DOCUMENT RESUME

ED 026 768 EC 003 029

Maryland State Comprehensive Mental Retardation Plan.Maryland State Board of Health and Mental Hygiene, Baltimore.Spons Agency-Public Health Service (DHEW), Washington, D.C.

Pub Date Jun 66Note- 54p.Available from-State Board of Health and Mental Hygiene, 301 West Preston Street, Baltimore, Maryland

21201.EDRS Price MF -$0.25 HC-$2.80Descriptors-Cooperative Programs, Custodial Mentally Handicapped, Educable Mentally Handicapped.

*Educational Needs, *Exceptional Child Research, Guidelines, Identification, Incidence, Interagency

Coordination, *Mentally Handicapped, Population Distribution, *Program Planning, Services, *State Programs,

Trainable Mentally Handicapped, Vocational EducationIdentifiers-Maryland

The comprehensive state plan which is reported was developed over an18-month period by nine cooperating task forces and uses federal, state, andcommunity resources. After an outline of 10 priority recommendations for the state, ageneral discussion of mental retardation is given which includes estimates ofprevalence at city, state, and national levels. The plan for services assesses presentand future specifics on prevention, diagnosis, and treatment at seven age levels frombirth through adulthood and old age. Tables present levels of retardation, Maryland's

five geographic areas, population projections in those five geographic areas,estimates of retarded persons by geographic regions, services provided in 1965, and

agency responsibility for services. A directory of available services in each area ofthe state is also included. (OF)

COMPREHENSIVE

LI

RETARDATION

Fowl

STATE OF MARYLAND

STATE BOARD OF HEALTH AND MENTAL HYGIENE

301 W. PRESTON STREET BALTIMORE, MARYLAND 11101

U.S. DEPARTMENT OF HEALTH, EDUCATION & WELFARE

OFFICE OF EDUCATION

THIS DOCUMENT HAS BEEN REPRODUCED EXACTLY AS RECEIVED FROM THE

PERSON OR ORGANIZATION ORIGINATING IT. POINTS Of VIEW OR OPINIONS

STATED DO NOT NECESSARILY REPRESENT OFFICIAL OFFICE OF EDUCATION

POSITION OR POLICY.

MARYLAND STATE COMPREHENSIVE

MENTAL RETARDATION PLAN

HONORABLE J. MILLARD TAWESGovernor

STATE BOARD OF HEALTH AND MENTAL HYGIENE

301 West Preston Street

Baltimore, Maryland 21201

June, 1966

This Project was supported in part by a Mental Retardation Planning

Grant awarded by the- U. S. Public Health Service, Departmeni. of

Health, Education, and Welfare.

STATE BOARD OF HEALTH

AND MENTAL HYGIENE

AARON A. DEITZ, M.D., Chairman

LEO H. BARTEMEIER, M.D.

J. EDMUND BRADLEY, M.D.

MISS IRENE f M. DUFFY, R.N.

NOEL E. FOSS, PH.D.

MR. WALTER N. KIRKMAN

CORNELIUS W. KRUSE, DR. P.H., C.E.

MR. HARRY W. PENN

J. DOUGLASS SHEPPERD, M.D.

RUSSELL P. SMITH, JR., D.D.S.

JOHN C. WHITEHORN, M.D., Vke Chairman

HAROLD C. LLOYD

Assistant to the Chairmanand

Secretary of the Board

iii

STATE BOARD OF HEALTH AND MENTAL HYGIENE

Office of Mental Retardation

Steering Committee for Mental Retardation Planning

Miss Irene M. Duffy, R.N.Chairman

Cornelius W. Kruse, Dr. P.H., C.E.

John C. Whitehorn, M.D.

Mental Retardation Planning Committee

Mr. Ph Hip P. TownsendChairmanOffice of Mental RetardationState Board of Health and Mental Hygiene

Mr. Gary 0. GraySupervisor of Special Education for InstitutionsDepartment of Education

Mrs. Marguerite HastingsDirector of Community Services to the Mentally RetardedDepartment of Mental HygienePresidentAmerican Association on Mental Deficiency

Mr. James VidmarAssistant DirectorDepartment of Public Welfare

Benjamin D. White, M.D., M.P.H.Chief, Division of Community Services to the Mentally RetardedDepartment of Health

Mr. Myron WotringSupervisor of Services for the Mentally HandicappedDivision of Vocational RehabilitationDepartment of Education

Mr. Richard J. EnglerResearch AnalystOffice of Mental RetardationState Board of Health and Mental Hygiene

Mr. Richard H. SmithResearch AnalystOffice of Mental RetardationState Board of Health and Mental Hygiene

iv

OFFICE OF MENTAL RETARDATION PLANNING

Project Staff

July, I964January, 1966

Raphael MinskyCoordinator

Patricia SchmidfResearch Analyst

Caroline E. AshPublic Health Educator

Clayton B. StunkardStatistical Consultant

ADVISORY COMMITTEE ON MENTAL RETARDATION PLANNING

M. J. Donn Aiken

Mildred Atkinson

Edna Cook

Katherine Crabbs

R. M. Crosby

Mrs. Arthur Crum

Harold Edelsfon

Mathew S. Evans

Harry Hughes

Paul V. Lemkau

Alan Leventhal

Chairman

Bernard M. McDermott

Furman L. Templeton

Floyd McDowell

Mrs. Thomas F. McNulty

Park& Moore

Alfred D. Noyes

Robert L. Parrish

Tzvi H. Porafh

George A. Price

Frank Rafferty

George B. Rasin, Jr.

Manuel R. Roman

Mrs. E. Walter Shervington

STATE DEPARTMENT OF EMPLOYMENT SECURITY

Mental Retardation Planning Committee

Chairman

J. Donn Aiken

Henry P. Hammann Elizabeth Kennedy

Louise P. Thompson

STATE DEPARTMENT OF MENTAL HYGIENE

Mental Retardation Planning Committee

Chairman

Marguerite J. Hastings

Joseph H. Murray

Alice Tobler

T. Glyne Williams

Esther Wollin

STATE DEPARTMENT OF HEALTHMental Retardation Planning Committee

Chairman

Benjamin D. White

Florence Burnett

Herbert G. Fri'z

Bettie Rogerson

John L. Pitts

Thomas Schmidt

Jean Rose Stiff ler

Helen Wood

STATE DEPARTMENT OF EDUCATIONMental Retardation Planning Committee

Chairman

James A. Sensenbaugh

Gary 0. Gray George E. Klinkhamer

STATE DEPARTMENT OF CORRECTIONMental Retardation Planning Committee

Chairman

Loyal B. Calkins

James Jordon

Elaine S. Miller

Leo Rice

Henry 0. Walters

vi

TASK FORCE ON THE RECRUITMENT AND TRAINING OF

PROFESSIONAL AND VOLUNTARY MANPOWER

Chairman

Domink N. Fornarro

Michael BrockmeyerWesley N. Dorn

Henry F. Mark

TASK FORCE ON PREVENTION, IDENTIFICATION, AND TREATMENT

Chairthan

Kurt Glaser

Catherine Brunner

Raymond Clemmens

Leon Eisenberg

Thomas Gladwin

George Lentz

Verl Lewis.

Burton Pollack

Fredeirick Richardson

John Salley

Harrie Selznick

TASK FORCE ON RESEARCH: CLINICAL AND BEHAVIORAL

Guido Crocetti

Chairnian

Gerald Wiener

Imogene S. Young

Janet D. Hardy

TASK FORCE ON HOME AND FAMILY SERVICES

Chairman

Verl.S. Lewis

Mildred Johnson

Alice R. MayVerna Waskowitz

May Polk

Wilber P. Lille

yli

TASK FORCE ON LAW AND LEGISLATION

L. Whiting Fairinholt, Jr.

J. Harold Grady

Chairman

Leon H. A. Pierson

Marvin B. Stienberg

H. Paul Rome

Paul R. Schlitz

TASK FORCE ON PLACEMENT AND CARE FACILITIES

Chairman

Harry Citron

Sister Margaret Ann

Sister A. Augustine

Margaret Lodge Dyrne

Barbara Marlowe

TASK FORCE ON PUBLIC AWARENESS

Chairman

John D. Hackett

Rolf Hertsgaard Robert Morrissey

Maurice Jones Leon Rose

Harry Schriver

TASK FORCE ON EDUCATION, TRAINING, AND EMPLOYMENT

Chairman

Jean R. Hobe ler

Kenneth R. Barnes Jerome Davis

Ronald C. Johnson

TASK FORCE ON liEGIONAL COORDINATION:INTER-STATE AND INTRA-STATE

Chairman

4:*1-13afi'd 'Fielder

Miriam Hooper

Herbert S. Rabinowitz

George W. Sawyer

Morrh L. Schorr

TABLE OF CONTENTSPage

Foreword

Introduction 1

Priority Recommendations 3

What is Mental Retardation? 5

Incidence and Prevalence 8

Plan for Mental Retardation Services

Conclusion 30

Note and References 31

TABLES

Table I Levels of Retardation 7

Table II Maryland's Five Geographic Areas 11

Table III Maryland's Population Distribution 12

Table IV Number of Retarded Persons in Maryland 1Est.) 13

Table V Services to Retarded Persons: 1965 14

Table VI Agency Responsibility fol. Services 29

APPENDIX

Directory of Available Services 32

ix

IDREWØRP

Mental retardation is a complex social phenomenon which necessitates

the utilization of a wide range of Federal, State, and coinmunity resources

'to insure that comprehensive programs designed 'to meet the individual

.needs of Maryland's retarded citizens are provided.

The Maryland Comprehensive Plan is intended to be used as a

guide to State and communitY planners in the development of prograins. It

is expected that this Plan will be amended as new knowledge and changing

needs dictate.

In an undertaking of this nature, it is essential that a broad repre-

sentative sample of individuals and groups be involved. The further

development and implementation of this Plan depend upon the continued

cooperation and active participation of these interested citizens.

INTRODUCTION

The late President John F. Kennedy, convenedthe President's Panel on Mental Retardation onOctober 17, 1961, with the specific charge " . . . toundertake a comprehensive and coordinated at-tack on the problem of mental retardation andto prepare a National Plan to combat Mental Re-tardation."

A direct outgrowth of this initial activity wasthe submission to the President of "A Report ofthe President's Panel on Mental Retardation ; AProposed Program for National Action to CombatMental Retardation." Along with the submissionof this Report in October, 1963, Ten Reports ofthe Task Forces of the President's Panel werereleased for publication. In addition, the Ma-ternal and Child Health and Mental RetardationPlanning Amendments were signed into law asPublic Law 88-156. This legislation providedfunds, on a matching basis, to enable all statesto administer planning grant programs for thefollowing purposes :

A. Determination of needed action tocombat mental retardation in thestate and assessment of the resourcesavailable for this purpose.

B. Development of public awareness ofthe mental retardation problem and ofthe importance of combating it.

C. Coordination of state and local ac-tivities relating to mental retarda-tion.

D. Planning additional activities leadingto comprehensive state and local ac-tion to combat mental retardation.

E. Implementation of the plan as de-veloped and approved.

In October, 1963, His Excellency, J. MillardTawes, Governor of Maryland, recognizing thefact that previous planning for the needs of thementally retarded citizens of Maryland had beenneither comprehensive nor interdepartmental,established the Inter-Agency Commission onMental Retardation in order to achieve a degreeof cooperative and coordinated planningbetween State agencies. "Such a commission,"the Governor said, ". . . should better enable us toplan a total State program for the care of thementally retarded." At the same time the Gov-ernor designated the State Board of Health andMental Hygiene as the single State agency re-sponsible for comprehensive mental retardationplanning in accordance with the provisions ofPublic Law 88-156.

The main objective of Maryland's mental re-tardation planning effort is to achieve a co-ordinated and comprehensive program to combatmental retardation. To this end the Office ofMental Retardation Planning was organized inJuly, 1964, under the aegis of the State Board ofHealth and Mental Hygiene. This planning officewas assigned the responsibility for the develop-ment of a report consonant with the broad projectobjectives outlined in the terms and conditionsreceived from the United States Department ofHealth, Education, and Welfare. In January of1966, the Office of Mental Retardation Planningsubmitted to the State Board of Health and Men-tal Hygiene a report containing the results of itsendeavors. Because of the size of this report and

the number, variety, and conflicting recommen-dations which it contained, the Board appointeda Planning Committee of staff members fromvarious State agencies concerned with mental re-tardation to compile the information from thereport into a comprehensive mental retardationplan. This was the first time State agencies wereinvolved as a group in the planning process.

The Comprehensive Mental Retardation Planfor Maryland which follows, represents the com-bined efforts of the Mental Retardation AdvisoryCouncil, Task Forces, and the Committee com-posed of representatives of State agencies. ThisPlan is to be viewed as a flexible guide whichwill need to be reviewed, reevaluated, andchanged to meet the changing needs of Maryland.The following two variables contributed to theconstantly changing validity of data on mentalretardation in Maryland :

1. Population changes in the State havenot been consistent with populationprojections.

2. The involvement of State and localagencies in the planning operationhas by itself stimulated some im-provements in services for the men-tally retarded.

For these reasons the vast amount of statisti-cal data given in the report of the AdvisoryCouncil on Mental Retardation has been omittedfrom the Plan. The Planning Committee con-centrated its efforts on creative programmingand suggestions for effecting the Plan on a coop-erative basis between agencies. Anyone desiringmore background and supporting data than areherein contained should refer to the extensivetables in the report.

The Comprehensive Mental Retardation Planrepresents both a culmination and a desire. It

is the culmination of a cooperative process ofself-analysis on the part of State agencies, pro-fessionals, and the general public. Not everyonewill agree totally with the value judgments madeas a result of the analytic process, but a basicconsensus has been reached. More important,the presentation of this Plan represents a desireof the major State agencies concerned. Pri-marily it represents a guide for the retardedcitizens of our State, their parents, and theirfriends ; basic agreement has been reached asto the types of services needed to care for, train,and protect the retarded citizen. In addition, afirm commitment has been made to the evengreater goal of eventual prevention of retarda-tion through elimination of the diseases and con-ditions which cause it. Mental retardation is acomplex rather than a simple phenomenon. Itcannot be prevented, cured, or ameliorated byphysicians, social workers, educators, or anyother professional or lay group acting alone. Abroad cooperative effort must be launched andcarried through to completion. The ideas pro-posed in the Plan which follows may be expen-sive, far-reaching, difficult, and sometimes evenarduous ; moreover, results cannot be absolutelyguaranteed. It is the belief of those presentingthis Plan that the citizens of Maryland will bewilling to make the necessary effort and will ex-press this willingness in action.

Perhaps the most important desire representedby this Plan is for interagency cooperation.From the earliest stages of planning to thewriting of the final draft, many agencies andmany groups were involved. Total unanimity wasnot achieved, but it was closely approached. Ithas been shown once again that a sincere de-sire to solve a common problem can dissolve manyprejudices and professional differences of opin-ion. For the future of the mentally retarded,there is indeed new direction to meet their needs.

Itvir

4

2

PRIORITY RECOMMENDATIONS

1. The charge to the Governor's Inter-AgencyCommission on Mental Retardation should

be clarified and redefined. It is recommended

that the Commission be strengthened by ex-panding it to include representatives of the

State Department of Correction, the StateDepartment of Juvenile Services, a repre-sentative of the consumer group, and arepresentative of the State Board of Health

and Mental Hygiene which latter agency has

been designated by the Governor as the State

agency responsible for mental retardationplanning and facilities construction. Con-

sideration should also be given to including

representation from the Legislature.

It is further recommended that the Gov-

ernor's charge to the Inter-Agency Commis-

sion include direction that these representa-tives meet at least every other month toperform the following functions:

A. The Commission will advise and assist

the Governor concerning mental retar-dation as he may require with respectto :

1. Evaluation of the total State efforttoward combating mental retarda-tion.

2. Coordination of the activities ofState agencies responsible for pro-viding services to the retarded.

3. Provision of liaisOn among Stateand local governments, foundations,and private organizations concern-

3

ing their activities in the field ofmental retardation.

4. Development and dissemination ofinformation to the general publicthat will tend to reduce the inci-dence and ameliorate the effects ofmental retardation.

B. The Commission will mobilize supportfor mental retardation activities bymeeting with and providing informa-tion for appropriate professional organ-izations and broadly representativegroups.

C. The Commission will make reports orrecommendations to the Governor as hemay request or as the Commission maydeem appropriate.

2. The meetings of the Planning Committee

composed of representatives from State de-partments having responsibility for the men-tally retarded should be continued on amonthly basis. The State Board of Healthand Mental Hygiene should arrange for themeetings of this committee through its ex-ecutive staff and should forward reports onthis committee's deliberations to the Gov-ernor's Inter-Agency Commission.

3. A systematic program of case finding should

be initiated, including a mental retardationregister to be maintained by an expandedstatistical staff of the Department of MentalHygiene. This case register should be sepa-rate from but coordinated with the psy-

chiatric case register. All agencies servingthe mentally retarded should be required toprovide data for the case register, and per-tinent birth certificate data should also beincluded.

4. Diagnostic and evaluation services by teamsof specialists trained in mental retardationshould be expanded for all age levels of thementally retarded. The team should consistof a physician, a psychologist, a socialworker, and others appropriate to the age andcondition of the retarded individual. Everyretarded person and every person suspectedof being retarded should be entitled to athorough evaluation whenever major plansare being made for his future.

5. A comprehensive preschool program shouldbe developed for all retarded and deprivedchildren. This is the age at which programsof sensory development and behavioral train-ing techniques have the greatest positiveeffects. An intensive preschool programcould prevent many cases of mild retarda-tion.

6. A systematic array of support servicesshould be developed for retarded adults.These services should include : medicalcare, foster care, foster group homes, guard-ianship, small residential centers, day careprograms, small group homes, counseling,and financial assistance. The purpose ofthese services is not to take away the free-dom of retarded citizens but to provide themthe help they need to live in our complexsociety.

7. A dual program of recruitment and develop-ment of training programs should be or-ganized to alleviate the manpower shortageof trained workers in the service areas as-sociated with mental retardation. Trainingprograms for special education teachers andothers working in the field of mental re-

.4

tardation should be supplemented and ex-panded at two centers : Coppin State Col-lege and the University of Maryland. Thesetwo institutions could provide sufficienttraining programs, if properly developed.This limitation is preferable to frawnentingthese programs in many schools. Offeringsshould include programs leading to Associ-ate, Bachelor's, Master's, and Doctoral de-grees as well as shorter training programsfor special needs. Scholarships should bemade available at all degree levels.

8. Courts, law enforcement agencies, and pro-bation officers should be made more awareof mental retardation as it affects those withwhom they come in contact. Appropriatechanges in State correctional and juvenileinstitutions need to be made to provide forthe needs of the mentally retarded indi-viduals confined there.

9. Appropriate legislative changes should bemade to permit the Department of MentalHygiene to control admission to residentialprograms for the retarded. The courtsshould no longer be permitted to commit aperson directly to a residential program. Re-ferral should be made to the operatingagency for evaluation and proper program-ming; the agency can then decide whetherresidential care or another community basedprogram would be more advantageous to theindividual and the community as a whole.

10. Professional seminars and discussion groupsshould be sponsored through the Universityof Maryland and Coppin State College aswell as through other colleges and hospitals,both State and private, for all who come intocontact with mentally retarded persons inthe course of their work. Such groups shouldinclude: social workers, employnient* coun-selors, judges, clergymen, physicians, nurses,law enforcement officers, teachers, and em-ployees of private residential facilities.

WHAT IS MENTAL RETARDATION ?

The lack of comprehensive planning, the over-lapping and simultaneous omission in the pro-vision of services, and the confusion in the publicmind about mental retardAtion can all be tracedto lack of agreement among experts as to ex-actly what is meant by mental retardation. Inretrospect, professionals dealing with mental re-tardation have often seemed like the three blindmen in the classic story who each described anelephant differently after touching respectivelya tusk, an ear, and a tail. All three were abso-lutely correct ; but they could not see the pointof view of the others. Similarly, medical, psy-chiatric, psychological, and educational writingsand research on mental retardation have oftenappeared to not even be dealing with the same con-dition. In fact, they were not.

Perhaps the extremes of the problem can bestbe seen by comparing the point of view of phy-sicians and psychiatrists in residential facilitieswith the point of view of special educators inthe public schools. The public schools workedwith many retarded children, but mostly withthe milder levels of retardation. In recent yearsthe scope of school coverage has been extendingdownward to include more seriously retardedchildren, but these children represent an extrememinority of the total educational enterprise. Theinstitutional psychiatrist and physician, on thecontrary, began with the other end of the con-tinuum. The most severe cases of retardationwere the most certain to be admitted to the largeState institutions. Almost all of these cases of re-.tardation were caused by or associated with dis-

ease or trauma. If a mildly retarded personcame to an institution, his condition usuallyshowed other handicaps in addition to retarda-tion.

These different points of view along with thoseof social workers, psychologists, jurists, andothers led to a wide variety of terms, labels, anddefinitions for mental retardation. Idiots, im-beciles, morons, subnormal, deficient, educable,trainable, custodial, marginal, borderline, andfeebleminded are among the many terms usedfor different categories of retarded persons inthe twentieth century. Definitions of mental re-tardation have ranged from too narrow to ex-tremely broad. Present space does not permit adetailed survey of this rather fascinating termi-nological history. The definition and categoricalterms being proposed for present and futurepractice are of far greater importance.

The definition of mental retardation proposedby the American Association on Mental Defi-ciency is a suitable, standard, interdisciplinarydefinition of Mental Retardation. For the pur-poses of planning in Maryland this definition hasbeen used in all phases of the planning opera-tion : Mental retardation ref ers to subaverage,general, intellectual functioning which originatesduring the developmental period and is associatedwith impairment in adaptive behavior?

Subaverage refers to performance which isgreater than one standard deviation below thepopulation mean of the age group involved onmeasures of general intellectual functioning.

1,7

The level of general intellectual functioning maybe assessed by performance on one or more of thevarious objective tests which have been developedfor that purpose. Though the upper age limit ofthe development period cannot be preciselyspecified, it may be regarded for practical pur-poses as being approximately sixteen years. Thiscriterion is in accord with the traditional con-cept of mental retardation with respect to ageand serves to distinguish mental retardationfrom other disorders of human behavior. Thedefinition further specifies that the subaverageintellectual functioning must be reflected by im-

pairment in adaptive behavior. Adaptive be-havior refers primarily to the effectiveness of theindividual in adapting to the natural and socialdemands of his environment. Impaired adaptivebehavior may be reflected in : (1) maturation,(2) learning, and/or (3) social adjustment.These three aspects of adaptation are of differentimportance as qualifying conditions of mentalretardation for different age groups.

In other words, this definition gives us a broaddescription of a condition which may afflict awide variety of individuals in a wide variety ofdegrees. Its primary classification cannot be bycause (etiology) because it has a variety ofcauses, some not yet fully understood. The con-dition manifests itself in different ways duringdifferent periods of the life span. In young chil-dren it is often seen as a delay in growth, speechdevelopment, or general behavioral maturation.In its more serious forms it is usually associated

with some additional physical involvement. Inchildren of school age, retardation means the in-ability to learn ; even the mildly retarded child isseveral years behind his age peers in "grade"placement. In adults retardation appears as aninability to conquer the problems presented by thedemands of independent living in society. Theretarded adult may need help with money mat-ters ; he may require personal protection ; he mayrequire total care.

The American Association on Mental Defi-ciency lists four levels of retardation : profound,severe, moderate, and mild. Traditionally theselevels have been associated with numericalscores on tests of intelligence. More recent think-ing prefers to consider these levels in terms oflevels of functioning as manifested by behavior.This behavior is different at different ages.(Table I presents descriptions of this behaviorin schematic form.) The common denominator ofmental retardation is that the immediate causeof the behavioral malfunction is an intellectualdeficit. The uncommon factors are the many dif-ferent causes of retardation on one hand and itsmany different manifestations on the other.

It is important to note that a person may bediagnosed as retarded at one stage of life and notat another. Improvement may be due to matura-tion, training, surgery, medical treatment, or acombination of these factors. Although often apermanent condition, mental retardation is notessentially permanent or unimprovable.

LEVEL AGE 0-5

Table I. LEVELS OF RETARDATION*

Profound Gross retardation; minimal capac-

ity for functioning in sensori-

motor areas; needs nursing care.

Severe Marked delay in motor develop-ment; little or no communicationskill; may respond to training inelementary self-help, e.g., self-

feeding.

Moderate Noticeable delays in motor devel-opment, especially in speech; re-sponds to training in various self-help activities.

Mild Often not noticed as retarded by

casual observer but is slower towalk, feed self, and talk than most

children.

AGE 6-21

Obvious delays in all areas of de-velopment; shows basic emotionalresponses; may respond to skillful

training in use of legs, hands andjaws; needs close supervision.

Usually walks barring specific dis-

ability; has some understanding ofspeech and some response; canprofit from systematic habit train-

ing.

Can learn simple communication,elementary health and safety

habits, and simple manual skills;does not progress in functionalreading or arithmetic.

Can acquire practical skills anduseful reading and arithmetic toa 3rd to 6th grade level with spe-cial education. Can be guided to-ward social conformity.

AGE 21 and Over

May walk, need nursing care, haveprimitive speech; usually benefitsfrom regular physical activity; in-capable of self-maintenance.

Can conform to daily routines andrepetitive activities; needs continu-ing direction and supervision inprotective environment.

Can perform simple tasks undersheltered conditions; participates insimple recreation; travels alone infamiliar places; usually incapable

of self-maintenance.

Can usually achieve social and vo-

cational skills adequate to self-

maintenance; may need occasionalguidance and support when underunusual social or economic stress.

* Adapted from President's Panel on Mental Retardation 1962

INCIDENCE AND PREVALENCE OF RETARDATION

In lieu of a complete census-diagnosis of theentire American population a precise determina-tion of the incidence and prevalence of mentalretardation represents a complex statistical pro-cedure. The implementation of comprehensiveplanning efforts in all fifty states will eventuallyrefine present figures which are largely basedon statistical inference. The President's Panelon Mental Retardation (1962) reported that men-tal retardation affects twice as many individualsas blindness, polio, cerebral palsy, and rheu-matic heart disease combined. It is estimatedthat 3 per cent of the population or 5.4 millionpersons are classified retarded and are using serv-ices at any one time.2 An additional 126,000babies are born annually who will 1:7, regarded asmentally retarded at sometime in their lives. By1970, it is projected that there will be 6.4 millionretarded of which 400,000 will be so severely re-tarded that they will require constant care.

Improved and more extensive prenatal, obstet-rical, and pediatric care has resulted in markedincrease in the infant survival rate in the nationover the past 20 years. But such efforts havealso resulted in increasing the survival rate ofall infantsthe premature, handicapped, or mal-formedas well as the wellborn. Since mentalretardation is one of the major conditions as-sociated with such handicaps in infants, im-proved care has paradoxically increased the num-ber of retarded for whom special services willbe needed. Disease control, new drugs, and higherstandards of living have steadily increased thelife span of most Americans. While the men-tally retarded as a group fall below the average

8

life expectancy, the number of years the av-erage retarded individual lives has been increas-ing proportionately with the overall average.With increased availability of health services,the life span of the retarded may continue to in-crease, and this will add to the numbers of thementally retarded in the upper age levels.

At the profound, severe, and moderate levels,mental retardation strikes all socioeconomic lev-els of the community with about equal incidence.The mild level of retardation has a higher in-cidence rate among poor, culturally deprivedgroups. For this reason, there are large concen-trations of mildly retarded individuals in urban(inner city) areas; there are also some notablepockets of retardation in some rural communi-ties. Although the 3 per cent figure is un-doubtedly valid as a national average, it gives noreal clues as to the incidence or prevalence of r&,tardation in any given area. School officials re-port that in Baltimore City the prevalence ofmild retardation among school age children isclose to 9 per cent.

The official 1960 census data were used to pro-vide a baseline upon which to develop populationprojections for the years 1965-1970. These pro-jections were provided by the State PlanningDepartment. In order to make these data mean-ingful to the planning activity, the format illus-trated in Table II was prepared. This table indi-cates the population distribution for the years1960, 1965, 1970 by age and geographic area.This information provided the basis for develop-ing Tables III and IV which project the population

and estimate the number of mental retardatesby age, degree of retardation, and geographicarea for the years 1960, 1965, and 1970. Sixdevelopmental periods relating to the followingage intervals were used : 0-4, 5-19, 20-29, 30-49,

50-64, and 65 +. The terms mild, moderate se-vere, and profound used in this report correspondto the now outmoded educational classificationsof educable, trainable, and custodial ; custodialbeing equivalent to severe and profound com-bined. These groupings are comparable to theAmerican clinical classifications of moron, im-becile, and idiot. Intelligence scores associatedwith these levels are approximately 50-79, 20-49,0-19 ; mental age equivalents at maturity are cor-respondingly 8-12, 3-7, 0-2 years. These datawere in turn specifically related to the twenty-three counties and Baltimore City which representthe total political subdivisions of the State. Thesesubdivisions were delineated into five geographicareas in accord with the Mental Retardation andMental Health Construction Plans for 1965. Theselection of these service areas was based on tra-ditionally accepted divisions : Eastern Shore,Southern Maryland, Northwestern Maryland,Maryland National Capital Area, and the Balti-more Metropolitan Area. Utilization of theseareas will facilitate the integration of existingand planned facilities and services with popula-tion characteristics, transportation patterns, and.socioeconomic variables which are directed to-ward the eventual provision of a full range of

specialized services required for the optimal careof our retarded citizens.

It is estimated, on the basis of population pro-jections for 1965, that 3,445,900 residents of allages reside within the State of Maryland. Anestimated 103,382 mentally retarded individualsare included in this projection. Of this number,89,596 are classified as mildly retarded, 10,339moderately retarded, and 3,447 severely or pro-foundly retarded. These estimates are based onthree per cent of the total State population.

It was possible to identify 32,676 mentally re-tarded individuals receiving services (Table V)although it must be noted that this figure isnot necessarily free of overlapping data. Theremaining 70,000 individuals not identified todate may be accounted for in one or more of thefollowing categories :

1. Large numbers of mentally retarded per-sons of all ages remain unidentified asa result of inadequate services. When afull range of services becomes available,

'7,17';:"=.7,=

9

the advent of case findings on a State-wide basis will identify these individuals.Initiation of the mental retardation reg-ister will facilitate this process.

2. There are mildly retarded children in thepreschool age range who are not identifieduntil they enter kindergarten or elemen-tary school programs.

3. In Baltimore City 47,000 children receivePublic Welfare aid from the fund forfamilies of dependent children. Many ofthese children are mildly retarded.

4. The Baltimore City Public School Systemestimates that there are between 4,000and 5,000 four-year-olds who can be ex-pected to experience problems in theirinitial school experiences and developpatterns of repeated failures throughoutthe regular school programs.

5. There are mildly retarded students inregular class placements in public schoolprograms throughout the State who areexperiencing poor adjustment and aca-demic failures.

6. Many of the unskilled, chronically unem-ployed who marginally exist in the vari-ous counties and Baltimore City aremildly retarded.

7. There are mentally retarded children andadults cared for by families who are un-willing to seek outside assistance and whoare unknown to any agency.

8. Handicapped children and adults who arementally retarded but whose diagnosisis secondary to another medical classifi-cation. These individuals are receivingtreatment.

The vast majority of the unidentified retardedfall into the mild classification.

The estimates presented are not to be consid-ered as absolute. The actual determination ofthe true extent of mental retardation is subjectto contiLued examination. Investigation such as"The Rose County Study,"3 undertaken by TheJohns Hopkins School of Hygiene and PublicHealth may be expected to yield the definitiveresults necessary to conduct a Statewide epi-demiological study. Preliminary analysis of dataindicates a prevalence of two to more than threetimes the 3 per cent estimate, depending upon theage group considered. However, during the initial

stage of planning there existed no other dataupon which to develop more reliable estimate:;.The selection of population projections developedby the State Planning Department was basedon the immediate need for this information.Within the past few months, the State Depart-ment of Health has released the statistics for theyear 1964.4 The population of Maryland was es-timated in this report to be 3,465,640 for theyear ending July 1, 1964. This figure is greaterthan the estimate used for determining the in-cidence of mental retardation for the purposes ofplanning. The expressed variance reveals thecomplexities involved in the use of statisticaldata And procedures. Statistical consultation in-dicates a safe rule-of-thumb in allowing for a10 per cent differential when applied to pro-gram development. Although the planning proc-ess has been able to identify 0.9 per cent of thetotal population as receiving services at the pres-ent time, this in no way negates the assumptionsupon which the estimates were based. The testof time and continued study will provide the finaldetermination of the extent of mental retarda-tion. Planners are urged to use these estimatesuntil further verification is provided. Regardlessof the estimate to be used as a standard, theprovision of services and facilities will not, in thenear future, exceed the demand. It is stronglyrecommended that the presented data be used asstandard estimates of the extent of mental re-tardation for the purposes of developing pro-grams.

Implications for programming are found in the

data for 1970, which point to the increasing de-mand for special education provisions for thoseof school age (549 years). Increments to a totalof 33,773 are predicted for the next five years.Additionally, comprehensive services, includingwork experiences, should be developed to meet theneeds of the retardate during the next develop-mental state of maturity (20-49). It is estimatedthat this grouping will number 44,408 duringthe time period stated. Approximately 24,151 re-tardates approaching old age (50-64+ ) will re-quire a full range of work opportunities, recrea-tional activities, and supervised medical care pro-grams. If the increasing-population demands areto be adequately met, it will be necessary toinitiate planning for these services immediatelyand beyond the scope of those presently in de-velopment. Of the 32,676 identified retardatesall but 4,244 can benefit from educational services.This finding emphasizes the increased responsibil-ity on the part of education to increase the rangeof services presently offered and to encourageeducators to take a more active part in all phasesof program planning and development. The lackof adequate record keeping on the part of agen-cies involved in mental retardation programmingrepresents one of the most significant findings ofthe varied activities of the Office of Mental Retar-dation. It is, therefore, strongly recommendedthat agencies make provisions for the collection ofdata relative to the identification, classification,and follow-up of diagnosed cases of mental re-tardation through the development of an inter-agency mental retardation register.

11111111111

10

1

Tab

le 1

1.

A/a

l/3-6

144(

jjaile

geyt

rAic

t&ao

f

ST

AT

E O

FM

AR

YLA

ND

Mar

ylan

d St

ate

Plan

ning

Dep

artm

ent

1960

Cen

sus

Dat

a

POPU

LA

TIO

N B

Y A

RE

A

YE

AR

III

III

rvV

TO

TA

L

1960

1,80

3,74

569

8,32

326

7,73

824

3,57

087

,313

3,10

0,68

9

1965

1,96

2,76

084

8,85

027

7,02

025

7,93

099

,340

3,44

5,90

0

1970

2,13

3,92

01,

033,

990

285,

010

272,

250

111,

450

3,83

6,67

0

EST

IMA

TE

D N

UM

BE

R O

FM

EN

TA

LL

Y R

ET

AR

DE

DPE

RSO

NS

BY

AR

EA

YE

AR

III

III

IVV

TO

TA

L

1960

54,1

1120

,949

8,03

37,

307

2,62

093

,020

1965

58,8

8425

,465

8,31

17,

741

2,98

310

3,38

4

1970

64,0

2031

,019

8,54

88,

168

3,34

511

5,10

0

Table HI. MARYLAND POPULATION DISTRIBUTION

BY AGE AND GEOGRAPHIC AREA: 1960 CENSUS

AGE GROUP

YEAR 0-4 5-19 20-29 80-49 50-64 65+ Total

AREA 1960 208,772 478,236 228,351 508,758 243,288 136,340 1,803,745

I. 1965 210,710 578,700 248,010 501,300 270,000 154,040 1,962,760

1970 233,200 627,660 314,930 487,620 297,400 173,160 2,133,970

AREA 1960 90,986 205,314 85,380 210,513 73,190 32,940 698,31'3

II 1965 98,940 265,840 113,520 233,340 96,770 40,440 848,850

1970 120,880 313,790 167,820 256,91(." 125,070 49,520 1,033,990

AREA 1960 27,220 73,561 31,127 70,709 39,018 26,103 267,738

III 1965 27,510 74,710 36,700 67,780 42,360 27,960 277,020

1970 27,790 73,390 44,370 64,420 44,990 30,050 285,010

AREA 1960 26,521 66,024 27,619 62,314 34,710 26,382 243,570

IV 1965 27,540 70,780 33,060 61,370 37,710 27,470 257,930

1970 29,230 74,310 41,120 59,410 39,650 28,530 272,250

AREA 1960 13,021 28,728 12,417 20,373 8,000 4,774 87,313

V 1965 14,060 32,990 15,180 22,320 9,630 5,160 99,340

1970 14,310 36,540 18,520 25,120 11,210 5,750 111,450

12

Maryland State Planning Department

1960 Census Data

Tab

le IV

.E

ST

IMA

TE

D N

UM

BE

R O

FM

EN

TA

LLY

RE

TA

RD

ED

PE

RS

ON

S

BY

AG

E, D

EG

RE

E O

FR

ET

AR

DA

TIO

N, A

ND

GE

OG

RA

PH

IC A

RE

A: S

TA

TE

OF

MA

RY

LAN

D

AG

E

TO

TA

L0

- 4

5 -

1920

- 6

465

+

Deg

ree

of R

etar

datio

nM

ILD

MO

D.

PRO

.M

ILD

MO

D.

PRO

.M

ILD

MO

D.

PRO

.M

ILD

MO

D.

PRO

.I

MIL

DM

OD

.PR

O_

Perc

enta

ge2.

6%0.

3%0.

1%2.

60.

30.

12.

60.

30.

12.

60.

30.

12.

60.

30.

1

AR

EA

1960

46,8

975,

410

1,80

45,

427

626

209

12,4

331,

434

478

25,4

902,

937

979

3,54

540

513

5

1965

51,0

335,

888

1,96

35,

478

631

209

15,0

471,

736

579

26,5

023,

057

1,01

94,

006

459

153

1970

55,4

846,

402

2,13

46,

064

699

234

16,3

191,

883

628

28,5

983,

297

1,09

94,

502

522

174

AR

EA

1960

18,1

562,

095

698

2,36

627

391

5,33

861

520

59,

596

1,10

436

885

699

33

II19

6522

,069

2,54

784

92,

572

297

996,

912

798

266

11,5

351,

334

444

1,05

112

040

1970

26,8

833,

102

1,03

43,

143

363

121

8,15

894

131

414

,296

1,64

754

91,

288

147

49

AR

EA

1960

6,96

180

526

770

882

271,

913

219

733,

664

423

141

679

819" _

i

III

1965

7,20

383

127

771

583

281,

942

224

743,

820

437

146

727

8428

1970

7,41

085

428

472

383

271,

908

221

743,

997

462

154

781

9030

AR

EA

1960

6,33

373

024

469

179

271,

717

198

663,

242

369

123

686

7826

IV19

656,

709

774

258

716

8329

1,83

921

271

3,43

739

513

171

384

28

1970

7,07

981

627

376

187

301,

931

223

763,

644

420

140

742

8729

AR

EA

1960

2,27

026

288

338

4013

747

8729

1,06

112

341

125

165

V19

652,

584

299

100

365

4314

858

9933

1,23

014

147

134

155

1970

2,89

833

511

237

143

1495

011

037

1,42

616

555

149

155

Mar

ylan

d St

ate

Plan

ning

Dep

artm

ent

1960

Dat

a

Table V. SUMMARY OF IDENTIFIED MENTALLY RETARDED

PERSONS RECEIVING SERVICES IN MARYLAND: 1965

I. EDUCATION 1. 2

1. Public Schools 22,487

2. Private Schools 1,010

8. Assignment unknown 8,740

27,237 27,287

II. SHELTERED WORKSHOPS ANDOCCUPATIONAL TRAINING 189

III. DAY CARE AND NURSERY CENTERS 886

IV. RESIDENTIAL1. Rosewood State Hospital-School ages 1,195

2. Rosewood State Hospital 2,467

8. Henryton State Hospital 343

4. Private 298

8,108 8,108

V. DIAGNOSTIC AND EVALUATIONCENTERS s

1. Baltimore City 400

2. Rosewood State Hospital 236

8. Health Department-Mobile Team 97

4. Waiting lists* 200

982

VI. MARYLAND PENAL INSTITUTIONS* 706

VII. MARYLAND TRAINING SCHOOLS* 850

VIII. STATE MENTAL HOSPITALS* 700

IX. VOCATIONAL GUIDANCE, TRAINING,AND CONSULTATION 2t 4 376

X. DEPENDENTS OF MILITARYPERSONNEL s 90

TOTAL 32,676

1 Either in regular public school classes, day care programs, or placement unknown.2 Excluding 1195 school age residents of Rosewood State Hospital-listed under IV-1.s Not included in total; these individuals may be counted in other categories.4 State Department of Education: Division of Vocational Rehabilitation.

SOURCE : Maryland State Construction Plan. State Board of Health and MentalHygiene, 1965. Agency Mental Retardation Planning Committee representatives.

6 0.9% of Total Population.*Estimates.

'14

A PLAN FOR MENTAL RETARDATION SERVICES

The outline of goals, present services, andneeded services which follows was written by thePlanning Committee on Mental Retardation us-ing the report of the Office of Mental RetardationPlanning as its resource document. The analyz:sand recommendations represent the consensus ofthe entire committee except in those few instanceswhere a minority opinion is noted. These differ-ences, though few, are important because theyrepresent lack of agreement between agencies andprofessional groups which must be resolved before

comprehensive programming can become a reality.

Readers desiring more details or backgrounddata are referred to the Office of Mental Retar-dation Planning report ; its extensive compilationof data and detailed professional opinions is fartoo lengthy to be reproduced here. It should alsobe noted that in some instances a type of serv-ice is discussed with the age group where it isof the greatest concern ; this does not mean thatthe service is or should be limited to that agegroup.

Philosophical Positions and Recommendations Applicable to Mental

Retardation Planning for

A. Implementation of the Comprehensive Men-tal Retardation Plan is the responsibility ofall the citizens of Maryland. The PlanningCommittee found that when attention wasfocused on services needed, there was littleneed for legislative change. The Plan canbe implemented by the present structure ofState Government, provided it receives theunqualified support and cooperative effortof the Governor, the Legislature, the variousState agencies, and the voters of our State inproviding sufficient funds for the servicesrequired.

B. Primary emphasis must be placed on effortstowards the prevention of retardation. Thisincludes both basic research aimed at theprevention of causes and a concentration of

15

All Age Groups

services to the retarded individual and hisfamily early in the life span. The benefitsof such service will be magnified many timesin terms of the reduction in human sufferingand the expenses of inappropriate use ofresidential care services. Note: Tradi-tionally, state governments have not takenan active role in supporting basic research,leaving this responsibility to the FederalGovernment and private foundations. It ishoped that our State Government might alterthis pattern by including research needs infuture agency budgets. Such a change wouldstimulate the talents of the many expert pro-fessionals in State service, make Marylanda very attractive place for new professionalmen and women, and result in better serviceto our retarded citizens.

C. Administration and coordination of servicesfor the retarded will not prove to be a diffi-cult problem if approached from an attitudeof cooperation. There is no need for anynew agencies or for large quantities of newlegislation and regulations. Cooperation be-tween agencies can be achieved by two basicsteps:1. Both the Governor's Inter-Agency Com-

mission and the present Planning Com-mittee of practicing professionals at theprogram level in the field of mental re-tardation should continue to meet, thelatter on a monthly basis. Between them,these two groups can assure continuityin program development.

2. For each stage of the retarded person'slife one agency should be given primaryresponsibility for providing or obtainingservices ; the principal responsible agencywill obtain from other agencies thosespecial services which they are profes-sionally competent to provide.

D. Agencies providing services for the mentallyretarded should be aware of their areas ofgreatest professional competence. Imple-mentation of this philosophy will requirethat all persons think beyond tradi-tional approaches of individual agencies asthey now exist. Opportunities to begin im-plementing this philosophy will present them-selves during the transitional period throughmodification and adjustment of existing pro-grams. Program levels could be raised ifspecial services were obtained from agenciesbest equipped to provide them. For exam-ple, educational programs should be operatedby the State Department of Education andthe local boards of education ; conversely,school health facilities should be operated bythe county health departments ; the Depart-ment of Welfare should take more responsi-bility for obtaining foster placements, giv-ing financial assistance, and cooperatingwith the State hospitals in this obligation ;home visiting of families with retarded chil-dren should be organized by the Departmentof Welfare. These are but a few examplesof the principle of agency responsibility andcooperation. The basic areas of responsi-bility can be summarized in three state-ments:

1. Prevention and treatment of the diseasesand physical conditions causing and re-

16

E.

F.

G.

H.

A.

lating to mental retardation in the com-munity are the concern of the Depart-ment of Health.

2. Education and training of the mentallyretarded are the responsiblity of theDepartment of Education and the Di-vision of Vocational Rehabilitation.

3. Twenty-four hour care and support serv-ices are vested in the State Departmentsof Mental Hygiene and Public Welfare.

The mechanisms of evaluation research mustbe built into all new programs. If this isnot done, the projects value will never beknown; and economy of programming willsuffer.

The regional approach is appropriate for andshould be utilized in areas of sparse popu-lation to provide certain services not other-wise feasible. Services should be providedas close as possible to where the retardedlive with a minimum of dislocation. Greaterimpetus needs to be given to the develop-ment of small regional residential centers.Community services should be provided formost retarded persons with residential serv-ices being utilized for observation, evalua-tion, and for treatment and training ofproblematic cases.

Barriers which make general communityservices unavailable to the mentally retardedpersons should be removed. The retardedshould have access to all services which areapplicable to his needs, and if these fail tomeet his needs, enriched or special servicesshould be provided so that each retarded per-son may develop to his full potential.

A continuum of service must be providedso that no individual is lost in the transitionfrom one stage in his life to another.

AGE: 0 1I. GOALS

Prevention: The prevention goal at this ageas well as in the prenatal period is to preventretardation by preventing the diseases andaccidents which cause it. It is in the areaof retardation caused by disease that themost promising area of prevention lies.Progress in the field of genetics and geneticcounseling opens another area of possibili-

ties. If preventive measures are to be ef-fective, early detection is an absolute neces-sity.

B. Diagnosis: The main goal of diagnosis atthis age is detecting retardation, if possible ;another important goal is the detection ofdiseases which may cause retardation.

C. Treatment: At this stage of research re-tardation is medically incurable. It can insome cases be ameliorated as to its effectsby education and training or even sensorystimulation ; but retardation is the result ofdisease or trauma and not a disease itself.We can often treat and cure the disease it-self thus preventing the retardation.

II. PRESENT SERVICES

A. Prevention: Present services related to pre-vention of mental retardation during theprenatal and infant period :

1. Prenatal and infant care are supplied ona very rudimentary basis to about 10per cent of those needing these services.

2. Immunization: Only smallpox inoculationis compulsory at the present time.

3. Screening: The only effective screeningprogram directly affecting mental retar-dation in current use is the screening pro-gram for Phenylketonuria. The presentblood test assures about 90 per cent cov-erage.

B. Diagnosis: Almost all diagnosis both ofcausative conditions and of mental retarda-tion itself is done by the family physician.A few counties have pediatric consultationavailable through the health clinics.

C. Treatment: For many of the diseases andconditions causing mental retardation treat-ment is available ; earlier and more effectivescreening and diagnosis are needed.

ID. NEEDED SERVICES

A. Prevention1. Prenatal and infant care need to be in-

creased ; a public campaign should beundertaken to increase the use of exist-ing health clinics.

2. Cooperative home visiting should be un-dertaken by the Department of Health

17

B.

C.

and the Department of Welfare to allhomes in which there are mentally re-tarded children or adults.

3. Local school boards should set up parenteducation programs dealing with mentalretardation.

4. Genetic counseling should be providedthrough the local health clinics.

5. More information about the relevant as-pects of amily planning should be madeavailable through the local welfare de-partmentn and the public health nurses.

Diagnosis

1. Pediatric consultation should be madeavailable at all county and city clinics.

2. Broader acreening techniques need to beapplied in hospitals and clinics.

3. Health education of both professionalsand laymen needs to be promoted in thearea of menial retardation.

Treatment: In addition to medical treatmenttechniques there is need for more foster carehomes of an adequate nature and some fostergroup homes. More will be said later aboutthe foster care needs of adults.

AGE: 2-4 (inclusive)I. GOALS

A. Preventiow The preventive efforts neededfor this age group represent a continuationof the initi al services of prevention in thepreceding group (0-1) with the additionof one new major aspect. The possibilityof preventi ng many cases of mild retarda-tion is a real possibility.

1. Severe and Profound: Most of thesecases are identifiable in infancy and areno longer preventable at this age. Goodchild care practices will reduce the num-ber of cases due to trauma and disease.With those cases already identified, pre-vention becomes a matter of preventingsecondary effects and what could be com-plicating secondary handicaps.

2. Moderate: Some of these cases will al-ready have been identified during the 0-1age. Other cases will be identifiable at

this age. Some caused by disease, acci-dent, etc., are preventable.

3. Mild Retcirclation: Mildly retarded chil-dren do not appear to be abnormal at thisage ; such retardation becomes evidentand a problem when the child entersschool. This mild retardation has threecauses :

a. Diseases and accidents. B.

b. General medical problems and es-pecially hearing problems which re-main unattended.

c. Deprivation due to social, cultural,and emotional factors.

Retardation of the mild variety is largelypreventable during the 2 to 4 age span be-cause this type of retardation is clearlylinked with speech development and intel-lectual development dependent on the earlyuse of language and symbolic behavior ingeneral. One of the best and simplest formsof prevention is adequate child care andhealth services generally.

The problem of cultural deprivation andmental retardation is somewhat more com-plex. The more pragmatic position wouldseem to be the most tenable one, viz : chil- C.

dren who, at any given time, are functioningas retarded should be categorized as re-tarded and given service. If their level offunctioning is sufficiently raised to placethem within the range of normal function-ing, then the condition should be consideredameliorated. The distinction between severecultural deprivation and mild mental retar-dation is of little use from the point of viewof prevention and service. Extended differ-ential diagnosis can distinguish between thetwo at least by school age. Such diagnosisis hardly feasible when both costs and num-bers of children involved are considered.The goal with culturally deprived childrenis to give them sufficient sensory and cul-tural stimulation beginning at age two toprevent the effect of deprivation from de-veloping into retardation.

Once a deprived-retarded child reachesschool age, dramatic amelioration of func-tioning level is no longer possible. Specialclasses for the mildly retarded without addi-tional supporting services do not appreciablyameliorate mental retardation ; the best theycan do is improve the retarded child's

18

chances for later success in society. Thatdramatic changes in level of intellectualfunctioning can occur in earlier age groupshas been amply proven by several majorpieces of research. The most significant ofthese was the Champagne-Urbana study5in sensory stimulation of young retardedchildren.

Diagnosis1. Severe, Profound, and Moderate Retarda-

tion: The diagnostic goals at this ageare approximately the same as for thepreceding age group. Some additionalreferrals for diagnosis will come fromparents and family physicians who be-come aware of abnormal delays in de-velopment. These cases should all be ex-amined for possible retardation.

2. Mild: A diagnosis of retardation of themild sort should not be made at thistime. The child who has sensory prob-lems or is suffering the beginnings ofdeprivation should be picked up andscreened for treatment in the preventiveprogram. By this means, a diagnosis ofretardation may become unnecessary.

Treatment1. Severe and Profound: A large number

of cases of severe and profound retarda-tion will require residential care. Manyfamilies, because of varying circum-stances, will not be able to care for suchchildren much beyond their earliest years.Some possible alternatives to residentialcare would be group foster homes, com-munity day care centers for the youngerage groups, and activity centers for oldergroups.

2. Moderate: For this group of retardedchildren, complete cure or total amelio-ration of retardation is not usually a rea-sonable goal, although with early involve-ment in suitable programs, a considerabledegree of habilitation is quite possible.(The possibility of inaccurate diagnosisand prognosis in regard to the intellec-tual potential of young children demandsgreat care in evaluation, if serious con-sequences are to be avoided.)

This group of retarded children al-ready exhibits developmental problemssufficient to indicate that a training pro-

gram is needed.6 These children need atwofold program of training: help in ac-quiring the skill of daily living and stim-ulation to aid sensory development andlanguage development. Along with thistraining program, they require a widerange of special health services aimed atpreventing the development of complicat-ing secondary handicaps. Since most ofthese children can remain at home, ifsuch a treatment program is available inthe community, the implementation ofthis program will be less expensive thanlong-term residential care.

3. Mild: It was stated above that mild re-tardation should not be diagnosed as suchat this age. We are here dealing with atreatment program for deprived childrenaimed at preventing cultural deprivationfrom leading to retardation.

The program referred to should also beopen to all children, regardless of environ-ment, who are exhibiting developmentaldelays which place them within a mildlyretarded range of functioning. The pro-gram for these children would be aimedat isolating and, if possible, overcomingtheir specific developmental problems, es-pecially in the area of learning. Thetreatment program for this entire groupshould make available the following serv-ices depending on the need of each indi-vidual child:

a. Medical and dental care

b. Vision and hearing corrections

c. Speech pathology services

d. Training in daily living skill

e. Programmed training in language E.development (remediation of sub-cultural language patterns)

f. Experience in self-expressionthrough play and conversation.

Nutritional services

Involvement of parents throughcounseling, mother helping in pro-gram, session for parents, etc.

i. Clothing aids

Such a program will remove the need F.for many special services to the mildlyretarded in school years, since it will

enable many of these children to func-tion within the normal range of behaviorand to take their place in the regularclassrooms.

II. PRESENT SERVICES

Present services are available in a widely vary-ing array, often inconsistent with needs and gen-erally smaller in scope than required.

A. Residential care for the severely and pro-foundly retarded is provided at RosewoodState Hospital and Henryton State Hospital.

B. Special diagnostic and evaluation servicesare provided through certain county healthclinics, as well as through the central clinicslocated at University of Maryland and TheJohns Hopkins Hospital. These clinics needto be expanded to include all local healthdepartments throughout the State.

C. Day-care centers for the severely and pro-foundly retarded are operated by the De-partment of Health in many places through-out the State. These centers began in 1961and have grown as the community need haspresented itself. This is not to infer that, atthe present time, all age groups are beingserved adequately.

D.

g.

h.

19

Preschool programs of the "Head Start"variety are operated through the localboards of education under Federal Anti-Poverty Legislation. These programs areaimed at the needs of deprived children.They need to be broadened in scope to in-clude diagnostic, clinical, and health serv-ices, as well as to include younger age groups.The initial results of these programs are en-couraging.

Family services are provided mainly by theDepartment of Welfare (and a few privateagencies). These services are basicallysound but need to be increased and ex-panded to include specific aid in child careguidance to families with retarded (mod-erate, severe, and profound) children who,because of income levels, are not entitled towelfare services. The Department of Wel-fare family services reed also to be co-ordinated with the day-care and preschoolprograms.

The community mental health centers servean important function as one of the con-sultation services to individuals who present

associated emotional or behavioral problemsrequiring specialized psychiatric help.

III. NEEDED SERVICES

In order to coordinate present services as wellas to expand them to meet needs, the followingplan for a comprehensive preschool program forretarded and deprived children is proposed. Thiscomprehensive program could be started by com-bining under a cooperative effort several al-ready existing programs : the day care centersoperated by the health departments in manyplaces throughout the State, the preschoolclasses for hp,ndicapped children in Anne Arun-del and VSshington counties, and the "HeadStart" projects operated with the help of Federalfunds by the local boards of education.

A. Preschool centers for retarded and deprivedchildren should be established in communi-ties throughout the State. Four groups ofchildren would be served in these centers :

1. Severely retarded children from allfamilies

2. Moderately retarded children from allfamilies

3. Children with specifically diagnosed de-velopmental delays

4. Culturally deprived children: All chil-dren aged 2 to 4 from families who areeither on the Department of Welfarerolls or who fall within the poverty lim-its as defined by Federal law.

B. These community centers would provide thefollowing services:

1. Diagnostic and evaluation services: Adiagnostic team consisting of a pediatri-cian, psychologist, educator, and socialworker would operate large comprehen-sive evaluation clinics from these centers.

2. Health and clinical services: These serv-ices would be provided to all children in-volved in the program but would be de-pendent on the ability of their parents orguardians to pay. Such services would in-clude : medical, dental, visual, and audi-tory correction, inoculation, etc.

3. Family services: Social work servicesto the families would be provided by the

20

Department of Welfare and would in-clude home assistance in problems ofraising retarded children, assistance withgeneral child care and home managementproblems where needed. Involvc ent ofmothers in the program at the centeris also desirable whenever possible.

4. Educational and training services: Serv-ices specific to the four types of chil-dren in the program would be providedby the local Department of Education.This program would be staffed by teach-ers trained in special education alongwith teacher aides.

C. Administration and organization

1. It is imperative that each agency in-volved (health, mental hygiene, educa-tion and welfare) provide those serviceswhich they are best equipped profession-ally to provide. Coordination of servicesis required, but excessive overlapping ofservices should be avoided. Some appar-ent overlapping is necessary to preventgaps in services.

2. One agency should have major responsi-bility for the program receiving specialservices from other agencies. The localboards of education appear to be themost practical choice for coordinatingagencies since it is likely that the cen-ters would be placed adjacent to schools.

The choice of a coordinating agency,although important, is not nearly so im-portant as having each agency provideand be professionally responsible forthose services that are within its area ofprofessional competence.

Note on Minority Opinion: The State Depart-ment of Health, through its representative onthe Planning Committee, while subscribing tothe general philosophy of professional separa-tion and responsibility stated above under"Philosophical Positions," objects to its appli-cation to the day care centers as now op-erated by that Department. The remainderof the members of the Working Committee areunanimous in feeling that the Department ofHealth should transfer the education and train-ing aspects of the day care centers to theState Department of Education as the agencybest able to provide professional supervision.

AGE: 5In the preceding -_,action (age 2-4) a broad

program of preschool services was outlined forfour types of children :

1. Severely retarded

2. The moderately retarded child

3. The culturally deprived child

4. The child with specific delays in develop-ment.

Such a program should continue at age 5. Thespecific goals and services to be discussed belowhave to do with school admission in general. Thetransition between the preschool center and theschool proper should be preceded by a full evalua-tion and educational planning session. Whetherthis occurs at age 5, 6, or 7, depends on :

1. The compulsory attendance age

2. The extension of compulsory attendanceto handicapped children.7

I. GOALS

A. Prevention: By age 5, the intellectual de-velopment of the child has progressed tothe extent that little more can be done byway of preventing retardation. Almost allcases of severe, profound, and moderate re-tardation can be identified by this time. Theremainder of the cans of moderate and mildretardation become apparent when the childfails to progress in school. Present researchevidence seems to indicate that preventionof these cases of retardation must occur dur-ing the 2-4 age range. From age 5 on, theonly prevention involved is for those casesthat would result from disease or accident.

B. Diagnosis: At the time of school admission,diagnosis is the most important aspect ofthe retarded child's program. Proper schoolDrogramming should begin with the first dayof school rather than beginning after the childfails the first or second grade. Complete andcareful diagnosis is needed to distinguishamong mild retardation, moderate retarda-tion, deprivation without retardation, autism, B.hearing loss, speech defects, and emotionaldisturbances. Each of these different prob-lems requires a different sort of educationalprogram. The diagnosis, therefore, must bepositive as well as negative. The child's as-

C.

A.

21

sets and limitation must both be known sothat proper treatment can be provided. Noneof the children involved should be made toexperience school failure before receivingproper diagnostic services.

Treatment: The goals of treatment for 5-year-old retarded children are essentially thesame as for the preceding age group.

1. Severe and Profound: Many of thesechildren will be in community day-careand residential care facilities. In manyinstances, under the aegis of a sequen-tial, developmental program, they will becapable of benefiting from fundamentaltraining, social habit training, and occa-sionally some will progress to specialeducation classes.

2. Moderate: If the diagnostic evaluationstill indicates moderate retardation, theprogram of training in daily living skillsand sensory development should continueas with the 2-4 age group. A few chil-dren previously in this group will nowtest in the mildly retarded range and betreated with that group.

3. Mild: This group of children will notbe the same group that existed at the2-4 age. Many of those children will nowbe functioning in the normal range, ifthe preschool program has been success-ful. On the other hand, some additionalcases will be identified at the time ofschool admission. Mildly retarded chil-dren should participate in a kindergar-ten situation with normal children. Theyhave a definite need for the sort of so-cialization and school-readiness activitieswhich the kindergarten provides.

II. PRESENT SERVICES

The type of diagnostic evaluation describedhere is nowhere available in the State ofMaryland. Every school system employs somesort of screening techniques but withoutsufficient follow-up evaluation. In mostcases, retarded children are identified afterthe first or second grades.

The diagnostic and evaluation clinics atRosewood, The Johns Hopkins, and the Uni-versity of Maryland hospitals and the StateHealth Department need to be expanded.Their chief weakness, at present, is a lack ofeducational planning in the case report.

C. Xindergarten programs are not yet very ex-tensive in the public schools. Where theyexist, they are on a tuition basis.

D. The compulsory school attendance age of7 is too high. This permits parents to keepchildren home when they could profit fromspecialized school programs. It also allowslocal schools to avoid developing specialschool programs for the retarded until thatage.

III. NEEDED SERVICES

A. The most pressing need for additional serv-ices at this age is adequate screening pro-grams and diagnostic evaluation at schooladmission.

1. After the initial screening, all childrensuspected of a mental handicap shouldreceive a detailed diagnostic evaluation.The examination should include the serv-ices of a physician, a psychologist, andan educator. In many cases, a psychia-tric or neurological examination will alsobe necessary. Coordination of this serv-ice should be the responsibility of thelocal health departments.

2. All children previously identified as mod-erately retarded along with all culturallydeprived children served in the 2-4 pro-gram should be reexamined by the samediagnostic team.

3. These examinations should be requiredfor school admission as is the smallpoxvaccination.

B. Kindergarten programs should be providedfree by the public schools to all retarded B.children starting at age 5. The mildly re-tarded should attend with normal children.A separate program will have to be providedfor moderately retarded children.

C. Compulsory school attendance laws shouldinclude the retarded down through age 5.Exception should be made only for childrenwho present a health or sanitation problemor who are totally unmanageable. Day-careservices will need to be provided for someof the profoundly and severely retarded.

D. The three major diagnostic and evaluationclinics at Rosewood, The Johns Hopkins, andUniversity hospitals should provide freeservice to all and should include an educa-tional diagnosis. The advent of the full

E.

A.

22

team for diagnosis and evaluation will alterthe role of the three major clinics to greaterspecialization in more problematic cases.

The possibility of kindergarten admission atage 5 on a monthly basis should be consid-ered for the retarded (and possibly for allchildren). This system would allow a smoothspacing of examinations and school regis-tration. One reason for the present lack ofpreschool diagnosis is the annual rush atthe time of school registration.8

AGE: 6-12 (incitosive)I. GOALS

Prevention: The goals of prevention fromthis age on are basically concerned withpreventing the effects of retardation. Theretarded child must be helped to develop hispositive assets to the fullest possible extentin spite of handicaps. In this way, mostmildly and moderately retarded children canbecome at least partially self-supportingmembers of the community. Many can be-come fully self-supporting for at least a partof their lives. Investments in the preventionof the effects of retardation have both ahumanitarian and economic implication.Residential care should be viewed as a com-munity resource which provides evaluationand treatment services for problematic casesrequiring both short- and long-term care.Long-term care is required only for thosewho cannot remain at home due to specificcircumstances.

Diagnosis: Initial diagnostic evaluationmust be followed by an appropriate program.The importance of the periodic follow-upevaluation must not be overlooked. Periodicreevaluations are needed for two reasons :

1. Changes in the individual child's pro-gram must be made as his level of func-tioning changes. If early programs havebeen successful, such changes may beexpected.

2. Reevaluation of retarded children atfrequent intervals is needed in order toprovide the necessary data for properevaluation of the programs themselves.Baseline data are necessary to analyzeprograms of treatment that appear to beineffectual.

C. Treatment: The treatment goal for schoolage retarded children is to give them thebest chance possible to develop into adequateor nearly adequate members of society.There are three areas which need specialattention :1. Health services: Many retarded children

have special health problems, includingmultiple physical handicaps. In the caseof mildly retarded children from poorenvironments, the general health prob-lems associated with deprived neighbor-hoods are encountered. Poor health situ-ations are apt to compound the alreadyexisting handicap.

2. Family Services: Most parents of re-tarded children want to keep their chil-dren at home at this age. This is possibleif they have access to knowledge aboutthe care and training of retarded chil-dren in the home. As the family growsolder, these children present increasinglydifficult problems rathei than easier ones.

3. School Services: A few mildly retardedchildren can learn with normal children.Most retarded children, however, willcontinue to require special school pro-grams. The goals of these school pro-grams are : Socialization, language andcommunication skills, and training foreconomic usefulness. When compulsoryattendance laws first began, retardedchildren were excluded as being unable toprofit from public education. It is nowrecognized, however, that the presenceof the retarded child in school is bene-ficial to both him and other children pro-vided he is given a program to meet hisneeds.

II. PRESENT SERVICES

A. Health Services: At present, health servicesto the retarded can be described as fair.Some families of lower income need finan-cial aid to obtain special health services fortheir retarded children. Private physiciansdo a good job of treating retarded childrenand they should continue to be the primarysource of medical services for retarded chil-dren living at home.

B. Family Services: These are at present al-most nonexistent. There is no group offamily or child care workers in the com-munity with the special training needed to

^

23

C.

A.

B.

help parents of the retarded. Primary re-sponsibility for this service should be givento the Department of Welfare.

School Services: Every county and Balti-more City have some special classes forhandicapped children. Retarded childrenare enrolled in classes for the retarded aswell as in classes for children with specificlearning problems. School reports indicatethat 70 per cent of the retarded childrenidentified are enrolled in special classes. Theweakness of the present school program istwo-fold :

1. Lack of trained personnel: Only 50 percent of special class teachers are fullycertificated.

2. Overcrowded classrooms: This is es-pecially the case in Baltimore City wherefinancial problems in the school systemhave resulted in overcrowded conditionsin all classrooms. Baltimore City has alarge waiting list of moderately retardedchildren awaiting school admission.

The 70 per cent enrollment figure includesthe Rosewood State Hospital School and pri-vate and parochial school placements. For re-tarded children below the mild level, theState Department of Education provides par-tial tuition support to the families of thechildren, when private school is reauired.Increased efficiency in identification andevaluation will initially increase the needfor special class expansion. Eventually thepreschool program should reduce the needfor so many special classes for the mildlyretarded, especially in Baltimore City.

III. NEEDED SERVICES

Health Services: The possibility of medicalaid to families of retarded children should beconsidered. This could be in the form ofmedical care through the Department of Wel-fare or in the form of services through localhealth clinics. It would seem preferable thataid be given to the families so that theymight obtain services from their familyphysician.

Family Services: Families of retarded chil-dren should be eligible for family servicesfrom the Department of Welfare. Specialworkers will have to be trained in the areaof mental retardation in cooperation withthe Department of Health to meet this need.

C. School Services: Several steps need to be

taken to improve the school program :

1. The compulsory attendance law has beenextended to include retarded children.The school should be left with the dis-cretionary authority to exclude onlythose children who are physically or so-cially unmanageable.7

2. iiiereased State aid should be given tothe development of teacher training pro-grams in special education. The secondundergraduate program in mental re-tardation in Maryland was opened lastyear at Coppin State College ; the onlyother such program is at the Universityof Maryland. This program should beexpanded to make Coppin a teachertraining center for teachers of all typesof handicapped children. This wouldbe preferable to having small, poorlystaffed programs at other State Colleges.The Coppin program, along with the pro-gram at the University of Maryland,would provide two centers for the train-ing of special class teachers. An Asso-ciate of Arts program for teacher aides,case workers, and preschool workersshould also be introduced at Coppin andthe University. Since the greatest needfor additional personnel in mental re-tardation work will be in the City, Cop-pin's location makes it an ideal centerfor this purpose.

3. Multicounty supervisory services shouldbe set up on a contractual basis to pro-vide more local educational supervisors inspecial education to update curricula andmethods. The smaller counties cannot af-ford supervisors trained in mental re-tardation on an individual basis.

4. State aid for classes of handicapped chil-dren should be extended to includeclasses for the mildly retarded. Theamount of this aid should be increasedto cover actual costs. (This would greatlyreduce the need for more expensive pri-vate programs.) Current actual cost is$1,300 per class.

5. Curriculum and methodological changesshould be made in classes for the re-tarded to include more behavioral con-ditioning techniques and more prevoca-tional training.

24

6. The school at Rosewood State Hospitalshould be expanded as there are childrenin the hospital capable of profiting fromschool programs who are now excludeddue to limitations of staff and space. Theschool also lacks sufficient consultativestaff to provide needed reevaluations.

IV. RESIDENTIAL CARE

The need for residential care for school-ageretarded children other than those in the pro-found and severe categories is usually due tosome other problem than retardation alone. Typ-ically there is an associated physical or emo-tional handicap. Often the need for residentialcare arises from family problems. Social workservices are needed to provide basic liaison withthe community and to enhance the possibility ofearly community placement.

Overcrowding, understaffing, and outdatedbuilding design prohibit optimal programming atRosewood State Hospital ; the general level ofcare is as good as could be expected under the cir-cumstances. The school program is educationallysound but is not nearly large enough to supplyeducation and training to all the mentally re-tarded persons at Rosewood capable of profitingfrom them. More attention should also be givento those special services aimed at removing theimmediate need for residential care. Terminal,full-time residential care should not be used forthose who do not really require it.

In recent years, the Department of Mental Hy-giene has been providing a program of temporaryadmission to Rosewood and Henryton State Hos-pitals for retarded children and adults who areliving in the community. This program permitsparents and guardians of the retarded to have atemporary respite from their responsibilities forshort periods, usually in the summer. This pro-gram should be more widely publicized andutilized. Residential facilities should provide day-care services for the community.

AGE: 13 -19 (inclusive)I. GOALS

A. Prevention: The goals for prevention forthe 13 to 19 age group can be summarized bysaying that the aim of programs for teenageretarded members of the community is totrain them for as much later independencein the community as is reasonably possible.

ory, r " `

Preventive efforts are aimed at pre -entingthe one specific effect of retardation whichis most seriousoverdependence on othersboth economically and personally.

B. Diagnosis: Reevaluation should continuethroughout this age range. Of new im-portance at this age is the need for a com-plete range of prevocational aptitude tests.These are necessary so that the last years ofschool training may consist of appropriatevocational preparation.

C. Treatment: Adequate prevocational train-ing is the goal at this age. This includesspecific job skill and also work habits andsocial adjustment.

D. General Note on the Provision of Servicesto the Retarded: From age 13 on throughadulthood it should be noted that there is adistinction to be made b tween making aretarded person eligible for special servicesand making him in any way dependent. Thepurpose of providing him with supportiveservices in the community is not to impair hisfreedom or hinder h'm in any way ; it israther to make his freedom in the commu-nity possible while protecting him from suchproblems of living as he might not be ableto take care of without help.

E. Delinquency among Retarded Youth: Re-

tarded young people (including the mildlyretarded) who commit crimes or who are ad-judicated delinquent should receive specialprograms of behavioral training. These pro-grams should be geared to the special needsof this group. The fact of special classplacement in school in a class for retardedchildren should be prima facie evidence ofmental handicap and should be taken intoaccount at the time of the trial or juvenilehearing. Pretrial evaluation by a full diag-nostic and evaluation team knowledgeable inmental retardation should be required in allcases.

A.

II. PRESENT SERVICES

Secondary School Classes for Mildly Re-tarded Adolescents: These are prevocationalclasses in secondary schools. Where theyexist (Baltimore City and about one-thirdof the counties) , the curriculum is basicallysound. An adequate aptitude testing pro-

25

gram is lacking. Some school systems stilllack a well-defined "leaving" system for theseclasses. Some give diplomas, others give cer-tificates of attendance. Many of the studentsleave these classes upon reaching their six-teenth birthday.

B. Classes for Moderately Retarded Adoles-cents: These classes are generally not heldin the secondary school. They are usually anextension of the elementary classes for mod-erately retarded children. Again, the "leav-ing" system needs improving. Many of thesechildren leave the class, return to theirhomes, and do nothing for several years.When they are picked up by Vocational Re-habilitation, they have already lost much ofwhat they had learned in the school pro-gram. A similar gap exists between theschool program and the Vocational Rehabili-tation program at Rosewood State Hospital.

C. Day-Care and Activity Centers: These cen-ters are operated by the Department ofHealth in Baltimore City and twelve of thecounties. Retarded adults require varioustypes of support services. The State De-partment of Health is operating some adultactivities centers on the day-care model.Sheltered workshops for the most part havebeen sponsored by private organizations,usually the Maryland Association for Re-tarded Children and Goodwill Industries,Inc., with services purchased by the Divisionof Vocational Rehabilitation.

D. Henryton State Hospital: This new Statehospital is conducting a rehabilitation andtraining program for retarded youth andadults. The program is an extremely in-tensive one designed to facilitate the move-ment of moderately and severely retardedpersons into community placements.

E. Vocational Rehabilitation has been expand-ing its services during the past two years.Mentally retarded youngsters now becomeeligible at age 15. Until recently, lack ofstaff and community facilities have pre-vented adequate coverage of the potentialcase load of retarded clients. This situationis rapidly being remedied. In consonancewIth the expansion of the Vocational Re-habilitation program, joint programs arebeing set up by the schools. These are trulycooperative programs between VocationalRehabilitation and the local schools.

F. The Maryland Children's Centers were de-

signed to be study centers for delinquentadolescents available to the courts for pre-trial evaluation. In spite of the existence of

these facilities, mentally retarded adoles-

cents can &ill be found in training schoolsfor delinquents. All of the cases in theseinstitutions are of the mild type but evenfor these children this is an inappropriateplacement. It is possible to transfer a childfrom a training school to Rosewood, but this

may be an involved process, which maysometimes take several months. Further-more, it is still possible for a retarded child

to be transferred to the jurisdiction of crim-inal court for trial and sentencing.

HI. NEEDED SERV

A. The secondary school pretarded adolescents i

Vocational Rehabilitapanded as follows :

1. These programs should be expanded nu-merically to cover all mildly retardedadolescents.

ICES

rogram for mildlyn cooperation withion should be ex-

2. The work-study program should includethe awarding of a diploma based on com-pletion of a definite program sometimebetween age 16 and age 21. This shouldnot be interpreted as excluding the indi-vidual from further programs of train-ing and vocational rehabilitation.

3. The Vocational Rehabilitation programshould be extended downward in age toage 13. At this age, Vocational Rehabili-tation should officially list the child onits rolls and administer a complete bat-tery of aptitude tests in addition to ac-cumulating data necessary for the estab-lishment of eligibility. The final yearsof the secondary program should bebased on the results of these tests cou-pled with a realistic evaluation of thecommunity employment situation.

B. Similar close cooperative program shouldbe set up between Vocational Rehabilitationand the school programs for moderately re-tarded adolescents.

C. A broad program of sex education for theretarded needs to be developed and imple-mented. Parents have shown little inclina-

26

D.

E.

F.

tion and less ability in this area and theschool curricula in general do not cover thesubject well if at all. This program shouldbe begun in the home with the assistance ofthe family worker from the Department ofWelfare. It should be continued in the schoolas a full section of the curriculum at severaldifferent levels. For retarded youth in in-stitutions, the program should include in-service training of the related members ofthe cottage staff. Since these workers haveclose contact with the retarded, their co-operation in a program of sex education isessential.

Delinquent adolescents who are mentally re-tarded should be referred to a special train-ing program which should be developed atRosewood State Hospital. Any child whohas been placed in a special class because ofmental retardation should be ineligible fortraining school placement. If transfer tocriminal court is necessary, and commit-ment to a correctional institution follows,the offender should be transferred to Rose-wood or Clifton T. Perkins hospitals. Ifproper pre-trial of delinquents suspected ofmental retardation is to become availableto the courts, full use must be made ofpresently existing and future evaluationcenters which are properly staffed. Thesecenters should include Rosewood State Hos-pital, Clifton T. Perkins State Hospital, TheJohns Hopkins and the University hospitals,local retardation and mental health centersand the Maryland Children's Centers.

Sheltered workshops should be supported byFederal, State, county, and City Govern-ments as well as cooperative agreements bya combination of these political entities andnonprofit organizations. In some cases,these workshops may operate at a loss, butthis loss is more than compensated for bysavings in care. Greater emphasis needs tobe placed on including more severely re-tarded in sheltered workshop programs. Anawareness of the full potential of theseverely retarded is slowly being achieved.

Recreation: Retarded adults should be ableto participate in community recreation pro-grams with a minimum of program modifi-cation. Community recreation programsshould plan for and offer special activities forretarded citizens.

AGE: 20 44I. GOALS

A. Prevention: The goal for this age groupconsists of helping the retarded adult live

in the community as long as possible by giv-

ing him the support services he needs.

1. Profound : The goal for the profoundlyretarded is improved physical care.

2. Severe : The goal for the severely re-tarded is improved physical care withsensory development and training in

order to obtain increased level of func-

tioning.

3. Moderate : Most moderately retardedadults can live in the community on apartially independent basis. Some canmake a partial contribution to their owneconomic support through subsidized in-

dustry.

4. Mild : Almost all mildly retarded adultswill be found in the community. If earlyprograms of education and vocationalrehabilitation prove successful, many ofthose people will become independentsupporting members of the communityand will, in this sense, no longer be classi-fied as retarded.

II. PRESENT SERVICES

A. Retarded adults are currently eligible forrehabilitation services. Recent expansion of

this area has enabled more case coverage.Almost all profoundly retarded adults are in

a State-operated residential facility.

B. Provisions for residential care of the pro-foundly and severely retarded at RosewoodState Hospital and Henryton State Hospital

seem to be adequate. Provisions are alsoavailable for temporary admission of non-institutionalized retarded adults.

C. Foster care and guardianship services formoderately retarded adults are available,

but these services are limited as to quality

and quantity.

D. A growing awareness of the problem of men-

tal retardation is apparent in our courtroom

27

E.

F.

A.

B.

C.

D.

E.

procedures, but too many mentally retardedmen and women are still being sentenced tocorrectional institutions (currently 706).

The Department of Employment Securityprovides limited service in locating employ-ment for retarded adults.

Some retarded adults are receiving servicesin the Department of Health day-care cen-ters ; this form of service is not yet as ex-tensive as it should be.

NEEDED SERVICES

All identified mentally retarded adultsshould have the benefit of vocational rehabil-itation assessment and evaluation for de-

termination of eligibility for rehabilitationservices and should receive them wheneverthey are eligible.

The greatest need in service for retardedadults is an expansion of the foster care andguardianship program. A campaign shouldbe initiated to find foster parents or groupfoster homes for retarded adults in the com-munity. Incentives for persons in the com-munity who take on the responsibility ofguardianship of property should be providedin a realistic manner. The qualificationsfor guardianship can be more readilyestablished through such an approach.

A joint program for the employment of theretarded should be undertaken by the De-partment of Employment Security and theDivision of Vocational Rehabilitation. Theoperating mechanism for such a service al-ready exists in the form of an agreementbetween these two agencies regarding handi-

capped persons in general.

Further use should be made of availableprograms of temporary admission to Rose-

wood and Henryton State hospitals and anyother future programs that are developed.

The Division of Vocational Rehabilitationshould provide programs of short-term voca-tional training for retarded adults at Rose-wood and Henryton State hospitals and otherresidential facilities to be developed in the

future. The mechanism for this has already

been made operative at Rosewood State

Hospital.

F. More small residential care institutions areneeded throughout the State ; such facilitiesput residential care on a more easily acces-sible basis. Community ties are difficult tomaintain if patients must travel over fiftymiles to obtain residential care. Severalfacilities of this type have already been pro-posed by the Department of Mental Hygiene.

G. Ideally, all mentally retarded persons whocommit crimes should be treated in facili-ties for the retarded ; however, since thismay not be immediately feasible, the De-partment of Correction, in the meantime,should set up a special program of rehabili-tation and training for retarded inmates,including the mildly retarded. At present,

these inmates do not receive either sufficienteducation or sufficient training because oftheir employment in the State Use IndustrySystem.

AGE: 45 and overThere is no essential difference as far as need

for services is concerned between this and theprevious age group. All services discussed forthe previous group will continue throughoutadulthood. The need for nursing homes and othergeriatric services will probably occur sooner withcertain segments of the retarded population thanwith the normal population ; the services re-quired, however, are identical.

28

ST

AT

E A

GE

NC

YR

ES

PO

NS

IBLE

FO

RS

ER

VIC

ES

-A

GE

GR

OU

PS

Prin

cipa

lA

genc

yH

ealth

Dep

t.E

duca

tion

Dep

t.E

duca

tion

Dep

t.E

duca

tion

Dep

t.

Edu

catio

n D

ept.

and

Div

isio

n of

Voc

atio

nal

Reh

abili

tatio

n

Wel

fare

Dep

t.an

dM

enta

l Hyg

iene

Dep

t.

The

Com

mun

ityor

Res

iden

tial

Faci

lity

Edu

catio

nD

epar

tmen

tPa

rent

Edu

catio

nPr

ogra

ms

Pres

choo

l Cla

sses

"Hea

d St

art"

Prog

ram

Soci

aliz

atio

nT

rain

ing

in D

aily

Liv

ing

Skill

sL

angu

age

Sens

ory

Stim

ulat

ion

Pres

choo

l Cla

sses

"Hea

d St

art"

Prog

ram

Soci

aliz

atio

nT

rain

ing

in D

aily

Liv

ing

Skill

sL

angu

age

Com

mun

icat

ion

Skill

sSe

nsor

y St

imul

atio

nK

inde

rgar

ten

Scho

ol S

ervi

ces

Spec

ial C

lass

esSo

cial

izat

ion

Lan

guag

eC

omm

unic

atio

nSk

ills

Sens

ory

Stim

ulat

ion

Scho

ol S

ervi

ces

Spec

ial C

lass

esSo

cial

izat

ion

Prev

ocat

iona

lT

rain

ing

Scho

ol S

ervi

ces

Spec

ial C

lass

esE

veni

ng C

lass

es

Eve

ning

Cla

sses

Hea

lthD

epar

tmen

tPr

enat

al a

ndIn

fant

Car

ePe

diat

ric

Con

sulta

tion

Gen

etic

Cou

nsel

ing

Dia

gnos

isPK

U S

cree

ning

Initi

al S

cree

ning

Hom

e-nu

rsin

g

Day

Car

e C

ente

rsM

edic

al a

ndD

enta

l Car

eV

isio

n an

d H

eari

ngC

orre

ctio

n

Day

Car

e C

ente

rsM

edic

al a

ndD

enta

l Car

eV

isio

n an

d H

eari

ngC

orre

ctio

n

Day

Car

e C

ente

rsM

edic

al a

ndD

enta

l Car

eV

isio

n an

d H

eari

ngC

orre

ctio

n

Day

Car

e C

ente

rsM

edic

al a

ndD

enta

l Car

eV

isio

n an

d H

eari

ngC

orre

ctio

n

Day

Car

e C

ente

rsM

edic

al a

ndD

enta

l Car

eV

isio

n an

d H

eari

ngC

orre

ctio

n

Day

Car

e C

ente

rsM

edic

al a

ndD

enta

l Car

eV

isio

n an

d H

eari

ngC

orre

ctio

nG

eria

tric

Serv

ice

Men

tal H

ygie

neD

epar

tmen

tR

esid

entia

l Car

eD

iagn

osis

Gua

rdia

nshi

pFo

ster

Car

eFo

ster

Gro

upH

omes

Smal

l Res

iden

tial

Cen

ters

Res

iden

tial C

are

Dia

gnos

isG

uard

ians

hip

Fost

er C

are

Fost

er G

roup

Hom

esSm

all R

esid

entia

lC

ente

rs

Res

iden

tial C

are

Dia

gnos

isG

uard

ians

hip

Fost

er C

are

Fost

er G

roup

Hom

esSm

all R

esid

entia

lC

ente

rs

Res

iden

tial C

are

Dia

gnos

isG

uard

ians

hip

Fost

er C

are

Fost

er G

roup

Hom

esSm

all R

esid

entia

lC

ente

rs

Res

iden

tial C

are

Dia

gnos

isG

uard

ians

hip

Fost

er C

are

Fost

er G

roup

Hom

esSm

all R

esid

entia

lC

ente

rs

Res

iden

tial C

are

Dia

gnos

isG

uard

ians

hip

Fost

er C

are

Fost

er G

roup

Hom

esSm

all R

esid

entia

lC

ente

rs

Res

iden

tial C

are

Dia

gnos

isG

uard

ians

hip

Fost

er C

are

Fost

er G

roup

Hom

esSm

all R

esid

entia

lC

ente

rs

Div

isio

n of

Voc

atio

nal

Reh

abili

tatio

n

-

Voc

atio

nal A

sses

s-m

ent a

nd E

valu

atio

nof

Elig

ibili

ty f

or R

e-ha

bilit

atio

n Se

rvic

esJo

b Pl

acem

ent a

ndC

ouns

elin

gSe

rvic

es to

She

l-te

red

Wor

k Sh

ops

Vis

ion

and

Hea

r-in

g C

orre

ctio

n

Voc

atio

nal A

sses

s-m

ent a

nd E

valu

atio

nof

Elig

ibili

ty f

or R

e-ha

bilit

atio

n Se

rvic

esJo

b Pl

acem

ent a

ndC

ouns

elin

gSe

rvic

es to

She

l-te

red

Wor

k Sh

ops

Vis

ion

and

Hea

r-in

g C

orre

ctio

n

Voc

atio

nal A

sses

s-m

ent a

nd E

valu

atio

nof

Elig

ibili

ty f

orR

e-ha

bilit

atio

n Se

rvic

esJo

b Pl

acem

ent a

ndC

ouns

elin

gSe

rvic

es to

She

l-te

red

Wor

k Sh

ops

Vis

ion

and

Hea

r-in

g C

orre

ctio

n

Wel

fare

Dep

artm

ent

Fam

ily P

lann

ing

Fam

ily S

ervi

ces

Chi

ld C

are

Gui

danc

eFo

ster

Car

e H

omes

Fost

er G

roup

Hom

eA

id f

or M

edic

alC

are

Hom

e V

isits

Gua

rdia

nshi

pC

loth

ing

Aid

Fam

ily S

ervi

ces

Chi

ld C

are

Gui

danc

eFo

ster

Car

e H

omes

Fost

er G

roup

Hom

eA

id f

or M

edic

alC

are

Hom

e V

isits

Gua

rdia

nshi

pC

loth

ing

Aid

Fam

ily S

ervi

ces

Chi

ld C

are

Gui

danc

eFo

ster

Car

e H

omes

Fost

er G

roup

Hom

eA

id f

or M

edic

alC

are

Hom

e V

isits

Gua

rdia

nshi

pC

loth

ing

Aid

Fam

ily S

ervi

ces

Chi

ld C

are

Gui

danc

eFo

ster

Car

e H

omes

Fost

er G

roup

Hom

eA

id f

or M

edic

alC

are

Hom

e V

isits

Gua

rdia

nshi

pC

loth

ing

Aid

Mar

riag

eC

ouns

elin

gFa

mily

Ser

vice

sC

hild

Car

eG

uida

nce

Fost

er C

are

Hom

esFo

ster

Gro

upH

ome

Aid

for

Med

ical

Car

eH

ome

Vis

itsG

uard

ians

hip

Clo

thin

g A

id

Mar

riag

eC

ouns

elin

gFa

mily

Ser

vice

sC

hild

Car

eG

uida

nce

Fost

er C

are

Hom

esFo

ster

Gro

upH

ome

Aid

for

Med

ical

Car

eH

ome

Vis

itsG

uard

ians

hip

Clo

thin

g A

id

Mar

riag

eC

ouns

elin

gC

hild

Car

eG

uida

nce

Fost

er C

are

Hom

esFo

ster

Gro

upH

ome

Aid

for

Med

ical

Car

eH

ome

Vis

itsG

uard

ians

hip

Clo

thin

g A

idO

ld A

geA

ssis

tanc

e

CONCLUSION

Maryland's Comprehensive Mental RetardationPlan comes to her retarded citizens, their fami-lies, and their friends as the best answer to yearsof fumbling and frustration and as the fulfill-ment of their dream for hope in the struggle forhelp with the problems caused by mental retar-dation. Implementation of thiz Plan will pro-vide a realistic framework for a full, meaning-ful life for those retarded, both children andadults. It will also provide for prevention andelimination of many possible cases in the future.

Achievement of these goals, even the real andfirm possibility of their achievement, comes asa harbinger of hope to all.

These goals can be achieved, to the relief oftaxpayers, without new agencies being createdto swell the encumbered ranks of bureaucracy,further complicating an already complex gov-ernmental structure. Services in mental retar-dation are expensive but lack of them is, in thelong run, far more costly. This Plan places itsgreatest emphasis and concentrates its costly ef-forts in the early years of a retarded person'slife, which are the years where we can speak interms of prevention, improvement, and, hopefully,even of elimination. If a retarded person is allowedto reach adulthood without treatment, the costis far greater and frequently results in the needfor total residential care.

30

To all concerned with services to the retarded,the Plan does more than simply call for coopera-tion. It furnishes a workable mechanism for co-operation in providing services. The Plan isbased upon a belief in professional competenceand provides that each agency be assigned re-sponsibility for those services which it is mostcapable of rendering. To assure full provisionof services, one agency is designated primaryresponsibility in a specific stage of the retardedperson's life with the additional responsibility tothis agency for assuring that ancillary servicesfrom other agencies are provided. Existing agen-cies are fully capable and willing to provide forthe needs of the retarded. All necessary fundsshould be used for the continuance and expan-sion of existent programs rather than beingwasted on unnecessary additional agencies, ex-pensive overlapping, or the development of hier-archical government structure. Reliance in thephilosophy of professional competence is the bestassurance for improved quality in services to theretarded.

Any plan, however well intentioned, is still aplan. It is the phase of implementation whichchanges the plan for hope to reality. Implemen-tation is the concern of all and its success) de-pends upon total support and cooperation. Thehopes which now lie before us must be changedinto realities through implementation of thisPlan.

NOTES AND REFERENCES

Heber, Rick. A Manual on Terminologyand Classification in Mental Retarda-tion, American Journal of Mental De-ficiency Monograph Supplement, April,1961.

2. The 3 per cent figure is a statistical phe-nomenon derived from that area underthe Gaussian Curve which is more thanone standard deviation below the mean.In this sense it is accurate by definitionsince the Heber definition is an opera-tional one implying a reference to thestandard deviation concept. This roughlycorresponds to the traditional descrip-tion of a verbal intelligence quotient ofapproximately 70 to 75 or below.

3. Epidemiology of Mental Retardation in aRural County : Rose County StudyTheJohns Hopkins School of Hygiene andPublic Health. Maternal and Child Health,Crippled Children's Service ResearchGrant Program, Department of Health,Education and Welfare.

4. Final Vital Statistical Tables : 1964Maryland State Department of Health,Division of Statistical Research and Rec-ords, 9/65.

5. Kirk, Samuel. Early Education of theMentally Retarded. University of Illi-nois Press, Urbana, 1958.

6. No distinction is being made in this re-port between education and training.The terms may be taken as synonomous.

7. There is a distinction between compul-sory financing and compulsory attend-ance laws. Art. 77, Sec. 241 is a com-pulsory financing law. A compulsory at-tendance law for handicapped childrenwas passed by the 1966 Legislature andsigned by the Governor.

8. This system has been used in New Zea-land ever since the advent of compulsoryeducation there. It is extremely efficientand avoids the false assumption involvedin "homogeneously" grouping youngchildren.

31

DIRECTORY OF AVAILABLE SERVICESAREA I

FacilitySponsor-ship Programs

AgeGrouping

Level ofRetardation

Angel's Haven Non- Residential School Moderate

RFD 2, Box 548 profit age

Point Pleasant RoadGlen Burnie, MarylandSO 1-1588

Anne Arundel County Day Public Day Care 4 4- Severe

Care Center for theRetarded, Inc.14 Hilltop RoadAnnapolis, Maryland

Anne Arundel County Public Clinic Pre- All

Multi-Problem Clinicfor Children, Anne

(County) school

Arundel County HealthDepartmentAnnapolis, MarylandCO 7-8151

Anne Arundel County Public Public Special School Educable;

Schools (County) education age Trainable

P. 0. Box 951(Elementary)

Green StreetAnnapol. 3, Maryland

Anne Arundel County Non- Sheltered 18 + Mild;

Sheltered Workshop profit workshop Moderate

Earleigh Heights, Maryland

Arlington Cooperative Non- Day Pre- Mild; .

Day Nursery profit care school; Moderate;

7310 Park Heights AvenueBaltimore, Maryland

Schoolage

Severe

486-2483

Baile Hall Day Care Non- Day 7 to Moderate;

.. Center, Route 1 profit care . . 21 + Severe

New Windsor, MarylandNE 5-5643

Baltimore City Public Public Special School Educable;

Schoolseducation age Trainable

3 East 25th StreetBaltimore, Maryland

Baltimore County Public Public Special School Educable;

Schools, Aigburth Manor education age Trainable

Aigburth RoadTowson, Maryland

Baltimore Goodwill Non- Occupa- Adult Mild

Industries, Inc.201 South Franklin Street

profit tionalcenter

Baltimore, Maryland327-1555

32

Facility .

,

Sponsor-ship

.Programs

I

AgeGrouping

Level ofRetardation

I

Baltimore GoodwillIndustries, Inc.201 South BroadwayBaltimore, Maryland

Carroll County PublicSchools, County OfficeBuildingWestminster, Maryland

Central Evaluation Clinicfor ChildrenUniversity of MarylandHospital112 South Greene StreetBaltimore, Maryland955-2121

Children's RehabilitationInstitute, Inc.Westminster RoadReisterstown, Maryland833-5100

Chimes Day CareActivity Center1813 Thornbury RoadBaltimore, MarylandFO 7-0400

Coppin State College2500 West North AvenueBaltimore, Maryland

Diagnostic & Advisor:Services for HandicappedChildren, State HealthDepartment (Mobile Clinic)Harford County HealthDepartment AnnexRevolution StreetHavre de Grace, Maryland

Diagnostic Center forHandicapped ChildrenJohns Hopkins UniversityHospital, 601 NorthBroadway, ..

Baltimore, Maryland955-5636

Diagnostic & EvaluationCenter for HandicappedChildrenJohns Hopkins Hospital709 Rutland AvenueBaltimore, Maryland 21205

. . . . Non-:profit

Public

. .Public(State)

Non-profit

Non-profit

Public(State)

Public(State)

Non-profit

Public

.

. Sheltered .

**workshop

Specialeducation

Diagnosis;Eval-uation

Education;Residentialtreatment

Day Care

Undergraduatespecial educationprogram inmental retarda-tion

Diagnosis;Evaluation

.

Diagnosis;Evaluation

. .

Diagnosis;Evaluation

16+ .

.

Schoolage

Pre-school;Schoolage

Preschool;Schoolage

SchoolageAdult

Preschool;Schoolage

Preschool;Schoolage

0 - 21

All

Educable;Trainable

All

Mild

All

Mild;Moderate;Severe

All.

.

.

All

,

.33

FacilitySponsor-ship Programs

I

AgeGrouping

Level ofRetardation

Educational and Child Non- Diagnosis; School Mild

Guidance Clinic profit Evaluation age Severe

233 Homeland AvenueBaltimore, MarylandID 5-5310

Emmorton Special Public Day care 6 - 19 Trainable

School (County)Bel Air, Maryland

Hayford County Day CareCenter for Retarded

Non-profit

Day care 3 to 21 + All

Children, 205 Hayes StreetBel Air, MarylandTE 8-5644

Harford County Public Public Special School Educable;

Schools education age Trainable

45 East Gordon Street(Elementary)

Bel Air, Maryland

Havre de Grace Special Public Day care 6 - 19 Trainable

School (County)Stokes StreetHavre de Grace, Maryland

Henryton State Hospital Public Residential School Severe

Henryton, Maryland (State) training age;

787-2400Adult

Howard County Public Public Special Educable;

Schools education Trainable

Clarksville, Maryland(Elementary)

Loyola College Jesuit Master's4501 North Charles Street Order Degree;

Baltimore, Maryland Special education inmental retardation

Oakwood SchoolOakwood Road

Public Specialeducation

4 - 15 All

Glen Burnie, Md.

Occupational Training Non- Sheltered 18+ Mild

Center & Sheltered Work-shop for the Retarded

profit workshop ' Moderate

4321 Old York RoadBaltimore, Maryland889-7040

Perryville Special Public Education 6 - 18+ Trainable

School (County)Perryville, Maryland

Providence Center forExceptional Children

Non-profit

Day Care it to 21+.

All

1790 Lincoln DriveAnnapolis, Maryland268-0005, 263-9489 ,

FacilitySponsor-ship Programs

AgeGrouping

RetardationLevel of

Rosewood State HospitalOwings Mills, MarylandHU 6-5200

Public(State)

Residential,Diagnosis,Evaluation,Day Care

All All

Rosewood Education Dept. Public Special 6 to 16 Educable;

Rosewood State Hospital (State) education.

Trainable

Owings Mills, MarylandHU 6-5200

Rosewood Vocational Public Vocational 14 + Educable;

Rehabilitation Unit (State) training; Trainable

Rosewood State Hospital Job develop- with work

Owings Mills, Maryland ment & place-ment. Follow-up services

potential

St. Anne's Special Non- Education School Mild

Classes2211 Greenmount Avenue

profitchurch

age

Baltimore, MarylandSA 7-7777

St. Bernadine's Special Non- Education School Mild

Education School3814 Edmondson Avenue

profitchurch

age

Baltimore, MarylandWI 7-2815

St. Elizabeth's School Non- Education School All

for Special Education3725 Ellerslie Avenue

profitchurch

age

Baltimore, MarylandBE 5-9058

St. Francis School forSpecial Education2226 Maryland Avenue

Non-profitchurch

Education Schoolage

Mild,Moderate,Severe

Baltimore, Maryland235-3378

St. Gabriel's Home Non- Residential Pre- Moderate

Hilton Avenue profit education school;

Catonsville, MarylandRI 7-6767

church Schoolage

St. Katherine's Special Non- Education School Mild;

SchoolRose and Preston Streets

profitchurch

age Moderate

Baltimore, Maryland727-7777

School of the Chimes, Inc. Non- Education School Mild;

1803 Thornbury Road profit age Moderate

Baltimore, Maryland (Assn.)FO 7-7007

.35

FacilitySponsor-ship Programs

AgaGrouping

Level ofRetardation

Searchlight Day Care Non- Day care 3 to 12 Moderate;

Center profit Severe

Coppin State College (Assn.) Profound;

2500 West North AvenueBaltimore, MarylandLA 3-1111

.

Searchlight Day CureCenter

Non-profit

Day care 5 to 21 All

Cherry Hill Community (Assn.)Building2700 Spelman RoadBaltimore, Maryland355-9563

Searchlight Day Care Center Non- Day care 7 to 21 + Moderate;

5217 Denmore Avenue profit Severe

Baltimore, Maryland (Assn.) Profound;

642-7945

Searchlight Day Care Center Non- Day care School Severe

4119 Kennison Avenue profit age Profound

Baltimore, Maryland664-6851 . .

Searchlight Day Care Center Non- Day care Pre- 3 to 12

Lexington-Poe Housing Proj. profit school;

211 North Fremont StreetBaltimore, Maryland

(Assn.) Schoolage

WI 5-3120

Searchlight Day Care CenterPatapsco Methodist Church

Non-profit

Day care 3 to 21 + All

1700 Church Road (Assn.)Baltimore, Maryland288-9741

Searchlight Day Care Center Non- Day care 3 to 21 All

St. Luke's Evangelical profitChurch7001 Harford RoadBaltimore, MarylandMO 4-6851

Searchlight Training Center Non- Education School All

4119 Kennison Avenue profit ageBaltimore, Maryland .

MO 4-6836.

..

Searchlight Training Center7910 Stansbury Road

Non-profit

Education 5 to 21 Severe

Baltimore, Maryland (Assn.)AT 2-2165

Searchlight Training Center Non- Education School All'7308 York Road profit AgeTowson, Maryland (Assn.)VA 3-6145

36

Facility.

Sponsor-ship Programs

. . .. . , .

AgeGrouping.. .

Level ofRetardation

State Department of Public Consulta- School Educable;

EducationDivision of Instruction

(State) tion Servicesto all counties

Age Trainable

Special Education & Balto.

301 West Preston Street City

Baltimore, Maryland837-9000, Extension 460

State Department of Public Vocational 14 + Educable;

Education (State) guidance; Trainable

Division Vocational Rehabil-itation2100 Guilford AvenueBaltimm e, Maryland837-9000, Extension 8629 .

Training;Consulta-tion; Physi-cal restor-ation; Place-ment

,

State Departmmit of Health Public Statewide AU All

Bureau of Preventive (State) Consulta-

Medicine tion

Division of Community Services

Servicesfor Mentally Retarded301 West Preston StreitBaltimore, Maryland 21201837-9000, Extension 8360

State Department of Mental Public Statewide All All

Hygiene, Bureau of Corn-munity Program Services:

(State) Consulta-tion

Mental Retardation Services

301 West Preston StreetBaltimore, Maryland837-9000, Extension 675

State Department of Health Public Statewide Birth to All

Bureau of PreventiveMedicine

(State) Consulta-tion

21

Division for Crippled Services .

Children .

Baltimore, Maryland

State Department of Health Public Statewide All All

Division of Public HealthNursing

(State) Consulta-tion

.

State Office Building Services

Baltimore, Maryland

Sheltered Workshop of the '' Non- Vocational School All

Baltimore League for profit training; age;

Crippled Children1111 East Cold Spring Lane

Occupationaltraining

Adults

Baltimore, Maryland

FacilitySponsor-ship Programs

AgeGrouping

Level ofRetardation

Sunny Acre Public Special 4 to 21 Moderate;Spa Road education SevereAnnapolis, Maryland

Sunny Glen Public Special 4 to 15 Moderate;First Avenue education SevereGlen Burnie, Maryland

Sunny Meadows Public Special 4 to 21 Moderate;Crownsville, Maryland education Severe

Sunnyside School Public Special 4 to 16 Moderate;Quarterfield Road education SevereGlen Burnie, Maryland

Millersville Public Special 14 to 21 Moderate;Training Center education; SevereMillersville, Maryland Vocational

development

Towson Coop. Day Nursery Non- Day care Pre- Mild;Hampton Lane & Dulaney profit school; ModerateValley Road,Towson, Maryland

Schoolage

CL 4-1925

Towson State College Public UndergraduateYork RoadTowson, Maryland

(State) Minor Coursein SpecialEducation forMental Retardatian

AREA II

Brookland Child Center8306-68th Avenue

Non-profit

Day care 6 to 12 Educable

Berwyn Heights, Maryland

Cerebral Palsy Center Non- Education Pre- MildJessup Blair Park profit school;Georgia Avenue andBelair Road

Schoolage

Silver Spring, MarylandJU 8-4075

Christ Church Center Non- Education 5-10 Mild;8011 Old Georgetown Road p?ofit Moderate;Bethesda, Maryland Severe

Consultation and GuidanceCenter

Non-profit

Diagnostic 3+ All

1103 Spring StreetSilver Spring,Maryland 20014

38

FacilitySponsor-ship Programs

AgeGrouping

Level ofRetardation

Health Department Servicesfor Retarded and Handl-capped ChildrenPrince George's CountyHealth DepartmentCheverly, MarylandSP 3-1400

Hope Day Care Center6100 South Gate DriveTemple Hills, Maryland

M.A.R.C. Day Center5033 Wilson LaneBethesda, Maryland

Melwood AgriculturalTraining CenterDower House RoadUpper Marlboro, Maryland599-6266

Montgomery County MARCDay Care Center11212 Norris DriveSilver Spring, Maryland949-1464

Montgomery County MARCNursery School forRetarded Children9601 Cedar LaneBethesda, MarylandWH 2-3800

Montgomery CountyPublic Schools850 N. Washington StreetRockville, Maryland

Montgomery CountySheltered Workshop818 Silver Spring AvenueSilver Spring,Maryland 20910

Occupational Training Cen-ter & Workshop of PrinceGeorge's CoUnty Associationfor Retarded Children, Inc.4501 Hamilton StreetHyattsville, MarylandUN 4-1600

Prince George's CountyPublic SchoolsUpper Marlboro, MarYland

Public(County)

Non-profit

Non-profit(Assn.)

Non-profit

Non-profit(Aun.)

Non-profit(Assn.)

Public

Non-... profit

Non-profit(Assn.)

Public

Diagnosis;Evaluation

Day care

Education

Occupa-tionaltraining

Day care

Education

Specialeducation

Shelteredworkshop;Occupationaltraining

ShelteredworkshopOccupationaltraining

Specialeducation

All

3 to 16

14-26

Schoolage;Adult

13 to24 +

Pre-school;Schoolage

.

Schoolage

16 -I-

16+

Schoolage

All

Mild;Moderate;Severe

Mild;Moderate

Mild;Moderate;Severe

Mild;Moderate;Severe

Mild;Moderate;Severe

Educable;Trainable(Elementary)

Mild;Moderate

Mild;Moderate

.

Educable;Triinable(Elementary)

39

FacilitySponsor-'ship Programs

AgeGrouping

Level ofRetardation

Prince George's County Non- Day care 3 to AllRetarded Day Care Cen-ter, Inc.

profit 21

78th and Garrison RoadWest Lanham HillsHyattsville, Maryland .772-1666

School of Hope7212 Gateway Boulevard

Non-profit

Day care 3 to 12 Trainable

District Heights, Maryland

School of Hope for Non- Day care 4 to 14 Severe;Exceptional Children profit TrainableRoute 1Clinton, Maryland

St. Christopher EpiscopalChurch

Non-profit

Day care 21 + Trainable

8001 Annapolis Road .

Lanham, Maryland .

St. Maurice Day School Non- Education School Mild10000 Kentsdale Drive profit agePotomac, Maryland churchAX 9-9423

University of Maryland Public Master'sCollege of Education ( State) (MentalSpecial Education Program Retardation)College Park, Maryland Doctorate; .

(SpecialEducation)*

,

* Concentration in Mental Retardation, Spring, 1966.

. . .

AREA III

Allegany CountyPublic Schools108 Washington StreetCumberland, Maryland

Public Specialeducation

Schoolage

Educable;Trainable(Elementaiy)

..

Diagnostic Eind Advisory : . Public : ...,. Diagnosis; .Pre- Mild;

Serviceslor Handicapped (State) Evaluation school; .Moderate;Children, State HealthDepartment (Mobile

.. ' Schoolage

Severe

Clinic) .

Allegany County HealthDepartmentUnion Street Building111 Union Street .Cumberland, Maryland

40.

Facility .

Sponsor-ship Programs

AgeGrouping

Level ofRetardation

Diagnostic and AdvisoryServices for HandicappedChildren, State HealthDepartment (MobileClinic)Frederick County HealthDepartment12 East Church StreetFrederick, Maryland

Diagnostic and AdvisoryServices for HandicappedChildren, State HealthDepartment (MobileClinic)Garrett County HealthDepartmentMemorial HospitalOakland, Maryland

Frederick CountyPublic Schools115 East Church StreetFrederiek, Maryland

Garrett CountyPublic School's40 South Fourth StreetP. 0. Box 73Oakland, Maryland

Green Street SchoolOakland, Maryland

Hagerstown GoodwillIndustries, Inc.223 North Prospect StreetHagerstown, MarylandRE 3-7330

Jeanne Bussard ShelteredWorkshop101 West SoutbiStreetFrederick, Maryland663-9588

The Kemp Horn TrainingCenter, Center RoadSmithsburg, MarylandRE 9-5530

Potomac Valley FriendsAware of Mentally Retardedand Handicapped ChildrenInc.739 Washington StreetCumberland, Maryland

.

..

-

. Public(State)

Public(State)

Public

Public

Non-profit

. Non-profit

Non-profit

Non-profit

Non-profit .

(Assn.) ;

c.

Diagnosis;_Evaluation

. .

Diagnosis;Evaluation

Specialeducation

Specialeducation

Day care

Occupa-tionaltraining

Shelteredworkshop

Residen-tial

Day care

.. 1

Pre-school;Schoolage

Schoolage

Schoolage

Schoolage

8 to 21

Schoolage;Adult

Schoolage;Adult

All

17 to 21 +

. ,

.

Mild

Mild;Moderate;Severe

Educable;Trainable(Elementary)

EducableTrainable(Elementary)

Trainable

Mild;Moderate

.

Mild;Moderate

All .

.Moderate;Severe

.

FacilitySponsor-ship

Programs AgeGrouping

Level ofRetardation

.Tipahato Propri- Residen- AU All

Blue Ridge Summit etary tialMaryland241-3141

Washington County Public Special School Educable;Public Schools education age TrainableBox 730 (Elementary)Commonwealth AvenueHagerstown, Maryland

_

Benedictine School for Ex-ceptional Children, Inc.Ridge ly, Maryland634-2112

Caroline County PublicSchools, Law BuildingDenton, Maryland

Non-profitchurch

Public

Residentialeducation

Specialeducation

Schoolage

Schoolage

Mild;Moderate

Educable;Trainable(Elementary)

Ceeil CountyDay Care Center

Non-profit

Day care 3 to 12 All

Holly Hall, P. O. Box 572 (State)Elkton, Maryland 21921

Cecil County Public Schools Public Special School Educable;Booth Street Center education age TrainableElkton, Maryland (Elementary)

Diagnostic and Advisory Public Diagnosis; Pre- AllServices for Handicapped (State) Evaluation school;Children, State HealthDepartment (Mobile

Schoolage

Clinic)Cecil County Health Dept.201 Courthouse BuildingElkton, Maryland

Diagnoitic and Advisory Public Diagnosis; Pre- AU

Services for Handicapped (State) Evaluation school;Children, State HealthDepartment (Mobile

Schoolage

Clinic)Wicomico County HealthDepartmentWatson Memorial BuildingWest Locust StreetSalisbury, Maryland

Diagnostic and Advisory Public Diagnosis; Pre- MIServices for Handicapped (State) Evaluation school ;Children, State HealthDepartment (Mobile Clinic)

Schoolage

Worcester County HealthDepartmentSnow Bill, Maryland

FacilitySponsor-ship Programs

AgeGrouping

Level ofRetardation

Diagnostic and Advisory Public Diagnosis; Pre- All

Services for Handicapped (State) Evaluation school;

Children, State HealthDepartment (Mobile Clinic)

Schoolage

Somerset County HealthDepartmentPrincess Anne, Maryland

Dorchester County Public Special School Educable;

Public Schools education age Trainable

403 High Street (Elementary)Cambridge, Maryland

Kent County Public Schools Public Special School Educable;

400 High Street education age TrainableChestertown, Maryland (Elementary)

Queen Anne's County Public Special School Educable;

Public Schools education age Trainable

Centreville, Maryland (Elementary)

Somerset County Public Public Special School Educable;

Schools education age Trainable

Court House Annex (Elementary)Princess Anne, Maryland

Talbot County Public Public Special School Educable;

Schools education age Trainable

P. 0. Box 1029Washington StreetEaston, Maryland

Wicomico County Public Non- Day care 7 to 16 Severe

Schools, Court House profit EducationMain StreetSalisbury, MarylandPI 9-6817

Worcester County Public Public Special School Educable;

Schools, County Service education age TrainableBuilding, Market Street (Elementary)Snow Hill, Maryland

AREA V

Calvert County Public Public Special School Educable;

Schools,Dares Beach Road

education age Trainable(Elementary)

Prince Frederick, Maryland

Charles County Public Public Special School Educable;

Schools, education age Trainable

The Health & EducationBuildingLa Plata, Maryland

43

FacilitySponsor-ship

-.

Programs. Age

GroupingLsvel ofRetardation .

-.,

MARC Day Care Center Non- Day care . . 5 to 21 + Mild;

Shelton Building profit Moderate;

Box 222 (Assn.) Severe

LaPlata, Maryland934-4561

St. Mary's Association forRetarded Children Day CareCenter

Non-profitchurch

Day care All All

St. Peter's Episcopal HallLeonardtown, Maryland

St. Mary's County GroupDay Care Center, Inc.

Non-profit

Day care 5 to 12 All

Patuxent Heights (Assn.)6 Lincoln DriveLexington Park, Maryland862-3461

St. Mary's County Public Special School Educable;Public Schools education a ge TrainableLeonardtown, Maryland (Elementary)

_