not enough appropriate facilities here. There is a waiting list of 398 children for these tuition grants. It is the opinion of our Association that the highest priority need for children is the creation of a system of four comprehensive care centers, located in the four health areas of the city, A, B, C, & D. Each of these centers would care for 100 patients on a daily basis, with residential facilities for twenty out of the 100 children. "Residential treatment" is essentially a therapeutic milieu designed to provide corrective life experiences to counteract the damaging and painful experiences which led to the child's emotional disturbance. Residential treatment provides a variety of programs that include various forms of therapy (individual and group), education, nursing care, and the other kinds of adult supervision required for 24-hour living. The basic elements in treatment are "people, things and cultural patterns" within a consistent, planned and controlled environment. This requires a staff of skilled personnel, trained and experienced in working with children, and able to collaborate in a complex and highly varied program. Such a program also requires close collaboration with people in the child's natural environment, such as parents, other family members and teachers. It should often include supportive therapy with the family. It also requires out-patient facilities for use as the child moves toward community living. These residential facilities are necessary for youngsters with severe emotional disorders and mental illness. The severity of their disorders presents extremely complex problems: those of deep emotional hunger, extreme over-activity, withdrawal from the outer world, extremely high levels of aggression, violent uncontrolled behavior, bizarre and incomprehensible reaction patterns. A wide range of services are essential for the full care of such children. These children need more than individual treatment; they need an all-embracing care which is therapeutic in nature and which includes attention to their total development. For instance, they need individualized, highly skilled attention to their educational and recreational needs; and their daily routine needs to be handled with psychological skill. Obviously, such treatment is expensive. In our local private institutions the cost ranges from $11,000 to $26,000 per child; in the state of Massachusetts where by law all children have been deinstitutionalized (those in correctional facilities, institutions for mentally retarded, etc.) and placed in small residential treatment facilities, the cost per child is estimated at $7,000 per year. The cost of providing residential treatment services at the Espiscopal Church for Children in York, South Carolina is $9,115.50 per child, per year. The Executive Director of the Espiscopal Church Home for Children in York, South Carolina is $9,115.50 per child, per year. The Executive Director of the Episcopal Church Home for Children, Mr. H. S. Howie, Jr., has stated that "without residential treatment services these children would have to spend their adult lives in state institutions." South Carolina's state Senator Waddell has estimated the cost of keeping a child in a state institute for his life expectancy at $1 million dollars for six children. To the cost of keeping a child institutionalized, we must add the other side of the picture the 40 year work expectancy as a productive human being, the loss in state and federal income tax dollars ... But even more important than all of this . . . how can we measure the cost of the salvaging of a human personality? Publications from the National Institute of Mental Health state that the average cost, nationwide in 1969 for residential treatment was $9,855 per child. The D.C. Mental Health Association urgently requests that this Committee act favorably on legislation creating a system of "comprehensive care residential treatment centers.' These centers, one for each geographic area of the city, should be kept small and as homelike as possible. The Congress has already provided funds for constructing two such centers and $600,000 for operating costs, insufficient to run even one of them based on the program budget and staffing plan designed by Dr. Essex Noel, Director of the Mental Health Administration. (Appendix C) What we are requesting you to do today is to authorize the creation and operation of four centers or two more than are currently contemplated The additional capital cost we estimate at 1.5 million dollars, the yearly operating cost would be approximately 4 million. These figures are high, the benefits incredibly higher We would all agree that it is impossible to place a price tag on the saving of a human life. But we also are aware that Congress understandably wants to know what they are buying with every public dollar. Accordingly, if we assume and this is conservative-that these centers will treat 400 children each every year and that perhaps half of them will, because of the treatment, not have to undergo institutionalization, then, applying Senator Waddell's figures for the life-long lock-up, we will be saving $135 million for this annual expenditure of 4 million on the four centers That works out to a $50 return on every $2 invested Would any of you hesitate to invest money, let alone the public's in such a proposition? SPECIAL EDUCATION As you can see the creation of a system of residential treatment facilities is costly, yet so urgent for the severely ill child. It makes sense, it seems to us, to develop programs that will prevent thousands of children from ever needing residential care. The best way to do this is to improve the Department of Special Education of the D.C. Public Schools. When we address ourselves to the problems within the Department of Special Education we become the advocate of all children, not just the mentally ill. Children who suffer from any physical handicap-bad vision, bad hearing, dyslexia, slight mental retardation are particularly vulnerable to becoming emotionally disturbed. So we have a two pronged interest in the Department of Special Education. We are interested in seeing that the child who suffers from serious emotional disturbance is not denied his right to a free public education. Secondly, we are concerned with helping these already "exceptional" children (the ones who are blind, deaf, retarded, suffering from muscular or neuromuscular handicaps) from becoming emotionally disturbed. (For a description of the type of children who need special education classes, please see Appendix E, page 1-2.) The history of special education in D.C. has been one of late development, uneven growth, and constant pressure to do more with limited resources. Thus, quality of programing has suffered. Children now in special education programs are inadequately served because sufficient funds have not been made available. When the regular classroom teacher believes that the child is not functioning well in the classroom, she refers the child for testing to the Department of Pupil Personnel. After a long wait, the child is finally tested. Then begins the really long wait. Some parents have reported to us that they have waited as long as three years after the child was tested and diagnosed as needing special education, before the child was finally placed in a special education class. In the meantime, the child was disrupting the classroom, making it impossible for the other children to learn. He was not learning at his potential level himself, due to his handicap. Chances are very good that at times his frustration level was overwhelmed and he acted in an aggressive and threatening manner toward his classmates and teacher. If his behavior was bad enough, he was dismissed from the school, and probably roamed the streets until his parents realized he was out of school. In fact, recommendations for special education placement either in the District program or through tuition grants far exceed the present program capacity. As of the week of September 27, 1971, 1,501 children who require special education services were on "the waiting list" and are not now receiving those services. Most are attending regular elementary school programs. The Department of Education has no data available on the adolescents or for those children and youth who are not now enrolled in a D.C. public school. The above figure of 1,501 on the waiting list represents only those children attending elementary schools who have actually been identified and diagnosed as needing special education classes. To service these children, a special allocation of $3.5 million dollars is needed immediately. But that would be just the beginning. According to the U.S. Office of Education, the Bureau for Education of the Handicapped there are an estimated 18,296 children currently living in D.C. who require special education services. We can only identify 6,264 of them by name; the others are still waiting to be noticed and tested. To provide special education classes for the children in Washington who need these services would cost $41,566,280 per year. The FY 1972 Budget Request s for $6.995 million. To provide for minimal needs for only those children already dentified would cost $10.563 million. (See Appendix D.) We believe that it is the right of every child in America to receive a free public education that meets his needs. Thousands of children in Washington are being denied this basic right. And their classmates are suffering also, because with so much disruption in the classroom, everyone loses. For these reasons we believe it is mandatory at this time that Congress enact egislation to assure that funds are appropriated to meet the needs of emotionally disturbed children, and all children who are "exceptional," including the gifted hildren in our midst. The legislation should be both comprehensive and specifically enforceable. The Statutes of the District now merely provide that specialized instruction for the mentally disturbed child shall be furnished "if such instruction is available." There are no provisions for identification and placement of the child, financing or enforcement. There is ample precedent for comprehensive legislation. The statutes of all of the states provide for special education of the disturbed child. They vary dramatically in scope and approach-thus approximately one-half of the states require mandatory special education while the other half adopt a voluntary approach. At their best, the state statutes represent an enforceable commitment to the emotionally disturbed child; at their worst, as in the District of Columbia, they are so vague as to be illusory. We recognize that laws, of themselves, do not effect an instant cure. Thus 30 states during the 1968-1969 school year were serving less than 11% of their emotionally disturbed children. However, legislation evidences a written public policy to recognize, confront and deal with a social ill. Therefore, we support, and hope that your Committee will support when presented to it, legislation for the District of Columbia which -Requires mandatory education for the exceptional child. -Establishes procedures for identification and placement of the child, and ensures due process for the child and family. -Designates the agency responsible for supervising the program and identifies the program facilities. -Establishes standards for teacher qualification and administrative staff. -Sets forth specific requirements for matters such as continuing evaluation, transportation of children, teacher-child ratios. -Provides for funding and enforcement mechanisms, to guarantee that these funds may only be used for special education and not merged into or diverted to other needs. I would like to point out, Mr. Chairman, that your own state of South Carolina has enacted legislation creating residential treatment facilities for children; your state also has a statute calling for special education for handicapped children. Again our cost analysis more than justifies our request. For $3.5 million we can handle an additional 1,500 children. If even 25% of them would otherwise be forced out of the school system into institutions, we will save $64 million over their lifetime, a return of close to 20 to 1. CHILDREN IN FOSTER HOMES The third and last recommendation we wish to make today concerns small children placed in foster homes in Washington. There are all kinds of reasons why children must be placed in foster homes, and all the reasons are unhappy. Perhaps their parents are separated, mentally ill, in jail, or have recently died. Sometimes simple poverty is the reason why children must be removed temporarily from their natural parents. There are over 500 children between birth and five years of age currently living in foster homes in the Washington area. Some of these homes are gloomy and dreary. Even while the search for better foster homes and more skilled and compassionate foster parents goes on, it is imperative that the D.C. government take measures supportive of foster parenthood, and these very high risk children. I say "Highrisk" advisedly. A very large percentage of children who have lived in foster homes during the early years of their lives become mentally ill. It is incumbent on us to take preventive measures to protect these children. The D.C. Mental Health Association embarked on a project five years ago to establish a model of a therapeutic nursery school for children in foster homes. After much careful planning by our most skilled professionals, we opened the "Child Learning Center" at Catholic University of America, in September, 1971. This pilot project, unique in the United States, was funded entirely by money we raised with our annual Bal du Futur. The Center includes substantive learning of the Head Start type. But more importantly, it's purpose is preventive and therapeutic. The foster mothers assist the teachers, just as mothers in the neighborhood nursery schools do. But here the purpose is for the foster mother to learn specific child rearing rechniques. Also, if problems develop, the teachers and social workers are trained to recognize them immediately and intercede to help the child. Weekly parents meetings are held so parents can explore their problems and discuss ways in which they might be more helpful to their children. This nursery school situation works to build the child's self esteem, strengthen the foster mother's understanding of what is going on inside the child, and give her an outlet for problems with her child. We have built into this Child Learning Center some minimal evaluation techniques, and we hope to assess how this approach has benefited each child this coming June. Our research results will be general and individual. It is our firm belief that an early childhood education system, perhaps based on the model we have developed, must be designed to meet the needs of children in foster homes, and be made available as soon as possible to these five hundred children in D.C. Placing these children in foster homes, rather than a large institution, is both healthier for the children and less expensive to the city. We believe that the money saved by placing them in foster homes should be used to provide supportive services to these high-risk children; we believe this early childhood education system is a must for these children. At Catholic University we are spending $2,000 per child per year. We believe it could be done less expensively by including more children in each nursery school. (We have only ten children in our Center because the physical facility is very small.) We would estimate that this type of model could be duplicated by the city at a cost of approximately $1,500 to $1,800 per child per year. Our third request, Mr. Chairman, is that your committee act favorably on legislation creating an early childhood education system specifically geared to the needs of children in foster homes. We are modestly seeking coverage of only 500 children at the outset, Mr. Chairman. Were one-fourth of them to have to go to St. Elizabeth's or jail, society would have to spend $20 million on them, not three-quarters of a million. SUMMARY In summary then, the three requests we make of this Committee today are that it act favorably upon legislation affecting these 30,000 or more children. We ask you to authorize I. The creation of a system of four "comprehensive care residential centers" for children and adolescents, to be placed in the four health sections of the city. II. Enact a mandatory special education law. III. Create a system of early childhood education facilities, including children in foster homes. If we go home today, having failed to move this committee to action, then we or some other citizen group will come back in a year or two to repeat this request. Meanwhile, the cost of providing services for those needing special attention will easily be twice the substantiated figures or guesstimates we have unfolded to you today. The cost to society will be horrendous: wasted lives, wasted human potential. There will be more children on drugs, committing crimes, dropping out of school. Continued neglect of these children can only mean continuation of crime, violence, disrupted classrooms, and innumerable unfulfilled and unproductive lives. We think alternatives are clear: residential treatment services and special education classes and early childhood intervention programs or more drop-outs, more robberies, more assaults, more Lortons, more St. E's, more wasted lives. I know this kind of testimony is depressing, but so is reading our daily newspapers. We are past the urgent stage. We must provide treatment for these children who are, by anyone's definition, mentally ill. If we are ever to make a dent in the adult mentally ill population, we must begin by treating the problems of our children. We cannot continue to allow children to be sent to correctional institutions, when what they really need is psychiatric treatment. I know that you recognize that the children of today represent our nation's future, our most precious national resource. In Washington, this morning, many children are out of school because they are emotionally ill and yet they go untreated. Hundreds more are finding their way to detention facilities at Laurel, or to Juvenile Court-something which could have been prevented if services had been readily available a few years ago. The need is obvious. Our child-care professionals know how to help these troubled children; we know how to rehabilitate them. What we need from this committee is the commitment to fill the glaring gaps in service which spell disaster for so many of our children. Appendix A: Three definitions of an emotionally disturbed child. Appendix B: Review of D.C. Facilities for Disturbed Children by the D.C. Mental Health Association. Appendix C: Budget and Staffing Plan for a Comprehensive-Care Residential Treatment Center. Appendix D: "Needs Of Exceptional Children In The District of Columbia" Prepared by staff of the Department of Special Education. APPENDIX A The Joint Commission on the Mental Health of Children has made the following definition of emotionally disturbed children: "An emotionally disturbed child is one whose progressive personality development is interfered with or arrested by a variety of factors so that he shows impairment in the capacity expected of him for his age and endowment: 1) for reasonably accurate perception of the world around him; 2) for impulse control; 3) for satisfying and satisfactory relations with others; 4) for learning; or 5) any combination of these. DEFINITIONS Two descriptions of emotional disturbance are presented to indicate the range of considerations needed in selecting children for residential programs. The first is excerpted from a report "The Needs of Exceptional Children in the District of Columbia" prepared by the Department of Special Education. Seriously Emotionally Disturbed individuals exhibit one or more of the following characteristics over a long period of time and to a marked degree. (1) Inability to learn that cannot be explained by intellectual, sensory or health factors. (2) Inability to build or maintain satisfactory interpersonal relationships. (3) Inappropriate behaviour or feelings. (4) General pervasive mood of unhappiness or depression. (5) Tendency to develop physical symptoms, pains or fears associated with personal or school problems. The second description is taken from a booklet "From Chaos to Order," compiled by the American Association for Children's Residential Centers.", in an article on The Therapeutic Milieu. pp. 37-45 "Those disturbed children for whom residential treatment is the choice are among the very sickest, and therefore in dire need of the most intensive and pervasive treatment measures available. (These children) are often psychologically primitive, defective of ego, wanting in realistic self-assessment, impaired in ability to establish meaningful contacts with others, deficient in judgment, backward in the capacity to learn, and woefully innocent of the subtleties of symbolic communication." APPENDIX B REVIEW OF D.C. FACILITIES FOR DISTURBED CHILDREN (by The Sub-Committee on Mentally Ill Children, Children and Adolescents Committee, D.C. Mental Health Association) I. Goals and Method CONTENTS II. Statistical Findings and Comparisons 1965-1971 |