ment of the individuals who are affected, rather than quoting statistics to you which invariably need to be analyzed and examined in order to arrive at really what is going to happen.

The OEO guidelines, though developed in the absence of previous experience, have been very beneficial in allowing agencies that have operated under them to be creative and innovative in their approach to traditional problems.

In this manner many new programs have successfully resolved old problems because of the permissiveness of trying new ideas that has been embodied in OEO guidelines.

Beyond any doubt these programs begun by OEO would not have been acceptable if they had been placed in the bureaucratic system that has sought to standardize conventional answers to age-old problems, and particularly to multifaceted problems which require really complicated answers and innovative and creative ideas, in terms of applying services in a different way.

The basic Economic Opportunity Act had in it certain provisions and terms of qualifying those provisions which allowed a wise and prudent person to explore the imaginative possibilities to problem solving.

As an example, the phrase "maximum feasible participation" was a phrase used in the guidelines which had not been qualified before, and had to be defined by operational results.

That is, rather than by a previous definition.

No one knew what maximum feasible participation of the poor in problems really was, because it had never been tried before.

Numerous programs and projects with the community participating in planning, establishing priorities, setting policies, or giving advice and consultation to the operating agencies as to how they could effectively provide services to the community were begun by ŎEO.

Communities that had previously been denied services, and services were not accessible, had suffered through long periods of deprivation, and had been conditioned not to seek or to accept those services once they were available.

ŎEO permitted flexibility in operations which were different from the standard methods of operation for agencies and companies, which allowed them to get the job done effectively-to reach the poor in a way in which the services were acceptable to them, rather than the way in which the professionals thought the services should be applied. These modifications and the way in which these programs have been treated under the OEO program have been very beneficial and have stimulated creative ideas, and imaginative solutions to problems. In our organization, for example, we have been able to move the community consumer board from an advisory and consulting capacity to a full fledged board of directors, whose primary role is now that of policy and decisionmaking, and formulating the broad guidelines and criteria under which we carry out our daily operations of delivering health care.

I cannot begin to describe in this session the far-reaching benefits that will be derived from the training received which affects this transformation.

Our board of directors is a community and consumer board, and it operates exactly and more effectively than most boards of any comparable-size health institution in the community at large.

Their expertise of decisionmaking can be matched with that of any board of any comparable $5 million operation. The side effect of this kind of social change in the community cannot be measured; but obviously it can be no less than beneficial to the community in future years and in future ways.

Now, in education and training, another aspect of the thrust of OEO programs in the community is in the area of education and training of community residents for careers which previously had been jealously guarded by professional and voluntary organizations and associations to the extent that they have created an artificial health manpower shortage.

We have no professional manpower shortage in the health field; that is really my belief. What we do have is the misallocation-the underutilization and the uneven distribution of the already-trained professionals who spend a lot of their time-and I would estimate as much as one-fourth-in performing mediocre tasks that lesser educated and lesser skilled individuals can be trained to perform.

We have demonstrated that the effective utilization of professional manpower coupled with a more reasonable allocation of tasks can increase tremendously the services that can be rendered for the same dollar, and expenditures.

This is not to say that the costs are less at any given point in time; but it is to say that when health services are provided in a different way-that is, in an imaginitive way, utilizing community employees, over a long period of time the overall expenditure of health dollars per individual served is less because of the tremendous and total health concept in the delivery of services, which is relatively new.

We have a current employment level of 537 persons; of the 537 persons, 230 are community residents from the target area which we serve. At least another 75 reside in communities adjacent to the target area which we serve.

In terms of the overall unemployment picture this is but a drop in the bucket. But if all of the agencies and institutions serving the health needs of the community at large would follow our example in the utilization of manpower, and in the training and utilization of residents to an allied health position in new careers, there would then be a substantial increase in the employment of community residents in the allied health fields.

We did not effectively reach this level until we had gone through many experimental phases. How were we to train the persons who did not have the traditionally required educational background? New techniques of training, and new curriculum content had to be developed. New methods of teaching, and also new motivational inputs had to be created; which is but a little of what really had to be done.

The examples and patterns can be followed by other organizations. None of this would have been possible if we had been required by the funding agency to stick to traditional methods and systems of recruitment, and of examining persons who were eligible to be trained, as other agencies of the traditional sense have done.

The benefits of this cannot be measured yet, except by a few success stories that can be delineated; I am sorry, it is not a few, but a lot of

success stories. But we can delineate a few which were the direct results of these efforts.

For instance, there are numerous stories like the following one. A young man from off the corner who was on drugs was encouraged to be detoxified, and was then a job applicant, was given employment and encouraged to seek further training.

He went to a radiological technician school on our own premises, in his own community. He was graduated, and is now employed in one of the largest hospitals in Los Angeles County.

I can quote numerous other incidents of employees who are no longer with us who have gone through the same process emanating out of the community which we serve.

When we have a training class open to train 15 neighborhood health workers we get 130 applicants and find ourselves turning away numerous potentially good workers because we do not have the funds to train more than 15. And if we did-if we trained more than we could use there are no other medical facilities at the present time which are utilizing this kind of employee; and that is because the traditional rules and regulations of these institutions prevent them from bringing in community workers.

Yet this kind of employee provides the basis of the effective way in which we deliver our health services to our community. Without these workers we could not. They give validity to the concept that is often spoken of in congressional halls of community health services or health maintenance organizations.

Let's look at some of the economical influences that our organization has on the community. There are 230 employee families who are not on welfare rolls. Most of them were before they were our employees. They are now self-subsistent and contributing economically to the buying power of the community.

The 230 community residents have an annual payroll of approximately $1.2 million, which translated into buying power of the community represents some $6 million.

This is what in turn stimulates additional jobs in the community, and there is no way to measure what other effects this buying power has to the total community.

It is also one of our efforts to-whenever practical-encourage the development of community businesses, so that they can be the recipients of business contracts for services needed for our organization. We hope to increase the amount of this influence that the organization has had by stimulating the development of communityservice companies to sell services and goods to us, as well as to others who need the same services and goods.

All of these above things are still fringe benefits to the community outside of the actual delivery of health services, which is our primary mission.

Last year our center served 6,000 families, representing more than 20,000 persons who received services during that year on a continuing basis.

Our health services are delivered in a way that the total health problems of a family are assessed, and the multifaceted health problems of the family are attacked, and the problems are systematically resolved. The effect that this has on the economics, again, is staggering.

We estimated that more than one-half of the families we serve have had-or now have some illnesses or infirmitives which prevent them from being employable members of the community. If we have only resolved half of the problems of this group, we have increased the potential productivity of at least 1,500 heads of households.

We are in the process of developing a study which will determine this and produce statistical information to verify this professional estimation.

All of the approaches that have been permitted under OEO have still not been fully creatively explored. This is one of the reasons why we believe that the OEO program and the OEO agency should continue for the length of time that your committee is proposing.

We can envision a time when a community health status assessment will be made of all communities, and a measure over time taken to determine the effect the health services in the community have had on making improvement, all of which of course cannot be credited to any one center or any one health entity.

If the proposed health systems are to be effective, they too must be given the same degree of freedom in developing innovative and creative programs to effectively reach the needs of the communities, as OEO has been given in the last 5 years.

All communities are not the same, and do not have the same needs. Therefore, services that are given in any single community cannot be placed in the traditional mold and expected to work in other communities.

OEO has permitted the kind of different flexibility all across the country in various different communities that other Government agencies have denied.

Their standards are traditional; those standards are rules and regulations that must not be broken, or must not be deviated from. Most have failed to effect any solution to our major health problems.

I have tried to outline for this committee in broad terms some of the ways in which our particular project-which has as its primary mission the delivery of health care has been effective in implementing that primary mission in the way that provides other maximum benefits to the community, by virtue of delivery of this service.

I could also offer numerous other examples in each of the broad topics I have outlined above, where other organizations could follow suit if they were not bound by conventionalism, traditionalism, red tape, and bureaucratic fear of innovation.

The reason for my plea to you for the continuation of OEO on a more permanent basis is because of the effects that have been seen under its direction which could not have been realized under other governmental agencies.

It is true that there have been problems, and it is true that by traditional standards there may have appeared to be wasted dollars; but I wonder if we question the wasted dollars in developing the SST as closely as we question the dollars wasted for developing better human services to meet human needs.

If you have any questions[Applause.]

Mr. FORD. Thank you very much.

I didn't expect anybody from the west coast to question the SST. I am still not talking about those in the Midwest who voted against it.

How are you funded? Are you funded directly under the CAP agency?

Mr. COLE. No. We are funded directly, and we were funded directly originally; and I think at the time we were originally funded the CAP agency was not as developed and as large as it currently is.

Mr. FORD. Are you related to the program that is connected with the medical schools?

Mr. COLE. No; not currently.

Mr. FORD. That was in effect when we were out here a few years ago. Is that still going on?

Mr. COLE. Maybe I misunderstood you.

Which medical school? If it is the University of Southern California School of Medicine, then we are the same agency that used to be under the granteeship of the University of Southern California school.

As of January 1, 1970 the granteeship was transferred to the community cooperation.

Mr. HAWKINS. It is my understanding that the original grant was made through the University of Southern California Medical School. Mr. COLE. That is correct.

Mr. HAWKINS. The community board was set up at the time to be advisory, but with the understanding that with development, the board would come into prominence as a governing board.

Now, is that pretty much the way it is?

Mr. COLE. That has happened, and it occurred on January 1, 1970. Mr. FORD. What is the makeup of your board now?

Mr. COLE. We have a 25-member-we call it a community consumer board.

Of the 25 members, 17 are community residents of the target area we serve. Of the 17 members, 13 are eligible for services and receive services at the center.

Two members of the board, in addition to the 17, are from voluntary agencies that serve the community, and generally they are community representatives.

Then we have six members of the board that are experts or professionals, and they come from the fields of law, labor, finance, business, medicine, and dentistry.

Mr. FORD. I recall at the beginning hearing the program described to us several years ago, and I am happy to see that it is still going. What is your annual budget?

Mr. COLE. This year our budget will be approximately $6.5 million, with soft money. I mean, with soft and hard money.

The reason I say that is because it is difficult to predict. The budget that OEO sets is an approved budget; not necessarily a hard-money budget. It doesn't mean that we get the dollars; it means that a certain portion of that approved budget must be earned by the organization.

The earned money-or the earned income, so to speak-comes from a third-party favor, such as Medi-Cal and medicare. And as you recognize in this State, Medi-Cal is really soft money at the present time. Mr. FORD. That is a good way to describe it.

Mr. COLE. We expect that approximately together the total budget might reach $6.1 million this year.

Mr. FORD. Mr. Hawkins?

Mr. HAWKINS. Mr. Cole, as one who originally supported the program but who was criticized rather strenuously by many individuals—