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The concept of specialization also will play a role in site selection, at least in regard to certain facilities, for instance, centers serving individuals with acute medical and health problems call for location in desirable proximity to a medical center; a center "serving children of school age should be so located that the children have an opportunity to attend special classes in a public school; a behavior-shaping oriented center should be near a college, a university, or a similar source of psychological manpower.

Some Principles for Building Design

The traditional mental retardation institution was and to a considerable extent still is being built in a fashion that might be characterized as "from the outside in," determined by such factors as the size and shape of the land available, the number of people to be accommodated in the most economical size of buildings, and the most efficient distribution of buildings on the available land, taking into consideration length of steam tunnels, required electric cables, factors pertaining to food preparation and distribution, etc. After due consideration of all these factors, plans are designed for the most economical use of the building, and eventually one arrives at the space allocated to individuals and groups. And although the prescribed minimum square or cubic footage has been provided, the result (as has been amply described in this volume) is inadequate.

If we are to move to an architectural application of human management principles, then, of course, it will become necessary to reverse the process, and to plan the building "from the inside out" (Dybwad, 1967). First consideration will be given to the space that is to be set aside as the personal territory of the resident: his bed; his bedside table; the place for his clothes and other belongings; room for the table, and for a chair if he is to have one in his room; and, of course, determination of whether he is to share his room with others. From this most personal territory, consideration would then move to the living space he would share in common with others, such as space for leisure, dining, hobbies, sanitary facilities, cloak rooms, and storage space, keeping in mind the total group that is to live in this unit, whether six, eight, or ten, but hopefully not more. Having thus outlined the resident's intimate personal sphere as well as his immediate group sphere, the next determination would be, with due consideration of such factors as age, degree of handicap, etc., whether, in what fashion, and with how many other units this first unit may be joined.

The next consideration would then be how this larger constellation will be related to the surrounding community. There is no need to go into architectural details here.

Group Homes in the Community

A very important part in the residential human management service will be played by small group residences in the community such as hostels for young men and women in vocational training, in sheltered workshops, or in open employment; group homes for children who cannot live at home but for whom foster home placement is not, or at least not yet, indicated; aged retarded men and women who are not in need of a nursing home; and a variety of temporary or transitional group homes. Some local authorities in some countries, particularly in New Zealand and Australia, have rushed into construction of hostels and other group homes with rather disappointing results; in order to make construction "worthwhile," the homes were usually built for too large a number of residents, and the design carried all the earmarks of institutional construction. Furthermore, in order to obtain land, the location was often disadvantageous, but once the land was secured, there was the temptation to erect other structures on it, and thus the workshop was just a stone's throw from the group home which adjoined the day care center.

Experience has shown that it is far more preferable to rent, lease, or buy existing residential structures which can be adapted to group home living, and Sweden has successfully pioneered in demonstrating the feasibility of using one or two apartments in an apartment house as a hosteltype group residence for mentally retarded adults.

The Old Institution: Renovate or Discard?

One of the many obstacles to the development of dispersed, specialized residential services has been the existence of the large traditional multipurpose institutions. A common argument is that these institutions cannot be "abandoned," and that in our efforts to improve the services to the retarded in the community by means of either residential or nonresidential services we cannot neglect the welfare of those retardates already in our institutions. Consistent with this are those who advocate massive financial investment in the existing institutions in order to bring the physical facilities and programs to what are considered acceptable standards.

Examination of some hard facts, however, reveals rather unequivocally that such a course of action is at best ill advised, and at worst unfeasible, and a poor service to the residents now housed in such institutions.