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One of the arguments made against assumption of this responsibility by the public schools is that sooner or later children classed as trainable will find their way into public institutions. This point has been effectively refuted by a study by Gerhart Saenger, sponsored by the New York State Interdepartmental Health Resources Board and published under the title The Adjustment of Severely Retarded Adults in the Community. (5) Saenger followed up a large sampling of pupils who, between 1929 and 1956, had attended classes in the public schools of New York City set aside for pupils with I.Q's of between 40 and 50, that is, the upper level of the trainable classification. The findings revealed that two-thirds of these former pupils were living in the community (1,742 out of a total of 2,640); only 26 per cent were institutionalized. (The remaining 8 per cent had died since leaving school.) Even though some of those now in the community may eventually be admitted to institutional care, others who were so committed might well have remained in the community had there been available the persently -sic- still limited facilities. Twenty-seven per cent of those who resided in the community worked for pay at the time of the study; and an additional 9 per cent had no job at the time but had previously worked. Thus the Saenger study, undoubtedly of greatest significance to community planners, points up that the trainable group not only must be considered for public schooling but, in addition, merits screening for vocational preparation or rehabilitation.

Rehabilitation

While the mentally retarded have been included within the scope of activities of the federal Office of Vocational Rehabilitation since the Barden-LaFollette amendments of 1943, it was only since the amendments of 1954, Public Law 565, that there has been distinct growth and development of vocational rehabilitation services for this group. Specialized sheltered workshops for the mentally retarded have rapidly grown in number since that time; and in 1959 the National Association for Retarded Children published the results of a survey which reported on 56 sheltered workshops operated by NARC member units. Twenty-six of these included young adults classed as trainable. Experience in the workshops over the past several years has brought out clearly that the mentally retarded can be gainfully employed in a wide range of jobs, including manufacturing, and that the success of the retardate in the workshop does not depend as much on his intellectual endowment as on his personality structure and adaptive behavior.

The success of present rehabilitation programs has suggested an extension beyond the limits of productive, potentially gainful activity into so-called independent living programs. Here the emphasis is on training the severely handicapped person toward greater independence in matters of simplest daily living, such as self-care. In considering legislation to that effect, Congress was made aware that a question can be raised as to whether such program should be the responsibility of the public welfare agency or possibly be a joint effort of the two.

Residential Care

In view of the fact that not only lay citizens but many professional people are inclined to associate the problem of mental retardation with institutionalization, it is significant that federal figures for 1957 indicate that of the 5,000,000 retarded persons in the United States, only 150,000 reside in public institutions. These same figures indicate that the number of high-grade retardates is decreasing and the number of severely retarded increasing in the institutional population. Practically all states have long waiting lists, so that the figure for needed institutional beds exceeds, by far, the 150,000 presently available. However, opinions vary sharply as to future trends. In the opinions of some the extension and improvement of community programs will limit institutional placement to the most severely retarded only. Others maintain that the institutions will also have increasingly a function as centers for intensive training and physical restoration, thereby improving the individual's capacity for adjustment in the community. Furthermore, the increasing life span of the mentally retarded brought about by improved health care, and in particular by the use of antibiotics, most likely will also eventually result in the need of residential facilities for these individuals in their later years.

It has been suggested that these tasks are sufficiently diverse in nature, requiring different facilities and different staff, to warrant breaking up the present large institutions into smaller units, better adapted to the needs of the respective residents and located closer to population centers.

Without doubt the institutions have not kept pace with the considerable improvement made in community facilities since 1950. The absence of evaluative research in the area of residential care is particularly significant in that regard.