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Finally, in talking about the WHO, undoubtedly the greatest challenge to our associations comes from the persons with mental Handicap themselves. After yesterday's exciting program, I do not need to spell out the significance of this self-advocacy movement further. It obviously is much easier for the League to arrange for participation of persons with handicap in a Congress like this, that takes place every four years, than for a long established large city association to work out meaningful participation or collaboration. I use the word collaboration because some of the groups which call themselves PEOPLE FIRST do seek an independent status rather than a formal membership arrangement.

Turning now to the WHAT, to the substance of the work of large city associations, the focal point today as always must be on the individuals with mental handicap and their families. Our new understanding of the developmental process of human growth as the mainspring of our activity presents new challenges. Traditional programming is no longer adequate in the light of a lifelong growth process that needs to be strengthened and supported for the disabled child from birth, and that is open-ended, that is to say, without fixed limitations once accepted as "realistic."

The new emphasis on early intervention has led to a rediscovery of the family. The emphasis is on bringing services for the handicapped infant and very young child to the home. This requires quite a shift in policy for societies that have developed a complex service system which serves the handicapped child away from home.

I am of course aware that there are associations which have done an exemplary job in this respect, but I see my task as pointing up problem areas that need attention and which the International League can help resolve through appropriate symposia, workshops, guidelines, and related materials.

How fast progress is made in our field is well exemplified in the area of early intervention, where we recognize the need of integrated services. Depending on circumstances, that may either be a program for many types of children with handicap, or, indeed, a general child health service.

On the other hand, changes must arise from our increasing understanding of the great importance of creating and reinforcing in young adults with handicap the awareness that they have grown out of childhood and must learn to enjoy their new status (and I should add here, of course, the words "in ways appropriate to their growth process").

To that extent, the comprehensive, all inclusive service complex developed by some of our large city associations needs to be dis-integrated so that adult services can be provided (as they usually are in our communities) separate and apart from those for children. And obviously this raises another and difficult question: What about the adolescent?

I am, of course, aware that large city associations with massive buildings and massive systems may not be numerous, but I do know of enough others which hope for and dream of the day when a benefactor or a new, generous government will enable them to have their own building complex with an extensive and comprehensive service system.

Turning now to the HOW, to procedural problems, the following points seem to be particularly germane to large city societies.

One relates to the style in which the association governs itself. Some of our large city associations have allowed themselves to grow to such proportion that they indeed constitute a major business enterprise, and that persuades them, of course, to hire business executives. Nobody should be surprised that this frequently results in an estrangement between the business managers, with their staffs, and the members -- the parents. In other large city organizations one can observe a similar phenomenon: a highly qualified, properly certified staff, directed by an executive director who is also an outstanding professional. In the course of years this may easily result in a volunteer leadership on the board of directors which becomes so absorbed with professional services and all they entail that they themselves obtain almost professional status. But where, oh where, does that leave the general membership, old or new?

It is by no means a contradiction to emphasize the need for fruitful relationships with the relevant professional groups, because of the already mentioned trend towards integrated services, integrated across disabilities and disciplines. This would imply of course also a greater emphasis on specific fruitful relationships with parent associations representing different fields of handicap.

A major area of procedural and administrative problems relates to the financing. New developments in our field, related both to our much more positive outlook on mental disability and the potential of persons with handicap as well as our recognition of the rights of persons with handicap to respect and to dignity, put into serious question fund raising techniques which, in the past and right into the present, have played on the theme of "pity for the unfortunate" with great financial reward.