Library Collections: Document: Full Text

Today, the Association has close to 700 units throughout the country and in military establishments on foreign soil. Many of them maintain pilot projects of community services for the mentally retarded, and all of them assist in community and statewide planning. Increasingly this participation is recognized formally and officially. A recent check of sixteen special state commissions dealing with the problem of mental retardation showed that in eight of them representatives of NARC units had been asked to serve as commission members. In the institutional area, parents' associations are rendering extensive volunteer service and have furnished special recreational equipment.

Altogether, the form, scope, and effectiveness of NARC's activities on the local, state, and national levels constitute a new phenomenon in the field of health and welfare services; and throughout the published literature of recent years, it is acknowledged that it was this citizen effort that brought new vigor and broader perspectives to the field of mental retardation.

Service Programs

In spite of the tremendous progress that has been made in the care of the mentally retarded, it is not possible to point to any one community in the United States which offers a well-rounded program for the retarded, let alone is quantitatively able to deal with the service load.

Such a well-rounded program must provide for the mildly as well as the severely retarded; for those living at home as well as those requiring residential care; for the young and for the adult. The fact that many of these programs require active participation from a wide cross section of the professions, none of which can claim the dominant role, creates problems as to the appropriateness of administrative sponsorship and source of support. At least as far as the severely retarded are concerned, many communities have had no experience in providing services and are hesitant to assume such new responsibilities in a period of shrinking budgets. The number of retardates needing service suggests that many of these functions should be considered public responsibilities, yet there is no precedent as to which ones should be a municipal, county, or state responsibility.

Planning for specific services is further complicated by the fact that as the new programs initiated during the past five to seven years are taking effect, the needs for service are changing. Thus, a retarded child whose parents had the benefit of competent clinical evaluation and helpful parent guidance, and who has had the benefit of more adequate diet and physical regime and of some preliminary training and group contact in a preschool situation, presents quite different needs in terms of schooling and leisure-time activities than his far less fortunate counterpart did ten years ago. In turn, the improved schooling he now can receive in many communities is likely to improve his status in so far as eventual adult rehabilitation services are concerned.

With so much in flux, qualitatively as well as quantitatively, long-range planning is difficult.

The key problem confronting parents of mentally retarded children is the need for competent diagnostic services. Rather than find a solution through increasing the resources of existing child guidance clinics under psychiatric auspices, the basic NARC legislative program suggests that funds be made available to the U.S. Children's Bureau for development of pediatric clinic facilities as part of the maternal and child health programs supported by the Bureau in all the states. By 1959, Bureau funds had assisted in establishment of 50 such clinics in 44 states, and more than 30 community retardation clinics were operating with support from other sources. Unfortunately, this tremendous improvement still falls far short of existing needs, and waiting lists of from six months to one year are still not uncommon. This creates serious problems since, in at least some of the cases, a delay in proper diagnosis and consequent delay in proper management of the child may result in irreparable further damage. Furthermore, many of these new clinics are limiting their services to infants and pre-school children. Thus no facilities are available for re-evaluation of older children. Yet with the present state of knowledge, and thus further evaluations are needed as the child moves through developmental Stages.

With the establishment of so many special retardation clinics, the need for interprofessional as well as intraprofessional communication has become particularly acute; yet wide variations in the use of terminology and classifications provided a formidable block toward that goal. Therefore, the American Association on Mental Deficiency, through its Project on Technical Planning and Mental Retardation (supported by funds from the National Institute of Mental Health) undertook preparation of an extensive Manual on Terminology and Classification in Mental Retardation. (3) This Manual, published in September 1959, utilizes largely the etiological terminology of the American Medical Association's Standard Nomenclature of Diseases and Operations. A particularly significant contribution is the introduction of a new behavioral or psychological classification, using as its base two dimensions -- measured intelligence and adaptive behavior. It remains to be seen how quickly this new, diagnostically far more adequate classification will be generally accepted by all professions concerned as a substitute for the more and more inadequate traditional classification based on intelligence test performance alone.