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We must be aware of the need for team work among the professions and for maximum flexibility in deploying their respective competence in the broad field of mental retardation.

The Role of Community Services

A well-rounded program for the mentally retarded requires a wide network of services and facilities because it must provide for the mildly as well as the severely retarded, and for many different age groups over the life span. During the past 10 years tremendous progress has been made in communities throughout the country through the establishment of specialized programs for the benefit of the retarded. Yet, considering the numbers of the potential users and considering that we are dealing with a lifetime problem these accomplishments are only a token effort.

Mental retardation clinics can serve as an example: Ten years ago there was no facility available to provide for a comprehensive evaluation of a retarded individual, and for guidance and counsel to his family. Today there are 77 such clinics, most of them initiated with funds provided for this purpose by Congress, 23 are located in hospitals, 17 in local and district health departments, 13 in special community centers for the retarded, 11 in medical schools, 8 in state health departments, 3 in private schools, and 7 in state institutions. The main focus of the work of all the clinics is on diagnostic studies, a secondary focus on parent guidance. The service is directed primarily at the preschool group and in 1958, 75 percent of the 7,000 to 8,000 cases seen by the clinics were under 9 years of age.

Because the Federal funds for the clinics come from the U. S. Children's Bureau to the state health departments, a particular effort has been made to establish close working relationships with other aspects of public health programs such as well-baby clinics, premature baby programs, maternity, and obstetrical care facilities. Through training institutes for professional workers, through clinical demonstration, and participation in efforts to educate the public the clinics have performed a major educational task.

However, throughout the country last year they were able to serve only 7, 000 to 8, 000 children. This points up the unmet need for these services in communities throughout the country. Without the availability of specialized clinical services in the field of mental retardation it is not possible to build a comprehensive, coordinated, effective system of community services for the retarded. While it was wise strategy to begin with pediatrically oriented clinics for the young child, clinical facilities must also be available for the school-age child and the young adult since experience has shown that periodic reevaluation is essential in view of the dynamic character of mental retardation which makes it impossible to assess with a single diagnosis -- however comprehensive -- the future of an individual's growth and development.

In this respect community planners will have to face important questions: To what extent will it remain necessary to have separate clinical facilities for the mentally retarded? Should broader gaged clinic facilities be developed for all handicapped children with appropriate specialized services? If so, what would be the respective roles for pediatrics and psychiatry? Will it be necessary to include in such clinics more representation from the educational profession since clinic recommendations will have to relate themselves in many cases to a considerable extent to educational needs and existing educational facilities?

In planning clinical facilities for early diagnosis of mental retardation, case finding becomes an essential prerequisite. In terms of direct services this points to the contribution public health nurses and child welfare workers can make along with the physician and hospital personnel in those cases where indications of serious damage are noticeable. Another aspect of case finding might be the maintenance by official agencies of special registries such as those maintained by public health departments for crippled children. However, in most carts of the country public health nurses and child welfare workers have access only to a limited number of homes, nor do most families have the services of a pediatric specialist.

Another aspect of early diagnosis pertains to the multiple handicapped children. In the past there has been a tendency to overlook the possibility of corrective physical therapy with the more retarded child and there are indeed still states which as a matter of law or regulation categorically exclude mentally retarded children from the crippled children's program. Once we begin to deny helping services to those who are deficient, who is to say which degree of deficiency shall justify such denials? Also, children with multiple handicaps are often left out as they do not fit properly into existing compartmentalized programs.