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by Dr. Gunnar Dybwad, former Executive Director, National Association for Retarded Children.

An address presented at the 1959 Annual Convention of NARC.

It shall be my purpose here to discuss an outline of some of the changes and developments we need to expect in the residential care of the mentally retarded. Some of these matters may seem far distant from reality in one State, yet may already be partially in the process of establishment in another State. In my constant travels across the county I have opportunity to observe the striking differences in practices between the various States, and this, of course, is as true in Mental Retardation as it is in other fields of human welfare.

I am well aware that in the 20 years of my acquaintance with Mental Retardation institutions tremendous progress has been made, and there is ample reason to recognize the valiant and outstanding efforts of the administration and the staffs of many of them. However, these institutions had suffered the neglect of many decades, and even after such valiant and outstanding efforts we still find, almost universally, quite serious deficiencies.

Institutional care in general is not well accepted these days. Nearly everywhere there are efforts to do away with long established large homes for children and homes for the aged. And so even in the field of mental retardation some people have maintained that as far as the future of State institutions for the mentally retarded is concerned that there is no basis to think of such future since "Institutions are on their way out."

I most strongly disagree with this view. To be sure, we shall see many radical changes in our institutional patterns across the country, but we certainly will not only continue to need, but in my opinion will undoubtedly increase the use of facilities for residential group care of the mentally retarded. But what kind of facilities will be needed for what kind of group care?

As we consider first for whom we shall need these institutions of the future, some will be quick to suggest that present statistics provide the answer: there is a steady trend toward admission of only the more severely retarded individual. This is surely true as of now, but we must consider possible changes the future might bring, and here we might well hope that continued medical progress will substantially decrease the numbers of severely disabled and injured young mentally retarded children who now fill our waiting lists.

Certainly the monumental "perinatal" study currently undertaken at the National Institute for Neurological Diseases and Blindness in conjunction with fifteen medical centers in all parts of the country should direct us to improvements in such medical care.

On the other hand, however, there is good reason to question the belief that in future residential care will be needed only by the most severely retarded and generally handicapped persons. I would venture to put forth a quite contrary view and submit to you a list of other types of cases for whom we shall need and shall develop new types of such care.

To be sure, we shall first of all provide hospital facilities for those so severely handicapped as to require permanent around the clock nursing care. May I plead with you at this point to strike the words "custodial care" from your word book and to discourage their use by others in connection with the mentally retarded. There is nothing wrong with these words themselves, but their appropriate use is in the correctional field as regards prisons and reformatories, where secure custody is indeed a major program point. But what we need in our field for these most severe cases is not custody but nursing care under medical auspices.

Next in line I would put those children who are suffering from a combination of physical and mental handicaps, but who can be helped materially already in infancy by an intensive therapeutic program in a residential setting. Alleviation of the more severe physical debilities in this fashion should make it possible for a substantial number of these children to be cared for in their own families. I realize that this may sound far-fetched and dreamy at a time when in several of our States restrictions are still in force depriving even our high grade children living in the community of the therapeutic and restorative services under the crippled children's programs. But what I suggest here is not just humanitarian and concerned with the inherent rights of these children, but a sound and economical program in the interest of the State as a whole.

Next we come to quite a different program with emphasis on training rather than medical needs. Many severely retarded children age 5, 6 or 7 or thereabouts could profit from an intensive residential educational program over a period of one, two or three years, which would help the youngster sufficiently to return to his home and make a satisfactory adjustment there. I am speaking here of a group of children of whom some are at home while others are under care in institutions, but of whom none are receiving the intensive specialized education nurture which would enable them to make the kind of progress other more fortunate children can make in community classes.