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Interprofessional communication is not the only problem facing the clinics. Much thought has been given recently to improving communication between the clinic and the parent. Experience has brought out that it is difficult for the average parent to encompass the ramifications of a clinical diagnosis of mental retardation, and for this reason a number of clinics are presently supplementing their program of parent counseling with a broader program of parent education.

Furthermore, management of the more severely retarded child whose condition is often aggravated by serious physical impairments poses many special problems for the family. A number of clinics have therefore found it advisable to establish home training programs, usually utilizing the services of a specially trained public health nurse.

Since the prevailing attitude discourages more and more placement of infants or very young children in institutions unless they require intensive nursing care and medical supervision, the need for services to afford the child's mother some relief from care is becoming more evident. However, few communities so far are prepared to provide this relief either through homemaker service or day care. See FOSTER CARE FOR CHILDREN and HOMEMAKER SERVICE. While this type of service would be geared primarily to the needs of the mother and the family at large, communities have also begun to develop preschool services particularly adapted to provide group experiences to the young retarded child who formerly usually grew up in isolation from age-mates. For children with multiple handicaps, such programs also provide opportunities for physiotherapy, which often may be essential to equip the child for the more demanding standards of later schooling. General development of this type of service eventually may result in a substantial increase in admissions of the more severely retarded children to special education programs in the public schools.

Role of the Public Schools

The situation regarding schooling for the mentally retarded presents a very uneven picture throughout the country as is, of course, also the case with other specialized school public schools. Probably only one-fifth, or somewhat over 200,000 are receiving such instruction. While the situation is improving from year to year, there are still states where even classes for the high-grade retardates, the so-called "educables", are not yet mandatory upon the school boards. Even those school systems which are ready to provide for these children have difficulties establishing classes because of the acute shortage of qualified special education teachers. Appropriation by Congress in 1959 of $1,000,000 to advance training opportunities for teachers of the mentally retarded should ameliorate the situation. However, the results of such a program will not be immediately effective.

A controversy of major significance, which is evident in many parts of the country, pertains to schooling of the more severely retarded, the so-called "trainable" children. Both from school administrators and from certain leaders in the field of special education has come the assertion that these children are not fit subjects for the public schools but should be a responsibility of welfare agencies. On the other hand, a recent sociologically oriented text reports that an increasing number of public schools, utilizing their social service staffs in conjunction with the work of special teachers, are accepting a primary responsibility for the trainable as well as the educable retardate, and are seeking to discharge this responsibility with the aid of community welfare agencies whose resources they call upon as needed. (4) This matter is of crucial significance to community planners, not only from the point of view of providing the best possible care for these children but also because of the fiscal problems involved. If classes for trainables are a responsibility of the public schools, the source of funds is clearly established. If, however, the task of training the severely retarded is to be left completely to non-school community welfare agencies, as some educators advocate, there would not only be a question in many states as to administrative responsibility as well as source of funds, but there would even be a question as to whether this should be a public or a private responsibility. Therefore, it is significant that 37 states (as of August, 1959) allow for state-level support of classes for trainable children, either by specific mandatory or permissive legislation or by administrative regulation or interpretation.