The States might also use part of the $1 million additional funds to increase the number of well-baby clinics, to provide more funds for clinics for mentally retarded children, and for services for prematurely born infants. CRIPPLED CHILDREN'S SERVICES The increase of $1 million in crippled children's services grant funds provided by the House would be used generally to extend services under the program to more children. Under the crippled children's programs the States provide care not only to children with orthopedic handicaps but also to those with a wide variety of nonorthopedic handicaps, including cerebral palsy, epilepsy, speech and hearing defects, and congenital malformations, especially congenital heart disease. CHILD WELFARE SERVICES The increase of $1 million in child welfare services provided by the House would be used to expand and improve State and local programs primarily through additional staff, the training of additional workers, and to extend services in urban areas. Most of the child welfare services funds are used for salaries and for training of personnel providing services. As stated by the Secretary when he appeared before the committee, such an increase would further contribute to inflation and weakening of the national economy. It is recommended, therefore, that the increase over the President's budget be eliminated by the Senate. Senator HILL. Your statement will appear in full in the record. (The statement referred to follows:) STATEMENT OF CHIEF OF CHILDREN'S BUREAU ON GRANTS TO STATES FOR The 1960 estimate continues the 1959 amounts for maternal and child health services ($16,500,000), crippled children's services ($15 million), and child welfare services ($12 million). The Social Security Act Amendments of 1958 increased the amounts authorized for annual appropriation for each of the three grant programs under title V by $5 million: Maternal and child health services from $16,500,000 to $21,500,000, crippled children's services from $15 million to $20 million, and child welfare services from $12 million to $17 million. In addition, these amendments extended grants to Guam under all three programs, effective for the fiscal year 1960. The amendments also made a number of major changes in the child welfare provisions of the law. In 1960 State agencies will continue to use the grants for the three programs under title V for providing health and welfare services to mothers and children. In determining the most effective uses of these funds for extending and strengthening these services, States will continue to take into account in their planning the marked rise in child population, increasing costs of health and welfare services, and gaps in the respective programs in the individual States. There are several developments in the programs for which the Children's Bureau administers grants which we think have significance at this time. MATERNAL AND CHILD HEALTH SERVICES Grants are provided to enable States to extend and improve services for promoting the health of mothers and children, especially in rural areas and areas suffering from economic distress. The States must provide matching funds for one-half of the amount appropriated; the remainder is not matched and is distributed to the States on the basis of financial need of each State for assistance in carrying out its plans. State plans for the use of maternal and child health funds are made by State health agencies. The services are largely provided by local health departments. Under each of the appropriation acts since 1957, Congress has earmarked $1 million of the maternal and child health funds to be only for special projects for mentally retarded children. The States are continuing to use these funds earmarked by the Congress to initiate and expand programs of service to mentally retarded children. Within the past 3 years, the number of States with programs for mentally retarded children has grown from 4 to 44. For the fiscal year 1959, 30 States are spending $1,300,000 in special project grant funds from the Children's Bureau on projects covering a wide gamut of approaches to the needs of the mentally retarded child. Fourteen other States have programs financed by regularly apportioned Federal funds and State and local funds. The total budget for these 44 programs is about $2 million. These projects usually include one clinic, which can accept from 200 to 300 children a year. A great many requests for service have been stimulated from parents of the retarded because of these clinics. Training opportunities for professional health staff, such as physicians, nurses, nutritionists, medical social workers, are being financed in practically all States by maternal and child health funds. The main emphasis of the maternal and child health programs for which the Children's Bureau administers grants is on prevention. With over 4 million children being born each year, early health care for mothers and children become increasingly important. While the maternal mortality record in this country gives us reason for satisfaction, we still face the fact that deaths associated with childbearing in 1956 totaled over 165,000, of which 1,700 were maternal, over 85,000 were deaths of infants before or during birth, and 79,000. were infants under 1 month of age. And among the infants who did not die, there were many who will be handicapped all their lives. Medical prenatal and postnatal clinic services were given to 241,000 mothers during 1957. Children attending medical well-child conferences numbered 1,326,000. General pediatric clinics provided diagnoses and consultation for 147,000 children. State health departments provided expert medical care in hospital premature centers for 5,200 prematurely born infants. About 2,206,000 schoolchildren were examined by physicians in school health services. Vision screening tests were given to 4,089,000 children and hearing tests to 2,908,000 children. Some 1,715,000 children received smallpox immunizations, 2,967,000 diphtheria immunizations. Maternal and child health programs gave 11,809,000 children their polio immunizations. CRIPPLED CHILDREN'S SERVICES Grants are made to the States to extent and improve services for locating crippled children, and for providing medical, surgical, corrective, and other care and services for children who are crippled or who are suffering from conditions which lead to crippling. The States are required to provide matching funds for half of the amount appropriated; the remainder is not matched and is distributed to the States on the basis of financial need of each State for assistance in carrying out its plan. State plans for crippled children's services are developed by the State crippled children's agency and services provided by State and local agencies. A 1959 supplemental appropriation of $1,500,000 is being requested for crippled children's services, to be used exclusively for services for children with congenital heart disease. In order to provide for the most effective utilization of the funds, it is proposed that the funds appropriated remain available until June 30, 1960. The high cost of surgery for children suffering from congenital heart conditions and increasing demands for such surgery have exhausted funds available to support State programs for the current fiscal year. The number of children with congenital heart disease who receive medical services under State crippled children's programs increased from 2,000 in 1950 to 10,000 in 1957. It is estimated that 80 percent of the estimated 50,000 infants born each year with congenital heart defects can be cured by surgery. New medical knowledge and scientific techniques increasingly are being put to work to help children with the congenital absence of one or more extremities lead more normal lives. Recently 30 State crippled children's agencies reported they had provided medical services for over 2,000 child amputees, most of them congenital. Two special project grants have been used to develop information for the use of all States on how to fit prostheses to young children and how the loss of a limb affects the child's growth and development. Through a third special project grant, 12 major child amputee clinics are now collaborating on studies of the best kinds of artificial limbs for children and the best age for fitting those limbs. Interest is increasing in providing care for children with cystic fibrosis in the State crippled children's programs. Nine States now make specific provision for these children. With proper care, many of them can survive the most critical early years. Some Some 125,000 new cases were among the 313,000 children who received physicians' services under the crippled children's program in 1957. Forty percent of the expenditure of crippled children's funds goes for hospital care. 52,000 children received this care, averaging 24.4 days. There was a 6 percent increase in the number of children attending diagnostic clinics-to 246,000. These children made 506,000 clinic visits. CHILD WELFARE SERVICES Federal grants are provided to enable the States to establish, extend, and strengthen child welfare services for the protection and care of homeless, dependent, and neglected children and children in danger of becoming delinquent; and services for the return of runaway children to their own homes in other States. The law provides that State plans for child welfare services be developed jointly by the State public welfare agency and the Children's Bureau. The State agency administers the plan and services are provided by the State and local agencies. In addition to increasing the amount authorized for annual appropriation, the Social Security Act Amendments of 1958 made these major changes in the child welfare provisions of the act: (1) Expansion of services under this program to urban children on the same basis as to rural children Previously, the law limited the use of Federal child welfare funds to areas predominantly rural and to other areas of special need. (2) Revision of the formula for allotment of Federal funds so that allotment will be in direct proportion to total child population and in inverse proportion to State per capita income, provided that no State shall receive under the new formula less than it would have received prior to the 1958 amendments under an appropriation of $12 million. (3) Addition of new requirement for matching Federal child welfare funds with State and local funds, effective beginning with the fiscal year 1960. (4) Authorization permitting the reallotment of Federal child welfare funds. (5) Extension of the use of Federal funds for the return of children up to 18, instead of up to 16 as previously provided, as well as for maintenance of the child pending his return. (6) Establishment for 1 year of an Advisory Council on Child Welfare Services of 12 persons. This Council is to report its findings and recommendations, including recommendations for changes in the child welfare provisions of the Social Security Act, to the Secretary and to the Congress on or before January 1, 1960. The Congress appropriated $12 million for grants for child welfare services for the fiscal year 1959, an increase of $2 million over the amount appropriated for 1958. The funds for 1959 had been appropriated and apportioned to the States prior to the enactment of the 1958 amendments. Although the State plans were initially submitted for using funds in accordance with the provisions of the law prior to the amendments, the States will be using some of the increased funds for services to urban children, and improving provisions for the return of runaway children. A major purpose of child welfare services is prevention-prevention of family breakdown, and early help to children with social problems so that these problems will not become so serious that they hamper the child's optimum development of a healthy personality. Tension and strains in modern life are bringing their toll. The number of broken homes is rapidly increasing. State welfare departments are continually reporting the referral of more children who are neglected, abused or exploited by their parents. Some States report that children now coming for care are more emotionally disturbed than previously. The number of children involved in delinquent behavior steadily rises. Consequently, State and local public welfare agencies throughout the country are continuing to emphasize expansion and improvement of child welfare services to children and their parents in their own homes. These preventive services are focused on strengthening family life and averting foster placement of children, and on helping children when the first signs of trouble appear. At the present time, about 38 percent of the 340,000 children receiving child welfare services from State and local public welfare agencies are in their own homes or in the home of relatives. Even with the help of these services, however, State and local public welfare agencies still find it necessary to provide foster care for an increasing number of children. Currently, these agencies are caring for about 149,000 children in foster family homes or in institutions for dependent and neglected children. From the beginning of the Federal grant-in-aid program for child welfare services, States have recognized that in order to provide the quality of service needed to help children coming to their attention, competent professionally trained staff is required. Because of the scarcity of trained child welfare workers, States have consistently used Federal child welfare funds for the training of these workers in professional schools of social work. Between 1950 and 1955 the percentage of public child welfare employees with 2 years of professional training increased from 19 to 28 percent. States have gradually expanded coverage of child welfare services. The number of child welfare staffs providing these services increased from 2,863 in 1945 to 6,631 in 1958. Fifty-two percent of the counties in the country now have available the services of public child welfare workers, a rise of 32 percent since 1946. Between 1950 and 1958, estimated expenditures from local, State, and Federal funds went up 68 percent. The greatest proportion of this increase came from State and local funds. During this period it was necessary to increase salaries and to meet higher costs for care of children in foster family homes and in institutions. RESPONSIBILITIES OF STATES Senator HILL. These are all grants to States, are they not? Senator HILL. And the States match them? Mrs. OETTINGER. They have always matched those that had to do with maternal and child health and crippled children, but in the last amendments, after July 1959 they also match them in relation to child welfare services. Senator HILL. They will match all of them, won't they? Senator HILL. Then they start matching all of them? Mrs. OETTINGER. Yes. Senator HILL. The States will have to put up their part of the funds to get the Federal funds, is that right? Mrs. OETTINGER. Yes. 1959 FUNDS Senator HILL. Last year you had for these purposes $45 million, did you not? Mr. KELLY. Yes. That is the $43,500,000 plus the special million and a half which is now pending in the supplemental bill for congenital heart disease. Senator HILL. The $45 million includes what is in the supplemental bill. Mr. KELLY. Yes, that is right. Mr. WYNKOOP. The million and a half will remain available through the next fiscal year. Senator HILL. Yes, I understand that. It is so made in the supplemental. Mr. WYNKOOP. Yes. Senator HILL. What the House has done was to increase your appropriation $1 million in each one of these categories? Mr. MITCHELL. That is right. Senator HILL. That is in grants to the States. Senator HILL. I appreciate the fact, Mrs. Oettinger, that you are bound by the administration's budget, and the Secretary, and I realize your situation exactly, but speaking from your own personal judgment, these could be effectively and well used by the States, could they not? Mrs. OETTINGER. Yes, Senator, they could be. Senator HILL. Are there any questions, gentlemen? GENERAL WELFARE PAYMENTS Senator BYRD. Mr. Chairman, might I ask a question? Is there Federal participation with the States in the payment of general welfare payments? Mrs. OETTINGER. No. Senator BYRD. Approximately how many States require that a person be unemployable? Mr. MITCHELL. That is in the public assistance program, rather than the children's program. Senator BYRD. I am not talking about the Bureau. I am talking about the Bureau of Public Assistance. Is there participation there with the States in that category? Mr. MITCHELL. Not on general assistance, no. Your question went to unemployability in respect to the categories where the Federal Government matches the State expenditures or in general assistance. General assistance has no Federal funds at all. They are State programs. But in aging, dependent children, blind and the permanently toally disabled, the Federal Government participates in those expeditures. In general assistance, a great many States exclude the employables from eligibility for general assistance. I would have to submit for the record the actual number of those States that do that, if that is your question. Senator BYRD. That is it exactly. My State excludes employables and I was wondering what percentage of the States do not exclude the employables. Mr. MITCHELL. The public assistance people have left, and I don't have that in my mind. We will submit it for the record, and will be glad to. Senator HILL. Could you get them to prepare us a memorandum? Mr. TRUELSON. There are only a handful that do. We will provide the figures for the record. |