.6 47.4 48.2 43.2 44.5

J,3Jj 3,621 3,501 3,350 3,300

i.,921 2,173 2,102 1,958 2,034

h6.1 42.4 42.1 41.8 39.6
37.8 34.6

3,049 1,811 ).,040 1,754
2,"8) 1,523
2,430'1' 1,475 2,232 i 1,346

i:ii~

!I II

u;~

1,412 1.448 1,400 1,392 1,266
1,238 1,286 1.160
955 f86
919 939

!I

33.4
36.4 [I
35.1
33.4
33.3 II

30.7 30.2 28.4

II II

27.2 Ii
25.8
II 29. i II

31.3

30.0 39.6

I 33.9 40.9
32.6 39.7

30.i. 31.9

I
I

38.5 35.9

!

28.0 35.6

26.9 ! 36.2 i 25.3 34.0

25.5 30.3
23.6 ! 30.1

I

28.5 32.0
I 30.6 32.8

8,778 8,998
! 8,899
I 9,136 1 9,221
9,474 9,603 9,155 8,476 8,162
8,261 8,375

I

4,353 4,466 4,422 4,452 4,547
4,746 4,660 4,459 4,262 4,065
4,273 4,318

4,425 4,532 4,477 4,684 4,674
4,728 4,943 4,696 4,214 4,097
3,988 4,057

88.0 90.5 89.3 91.0 93.1
95.4 95.5 97.0 94.8 94.4
94.6 92.9

o.
White
57.9
66.0 63.7 64.9 68.8 68.4
68.5 72.1 70.0 67.2 67,9
67,9 69.7 68.6 69.2 71.3
73.5 71.6 74.0 73.7 71.3
72.9 70.1

Non'trlhite
66.5
79.9 80.8 84.0 91,3 97.5
96.5 104.5 113.0 114.9 118.2
U4.0 U8.0 U6.9 U9.7 132.5
135.9 139.3 137.7 133.7 139.2
138.9 141. 7

Ii

_.J..

.. l~

il

....

1 - ._ _ ~ L ~

t __ \ \

NOTE: Prior to 1938 al'J '-"ients are by place of occurrence; beginI'ling wi.th 1938 events are by place of residence.
*P :-~ of decreast' :r:Jm 1949 to 1950 is dir~ctly attributable to changes in classification of causes of death under the
Sixth Revision of the International List of Diseases and Causes of Deeth. Deaths from immaturity in 1968 and 1969 not comparable to previous year.,; du to Eighth Revision of Internet lonAI List of Dlseases and Causes of Death.

-35-

TABLE 1 (Cont'd)
SUMMARY OF SELECTED VITAL STATISTICS, GeORGIA, 1935, 1940, 1945 - 1969 (CONT'D.)

Deaths From Immaturitv*

Live Births to Unwed Mothers

Number

Rate

Number

Rate

Non-

Non-

Non-

Non-

ear Total White white Total White white Total White white Total White white

935 1,111

692

419 17.6 18.5 16.1 5,031

643 4,388 79.5 17.2 169.1

940 1,017

635

382 15.7 16.3 14.8 5,046

565 4,481 78.0 14.5 173.8

945

960

609

351 12.8 12.8 12.7 5,385

721 4,664 71.8 15.2 169.2

946 1,035

676

359 12.1 12.0 12.2 5,289

681 4,608 61.7 12.1 157.0

947 1,060

681

379 11.2 10.9 11.9 6,056

744 5,312 64.2 11.9 166.4

.948 1,052

.949 1,032

950

719

.951

707

.952

645

636

416 11.5 10.9 12.6 6,240

616

416 11.0 10.51 11.9 6,847

343

376 7.8 6.01 10.7 7,633

340

367 7.4 5.7 10.2 8,326

323

322 6.6 5.3 9.0 8,080

730 5,510 68.1 12.5 166.0 712 6,135 73.2 12.1 175.8 779 6,854 82.9 13.7 195.3 836 7,490 87.5 14.1 208.8 789 7,291 83.2 12.8 204.3

.953

609

254

355 6.3 4.1 9.9 8,407

794 7,613 86.3 12.9 213.0

1954

618

301

317 6.2 4.7' 8.9 8,967

960 8,007 89.5 14.9 223.7

1955

634

303

331 6.3 4.7 9.2 9,415

962 8,453 93.9 15.0 234.4

1956

573

300

273 5.6 4.6 7.4 9,916

988 8,928 96.6 15.1 241.3

1957

579

291

288 5.7 4.4 7.9 10,061 1,042 9,019 98.8 15.9 247.3

1958

558

259

299 5.6 4.0 8.4 10,247 1,114 9,133 102.7 17.4 255.9

1959

580

275

305 5.8 4.3 8.6 9,557 1,035 8,522 96.1 16.2 240.6

1960

601

302

299 6.0 4.7 8.5 9,584 1,163 8,421 96.1 18.1 238.6

L961

510

234

276 5.1 3.6 7.6 9,880 1,246 8,634 98.4 19.4 239.0

L962

462

230

232 4.7 3.6 6.6 9,742 1,177 8,565 . 98.4 18.5 242.8

L963

464

221

243 4.71 3.4 7.0 9,995 1,345 8,650 100.6 20.8 248.7

L964

492

238

254 4.9 3.7 7.2 10,324 1,474 8,850 102.6 22.6 249.3

L965

412

213

199 4.4 3.5 5.8 10,476 1,596 8,880 111.0 26.5 260.3

1966

372

204

168 4.2 3.5 5.3 10,161 1,747 8,414 113.7 30.2 266.9

1967

356

184

172 4.1 3.2 5.8 9,984 1,882 8,102 115.5 33.0 275.2

1968

250

133

117 2.9 2.3 4.1 10,046 2,112 7,934 115.0 36.0 276.4

1969

205

100

105 2.3 1.6 3.7 10,181 2,146 8,035 112.9 34.9 280.5

Total

Neonatal Deaths

Num~er

Rate

Non-

White white Total White

Nonwhite

2,489 1,346 2,267 I 1, Hl? 1,913 1,104 2,143 1,2.62
2,220 1,301

1,143 1,080
809 881 919

39.3 35.0 25.5 25.0 23.5

36.0 30.5 23.3 22.4 20.9

44.1 41.9 29.3 30.0 28.8

2,099 2,048 2,028 2,058 1,984

1,186 1,185 1,090 1,105 1,135

913 22.9 20.2 27.7 863 21.9 20.2 24.7 938 22.0 I 19.1 26.7 953 21.6 18.6 26.6 849 20.4 18.5 23.8

2,005 2,106 1,992 2,098
/2,062

1,083 1,186 1,091 1,141 1,148

922 20.6 17 .6 25.8
920 21.0 18.4 25.7 901 19.9 17.0 25.0
957 20.4 17.4 25.9 914 20.2 17 .6 25.1

2,046 2,126 2,121 1,976 1,927

1,150 1,196 1,187 1,073
1,058

896 20.5 17.9 25.1 930 21.4 18.7 26.3 934 21.3 18.4 26.5 903 19.7 16.7 25.0 869 19.5 16.6 24.6

1,933 1,880 1,755 1,557 1,491

1,102 1,051
974 872 873

831 19.5 17 .1 23.9 829 18.7 16.1 23.4 781 18.6 16.2 22.9 685 17.4 15.1 21.7 618 17.2 15.3 21.0

1,474

854

620 16.9 14.6 21.6

1,435

833

602 15.9 13.5 21.0

I Year

pn~t Neonatal Deaths Number
NonTotal White white Total

1935 1940 1945 1946 1947

1,827 1,470 1,268
925 1,019

881

946 28.9

664

806 22.8

624

644 16.7

4321 493 10.8

470

549 10.8

,

1948 1,051

475

576 11.5

1949 1,045 483, 562 11.2

1950 1,052

428

624 11.5

1951 1,198 ! 443

755 12.6

1952 1,174

432

742 12.1

Rate

Non-

White white Total

23.6 17.1 13.1 7.6

"'l31.2
23.4 16.8

7.5 17.2

I

I

I 8.1
8.2

1167..14\

7.5 17.7

7.5 21.0 .

7.0 20.8

Number
White
N 0 T

Marriages*Rate
Nonwhite Total White

Nonwhite

Divorces and Annulments Number Rate

A V
A I L A B L E

N 0 T
I

A V A I L A B
L E

1953 1954

I 1,046

386,

1,049

376

660 673

10.7 10.5

1955

993 I 365

628

9.9

1956

989

337

652

9.7

1957 1,037

334,, 703 10.2

6.2 5.9
I 5.7
5.1 5.1

18.5 18.8 17.4 17.6 19.2

52,092 51,698 54,780 52,221 51,235

40,894 41,149 43,062
41,398 41,090

11,144 10,495 11,653
10,769 10,080

14.5 14.1 14.7 13.8 13.3

16.2 16.0 16.5
15.5 15.0

10.3 6,809 1.9 9.6 7,041 1.9 10.4 7,547 2.0
9.6 7,751 2.0 8.9 8,798 2.3

1958 1,057

360

697 10.6

5.7 19.5 47,219 37,863

9,304

12.0 13.6

I 1959 1,107

1960 1961

I

1,161 974

359 395 316

748 11.1

766 11.6

658

9.7

5.6 6.2 10.9

21.1 48,928 21.7 49,448 18.2 52,062

38,913 39,400 42,335

9,970 9,983 9,655

12.3 12.5 13.0

13.7 13.9 14.8

1962 1,059

3&0

699 10.6

5.6 19.9 53,553 43,334 10 ,162

13.1 14.7

8.1 7,975 2.0 8.7 8,609 2.2 8.9 8,930 2.3 8.5 9,521 2.4 8.8 9,841 2.4

1963 1,151

3&0

771 11.5

1964 1,052

37.5

677 10.4

1965

979

325

654 10.4

1966

942

308

634 10.5

1967

811

264

547

9.4

5.9

5.8

5.4

5.3 4.6

I

22.2 19.0 19.2 20.1 18.6

56,803 60,228 55,537 54,502 57,218

46,684 49,691 44,755 43,678 45,725

10,112 10,535 10,781 10,823 11,493

13.6 14.3 12.7 12.2 12.7

15.7 16.4 14.3 13.7 14.2

8.4 10,569 2.5 8.8 11,312 2.7 8.7 12,043 2.8
8.5 12,921 2.9 9.0 14,347 3.2

1968 1969

749

284

465

8.6

625

235

390

6.9

4.8 16.2 61,252 48,901 12,351

13.4 14.5

3.8

13.6 64,003

50,700
,-=J . _._~

13.8

14.7

10.4 15,590 3.4 11.2 17,315 3.7

** Prior to 1954 fetal deaths include only those of twenty or more weeks gestation.

*- Race breakdown will not add to total due to events of unknown race.

Live birth and death rates are per 1,000 population, maternal death ratios are per 10,000 live births; all other rates and/or

ratios are per 1,000 live births.

Not Available - Immatu!"36~ths are not available prior to 1947.

TABLE 2

Birth Order & RlIce
~
Totl'll I 2 3 4 5 6 6a over Unknown
Whi te
Tot"l I 2 3 4 5 6 & over Unknown
~
Total 1 2 3 4 5 6 & Over Unknown

LIVE BIRTHS BY BIRTH ORDER, RACE AND AGE OF MarMER. GEORGIA, 196q

14 & Total ' Under

15-17

- - - - - - _ _ _ _ _~A'4'P.e......o.L Mother

3:_14-~5_::~-4I~:k' -l!unlIleL___
18-19 20-24 25-29:

-----I 14 &
Tetrl Undf>T

--+--

-

---

Rate Per ) 000 Females 15-17 18-19 20-24 25-29

30-34

35-39

Un40-4 kn ..

90,195 36,340 24,055 13,299
6,986,' 3,696 5,661
1
158 1
1 1 61,554 25,749 il
17'795~
9,489 4, 554 1 2,040 II 1,841 :1
86 :
I
28,641 10,591
6,260 3,810 2,432 1,656 3,820
72

529 7,731 12,564 34,763 20,800 8,839 3,787 1,142 40 72.3

501 6,554 8,522 15,391 4,313

782

219

45113

29.1

24 1,023 3, 081 111 ,568 6,326 1,570

384

73

6

19.3

1
---

125 14 2 2

I ; i~6' ~:;~; 14 705

4,766
~';;~Ii

2,103
I,~~~

617 122
:~~ ~~~

3

7 324 i 1:419 1,832 1,434 634 9

10.7
5.6
3.0
'+ .s

3

11

25

69
1

251

10

I

91 1 5

0.1

I
,I

i 100 3,622 7 ,506 25,019 I 5,99816,248 2,404\' 647110

98 3,243 5,612 12,261 3, 699

627

167

381 4

66.9 28.0

-2---

i 348 1,5921 8,678 5,483, 1,320 20 254 2,896 3,894 1,814

3
1-
7

I,;;: 36 1 852 31 220

1I'~i~

, 70
91 42

4~;

61Z

311 57 4 505, 104 i 2
;~~ I I~~ I I 52~ 23~ I

19.4 10.3
5.0 2.2 2 .0 0.1

i

429
403 22
1-
-
3

I

4,109

9, 744 1 4,802

3,311 2,910 3,130 614

"'~I 675 1,489 2,8901 843

105 11 1

521:
104 i
11'

1, 891 1
I'~~~I

872 798

2
I,~in:,~~~ I ~:il:J ~ 41

!7i 254 1

16

271

2,591 11,3831 495130

155

52 : 7 I 9

I I 250
289

I 73 16\ 2
112 18 I

310 1 1161 24 2

I

87.5 32.4 19.1 11.6
7 .4 5.1 11.1 0.2

I

5.8 5.5

i 53.4
45.3

130.3 88.4

201.2 89.1

130.1 I, 27.0

60.6 1 5.4

25_ 6 1.5

0.3 7.1 31.9 66.9 39.6 10.8 2.6

0.0 0.9 8.0 27.7 29.8 14.4 4.2

0

0.1

1.5 ILl 16.1 10.7 I 4.1

0

0.0 0.1 4.1 8.6 6.7 3.3

0

0.0 0.1 1.9 8.9 12.6 9.7

0.0 0.1 0.3 0.4 0.2 0.1 0.1

1.5 34 .0 105.8 196.4 135.2 I 57.9 22.0 1.4 30.5 79.1 96.2 31. 3 5.8 1.5

0.0 3.3 22.4 68.1 46.3 12.2 2.8

0

0.2 3.6 22.7 31.9 16.8 4.6

0

0.0 0.5 6.7 15.0 11.7 4.7

0

0.0 0.0 1.7 6.2 5.1 3.5

0

0

0

0.5 3.4 5.1 4 .8

0

0.1 0.1 0.3 0.1 0.0 0.0

I

I

17.8 16.8
0.9 0.0
0 0 0 0.1

107.5 198.5 86.61 114 . 2 17.7 58.4 2.7 20.4
~:~ I 4.1 0.4 0.1 0.3 0.1 0.6

1214.6 68.9 63.1 41.7 23.5 10.7 5.6 0.6

115.4 14.8 20.3 21.0 19.2 15.6 24.4 0.2

68.2 4.1 6.6 7.6 8.2 9.5 32.1 0.2

35.9 1.4 1.9 2.9 3.0 3.0
23.7 0.1

4 _0 ...

0.2 '"

0.3 '"
... 0.4 ... 0.5

... 0.4
2.2

......

0.0

3.0 0.2

......

0.3 0.5 0.6

.........

... 0.4 '"
1.1

0.0 '"

6.5 0.1 0.2

.........

... 0.2 '"
0.3

... 0.4 '"
5.2

0 '"

TABLE 3

LIVE BIRTHS TO UNWED MOTHERS, NUMBER AND RATE PER 1.000 LIVE BIRTHS, BY BIRTH ORDER. RACE AND AGE OF MOTHER. GEORGIA, 1969

= ~ = = = = = = ~ = = = = c , ---,=_=_====-~=-==-===.

---------

.

.

A&Lo_LMoth~L

~~_ _

~~~~~ 9l~~-~41-1 -~I - r=- ,:1' r 8;T""-,..-~~-~------- 14 &

Number

11 14-&1-

YOO e P.l'I_I

1 Tootal~_ ~115~1118-19 FO::~ 3O~]~+-3_5_-_39-1ll-o-_4_9-+_u_n_k' _:_QT_R_:_:e-j._T_o_t_al--11-_u_n_de_r+_l_5-_1_7-!-_18_-_1_9+-2_0_-_2_4+-2_5_-_2__

35-39 40-- unk';1 T

Under

i 25-29

_

Total I 2

0,181 5,931 1,854"

363 2,652 2,321 3,012 344 2,301 1,611 1,404
15 299 526 191

I 970 455
1861 48 1461 53

302 16, 171

i 94112 112.91'686.2,343.0 11184.1 86.61 I 5 4 1163.2 686.61352.0 189.1 91.21

1

,17.1 625.0: 292.3 110.1 I 6B.4

46.6 43.1 23.1

51.5 61.4 33.8

19.1 82.3 00.0 73.111\.1 01.1 44.3 95.0 0

3

855"

1

31

129 4541 160: 46

24,

4

- I 64.3!ipOO.0 1296.0 1 166.5 I 94.8 33.6 2\.9 38.9 32.8

0

4

518 I

-

~ver 5

344

6

634

-

:::~e

45

3

I -

341 5'

209 991

i 180 I
137

54 74

311 25;

B1
3I

I 74.1 91.1,

I 0 1\.41242.91108.91 10.0 34.4 49.2 56.7 00.0

0

0 1'157.1 140.4, 99.3 16.0 50.6 23.8 00.0

1

1

-

i 31 158, 180, 1881 "7

1

10

18

1

3:

-!

1I

' 112 0 11

0,500.0

0

784'8111~000'0 i.636.41400.0

114. 211 11 \.3 260.9 120.0

98.3 131.1105.1 33.3 0 111.1 0 00.0

Total 1 2
Z
5

2,146 1,595
I 216~~8 43

U6n&~~er I

34 18

37

479

521

I , 186 I 196: 7

31 -
=

466
Q
=

~i~: 464 53 1

i 534'
150
i

13 'I
~31~ I

14
13
i;

-

-

-_ 'I

5 I 22 I 10

=~

2

I~ I Ii

~!

II

1

~!1

Total 1 2 3 4 5 6&
over
unk.

8,035

i 326 1 2 , 73 1'194 1 2'226

114 'I 383

4,336

307 1,841 1,153

810 1113

34

':1 :il i :E ~~ ,~ 1,586

15

134

1

451

301

1
II

_ __ L 600

-

~~

~~1 3~L I

35

13

3

3

~3' I;3

6,

12

I " 34.91 310.011132.2 10.2 31.4 '1 12.3 11.5 14.6 20.1 00.0

61.91 317.6,143.1 82.1, 41.6 19.7 22.3 18.0 18.9 50.0

i~:~ ;;:~ I~:i ::~ I~:~ i~:~ ~ 15.1'

0 I' 25.9 33.31 17.3

6.1

9.8

9.6 52.6

0

g g ;;:: I

21.11

01 0

0

22.1 1 30.2 16.1 15.8

0

0

2~~:;I~'i511~4 222~2 2;::~ I11:;:~

0 18 0

23.0 0

8.5 0

I

267

81 11 2BO.5 759.9 528.8 354.1 228.4 16\.2 141.8 193.1 163.6 66.1

13

2

3 409.4 16\.8 556.0 396.2 218.0 184.0 219.4 250.0 285.1 33.3

14

4

253.4 681.8 429.6 311.1 221.8 129.3 160.0 191.8 250.0

o

19

2

192.1 ~OOO.O 352.4 236.1 205.2 149.1 117.6 169.6 111.1

o

25

5

19

3

185.41 181.8

0 0

90.9 307.1 118.1 194.2 135.5 215.5 208.3 00.0
o 454.5 193.8 116.9 111.3 166.7 93.8 00.0

116 65 I

157.11

0

315.01 \000.0

-37-

TABLE 4
MATERNAL DEATHS, NUMBER AND RATE PER 10,000 LIVE BIRTHS, BY RACE, GEORGIA, 1969

Cause and Eighth Revision International Classification List Number
Total, all causes (630-678)
Infections (630, 670-672) Ectopic Pregnancy (631) Hemorrhage of pregnancy, childbirth,
or puerperium (632, 651, 653) Abortion (640-645) Toxemia (637-639) Rupture of uterus (659) Embolism, Pulmonary (673) Anesthetic death (662) Other diseases and conditions during
pregnancy or puerperium (633-636, 674-678) Other accidents or specified conditions
during childbirth (650, 652, 654-658, 660, 661)

Total
29
1 3
1 4
-6 -5
6
3

Number White
11
1
-
1 2
12-
2
2

Nonwhite
18
-
3
-
2
-5
3
-
4

Totsl
3.2
I
0.1 0.3
0.1 0.4 0.7
0 0.6
0
0.7

1

0.3

Rate White
1.8
0.2 0
0.2 0.3 0.2
0 0.3 0
0.3
0.3

Nonwhite
6.3
0 1.1
0 0.7 1.7
0 1.1 0
1.4
0.3

Rsce And Sex
TOTAL Male Female
WHITE Male Female
NONWHITE Male Female

Under 1 Year
2,060 I, Jq4
80';
1,068 638 430
992 556 436

TABLE 5

INFANT DEATHS, NUMBER AND RATE PER l,OOC LIVE BIRTHS, BY RACE, SEX AND AGE,

GEORGIA 1969

Number

Rste Per ~l 000 Live Births

Under 28 Days

Under 28 Dsys

28 Days

Under

1- 6

7-27

to

Under

Under 1-6

Totsl

1 Day

Days

Days

1 Year

1 Year

Total 1 Day Days

--- ------------

1,435 874 561

765

509

161

481

295

98

284

214

63

625

22.8

15.9

8.5

5.6

320

25.7

18.8

10.4

6.4

305

19.8

12.8

6.5

4.9

7-27 Days
1.8 2.1 1.4

833

450

324

59

514

283

190

41

319

167

134

18

235

17.3

13.5

7.3

5.3 1.0

124

20.0

16.1

8.9

6.0 1.3

III

~14.5

10.8

5.6

4.5 0.6

602

315

185

102

360

198

105

57

242

117

80

45

390

34.6

21.0

11.0

6.5 3.6

196

38.3

24.8

13.6

7.2 3.9

194

30.9

17.1

8.3

5.7 3.2

28 Dsys to
1 Year
6.9 6.9 7.0
3.8 3.9 3.7
13.6 13.5 13 .7

-38-

FIGURE 1
IMPORTANT CAUSES OF DEATH, NUMBER AND PER CENT IN SPECIFIED AGE GROUPS, GEORGIA, 1969 (A cauae of death must _account for at least 57. of all deaths in a given age group to appear in the chart)

Cause of Death*
TOTAL, ALL AGES
Total, all causes
Heart disease Cancer Cerebrovascular Disease
Influenza snd Pneumonia Motor vehicle accidents All other accidents Diseases of veins and arteries Birth injuries, immaturity and other
causes of deaths of early infancy Other diseases of the respiratory system Homicides Diabetes m~llitus
All other causes

Number
41,183
13,818 5,723 5,714
1,901 1,750 1,447 1,097
1,088 970 737 737
6,201

Per Cent
100.0
33.6 13.9 13.9
4.6 4.2 3.5 2.7
2.6 2.3 1.8 1.8
15.1

UNDER ONE YEAR
Total, all causes
Influenza and Pneumonia Congenital malformations Postnatal asphyxia and atelectasis r...aturity Conditions of mother including
difficult labor Hyaline membrane Anoxic and hypoxic conditions
Accidents other than motor vehicle Symptoms and ill-defined conditions Certain gastrointestinal diseases
All other causes

2,060
341 266 253 205
168 145 141
62 61 57
361

100.0
16.6 12.9 12.3 10.0
8.2 7.0 6.8
3.0 3.0 2.8
17 .5

ONE-FOUR YEARS
Total, All causes
Accidents other than motor vehicle Influenza and pneumonia Motor vehicle accidents Congenital malformations Cancer
Other diseases of respiratory system Meningococcal infections~ lnfla...atory diseases of central
nervous system Other infective and parasitic diseases Other diseases of the centrsl nervous
system
All other causes
-39-

372

100.0

76

20.4

57

15.3

55

14.8

47

12.6

23

6.2

15

4.0

13

3.5

12

3.2

12

3.2

11

3.0

51

13.7

FIGURE 1 (Cont'd)
IMPORTANT CAUSES OF DEATH, NUMBER AND PER CENT IN SPECIFIED AGE GROUPS, GEORGIA, 1969 (A cause of death must account for at least 5% of all deaths in a given age group to appear in the chart)

FIVE-FOURTEEN YEARS

Cause of Death*

Total, all causes

Motor vehicle accidents Accidents other than motor vehicle Cancer

Congenital malformations

Influenza and pneumonia

Other diseases of the central

nervous system

Other infective and parasitic

diseases

I

Homicides

Heart disease

Other diseases of the respiratory

system

All other causes

550

100.0

148

26.9

140

25.5

74

13.5

27

4.9

21

3.8

14

2.5

14

2.5

9

1.6

8

1.5

8

1.5

87

15.8

-40-

APPENDIX I (Cont'd) The data on Appalachian children emphasizes the point that there is no comprehensive program in Appalachia (nor in Georgia) to provide services to children from birth to age six to aid their growth and development. Of the children in Appalachia enrolled in day care centers, the vast majority are in Head Start programs of one type or another (See
Table 6, page 42.) Head Start is the only program which calls for
comprehensive health, education and nutrition components. However, the program is designed for three-to-six year olds. There are no Head Start programs for children under three.
Table 7 shows the total number of children receiving Aid fer Dependent Children in Georgia's AppaJ:achi:an-region and the entire State.
Table 8 gives the recipient rates of Aid to Families with Dependent Children in Four Southern States.
-41-

TABLE 6

DAY-CARE CENTERS IN APPALACHIA, JULY 15, 1969

Alabama Georgia Kentucky* Maryland Mississippi* New York North Carolina Ohio* Pennsylvania* South Carolina* Ten'lessee Virginia West Virginia*
TOTALS

PRIVATE

Centers

Children

86

3,188

80

2,595

50

832

16

319

14

264

24

789

12

260

185

5,227

7

164

13

337

487

13,975

VOLUNTEER

Centers

Children

24

940

10

339

10

528

31

801

20

1,097

15

542

155

218

107

4,755

1

20'

16

539

389

9,561

OEO

Centers Children

21

1,079

11

701

34

923

4

148

3

99

11

493

10

71

2,123

11

384

3

179

5,950

HEAD START

Centers

Children

216

13,506

80

3,230

283

12,359

18

564

128

7,774

60

1,493

185

6,938

160

5,648

628

17,536

53

4,385

296

11,250

99

3,480

356

11,413

2,562

99,576

ALL PROGRAMS

Centers 3,617

Children 129,062

Data incomplete for these states. Source: The day-care information was obtained from the state Departments of Welfare, the Head Start data from the Office of Economic Opportunity.

TABLE 7

CHILDREN RECEIVING AID FOR DEPENDENT CHILDREN, JULY 15, 1969

Alabama Georgia Kentucky Maryland Mississippi New York North Carolina Ohio Pennsylvania South Carolina Tennessee Virginia West Virginia
TOTAL
UNDER 6

Appalachian Portion
43,916 11,357 40,169 3,223 13,874 12,163 13,408 22,054 124,036
3,853 32,887 6,241 62,569
389,750
128,617*

State Total
82,032 113,856 85,235 89,609 85,209 717,275 83,659 183,169 259,569
30,416 85,046 50,446 62,569
1,928,090
636,269

Note: One-third of the children on Aid for Dependent Children in the nation are under six. If this percentage is applied to the 389,750 Appalachian recipients, there would be 128,617 under six.
Source: Recipients of Public Assistance Money Payments and Amounts of Suck Payments, by Program, State, and County, February 1969, United States Department of Health, Education and Welfare, Social and Rehabilitation Service, National Center for Health Statistics.
Source: Tables 6 and 7 were taken from Appalachia, A Journal of the Appalachian Regional Commission, Volume 3, Number 4, January 1970, p. 5.
I."

~ ~~

~.

~

TABLE 8

~~

Recipient Rates of Aid to Families with Dependent Children
in Four Southern States August 1969

State

Number of Children receiving Aid to Families with Dependent Children per 1000 Population under 18 years of agel

United States

68

Georgia

72

Mississippi

96

North Carolina

47

South Carolina

33

IBased on Civilian Population as of August 2, 1969, estimated by the Social and Rehabilitation Service Administration
Source: Public Welfare Statistics in Georgia, Statistics Section, Division of Business Administration, Atlanta, Georgia, Volume 24, Number 3, p. 19.

-43-

APPENDIX II

DIRECTORY OF VOCATIONAL-TECHNICAL SCHOOLS

1970-71

ALBANY AREA VOC-TECH SCHOOL Howard D. Waters, Director 1800 South Slappey Drive Albany, Georgia 31705 (912) 436-0395)

ATHENS AREA VOC-TECH SCHOOL Robert G. Shelnutt, Director U. S. Highway 29 North Athens, Georgia 30601 i (404) 549-2360

ATLANTA AREA VOC-TECH SCHOOL Robert A. Ferguson, Director 1560 Stewart Avenue, S.W. Atlanta, Georgia 30310 (404) 758-9451

A--U-G-U._ST-A---A-REA VOC-TECH SCHOOL
George M. Hardy, Director 2025 Lumpkln Road Augusta, Georgia 30901 (404) 793-3470

BEN HILL-IRWIN AREA VOC-TECH SCHOOL Lewis I. Brinson, Director P. O. Drawer M Fitzgerald, Georgia 31750 (912) 468-7487

CARROLL CO. AREA VOC-TECH SCHOOL Jack H. Cox, Director P. O. Box 548 Carrollton, Georgia 30117 (404) 834-3391

COLUMBUS AREA VOC-TECH SCHOOL Perry Gordy, Director 4460 River Road Columbus, Georgia 31904 (404) 327-1798

COOSA VALLEY AREA VOC-TECH SCHOOL J. D. Powell, Director 112 Hemlock Street Rome, Georgia 30161 (404) 235-1142

DEKALB AREA VOC-TECH SCHOOL

GRIFFIN-SPALDING CO. AREA VOC-

Travis E. Weatherly, Director

TECH SCHOOL

495 North Indian Creek Drive

Edwin V. Lanqford, Director

Clarkston, Georgia 30021

P. O. Box 131

(404) 443-7151

Griffln, Georgia 30223

(404) 227-1322

.. -': ,

LANIER AREA VOC-TECH SCHOOL

John G. McCormick, Director

MACON AREA VOC-TECH SCHOOL

P. O. Box 58

Ben C. Brewton, Director

Oakwood, Georgia 30566

940 Forsyth Street

(404) 532-0191

Macon, Georgia 31201

(912) 743-6332

MARIETTA-COBB AREA VOC-TECH

SCHOOL

MOULTRIE AREA VOC-TECH SCHOOL

L. L. Leverette, Director

W. W. Hobbs, Director

980 South Cobb Drive

P. O. Box 399

Marietta, Georgia 30060

Moultrie, Georqia 31768

(404) 422-1660

(912) 985-2297

-44-

APPENDIX II (Contld.)

NORTH GEORGIA TECH & VOC SCHOOL James H. Marlowe, Djrector Lake Burton Road, Georgia 197 Clarkesville, Georgia 30523 (404) 754-2131
SAVANNAH AREA VOC-TECH SCHOOL C. W. Coons, Director 214 West Bay Street Savannah, Georgia 31401 (912) 236- 3400
SWAINSBORO AREA VOC-TECH SCHOOL M. D. Boatwright, Director 201 Kiet Road Swainsboro, Georgia 30401 (912; 237-6465
TROUP CO. AREA VOC-TECH SCHOOL Harold Wynn, Director Route 2, Whitesville Road LaGrange, Georgia 30240 (404) 882-2518
VALDOSTA AREA VOC-TECH SCHOOL Lamar Holloway, Director Route 1, Box 211 Valdosta, Georgia 31601 (912) 244-2316
WAYCROSS-WARE CO. AREA VOC-TECH Don Winters, Director 1701 Carswell Avenue Waycross, Georgia 31501 (912) 283-1866

PICKENS CO. AREA VOC-TECH SCHOOL J. A. Harris, Director Jasper, Georgia 30143 (404) 692-2461
SOUTH GEORGIA TECH & VOC SCHOOL
Dea o. Pounders, Director
P. O. Box 1088 Americus, Georgia 31709 (912) 924-2981
THOMAS AREA VOC-TECH SCHOOL Paul G. Sewell, Director P. O. Box 6 Thomasville, Georgia 31792 ('912) 226-3750
UPSON CO. AREA VOC-TECH SCHOOL E. G. McCants, Di~ector P~-O. Box 6 Thomaston, Georgia 30286 (404) 647-9616
WALKER CO. AREA VOC-TECH SCHOOL Larry Little, Director Box 454 Merry Meadow Lane Rock Spring, Georgia 30739 (404) 764-1016

-45-

APPENDIX III GEORGIA EDUCATIONAL PROGRAMS RELATING TO CHILD DEVELOPMENT

PROGRAM Dental Assistant
Dental Hygiene (Two Year Program)
Dental Hygiene (Four Year Program)
Dentistry Dietetics and Nutrition Nutrition
Hospital Administration
Physician
Practical Nursing

INSTITUTION
Atlanta Area Technical and Vocational School
1560 Stewart Avenue, S.W. Atlanta, Georgia 30310
Armstrong State College 11935 Abercorn Expressway Savannah, Georgia 31406
Medical College of Georgia Augusta, Georgia
Emory University Atlanta, Georgia
Georgia College Milledgeville, Georgia
School of Home Economics University of Georgia Athens, Georgia 30601
Georgia State University 33 Gilmer street, S.E. Atlanta, Georgia 30303
Emory University Atlanta, Georgia
Medical College of Georgia Augusta, Georgia
Albany Area Technical School Monroe Division
Albany, Georgia 31750
Athens Area Vocational-Technical School
Athens, Georgia
Athens General Hospital Athens, Georgia

-46-

APPENDIX III (Cont'd)

PROGRAM Practical Nursing (Cont'd)

INSTITUTION
Atlanta Area Vocational-Technical School
1560 Stewart Avenue, S.W. Atlanta, Georgia 30310
Augusta Area Vocational-Technical School
Augusta, Georgia
Atlanta School for Practical Nurse Education, Inc.
14 Ashby Street, S. W. Atlanta, Georgia
Baldwin Vocational School of Practi Nursing
Milledgeville, Georgia
Ben Hill County School of Practica: Nursing
Fitzgerald, Georgia
Brunswick Vocational School of Pra, Nursing
Brunswick, Georgia
Carroll County Area Vocational-Tee School
Carrollton, Georgia
Coosa Valley Vocational-Technical School
Rome, Georg ia
Dalton Vocational School of Practi Nursing
Dalton, Georgia
0' Elbert County Vocational School
Practical Nursing Elberton, Georgia
Gordon County Hospital Calhoun, Georgia

-47-

APPENDIX III (Cont'd)

PROGRAM Practical Nursing (Cont'd)

INSTITUTION
Griffin Area Technical-Vocational School
Griffin, Georgia
Macon Area Vocational-Technical School
Macon, Georgia
Marietta-Cobb Area Vocational-Technical School
Marietta, Georgia
The Medical Center School of Practical Nursing Columbus, Georgia
North Georgia Technical and Vocational School
Clarkesville, Georgia
Paulding Memorial Hospital Dallas, Georgia
Savannah Area Technical and Vocational School
Savannah, Georgia
South Georgia Technical and Vocational School
Americus, Georgia
Swainsboro Area Technical and Vocation School
Swainsboro, Georgia
Thomas Area Technical and Vocational School
Thomasville, Georgia
Tift County LPN School 1209 Tift Avenue Tifton, Georgia
Troup County Area Vocational-Technical School
LaGrange, Georgia

-48-

APPENDIX III (Cont I d)

PROGRAM
Practical Nursing (Cont'd)
Dietetics and Institutional Management
Nursing Associate Degree

INSTITUTION
Upson County Area VocationalTechnical School
Thomaston, Georgia
School of Home Economics University of Georgia Athens, Georgia
Abraham Baldwin Agricultural College Department of Nursing Education Tifton, Georgia
Albany Junior College Department of Nursing Albany, Georgia
Armstrong College Department of Allied Health (Nursing: Savannah, Georgia
Brunswick Junior College Division of Nursing Brunswick, Georgia
Clayton Junior College Head of Nursing Program Morrow, Georgia
Columbus College Department of Nursing Columbus, Georgia
Dalton Junior College Division of Nursing Dalton, Georgia
DeKalb College Department of Nursing Clarkston, Georgia
Georgia College at Milledgeville Department of Nursing Education Milledgeville, Georgia

-49-

APPENDIX III (Cont'd)

PROGRAM Nursing (Cont1d)
Associate Degree
Baccalaureate Degree
Diploma

INSTITUTION
Georgia Southwestern College Department of Nursing Americus, Georgia
Georgia State University Department of Nursing School of Allied Health Sciences Atlanta, Georgia
Kennesaw Junior College Nursing Education Marietta, Georgia
South Georgia College Division of Nursing Douglas, Georgia
Albany State College Division of Nursing Albany, Georgia
Georgia State University Department of Nursing School of Allied Health Sciences Atlanta, Georgia
Medical College of Georgia School of Nursing Augusta, Georgia
Nell Hodgson Woodruff School of Nurs: Emory University School of Nursing Augusta, Georgia
Valdosta State College Department of Nursing Valdosta, Georgia
Crawford W. Long Hospital School of Nursing
Nursing Education Atlanta, Georgia

-50-

PROGRAM
Nursing (Cont'd) Diploma

APPENDIX III (Cont I d)
INSTITUTION
Floyd Hospital of Nursing Nursing Rome, Georgia
Grady Memorial Hospital School of Nursing
Nursing Education Atlanta, Georgia
Hall School of Nursing Nursing Education Gainesville, Georgia
Macon Hospital School of Nursing Nursing Education Macon, Georgia
Piedmont Hospital School of Nursing School of Nursing Atlanta, Georgia
st. Joseph's Infirmary School of Nursing
Atlanta, Georgia
TTniversitv Hospital of Nursing Nursing Education Augusta, Georgia

-51-

APPENDIX IV
STANDARDS FOR MATERNAL AND CHILD HEALTH CARE
1. "Standards of Child Health Care," American Academy of Pediatrics (1970).
2. "Standards and Recommendations for Hospital Care of Newborn Infants", American Academy of Pediatrics (revised 1971).
3. "Report of the Committee on Infectious Diseases", American Academy of Pediatrics (1970).
4. "Care of Children in Hospitals", American Academy of Pediatrics (1970).
50 "Disaster and Emergency Medical Care", American Academy of Pec1i.2.::rics (1971) .
6. "Report of the Committee on School Health", American Academy of Pediatrics (1966).
7. "Day Care Standards for Infants and Children Under Three Years of Age", American Academy of Pediatrics (1970).
8. "Adoption of Children", American Academy of Pediatrics (1967).
9. "Rules and Regulations for Hospitals", Chapter 270-3-2, Georgia Department of Public Health (November 24, 1969).
10. "Rules and Regulations for Nursing and Personal Care Homes", Chapter 270-3-4, Georgia Department of Public Health (April 9, 1967).
11. "Conditions of Participation Hospitals--Federal Health Insurance for The Aged--Regulations", (Code of Federal Regulations, Title 20, Chapter III, Part 405), U.S. Department of Health, Education, and Welfare, Social Security Administration (June 1967).
12. "Conditions of Participation; Extended Care Facilities--Federal Health Insurance for the Aged--Regulations", (Code of Federal Regulations, Title 20, Chapter III, Part 405), U.S. Department of Health, Education, and Welfare, Social Security Administration (February 1970).
13. "Manual for Hearing Screening", Child Health Service, Georgia Department of Public Health.
14. "Vision Testinq Instructions for Snellen and Plus Lens Tests", Child Health Service, Georgia Department of Public Health.
15. "Rules and Regulations for Day Care Centers", Georgia Department of Public Health Family and Group Sections.
-52-

APPENDIX IV (Cont'd) 16. uJuly 12, 1966, Memorandum on Immunization Schedule", Office of
the Director, Georgia Department of Public Health. 17, "Manual of Standards in Obstetric-Gynecologic Practice", Second
Edition, The American College of Obstetricians and Gynecologists (April 1965).
-53-

APPENDIX V
IMMUNIZATION SCHEDULE RECOMMENDED FOR COUNTY HEALTH DEPARTMENTS IN GEORGIA

2 - 3 months DPT - 0.5 cc. tl)

3 - 4 months DPT - 0.5 cc. (1)

4 - 5 months DPT - 0.5 cc. (1)

9 months

Trivalent OPV (2), (2a) Smallpox Vaccination (3) Tcberculin test (elective) (4 )

10 months

Measles vaccine (5)

11 - 18 months Trivalent OPV (2), (2a) DPT - 0.5 cc. (1) Smallpox vaccination (3a)

2 - 6 years

DPT - 0.5 cc. (1) Repeat smallpox vaccination (3b) Tuberculin Test (6)

8 years

TD (adult type) Tuberculin test Typhoid vaccine

(7 ) (6 )
(11)

Pregnant women Trivalent OPV (8), (2a) TD (adult type) (9) See Also Note (10)

Other adults and Older Children See notes (2a), (9), and (11)

Emergency Immu-

nizations

Diphtheria, Hepatitis, Rubella,

Tetanus, Typhoid, Smallpox, Measles

See note (13)

(1) Immunization with DPT may be started at any age up to 6 years. Thereafter TD (adult type) should be used. See notes (7) and (9).

(2) Most infants have maternal antibodies against polio and are protected up to 9 months of age and very probably to approximately 12 months of age. The only purpose in beginning polio immunizations earlier than 9 months is to reinforce these maternal antibodies and to increase the possibility of a subsisting immunity in the child who may not be brought back to the clinic for a complete

-54-

APPENDIX V (Cont'd)

series of immunizations. However, the immunogenic response is poor and infants given OPV or IPV at less than 9 months of age should receive 2 additional doses of OPV thereafter. For these reasons, Health Department personnel ~ exert everv effort to insure return of the child to the clinic at this time for 2 doses. One dose of trivalent vaccine may not provl.de an adequate immunity against Type I.

(2a)

For children up to 10 years of age who have previously received Salk vaccine or 2 doses of monovalent vaccine or who have an uncertain polio immunization history, 2 doses of trivalent OPV are recommended. Except for those given monovalent vaccine before 9 months of age, as noted in (2) above, children who have received 3 doses of monovalent OPV vaccine need only 1 booster dose of trivalent OPV. The Department does not provide polio vaccine for persons 10 years of age or older except pregnant women. In an epidemic situation, happily an unlikely event, monovalent OPV of the type then causing cases or trivalent vaccine would be made generally available.

(3) Smallpox vaccination and OPV may be given at the same time.

(3a) If not vaccinated earlier. The flrst smallpox re-vaccination is recommended at 2 - 6 years.

(3b) Smallpox vaccination should be repeated every 5 years throughout school and adult life.

(4) Measles vaccination may obscure a positive tuberculin reaction. It follows that any intended tuberculin testing should be completed befort giving measles vaccine. The 1964 (14th) Edition of the Academy of Pediatrics Red Book says of measles vaccine, "Although no adverse effects have been noted so far, tuberculous children vaccinated with live vaccine should be under careful observation." The upcoming (15th) Edition apparently will not contain this note and the problem seems to consist primarily of the tendency of measles vaccine to obscure the tuberculin reaction. OPV immunization sometimes depresses tuberculin sensitivity after a lag period of 4 weeks and for approximately 2 months thereafter.

(5) For the present, measles vaccine is limited to children aged 9 months to 4 years who have not had measles. Maternal antibodies will reduce and may block entirely the immune response if the vaccine is given before 9 months of age, and 10 - 12 months is preferable from the purely immunologic point. of view. It is expected that the 4 year age limit will be raised when more vaccine becomes available.

Measles vaccine (Schwartz strain) may fail to immunize if given within 6 weeks after the administration of gamma globulin, plasma, or whole blood. Measles vaccine should not be given with smallpox vaccine or with OPV, nor should these follow within a period of less than one month.

-55-

APPENDIX V (Cont'd)
(6) Frequency of repeated tuberculin testing on unknowns and on non-reactors should be dependent on rlsk or exposure of children and the prevalence of tuberculosis in the population group.
(7) A triple antigen (OPT) is not recommended for children above the age of 6 years. However, a combined diphtheria-tetanus toxoid (adult type) may be given every 3 - 5 years throughout school life. Such additonal boosters are desirable.
(8) There is no contraindication to the administration of OPV to pregnant women and every reascn to consider that OPV would afford greater immediate protection at a time of hazard and stress: the ability of Salk vaccine to induce the timely formation of antibodies in the absence of a preexisting immunity is to be doubted. In the absence of a polio epidemic, there is question as to the need for any immunizing procedure during pregnancy. However, immunization of pregnant women affords a better chance that maternal antibodies will be present in infants as described in note (2a).
Salk vaccine will no longer be stocked in Central Supply. Trivalent OPV may be used for immunization of pregnant women. See also note (lC
(9) All adults should be immunized against tetanus or given a tetanus booster. The diphtheria antigen in TO (adult type) is unlikely to produce reactions and may be of value especially in young adults.
(10) DO NOT VACCINATE PREGNANT WOMEN AGAINST SMALLPOX OR MEASLES (RUBEOLA). These viruses may produce fetal damage.
(11) The present need for typhoid immunization is nominal except for persons subjected to a special exposure. However, "Vaccine is often deemed advisable for campers" and, for civil defense purposes, it is desirable that all persons receive at least a primary series of typho: vaccine. Persons at hazard may need a recall :injection every 3 years Where the risk has disappeared, booster doses are unnecessary. Exposure to typhoid fever, not merely to flooding conditions, is an indication for an immediate recall injection. If vaccine is in short supply, or time does not suffice, as in a civil defense emergency, one recall injection is enough regardless of the time interval since the last booster series is dubious at best. Intradermal inoculation produces fewer reactions and conserves vaccine in an emergency but the vaccine (0.1 ml.) must be given carefully if good immunization is to result.
(12) Do not combine two vaccines or a vaccine and gamma globulin in the same syringe. Those vaccines which can be so combined are prepared by the manufacturer in carefully formulated and balanced mixtures whi have been approved by the Division of Biologic Standards for use as
-56-

APPENDIX V (Cont'd)
the instructions specify. Administration of a vaccine in any way other than by the specified method constitutes an unapproved and unethical use. The person giving a vaccine under such circumstances assumes full legal responsibilities for any harm done or successfully alleged.
(13) Emergency Immunizations References are to Control of Communicable Diseases in Man, 10th Edition, 1965.
A. Diphtheria:
1. Exposed, unimmunized children, if not under daily surveillance, should be managed as follows: a. Give 10,000 units Antitoxin, and b. Up to 6 years of age, start DPT series. Ov~r 6 years of age use adult type TD, two injections, 0.5 mI. each, given 4 to 6 weeks apart. Four months later a third, booster dose should be given. This varies from Section 9, pp. 88-89.
2. Exposed, immunized children. Give DPT booster up to age 6 or TD booster after age 6.
B. Hepatitis:
1. Members of patient's household and sometimes others with intimate contact, but ordinarily not schoolmates, playmates and fellow-workers, are eligible to recelve gamma globuLln. a. Dose is 0.01 mI. immune globulin per pound of body weight. This varies from Section 9B, p. 116.
2. The name, race, sex, age, address, and attending physician of the index case must be reported via Central Supply.
C. Rubella:
1. Women in the first trimester of pregnancy exposed to rubella who have not developed symptoms are eligible to receive gamma globulin per pound of body weight. Blood specimens not mandatory but paired specimens, one taken as early as possible and one four weeks later, may be of great value and should be obtained. This differs from 9B5' p. 207.
2. The name, race, sex, age, address, and attending physician of the index case must be reported via Central Supply.
D. Tetanus - Section 9A 3 and 9A4 , p. 240, and notes (S) and (12) above.
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APPENDIX V (Cont'd)

E. Typhoid - Section 9BS' p. 260, and notes (11) and (12) above.

F. Smallpox - Section 9A4 , 9B4-9BS' 9C 3-9C 4 , pp. 218-219. G. Measles:

1. Special school immunization programs for non-immunes when cases first appear have been proposed as a possible lTeans of reducing spread to younger children in the home and as an aid in measles eradication. Immediate reporting to the local and State Health Department of the first appearance of measles in an elementary school or kindergarten is essential if this procedure is to be considered.
2. Unimmunized, non-immune children, less than 2 - 3 years old and other children at special hazard may be given 0.1 ml. immune globulin per pound of body weight for prevention of measles. Section-9BS ' p. 148. (0.2S ml. per kg. = 0.114 ml. per pound.)
3. Measles vaccine makes "modification" of measles obsolete. Protect and then immunize after a delay of 6 weeks. See note (S)

(14) This recommended schedule -- Reference No. 666-6-1830 -- will be changed when the availability of additional vaccine supplies or the development of new agents or new policies makes this possible. Each change, except for corrections of clerical errors or very simple modifications, will be made by re-issue of the entire recommendation with a new reference number.

(lS)

Vaccines and gamma globulin can be supplied only for the immunization procedures described in this schedule. Please discard all previous issues and revisions of immunization schedules.

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APPENDIX VI
SOCIAL SECURITY ACT, TITLE IV-~, FUNDING OF DAY CARE PROGRAM GEORGIA DEPARTMENT OF FAMILY AND CHILDREN SERVICES
Title IV-A of the Social Security Act permits State agencies such as the Georgia Department of Family and Children Services to receive localcontributed public or private funds for purposes of obtaining 75 percent Federal matching funds in contracting for provision of day care services in low income geographic areas within the state. Certain criteria must be met in several aspects of the total program of funding and implementation of the services. This document will explain the basic criteria and attempt to answer several specific questions which frequently arise.
Donor of Local Matching Funds
Since the Georgia Department of Family and Children Services has no funds to be used as the State's 25 percent share for day care funding, these funds must be contributed by a group, agency or organization in a local community. The following criteria is required in relation to the donor of local funds:
1. Funds donated on an unrestri cted basis are clearly acceptahle. The donor, for example, can be concerned about the need for day care in an area to be selected by the State.
2. Funds donated to support day care in a designated community (county, city, neighborhood, etc.) are acceptable provided the donor is not the sponsor or operator of the activity ~eing funded. Funds which would revert to the donor's facility or use are not acceptable.
3. The only exception to these criteria regarding the donor is in the case of Model Cities funds. A Model Cities agency can contribute funds with the stipulation that the State will obtain Federal matching and contract all funds back to the donor for administration of programs. Model Cities funds are the only Federal funds which can be used to draw additional Federal funds under Title IV-A.
4. In answer to specific common inquiries, funds contribued from united Fund sources are acceptable under the condition that the funds were not previously designated for a member agency and the United Fund does not restrict the State to contract the day care program to a member agency.
Designation of Community to Be Served
It is the prerogative of the donor to define or designate the "community" which will be served by the funds. Community is interpreted in a broad sense to mean a county, city, neighborhood, one or more blocks, housing
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APPENDIX VI (Cont I d)
project or development, etc. where there is a need for day care. However, a survey of that designated community must confirm that certain basic criteria is met in order for the funds to be used.
Since every child residing in the designated area and needing the services of the program is eligible to receive services, it is important to coordinate the designation of the size of the area (including number of children needing service) with the above criteria and the size program which can be established by the funds available.
In-Kind Matching
Unlike some of the Federally-funded programs such as OEO, Title IV-A funds cannot be used to match private in-kind contributions. In order for an in-kind contribution to be used for obtaining Federal matching, it must represent an expendjture of public - nnn-Federal funds. Staff time or services rendered by a public agency in the program could draw Federal matching. Contribution of a publlc building (no Federal funds used in construction, etc.) could be used to the extent of the rental value of the facjlity as a location for the day care center, etc. A church or private facility could not draw Federal matching but the total project funds could be used to pay rent for use of that facility and this might serve as an inducement for such facilities to be made available.
Use of Fees
Fees cannot be charged for children served through Title IV-A funded day care program. However, if a center or program serves children in addition to those contracted, fees may be charged. In such a situation, the contract <as mentioned below) between the Georgia Department of Family and Children Services and the contractor must reflect the intent of charging fees for these children.
Title IV-A funds cannot be used for construction, rennovation or other such capital expense required to develop a site or location for a center. They can be used to rent space for the day care program.
The Department of Family and Children Services will contract ill of the programs funded under Title IV-A. The contracts may vary widely in terms of services to be provided and are dependent on both services needed and availability of funds. It is possible to contract for establishment of new centers and programs or to purchase service to the extent of partial capacity of existing centers or programs.
The attached Day Care Projects Procedures Outline describes in more detail the exact steps which should be taken in applying for Title IV-A funds. Further questions regarding Title IV-A funding should be directed to: Mrs. Winifred Gerhardt, Day Care Consultant, State Department of Family and Children Services, AtJanta, Georgia 30334.
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APPENDIX VI (Cont'd)
DAY CARE PROJECTS PROCEDURES OUTLINE
1. Initial Inquiry: This may be in the form of a written communication from or personal contact with a potential contributor, day care center, or county or city officials exploring the possibility of having a day care project in a certain area to be funded by a combination of donated funds with Federal matching.
2. General Proposal by Contributor(s): A statement should be secured from one or more potential contributor concerning the estimated amount of money available as the local community share for day care services and in what particular geographic area the contributor is interested in making same available.
3. Specific Proposals by Contributor(s): This should be prepared and submitted by each contributor or by a combination of contributions in a given geographic area, glving information concerning the following subject matters:
A. (1) Finance--Amount of annual contribution for specified period beginning and ending when, payable when (contributed funds should be received two months prior, January 1, April 1, July 1, October 1).
(2) If any "in kind" contribution, indicate if same is from a public or private source, nature, value and how value arrived at.
(3) Names, addresses of other contributor(s) or potential contributors to the same project should be given, and indicate whether there are "in kind" contributions included from a public or private source.
B. Project Purposes--The proposal should indicate the general program purposes to be accomplished for which funds will be contributed which generally fall in one or more of the following combinations:
(1) Day Care Center Operation--rnformation should be given as to whether component services such as custodial care, emergency health and medical services, dental examinations and services, recreational activities, transportation of children between home and center, education or special tutoring are included.
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APPENDIX VI (Cont'd)
(2) Child Care--Indicate whether "in-home" care (by qualified non-relative person paid to provide child care in home of parents) or "family day care home" (outside home of parents) may be purchased with contributed funds.
(3) Indicate who is responsible for administration, finances, bookkeeping and reports required of contributors.
C. Geographic Area--Designate geographic area in which children live for whom child care services are to be provided with contributed funds (for example: county, city, specified census tracts, other well-defined boundary lines). Indicate whether qeographic area might be flexible depending upon subsequent detalls of required expenditures, eligibility criteria, surveys and need for additional facilities.
4. Contacts with Day Care Centers: If required information is not already available, it will be necessary for day care centers who desire to participate to take the following actions:
A. Surveys--Secure and present data to establish whether specified geographic area complies with state eligibility criteria and to assure that no discrimination against any child needing day care will exist. If survey indicates noncompliance with eligibility criteria, it may be necessary to restrict geographic area. Give source and date of data submitted.
Eligibility criteria requires comparison of chilil"'Bn pligible for child care provided by the project with total child population in the specified geographic area. Required surveys are to be submitted by contributors or those from whom services are to be purchased. However, some other party or organization may be secured to make it, but the state will not make it or include costs of doing so in project budget.
B. Negotiations and Selection of Day Care Centers in Project Areas:
(I) Determine compliance with Federal and state minimum day care requirements.
(2) Licensing of any new day care center in project areas.
(3) Receive proposals from day care center(s} in project areas who indicate their interest in operating same in accordance with purchase-of-service agreement. Specify location in area, type of services provided, staff available, annual budget, present and/or planned future capacity and minimum per child payments for which they will provide, what services to be
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APPENDIX VI (Cont'd) subsequently specified in the purchase-of-service agreement (weekly charge--indicate whether with or without transportation preferable)~ 5. Subsequent Actions by State DFCS with Federal Authorities and Other Agencies: A. Execution of contract with contributor(s) subject to approval of Federal authorities. B. Execution of purchase-of-service agreement with day care centers and others subject to approval of Federal authorities. C. Submit final project proposal to SRS and OCD of HEW for approval-including budget. Specify funds to be retained by State DFCS for administrative and supervisory purposes. D. Continue consultative and supervisory services to those with whom purchase-of-service agreements have been entered into and contributors during preliminary and implementation phases. E. Reports--Prepare and submit reports as required by Federal authorities. F. Secure Federal funds and make dishursements to those with whom contracts have been entered into (contributors and those providing services).
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APPENDIX VIr
RESOURCES AND EXISTING SERVICES
Local resources and existing services include, but are not limited to, the following:
Community Mental Health Centers and Out-Patient Clinics County Health Services (Local Health Departments) Crippled Children's Services (Welfare Department)
(Health Department) Crippled Children's Society Day Care Centers (Incomplete) Dental Clinics (Health Department) Diabetes Detection (Health Department) Diagnostic Occular Pediatric Clinic (Vision) Health Department Family Planning Clinics (Health Department) Home Health Services Home Training and Pre-school Programs (Department of Education
Mental Retardation) Hospital Reports Maternal and Child Health Clinics (Health Department) Muscular Dystrophy Association of America, Inc. National Multiple Sclerosis Society Georgia Society for Prevention of Blindness Georgia State Heart Association, Inc. Georgia Regional Medical Program Health Services Foundation Pediatric Otological Diagnostic Clinics (speech and hearing)
(Health Department) Pilot Dogs, Inc. Poison Control Center Public School Kindergartens Rheumatic Fever Prevention (Health Department) School Breakfast Program Services for the Blind (Welfare Department) Society for Crippled Children and Adults Speech and Hearing Clinics (Local Health Departments)
(Crippled Children's Society) State Institutes for the Mentally Retarded State Mental Health Facilities, Extended and Intensive Care Strep Throat Culture (Health Department) Tuberculin Testing and X-ray Reactors Clinics (Health Department) Vision and Hearing Screening (Health Department) Vocational Rehabilitation Programs (Bureau of Vocational Rehabili-
tation) Maternal and Infant Care Projects (Headquarters: Augusta, Atlanta) Diagnostic and Evaluation Projects (DeKalb, Muscogee, Chatham) Children and Youth Projects (Augusta)
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