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Encouragement of Healthy Controversy. Vigorous exchanges of viewpoints, and the airing of far-out concepts, new and old, appear to be an important medium of change. Thus, disagreement over practices and policies should be encouraged rather than inhibited. Such controversy should be encouraged even if it may be at times painful, unpleasant, or embarassing; the field has been much too apt to be concerned with the feelings of the administrators of institutions rather than with the feelings of the inhabitants. The American Association on Mental Deficiency in particular owes it to its professed objectives to enter actively into the many controversies which have been raised in recent years and to use the pages of its journals to reflect these issues. When institutional mismanagement, brutality, and indolence occur newspaper exposes perform an essential public service; however, of necessity they are "shot from the hip," and therefore all the more the profession should discuss in its journals the vital issues concerning practices in administration, rehabilitation, and therapy which are put into question through these "explosive" situations.

By the same token, institutions should actively seek the establishment of study and review committees, rather than having investigations and reforms thrust upon them. Such committees can be established to concern themselves both with the institution as a whole as well as with specific departments or activities, as suggested by Blatt.

Governmental Study. A mechanism of which the present book is a manifestation is government study, both on the national and the state level. Such study on a long-term basis is likely to have very salutary effects on the field. Already the federal government has made a vital contribution with its sponsorship of the President's Panel on Mental Retardation and the President's Committee on Mental Retardation, and its support of a nationwide effort for statewide comprehensive mental retardation studies. However, the very comprehensiveness of these studies on the one hand, and on the other, their coverage of only one state at a time, constituted a severe limitation. What is needed are studies jointly sponsored by the federal government and a number of states which will analyze, on a comparative basis, certain acknowledged problem areas in the field of residential services for the mentally retarded, leading to meaningful recommendations which relate to the reality encountered in the studies.

On a national level, relatively narrow but important areas within the broader scope of the subject matter might be singled out for study. For example, the President's Committee could sponsor the development of a handbook on normalization, spelling out in as much detail as possible, normalizing features of services and buildings.

Change in Governmental Granting Practices. The government can do much more than appoint study groups. It can give new directions by exercising greater discrimination in its granting practices. Federal legislation is needed which not merely encourages new service patterns but discourages continuation of the old ones. If the federal government will undertake the kinds of study suggested above, there would be increased likelihood that Congress would make it possible for government agencies to award grants more selectively. Thus, grants could be awarded to institutions that have shown evidence of their willingness to change, rather than to make awards in the hope that these will lead to change. Those states could be given priority which are actively supporting dispersal and integration of residential services, rather than states which continue to enlarge existing large institutions, or which place new residential facilities in remote locations .

Parents of Retarded Children as Change Agents. Aside from brief references in the chapters by Bank-Mikkelsen, Grunewald, and Klaber, relatively little has been said in this volume on the role and functioning of parents of retarded children in the field in general and in residential services in particular. Yet the official record will show that in Denmark, in Sweden, and also in Connecticut the associations of the parents of the mentally retarded not only played a most significant supportive role in the development of the service models described in this book but entered into the preceding conceptualization and social engineering in a very decisive way.

There are many other examples from the international scene showing parent associations as effective change agents. In the United States, the National Association for Retarded Children (NARC), with its research fund and distinguished research advisory board, contributed substantially to a change in scientists' view of this field as a legitimate and worthwhile area for scientific inquiry. From Canada, the Ontario Association for Retarded Children mobilized international interests in the special physical training needs of mentally retarded children and adolescents. In Western Australia, it was the parent associations which introduced a specialized clinic for the study of the mentally retarded in a setting since taken over by the state. In England, the National Society for the Mentally Handicapped contributed substantially to a change in service concepts for the severely retarded by the establishment of a national training center and hostel at Slough and of vacation and short-stay homes. Finally, in a symposium held in Stockholm in 1967, the International League of Societies for the Mentally Handicapped developed new formulations of the individual rights of the mentally retarded which have been recognized widely as the forerunner of a whole new conceptualization in the field of mental retardation, underpinning the broader concept of normalization.