contracted for services with a physical therapy group that repeatedly tola her there was no work available with them and to go into private practice (which she cannot afford to do).

Meanwhile, there is

such a pressing need for her services that she is doing work on a volunteer basis, because "I would rather work for nothing and have it get done than see it not being done at all". A valuable and dedicated professional, in an area that desperately neeus the service, and who "needs the money as much as anyone else", working for love and to keep busy because there is no available space, equipment or money for her.

If you think getting services to families is hard, we have had the devil of a time providing inservice, credited training for our staff, despite the fact that it is an objective in this orogram, with funaing provided for this purpose. Staff morale and self-confidence suffer as a result. The main schools in the area that could offer such training are one or more hours away from centers and staff homes, making it aifficult if not impossible for staff with families and other auties, to attend. Our attempts to go through our local branch of Community College have consistently met with hitch after hitch, resulting in nothing being done about training. Resources in any sort of job or academic training are well-nigh non-existent to either staff or parents in the majority of cases.

Morale is also low because of the consistently shabby way staff have been treated by the CAP agency, their own administrative staff and even sometines by the families they serve. Staff members feel they have no voice in policy or decisions made concerning their program. They have defeatist and pessimistic attitudes because of this. Often they have not been asked to volunteer for certain tasks (such as transporting families and attending evening Low Income

Association meetings) but have been told they must perform or lose These demands precluded staff members having any lives

their jobs. of their own, and involved overtime work for which they were not caid. Staff members have been subject to arbitrary dismissal from their jobs, placed on job probation, to shifts in Job location without prior warning, without knowing if such changes were justified and without chance to dfend themselves. They feel no group, union

or grant clause speaks in their behalf and they are right. They don't even have the benefit of a contract to fall back on. If placea in a threatening position, no matter how unjustified, they make little or no attempt to defend themselves. All this tends to make them hard to work with sometimes, since they are somewhat resistant to change and to put forth any effort other than essentially required. In some cases, this lack of motivation is inherent and persistent, in others due to years of nagging, brow-beating and low self-esteem. Since all center staff members are low-income members of the community (except for University Year for Action students and the coordinators) these people, who have had as little educational ondertunity and chance at jobs as the families they serve, have been shoved around by administrative staff on the Pro and CAP levels and sometimes by other agency staff as well. I find it ironic that in a program dedicated to the low-income family, that staff members are treated this way. I guess these jobs automatically are supposed to raise self-esteem and educational status with no other effort on the part of the program than to provide the job. It seems that staff members are suppose to be so grateful to have these jobs that they should do anything to keep them (including, at one time in the program's history, taking families grocery shopping day or night, any uay of the week). The sad thing is, through fear and not willingness,

they have done anything.

In conclusion, I hope that the Senator agrees that all families and ALL children, regardless of race, creed, color, rarital status, geographic location and socioeconomic level, deserve quality services and quality staff to deliver these services.

I hope this statement gives the Senator some insight into the neeus of rural programs and the families they serve. My staff and I would be happy to talk with you at any time.

Sincerely,

Carver Bishop

Carole Bishob

Center Coordinator

West Charleston Parent-Child Ctr.

RECESS

Senator STAFFORD. The subcommittee will come to order. The Chair is gratified to see that Dr. Marion McKee and Dr. Holmes are both here representing the American Academy of Pediatrics, and we invite the doctors to proceed in whatever order they care.

Panel of Vermont Members of the American Academy of Pediatrics

STATEMENT OF MARION C. MCKEE, M.D., DIRECTOR, MENTAL RETARDATION AND NEUROLOGY PROGRAMS, VERMONT STATE DEPARTMENT OF HEALTH

Dr. McKEE. I appreciate the opportunity, Senator Stafford and members of the committee, to comment on the Child and Family Services Act of 1975 before the Subcommittee on Children and Youth of the United States Senate. My comments will be made as a fellow of the Academy of Pediatrics, but also as well as director of the mental retardation and neurology programs of the Vermont State Department of Health. It is my responsibility not only to see that handicapped children receive adequate, comprehensive and coordinated care, but to seek ways to prevent these conditions.

The scope of this legislation is, indeed, broad and has the potential for great good. And I am particularly pleased that the writers recognize that "the family is the primary and most fundamental influence on children" and that it is the intent of the bill "to build upon and strengthen the role of the family." I think as an aside, too often both medical people and others intervene and attempt to take over and be the family or the parent where we need to work with parents in sometimes many difficult situations.

In a rural State, as well as urban, there are many services currently offered to young children. I think the remarks in this paragraph reiterate what has been said not only by Tom Davis, but many of the other speakers, in the importance of coordinating this act with others and other groups. Head Start, day care, parent action groups, EPSDT, home health agencies, mental health groups, public health nursing services, crippled childrens services, maternal and child health services, et cetera are all doing parts that are incorporated in this bill. And, at the present time, there is some duplication of services and at other times the needs aren't being met. I think there very much needs to be coordination so that all of the services are gotten to the children. I think it is vital that the new agency, if it exists as such, not just start a new program, but be required to know what else exists in a community and then coordinate and cooperate to get a bigger job done better.

I had some concerns and I wondered who would have the responsibility of evaluating the program, its goals, and assessing its successes or failures. Who will have the responsibility to help with changes to insure better programs and to insure good coordination? As I read the bill, I didn't feel that the local child and family service councils could do this. They would be very part-time and would not

have the time nor probably the know how of how to do it, although I am sure they ought to be involved in that process. So, basically, as the other speakers have asked, who is going to be responsible to see that it is done well, that it is done with cooperation and the quality is good?

Because our populations are small, there are areas where perhaps an appropriate percentage would not meet the so-called economically disadvantaged criteria; we have very small percentages of Indian and some of the other minority populations. Because of my own bias in working with handicapped children, I would like to see mildly handicapped children included in this program, even, in some instances, if both parents are not working or economic situations do not warrant it. Perhaps a sliding scale would permit this. These children are a strain upon families because of their constant care, mothers and siblings alike need a break, the children need the education and socialization that could be gained at such a center; and the parents need help and guidance with their rearing.

In Vermont, as in other areas, I am afraid professionals have given parents the idea that they do not know how to raise their own children. This is not true and parents need to be involved more and more in child rearing at home and in the centers. I see in this legislation many good ways of doing this. Under supervision, high school students might learn first hand what good child rearing is all about. I would have one word of caution, however. These centers ought not to be used for the employment of adults with behavioral or emotional problems needing work therapy. In other words, these ought not be rehab centers for people coming out of mental institutions. A child's personality is well formed by age 3 and at least 75 percent by age 5, so those caring for him in his younger years need to be very well balanced, warm, well integrated people, regardless of their socio-economic standing.

Again, because our population is scattered, these centers ought to be broad enough to include school age children after school, perhaps during vacations or for summer programs. And where there is need, they ought to augment not only educational but recreational, social and medical needs. Again, a plea for those whose income just misses the "economically deprived" and actually become much more deprived than those so designated.

We in the health department, and I am speaking primarily of the handicapped children services, give direct comprehensive service for certain problems, regardless of the ability to pay. We do not feel we can discriminate when other services are not available on a private basis. Those families who can, do provide a measure of payment where possible. In this program I see certain similarities. The Child and Family Services Act could be a major service agency, perhaps coordinating and contracting with other agencies for other parts of the total service. However, to do this, the financial standards would have to be slightly different than set up in the bill, or perhaps the definition of "handicap" could include not necessarily the child's handicap but perhaps maternal emotional illness or maternal mental retardation, as well as the handicap within the child himself, so that the child might be able to receive services because the parents were unable or needed help to give these services.