.MTM3Mg.MTM3Mg

Community Council of' the Atlanta Area inc~ newsletter Eu gene T. Branch, Chairman of the Board Duane W. Beck, Executive Director 1000 Glenn Building, Atlanta, Georgia 30303 Telephone (404) 577-2250 mrnOMPHIHIISIVE AHIAIIDI HIAllH PlANNING PHOUCI Raphael 8 . Levine, Ph.D. Director Alloys F. Branton, M.BA. Associate Director VOLUME I Cynthia R. Montague, Editor June, 1°969 IN THE BEGINNING-THE LAW Public Law 89-749 is cited as the "Comprehensive Health Planning and Public Health Services Amendments of 1966", and declares the following to be its findings and declaration of purpose. Sec. 2 (a) The Congress declares that fulfillment of our national purpose depends on promoting and assuring the highest level of health attainable for every person, in an environment which contributes positively to healthful individual and family living; that attainment of this goal depends on an effective partnership, involving close intergovernmental collaboration, official and voluntary efforts, and participation of individuals and organizations; that Federal financial assistance must be directed to support the marshalling of all health resources-national, state and local-to assure comprehensive health services of high quality for every person , but without interference with existing patterns of professional practice of medicine, dentistry, and related healing arts . (b) To carry out such purpose , and recognizing the changing character of health problems, the Congress finds that comprehensive planning for health services , health man power, and health facilities is essential at every level of government ; that desirable administration requires strengthening the leadership and capacities of state health agencies ; and that support of health services provided people in their communities should be broadened and made more flexible . NUMBER I The Partnership for Health Law requires that such planning be done with people rather than for people. Therefore , maximum participation of health "consumers", health professional s, governmental units and agencies, and other community organizations is a necessity. The law is telling the states and communities that they will be given increasing responsibility and power to determine their own best health interests, and that the current Federal practice of funding health-related projects through specific project-type grants will phase into a system of "block" grants to the states for use as local emphasis requires . Eventually, on ly communities which have organized themselves for comprehensive health planning may be eligible to receive Federal support. Ide as of excellence need corresponding institutions; the Comprehensive Areawide Health Planning Project is an example of such an idea. Such ideas need feet and so the pioneering march has begun towards healthful social change of a magnit ude never before undertaken . THE CONVENORS THE SALUBRIOUS WIND STOCKING OF CHANGE Vision of social and health planners of the Community Council of the Atlanta Area, Inc. (CCAA), made it possible for the Atlanta metropolitan area to be the first area in Georgia to receive an " organizational grant" for the purpose of defining and developing an agency which will be capable of doing comprehensive health planning and obtaining broad community support and participation in the planning effort . This grant, from the United States Public Health Service, through the Georgia Office of Comprehensive Health Planning, supports the CCAA in the professional and organizational effort necessary to instigate such an organization . Eu gene T. Branch, Chairman, Dr. Rob ert E. Wells, Chairman, Gilbert R . Campbell , Jr., Board of Directors, Communi t y Area Joint Hea lth Profession als Ch airman, Met ropo litan Council of the Atlanta Area, In c. Commit1ee on Comprehensive Area Council of Chambers Health Pl anning of Commerce The term " comprehensive" means that every aspect of the hea th landscape in the six-count y metropolitan area must be taken into account in the planning process. This includes not only the treatment of illness and injury but the prevention of same as well as compensation for any lasting effects received. In addition to the manifold activities of medical and paramedical personnel in the variety of health treatment facilities, planning must consider environme ntal controls of air, water , soil, fo od , disease vectors, housing codes and construction , and waste disposal. Needs for tra ining of health personnel , fo r improvement of manpower and facili ties utilizat ion, and for access to health care must be considered . The fields of mental health , dental health , and A necessary step in the organization al devel opment of the Comprehensive Are a wid e Health Planning Project was the convening of a large "Community Involvement Panel", to which approximately 170 representatives of agencies , organizations, and governmental units were invited·. In order to indicate the brea dth of concern for healt h planning in this commun ity , three major groups collaborated in issuing the invitation, and hence, became the "convenors" of the Panel. Shown are the chief officers (left to right) of the t hree groups: Eugene T. Branch , Chairman of t he Board of Directors , Community Council of the Atlanta Area, Inc .: Dr. Robert E. Wells, Chai rman of the Arca Joint Health: Professionals Committee on Comprehensive Health Pla nning Gilbert rPh".lhi i it!lfinn c:-hA11 l rf hP inf"l 11 n t1rl Tho-ro ..,_., (" . R l,.,.,.. ,..,..., ... ,..,.. ....... ,, i... ,-.. u t +1... c. rQm n ho11 Tr r'h .... ; .. ._,,,," ,...f th.n AA.ot .-r. n n l; +.-.n A .. " .. "' - -··· ,.. : I , ... f �DIRECTOR'S REPORT organi za tion , and (2) to devise an organiza ti onal structure for such opera ti on, including corpora te ident ity, policy Council , and the means of selecting the Council and writing its by-laws. Two of the activities undertaken in this field are (a) identification of community interest and decision groups involved in health activities , and holding literally scores of meetings with them ; and (b) working out the detailed plans for permanent agency and obtaining accept ance and endorsement of them by importan t groups in the community : governments , health officials and consumers' groups. Raphael B. Levine, Ph .D. On Thursday, June 5th, the long process of "community involvement" came to a successful climax, when the new "Metropolitan Atlanta Council for Health" met for the first time , and formally accepted the responsibility for guiding the destinies of comprehensive health planning in this six-county metropolitan area. The membership of the Council represents in the truest sense the "partnershi p for health" concept which is the basis of Federal support of comprehensive health planning. Local governments, major planning agencies, health providers, health consumers, public and private medicine, voluntary health agencies, poor and middle class , black and white , are all present on the Council . Moreover , they were selected for Council membership in the spirit of today's participatory democracy, rather than being appointed by a select body. I am enormously pleased with the caliber of this body of citizens, who will be making policy decisions on health matters for this community. I am convinced that , although they come from many different walks of life , they will function as the 18th Century Statesman, Edmund Burke , expected of the British Parliament : "Parliament is not a congress of ambassadors from different and hostile interests, which in te rests each must maintain , as an agent and an advocate, against other agents and advocates ; but Parliament is a deliberative assembly of one nation , with one interest , that of the whole-where not local purposes, not local prejudices , ought to · guide, but the general good, resulting from the general reason of the whole . You choose a member , indeed ; but when you have chosen him, he is not a member of Bristol, but he is a member of Parliament." ORGAN IZAT IONAL EFFORT The work during this organizational year has fallen into two major fields : (A) identification of the technical aspects of community health planning, and (B) development of an organization or agency capable of carrying out comprehensive health planning on a perma nent basis . A. Technical Aspects The principal technical objectives of this project are (1) to identify the community's principal health problems, and the probable, most urgent planning efforts which will have to be undertaken by the permanent organization during its first year of existence- 1970 ; and (2) to specify the numbers and qualifications of the technical staff who will be needed to carry out such planning. Two of the numerous activities undertaken by the staff and volunteers which bear on these objectives are (a) developing a "systems approach" in planning for the health field , involving cost-benefit analyses, and the building of community health " systems models", etc.; and (b) the use of volunteer "task forces" to identify and scope healt h problems through descriptions of problem areas, trends , reso urces, obstacles, and suggested solutions to the problems. A great deal of thanks is due to these hundreds of volunteers , both health professionals and other concerned citizens, for their efforts, expertise, and insights into the health picture of this community. B. Organizational Development The principal organizational objectives of the project are (I) to ..l ... ...... 11'1"111 ti...,.. 1,. ____ ..... _ - - - !l_ l _ ..] _____ _ J: -- -- ··- = ··· :_.,. . . 1...... _...__ ,. =- COBB COUNTY HEALTH ADVISORY COUNCIL ESTABLISHED In tune with the Comprehensive Areawide Health Planning concept , the Cobb County Health Advisory Council was recently born . The infa nt Council has the charge of determining the county's health needs in order of priority and how such needs should be met. Mr. William Thompson, Administrator for the Cobb Health Department, and Chairman of the newly formed Council has cited four areas of concern : service , manpower, fin ances, and facilit ies. The idea of such Health Advisory Councils grew out of the Partnership for Health Legislation of 1966 which established a program of providing matching funds to help communities obtain needed health services and facilities. Says Dr. Raphael B. Levine , Director of the Metropolitan Atlanta Comprehensive Areawide Health Planning Project, "Citizen participation in health planning at the local level as well as the metropolitan level is essential to a successful community-wide effort. It is most encouraging that the Cobb County Health Advisory Council has been formed" , he concluded. BACKGROUND-Dr. Raphael B. Levine Dr. Raphael B. Levine was educated at the University of Minnesota. There he received a Bachelors and Masters degree in Physics and a doctorate in biophysics . His recent professional work has consisted of developing "intelligent " computors which can learn to recogni ze patterns of behavior in complex systems (biological or physical). Some of his previous research activities concerned man's reaction to physical and emotional stresses of atmos pheric and space flight , as well as the electrical activity of the heart and brain. He has taught and done research at the University of Minnesota, the University of Illinois, and Ohio State University . Since 1958, he has been managing and performing research in t he Human Factors Laboratory and the Systems Sciences Resea rch Laboratory of the Lockhee d-Georgia Company . In 1968, he became the consultant to and then t he Director of the Comprehensive Areawide Health Plan ning Project for Metropolitan Atlanta under the Community Council of the Atlanta Area , Inc. He is currently serving as President of the Planned Parenthood Association of the Atlanta Area. BACKGROUND-Alloys F. Branton, Jr. Alloys F. Branton , Jr., was educated at the University of Minnesota where he received a Bachelor of Arts Degree, and at the University of Chicago where he received a Masters Degree in Hospital Administration. He was Health Division Secreta ry of the Co uncil of social Agencies of Greater New Haven, Inc., New Haven, Connecticut. Next , he served as a Health Consultant to the Community Health and Welfare Council of Hennepin County, Inc., Minneapolis, Minnesota . He came to Atlanta as Assistant Director of the Hospital and Health Planning Department, Community founcil of the Atlanta Area , Inc . He is now Associate Director of t he Comprehensive Areawide Health Planning Project. He also has an _appointment as adjunct faculty member Course in Hospital Arl.-n;n;c-trt'l+;nn C',..hnn.l Af' D,.. ,.. ;.,..,..,..,.. A~ --: .... : ... ..... ... ,._ ; ...,_... r, ,.. #, - - ! ... c, .._ ... ,,._ �Community Council of' the Atlanta. Area inc. newsl Eu gene T. Branch, Chairman of the Board Duane W. Beck, Executive Director 1000 Gl enn Building, Atlanta, Georgia 30303 Tel eph on e (404) 577- 22 50 t COMPREHENSIVEAREAWIDE HEAllH PlANNING PROJECT Raphael B. Levine, Ph.D. Director VOLUME I Cynthia R. Montague, Editor Alloys F. Branton, M.B.A. Associate Director November, 1969 MACHEAL TH NOMINATING AND PERSONNEL COMMITTEES Two very important committees were selected at the October meeting of MACHealth by nomination an d vote of the membership. The Nominating Committee will propose a slate of officers for the first Annual Meeting and election in January. The work of those officers will , to a great extent, determine the success of MACHealth in its first full year. Another duty of the Nomina ting Committee will be that of selecting organizat ions who will name members to MACHealth in subsequent years. This will be done by collecting and evalua ting a list of eligi ble groups in categories to b e represented . A fair rotation and equal representa tion will be achieve d in this way. The Personnel Committee will select and recommend to the Council a candidate for Director of the Agency. It wi ll also set personnel policies for the MACHealth staff. Members newly elected are: Nominating Committee Hon. L. Howard Atherton, Mayor of Marietta. He is also President , Georgia Municipal Association, member of the Georgia House of Representatives, Chairman of Metropolitan Atlanta Council of Local Governments . He has been a tireless supporter of MACHealth since its early inception. Mr. A. B. Padgett, Chairman Pro Tern of MACHealth. A Trust Officer of the Trust Company of Georgia, Mr. Padgett is on the Executive Boar d of the Community Council and was Chairman of the Steering Committee for the Comprehensive Health Planning Project. Dr. Robert E. Wells, Chairman of the Board , Fulton County Medical Society. He is an orthopedic surgeon , and directed the Joint Health Professionals Committee for Comprehensive Health Planning, as well as participating on the Executive Committee of the early Steering Committee. The Rev. Ervin B. Broughton, member of the Governing Board, Gwinnett County E.O .A. A retired Baptist minister, Rev. Broughton still pastors two churches, is a Mason and President of his Lodge , and works in his community for improved social conditions . He is a li felong resident of Lawrencevill e . NUMBER VI MRS. ELIZABETH C. MOONEY Vivacious Mrs. Elizabeth C. Mooney is a member of MACHealth. She was appoin ted to the MACHealth Board by Economic Opportunity Atlanta to represent the poor and near-poor. She resides in the Antoine Graves Homes, is secretary of the local Citizens Neighborhood Advisory Council (CNAC), an d a memb er of the Atlanta EOA Health Committee . Despite the absence of her larynx, she manages t o speak quite audibly and eloquently whether she is conversing with ~~' '"",...., Senator Russell in Washington about the _._,.__,_,,,·."" 1 welfare freeze o r passing the time of day wit h someone on the street in Atlanta .

it;t;~li:.,:;._.....,.J Mrs. Mooney , a retired nurse , has stood

th e test of surviva l for 64 years an d is still going strong. She has battled a heart condition, cancer, dia betes an d low bl oo d pressure ; she triumphs almost weekly over debilitative conditions of a more epheme ra l nature such as eye trouble and toe infections. Mrs . Moo ney's hobby is working with peo ple . She is always there , giving of herself; sometimes in the form of a fl ower arrangement which she has de signed with her _own hands , at other times, simply utt ering com fo rting wo rds from the heart. Mrs . Elizabeth C. Mooney-humanitarian, friend Memorial Hospita l, valuable member of MACHealt h . of Gra dy CONTRIBUTIONS FOR 1969 EFFORTS RECEIVED We acknowledge with thanks the recent contribution of the Clayton County Commission of $2280 toward the current year's operations of the Comprehensive Health Planning Project. We are also pleased to repo rt that the Gwrnnett County Comm ission has appropriated $1748 for the same pur pose. These amo unts, added to previous receip ts fr o m Fult on , DeKalb , a nd Do uglas counties , plus gifts from private sources, have made possible the work of the project to date . Such loca l fund s have served to " match " equal dollar amounts fr om the U. S. Department o f Hea lth , Education , and Welfar e . Personnel Committee Hon. Walter M. Mitchell , Chairman, Fulton Co unty Boa rd of Commissioners and Executive Committee member of the Steering Committee. Mr. Drew R. Fuller, Chairman , Health and Health Services Commi ttee Atlan ta Chamber of Commerce. He was also on the Steeri;g Co mmittee's Executive Co mmittee and has devoted much time a nd effort to t he o rgani zati o n and success of MACHea lt h . Mr. J. William Pinkston , Jr. , Ad ministra to r , Grad y Hos pital. He MENTAL HEAL TH HOUSE BI LL NO. 1 Frank Adams Smith In 195 8, th e Genera l Asse mbl y made a majo r revisi o n in the law relating to hospitali zin g the me nta ll y ill , acco rding to recomme ndatio ns of t he Joint Sena te-Ho use Menta l Hea lth Committee, chaired by Peyto n Hawes . Oth er min or revisio ns we re made in 1960 a nd 1964. In 1969 , ano th er majo r revisio n , Ho use Bill I . was ena c ted. has given ma ny ho urs in service t o the co nce pt of Comprehensive Hea lth Planning a nd in furt herin g its su ppo rt. In the 1969 Act , th e procedu re fo r Volun tary Admission and t he judi cial pro ce dures fo r Involu ntary Adm issi o n are sub sta ntiall y the sa me as in th e c urre nt law. Mrs . Loretta Barnes , Secretary Pro Tern of MACHealth. Her yeo man se rvice to t he Co uncil has been evide nt fro m t he start , an d is unselfis hl y given in additi o n to her wo rk fo r th e Interdenom inationa l Theo logica l Se minary a nd as a b usy mo the r. Whil e t he pro tectio n o f " rig hts o f the pat ient" was a predom inant chara cteristi c or the 1958 Ac t and of ucceeding Acts. t he 1969 Law e xte nds a nd broa dens this protect ion. Mr. Pau l Cadenhead, la wycr in privat~ pra ctice. president -elect . Allan ta Bar Association, past president o f · o t h At Ian ta Me11tal Hcaltll Association and Georg ia Associa tion for Men ta l Hea lt h . Th e 196 9 Act provides for emergency care up to 24 l1 o urs. and fo r cvaluati o11 and intensive Lrcatmcnt up tu 5 days: a nd li mit s further hosp ita lizatinn tl1 an initial six months. Addit iona l lw spi l:tl it.a tion can b.:- warrant.:-d unly b~ thorough .:-xaminatin n �\ of the patient indicating such need and by the authorization of the Court of Ordinary. The patient, his attorney, guardian or representatives , if they desire, can request a hearing. Emergency care, evaluation and treatment for a period of 5 days, and limitation of hospitalization, have not been provided in any prior law. Emergency care and evaluation plus short-term intensive treatment should prevent at least 50% of the patients now going to Central State Hospital from having to go there. The limitation to six months of the initial order for hospitalization forevermore bans the "putting away for life" of any mentally ill person. The philosophy of the 1969 law, simply stated, is that the mentally ill are in fact "ill" and should be treated as sick people and should have immediate and intensive care and treatment. This philosophy is identical with the philosophy of comprehensive mental health services enunciated by Congress in 1963. The metropolitan Atlanta area is fortunate in having a Regional Hospital which will be both an Emergency Facility and an Evaluation Facility. Also Grady Memorial Hospital is now performing the functions of an Emergency and Evaluation Facility. The governing authority of each county can choose between the "medical procedure," which is outlined in the new law, and the "judicial procedure" which is essentially the same as in the current law. No formal action is necessary for a county to operate under the "medical procedure" of H.B. I, but formal resolution by the governing authority is necessary to function under the "judicial procedure." Such action can be taken only once a year. \vrn thousand of these volumes, a\ d be surprised if the demand for copies is any less than this number. MACHealth is continuing to re·cei~e recognition from additional important age ncies: governments, medical professional associations, hospitals, voluntary organizations, and the like. Since June, some I 3 such agencies have added their recognition to the 45 who had done so by that date. The list now covers nearly all of the important health action agencies, as well as many of those concerned with matters closely related to health. MORE AIR CURRENTS Four people active in MACHealth affairs have recently been seen on the area television media: Mr. A . B. Padgett and Dr. Raphael B. Levine were seen on separate programs on Channel 11 in the series produced by the Urban Life Center of the Georgia State University . Mr. Duane W. Beck was a recent guest on the Ruth Kent 'Today in Georgia" show, speaking about the Community Council of the Atlanta Area. Mr. Louis Newmark was interviewed by Linda Faye on Channel 11 in connection with a session of the State Conference on Aging of which he was chairman entitled "Involvement of Older People in the Community. " The appearances of Dr. Levine on Pat Wilson's "Tempo Atlanta" show (Channel 36) began , and are scheduled to continue with a monthly ap pearance at 11 :30 A.M. on the fo urth Thursday of each month hereafter. ENVIRONMENTAL HEALTH TOUR In every step of the "medical procedure," the patient and representatives are notified of his right to an attorney, which the county must provide, if the patient is unable to pay for such services. The patient , his representatives and attorney are notified of patient's right to judicial intervention at any time they think his rights are abrogated . The Environmental Health Tour as presented in the August , 1969, Newsletter will be held on Thursday, November 13 , 1969. Notices with further details will be sent to all MACHealth members before that time. The sections of the law relating to "rights of patient" became effective June I , 1969. The remainder of the law becomes effective January I , 1970. MACHEALTH MEETING DAY CHANGED Quote How can we get more participation in solving environmental health problems? By encouraging community leaders to come to the Health De partment and o ther agencies to learn all they can abou t the environmental hea lth needs and then to approach the governmental officials in quest of meeting these needs. The MACHealth meeting day has been changed by action of the Council to the second Thursday of each month. This was done in order fo avoid a conflict with the Executive Committee of the Community Council of the Atlanta Area , Inc., which meets the first a nd third Thursday of each month . MRS. KATHARINE B. CRAWFORD-Trothplighted Cliffo rd Alexander , Environmental Health Planner DIRECTOR'S REPORT '.~ Raphael 8 . Levine, Ph.D . At the October meeting of MACHealth , the Council voted , a fter a spirited discussion , to approve the changes in language dealing with the responsibilities and influence of the new agency. A large maj orjty of the memb.ers agreed with t he committee a ppointed to negotiate the wording, that the new language fairl-y states the role of MACHealth in the health affairs o f the six-coun ty area. Several of the members felt , however , that MACHealth should play an even mo re infl uential role than indicated . I believe that all of the MACHealth staff an d Council members wan t this new age ncy to be just as effective as possible, since the needs fo r comprehensive planning were never greater than at present . In fact , MACHealth has already bee n able to influence rather strongly so me very important issues in the hospital and n ursing home field , and the Council's power of review of all locally-o rigi nated action projects in the health field will continue to work toward a trul y comprehensive , truly areawide kind of health planning. With the new wording approved , the staff was ab le to enter the final stage of revising o ur pro posal for fundin g by the Federal Department of Health . Educa tion , a nd Welfare . When completed , the pro posal wi ll be published in a single binding. alt hough the division into three volumes (projec t summary . b udge t a nd staff. and task force re purts ) will continue. We ex pect to print about u Compr e hensive Are awi d e H ea lth Planning's Organization Liaison, Miss Katharine B. Crawford, has left the organization to become the bride of Dr. Marvin D. Smith. The bride and groom will reside in Gadsden , Alabama where he h as es tablished a practice in Ophthalmology. Miss Crawford has made a tremendous c ontrib u t i on to the efforts of Comprehensive Health Planning and her presence will be missed by her friends and co-workers. The best life has to offer is wished fo r her and Dr. Smith. BACKGROUND-William F. Thompson-Consultant A hardwork ing member fo r MACHealth is William F . T hompson , Admin istrative Officer of the Cobb County Health Department. He fin ished secondary school at Young Harris Academy , going on to Piedmont College for a Bachelor of Arts Degree in mathemat ics and educa tio n. He was awarded a National Science Fo undation Scholarship to Washington Uni versity and received his Master's Degree in Public Health Administration from the University o f North Carolina . He has been a tub e r c ul os is inve ti ga to r; Di rec tor. Me di cal Self Help Program ; and :rn instru cto r in the Medi ·al Col leg uf Georgia , Gradua te Nur ing Division . Suppor!, d ,n oa,: by ArrJ,SidP Comprchens,vc H •alth f'lann,ng GrJ'1l No 41008-01 69 under,, t,on J l~(h) ot PublK Liv, 89 >~9 �E1J Gr..:r-1E CEC I r. BRANCH . C/wir111ru; vf tlu lfr1a1tl o! T>i1,:1.·1< 1rJ ALEX/'\ND.ER . , ,..CL' CJ;:,irn:ut1 ,JO_H N IZA RD . l"i<·i: Ch ~irm:;n MRS . T HOMAS H. Gl0 S ON. St·cri:1ar.•· D ON AL D H. GAREJ S , 7 rc•a Htrt.T D UANE \I'/. BECK. O NE TM OUSA O G l..E:NN BU ! L OI G , 120 MAR I ETTA S . , N . Vv . E\ ecu!i'-'t' Director ATL ANTA; GEORGI~ 30303 E L EF'HONE 577 - 2250 June 2, 1969 Hon. Ivan Allen, Jr. Mayor of Atlanta City Hall At lanta, Georgia 30303 ' Dear Mayor Allen: This is to inform you of activity taking plac.: since my earlier let te r to you on the subject of your membership on the new Metropolitan Atl anta Council for Health. There ha s been a slight chan~P in the meet ing time of the Council be.c ause of room assignment confli.c ·c . The fj ~ :i.. m ~ ti:,g of the Coun cil will be this Thursday at 11: cl CJ .~ • M. , i1:1 ·room ':;J9 of t he Glenn Building, 120 Marietta Street, N. W., Atlanta, Georgia. · The principal business of thif Council meeting will be to d~-~,:·:s s and -app~ove -the proposal to be submitted to the U.S. Public Health Servi ce, and to certify that the- Coun0 i l accepts responsijility for the policy aspects of comprehe·nsive areawide heal th planning in this metropolitan· community , beginning in J anu ary .1970. Addi tional business will be to discuss and approve Council By-Laws , . and to approve a prog ram of activities for the balance of 1969 . · These are recommende d to include (1) meetings, seminars, and f~e ld trips for f amiliarization of Council members with health problems of the communi ty and the types· of action the Coun cil can take; (2) the naming of a Personne l Committee for the purpose of . selection of a Director of Comprehensive Areawide Health Planning and the recruiting o f s ~aff prior to the beginning of operatiohs in January 1970; and (3) the naming of a Nominating _Committee for presenting a slate of permanent · officers to the firs t Annual Meeting in January, 197 0, Enclosed_ with this l etter are Volumes I and III~ of the Proposal, as they now exist. Additional material is still -coming in, but the pages you have before_ you include all of the vital material .on which y our approval is being asked . Volurrie II · of the Proposal cont ains d e tailed budgetary material, and will be cove r ed at the me eting . I would like to -invite your a t t e ntion · especially to . the follow~ng pages in Volume I: i - ii, 2-3, 8-9, 1 6-17 , 48-49 , 54-55; 64-65, 88-89, 90-91, 92 -93 , 96-97, 9 8-99, and the . By-Laws 100-107. Please read as· much of the_ other material as you may have time for.

.,._·.\

�ATLANTA METROPOLITAN AREA COMPREHENSIVE HEALTH PLANNING PROPOSAL VOLUME III TASK FORCE REPORTS

.....

Submitted by METROPOLITAN ATLANTA COUNCIL OF LOCAL GOVERNMENTS 20 June 1969 �This is an incomplete edition of VOLUME III, PROPOSAL FOR COMPREHENSIVE HEALTH PLANNING Other work is in process of completion. �TABLE OF CONTENTS Task Force Responsible Staff Member Manpower Mrs. Frances Curtiss, Chairman Manpower Shortages in Allied Health Professions Branton Home Health Care Edw~n C. Evans, M. D., Chairman Health Pr0blems Compounded with Socio-Economic Problems Mrs. Ella Mae Brayboy, Dr. F. W. Dowda, Chm. Maternal and Child Health, Family Planning Dr. Conrad, Chairman Better Mental Health for the Atlanta Area James A. Alford, M. D., Chairman Control of Air, Water Pollution and Waste Disposal Bernard H. Palay, M. D., Chairman Roberts 6 Bush 8 2 4 Levine 10 Smith 12 Alexander 14 Proctor Creek - Case Study of Multiple-Impact Health Hazards Otis W. Smith, M. D., Chairman Alexander 16 Public Health - Budgets 1 Boundaries and Personnel Wm. F. Thompson, Chairman Vector Control Mrs. Helen Tate ·, Chairman Emergency Health Services - The Systems Approach Dr. George Wren, Chairman Thompson 18 Alexander 20 Alexander 22 Prevention of Accidents Mr. Max Ulrich, Chairman Alexander 24 Medical and Dental Service/Information and Referral Dr. Robert Wells, Chairman Bush 26 Alcohol and Drug Abuse Mr. Bruce Herrin, Chairman Balancing the Costs of Health Care Smith 28 Bush 30 Bush 32 Suicide Prevention - Crisis Intervention W. J. Powell, Ph.D., Chairman Smith 34 Mental Retardation Program Needs Mr. G. Thomas Graf, Chairman Smith 36 Parks and Recreation Alexander 38 Rehabilitation Branton 40 Environmental Effects on Social and Economic Processes Mr. Clifton Bailey, Chairman Alexander 42 Environmental Effects on Mental Health Mrs . Faye Goldberg, Chairman Alexander 44 Mrs. Harriet Bush, Chairman Coordination of Planners Mrs. Harriet Bush, Chairman Mieczyslaw Peszczynski, M. D., Chairman �Table of Contents, Cont'd. Task Force Responsible Staff Member Home Sanitation Mrs. Helen Tate, Chairman Food Service Program Mr. a: DeHart, Chairman Alexander 46 Alexander 48 �FOREWORD TO VOLUME III The descriptive reports in this volume represent the efforts of some 27 "task forces" organized to assist the comprehensive health planning staff in identifying the Atlanta area's health problems in sufficient detail to project the scope of the first year of effort by the permanent planning staff. Several hundreds of area citizens, both health providers and health consumers contibuted their time, expertise, and insights in the preparation of these reports. Although in many cases, the task force reports were quite detailed and voluminous, all have been condensed for inclusion in this volume. The points of view expressed in these reports are those of the task forces themselves, and their recommendations deal with the specific problem areas, rather than with the total community health situation. As input to the total planning process, these are valuable documents, and the staff expresses great appreciation to the task force chairmen and members. i �Manpower Shorlage in Allied Health Professions SUMMARY: EXISTING VACANCIES WILL INCREASE ALARMINGLY WITH POPULATION GROWTH UNLESS MORE INDIVIDUALS ARE ATTRACTED AND RETAINED. THESE PROFESSIONS SHOULD BE UPGRADED AND PUBLICI ZED; EDUCATIONAL OPPORTUNITIES SHOULD BE DEVELOPED, AND TRAINING PROGRAMS COULD USE FINANCIAL SUPPORT. SYSTEMATIC EVALUATION OF EXISTING AND FUTURE NEEDS AND RESOURCES SHOULD BE DETERMINED AND UTILIZED AS THE BASIS FOR A COMPREHENSIVE EFFORT TO CORRECT THESE DEFICIENCIES. Problem: Demand grows faster than supply. Why? --While existing vacancies are distressing, --Population increases create new n eeds; --Public and professional awareness of these professions is minimum; --Required education (B.A. or corresponding degree) is not within the financial reach of many ; --Professional dedication is exacting; Y E T VOCATIONAL BENEFITS, CAREER OPPORTUNITIES AND PRESTIGE are inadequate. --Training programs are still in the development stage in Georgia; --Communication and coordination needed to unite all related health care groups behind a study and solution of this problem is lacking; --Funds to develop programs, sponsor students; for research and patient care are not available. --Accurate assessment of all needs - present and future, has not been made. Resources: There are clinical, medical, rehabilitation facilities which prov ide practical training, and while the number is increasing, further expansion will be necessary. One graduate and two undergraduate programs in Allied Health Professions are presently under development, but these will require time to grow and graduate trained individuals. Even these, however, cannot fulfill the number or variety of available positions. Solutions : Undertake systematic analysis of the entire problem to serve as a realistic basis for planning and corrective action. Provide financial support, develop career incentives, arouse public / professional interest in and for these professions . Develop transportation and communication networks in all areas: patients, employers, health professionals, institutional, organizations and associations, public and private agencies. Empahsize broad health service rather than: crisis oriented care . Improve and expand hospital and rehabilitation facilities to assist in training and improve use of present personne.l. Mount an aggressive campaign to recruit and retain - even recall existing personnel. - 4 - �111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 NUMI3ER OF. RE GISTERED ALLIED PROFESSIONAL PERSONNEL IN GEORGIA AND I N THE •. - .• • - • .. 1_..~ . • '·:· ./6 •• .,, • •• - ATLANTA METROPOLITAN AREA ~ ~ Georgia Metropolitan Area 4, 000_, 0 0 0 4 - - - - - - - - - - Population-------• l, 300,000 1 3 5 • - - - - - - - - -· Physical Therapists----+75 9,092 (3, 267)i..a....---• N u r s e s - - - - - - - - - , . 3 , 865 40•----------occupational Therapists---•-~19 1,0004---------•Social Se rvice-------•500 (100 students included) 175~~----------speech Pathologists----~-~75Jtl,. J:t,. (inactive) Jtl,.(public schools included) (1, 477/J �Home Health Care SUMMARY: THE PAUCITY OF HOME HEALTH SERVICES IN THE ATLANTA AREA LEAVES MANY PATIENTS WITHOUT NEEDED CARE, CREATES SERIOUS BOTTLENECKS IN INSTITUTIONS, AND LIMITS PHYSICIANS IN THEIR CHOICES OF SETTINGS WHERE PATIENTS CAN RECEIVE ADEQUATE CARE. THE ANSWER LIES IN THE AMALGAMATION OF ALL PROVIDER AGENCIES. Text Outline: i( We DO have: • duplication, fragmentation, and threats of further proliferation; • increasing service needs due to upward trends in population growth, longevity, institutional costs and manpower shortages; • seven agencies serving fewer than half of the patients who need services; • obvious gaps in services to the sick and disabled at home; • fairly adequate services for protecting the general community health; and • interest and concern for better coordination, primarily due to activity under- special projects over the past three years. i( We DO NOT have: • a central coordinating and research unit; • the most efficient, economical, and effective utilization of our limited supply of personnel; • whole-hearted cooperation and trust among agencies, institutions, other providers, and consumers; • insurance exchange to provide payment for home care in lieu of hospital care; • a structure to provide central information, liaison, and easy access to care; • designated responsibility for the expansion and development of _comprehensive personal care services at home; and • a well balanced range of services. i( Specific charge to comprehensive health planning: • Long Range: • Immediate: agressive action to amalgamate all agency providers of home health services; and central coordination and establishment of research and education programs in home health services. - 6 - �.... no maUer how strort.j ,_ Do Nor MRkE II OHi/ii{ ! Jkparafe /..i,r_k.s tfe llrLRNT//. !IR.Eli l(eeds a. cAairi o/ lt.6me lt~alt/i services A l.Lnifecl. Jlome liealtli Serv/ces ./lgenEY - 7 - �Meeting Health Problems Compounded with Socio-Economic Problems SUMMARY : THE POOR AND DISADVANTAGED SUFFER INEQUITIES IN HEALTH LEVELS AND CARE TINDER EXISTING INSUFFICIENT, INCONSISTENT .AND UNCOORDINATED ARRANGEMENTS WHI CH ALSO -DO NOT CONSIDER THE ALMOST INSEPARABLE SOCIAL, ECONOMIC AND CULTURAL PROBLEMS. A SYSTEM BASED ON IMPROVING LIVING CONDITIONS, HEALTH EDUCATION, AND CITIZEN PARTICIPATION WOULD PRODUCE MORE PERMANENT RESULTS WHILE MORE EFFECTIVELY UT_ILIZING PUBLIC FUNDS. Problem: Poor sanitation, inadequate and improper diet invite and perpetuate heal~h problems. The under and improper use of health services and resources lend to the seriousness and aggravation of health services and problems. Quality of housing and overcrowding are related to certain diseases, accidents, and mental disorders. All of these primary social and physical conditions are characteristic of the economic poor. Health care tends to be piecemeal, poorly supervised, and uncoordinated. Current Resources: Public Health Department programs, services, facilities Federal outlays of $465,453,901 in 1968 (HEW, HUD, OEO) Charity hospital with more than one thousand beds Local and State Government contributions Over twenty health-cent~red voluntary agencies Solution: A health centered approach to these problems should: • plan together with other social institutions, programs, and movements to develop adequate and safe living conditions in the areas of homelife, housing and neighborhood, transportation, health and general education, business and industry, legal arrangements, health resources, etc.; and • encourage the development and improvement of medical resources and programs to meet technological, organizational, cultural, geographical, numerical considerations of what our society needs. Trends: Indications are that as things go, "the sick get poorer and the poor get sicker." In turn, it is their voice which is s~ldom heard and f r equentl y not interpreted into programs designed for them. - 8 - �T PROBLEMS IDENTIFIED FOR COMPREHENSIVE HFALTH PIANNING BY A SAMPLE OF LOW-INCOME RESIDENTS Problem --- Meeting County Present 0 2 3 4 6 7 8 9 10 G F G F F F F F T A F L 5 8 18 6 8 6~ 1 24 15 10 HFALTH .o Knowledge of Services Trash, litter, refuse Emergency Care Discrimination at Hospital Insufficient Personnel Inadequate Services D D {{ A {t D D D D D D D D 2 1 {t

2

{t D D D. ~ Sewage 3 3 D Garbage and Rats Limitation of Charitr Care .Special Envioronmental Need Health Problems 4 1 [{{ {t D D D D 3 I~ Total

3 HFALTH REIA TED Finances Transportation

Garbage Service

Code Enforcement Housing Stre-et Lighting Fire Hydrants HousekeeEing: Mental Releasee Employment Health Related Problems Total All Problems Total G=Gwinnett County F=Fulton County I' D D

o

2 !{I D D D {{ D D D {( ·3 {( 4 {{ {( {( D D 3 3 0. a 1 Di .. D . . ~ ~ O .=mild l concern "t(=high concern Problem Indicators: ATLANTA (SMSA), 1960: Overall: Familie s with income under $3,001 Unsound housing units In Depressed areas: Families with income under $3,001 Persons per residential acre Non-wh ite: Percent of total population Median income Median years of education 21% 19% 52% 58 23% $3,033.00 7.6 �Title: Better Mental Health for the Atlanta Area SUMMARY: MENTAL HEALTH PROBLEMS GENERALLY ARE CAUSED BY STRESSES AND STRAINS ON PERSONS AND ARE DUE TO ENVIRONMENTAL PHYSICAL, SOCIAL, ECONOMIC, EDUCATIONAL AND OTHER FACTORS. ONE OUT OF TEN PERSONS COULD BENEFIT BY RECEIVING SOME FORM OF MENTAL HEALTH SERVICES. BUSINESS AND INDUSTRY SUFFER HEAVY LOSSES FROM THE IMPACT OF MENTAL ILLNESS ON EMPLOYEES AND THEIR FAMILIES. SURVIVAL OF OUR DEMOCRATIC INSTITUTIONS IN THIS HIGH ENERGY NUCLEAR AGE MAY WELL DEPEND ON MOBILIZING THE RESOURCES OF EVERY COMMUNITY TO FIGHT AND PREVENT MENTAL DIS- . ORDERS AND TO PROMOTE POSITIVE MENTAL HEALTH. Problem: 130,000 inhabitants of the metropolitan area (10% of population) could lead happier more effective lives if they had the benefit of modern mental health services. Ten percent ·of school children have handicapping emotional and psychological problems. need help towards self-realization. These children Heavy loss by business and industry in the metropolitan area due to impact of emotional and psychological disturbance on worker and family, can be drastically reduced by a comprehensive system of modern mental health services. Greater involvement of general hospitals, physicians, and psychiatrists is essential to proper development of mental health programs. Insurance coverage not yet adequate. More MANPOWER must be made available; better use should be made of present personnel and new sources of manpower explored. Mental health services must be brought to the people rather than administered for the convenience of the "establishment". Full developme nt of comprehensive community mental health centers in the ATLANTA AREA is a TOP PRIORITY. Total resources of every coITll!lunity should be mobilized to treat and rehabilitate victims of mental illness, to PREVENT mental disorders, and to produce a climate conducive to better mental health for all. Physicians could and should be first line of defense against mental illness, but their medical training has not prepared them for this role, The outpatient clinics, as a rule, are severely understaffed. A crucial barrier to the developing mental health program is lack of trained personnel. Current Status: No general hospital in the Atlanta Area accepts patients who are mentally ill. Exceptions: Emory University operates a ps ychiatric unit of twenty beds for patients selected for teaching purposes; and Grady Memorial Hospital has a psychiatric unit of thirty-six beds for emergency short-term patients. The public schools' staff, while improving in number and qualifications, is still inadequate. The State Retardation Center is under construction. Psychiatric units as components of comprehensive connnuniry mental health centers are under construction, as follows: Clayton County Hospital (25 beds); DeKalb General Hospita l (44 beds) ; and Norths i de Hospital, Fulton County (25 beds). There are four private psychiatric hospitals in the Atlanta Area (SMSA). The State Re gional Hospital (Atlanta) has been constructed and is being activated to ser ve fourteen counties. The State of Georgia has built the Georgia Mental Health Institute for the primary purpose of "training and r esearch" . Possible Solutions : The fu ll development of at le a st ten proposed comprehensive community mental health center s i n the Atlanta Are a will alleviate for the present many of the problems when they become oper ational. Mor e MANPOWER must be made available , better use should be made of pre sent per sonnel and new sources of manpower should be explored . Tota l rel i a nce mus t not be placed on hospitals, c linics, or mental heal t h pr ofe ssiona ls t o do t he "job" of dealing with menta l health pr ob l ems ; but r ather every resour ce in the community, such a s the schoo l s , the churche s , the court s , t he heal t h and welfa r e agenci es , et c . , should be fu se d with and oriented in ba si c principl es of ment al heal t h, t hat ea ch will be a pos itive f orce that will hel p cre a t e a climate conducive to be tter mental he a l th for a l l. �COMPREHENSIVE COMMUNITY MENTAL HEALTH PROGRAM ........ ........ ........ ........ ,, ,,,, ,, ,,,, . .... . ,, ,, ,, COMMUNITY HEALTH SERVICES ,,,, ,, ,,,, ,,' ,,' ,, . ...... .......... ........ .......... �Control of air, wate~ pollution and waste disposal vital to Atlanta Area future. SUMMARY: THE CONSERVATION OF ENVIRONME.NTAL RESOURCES OF AIR AND WATER AND THE RELATED CONTROL OF WASTE DISPOSAL ARE FUNDAMENTAL CONTRIBUTORS TO HEALTHFUL LIVING. IN THE ATLANTA METROPOLITAN AREA THE CRITICAL .PROBLEM IS ONE OF AREAWIDE PLANNING AND IMPLEMENTATION IN TERMS OF PRESENT AND PROJECTED POPULATION NEEDS. Problem: Present water resources will be adequate for future needs only if handled properly on a planned basis. Waste water, solid waste, and air pollution are compounding problems as a result of lack of overall planning and coordination among governmental bodies. Pollution of rivers and streams threatens health, recreation and wildlife. Automobile graveyards, rodent-infested litter and dump areas illustrate to the observer an increasing solid waste problem, Air quality control is insufficient for future needs as projected. Resources: Local govermnents and governmental agencies, collaborating organizations, University projects (especially the Comprehensive Urban Studies Program of Georgia State College), and planning agencies have sufficient resources to creatively deal with the problem, given funds and re~ponsibility. Solutions: Dissemination to governments and others of the exhaustive study prepared for · Atlanta Region Metropolitan Planning Commission, and implementation of its reconmiendations. Increased coordination of those concerned with the problem and able to enforce recommendations. Conscious, deliberate effort at connnunicating extent and import of the problem to the public. Recruitment of volunteers for active support. Regulations for usage and control developed and enforced. = 14 - �PROGRESS TOWARD PROVISION OF ...:•:••:·-::-:·.···

·-:-.:•.;.

............ ................. •:•·~~:::.-.·. .... ······:::. ........ .·.. : ..:. :·.·:..:

-:-·:.:::.•.·:.·

.............. ....... ·····.... .....·...... ...... ........

.....

-::

 ::=:-:-.

·.........

·::.;:::·=::

100 -.,., 0 .... ., 80 CD ., -. .... -.., -. - Q >- .A Q

............

...-..-..~=::: ::: : -a .., -a > V'I C 0 u -a

=:-:-:•:::-:::

.:..............

 ::.:: ~·-:.·. ·.·. ~::

-:::,:•::·.·:.......

-:;:::-:-:•;

···.- .. ~~·. 60 .. C 0

,

C. 0 A. -.,"' ADEQUATE SEWAGE TREATMENT IN GEORGIA . "' C

t

--. -., ..,.., -.,. ... .... 0 40 .c V') V') 0 C ~ CD POLLUTED STREAMS C I- 20 u A. 0 1-1 -65 1-1-66 1-1-67 DATE LEGEND Q Adequate Treatment Sewers, No Treatment ~ Inadequate Treatment Not on Sewerage POLLUTED AIR 1-1-68 �Proctor Creek - Case Study of a Multiple-Impact Health Hazard SUMMARY: PERIODIC FLOODING OF PROCTOR CREEK, A HIGHLY POLLUTED WATERWAY IN SUBURBAN ATLANTA, RESULTS IN CONTAMINATION, DROWNINGS, INCREASE IN NUMBER OF PESTS, DESTRUCTION AND LOSS OF PROPERTY. REDUCTION IN POLLUTION AND FLOOD LEVELS MUST BE SOUGHT TO IMPROVE OVERALL CONDITIONS IN THE NEIGHBORHOOD, Problem: ftn area involving 1200 residences and 6000 families encounters the following problems as direct result of pollution and flooding of the creek: Seven drownings in six years. Illnesses directly related to pollution. Sewage backup and overflow conditions in homes. Uninhabitable basements resulting from constant sewage backup. Severe, oppressive odors. Proliferation of pests, insects, rats. Property erosion, damaged building foundations, loss of large articles in floods. Fire hazard from oil and other flammable materials in creek. Current Resources: Georgia Water Quality Control Board, Public Works Department of Atlanta, the Corps of Engineers, and area industrial plants. Solutions: Alternative plans and detailed study of cost alternatives and benefits will be necessary for improvements of the creek and adjacent areas. Possibilities include: Channel improvements, floodwalls, enclosure, zoning restrictions. Controlled access to prevent drownings. Clean stream beds and banks of unsightly and hazardous objects that block stream flow. Separation of s~nitary and storm sewers. Make area adjoining stream part of a lineroe regional park. Evacuate residents and fill creek. Indict companies contributing to pollution. - 16 - �~ . -· -. . SOLID WASTE . .. HOUSEHOLDS NOT CONNECTED TO PUBLIC WATER O.Jper c en t Atlanta Connected [J 153,696 441 Not Connected • SEWAGE outside Atla nta DeKalb Co. Cobb Co. t/!~~'l.r.!/;, LJ60,523 CJ28,102 [2] 26,124 E ]10,41s [ ] 7,974 • • • 2,5i8 4,425 Clayton Co. Gwinnett Co 6,194 • 2,449 .4,770 ' HOUSEHOLDS NOT CONNECTED TO PUBLIC SEWERS AIR POLLUTION 11 pe r cent 38 per cent Atlanta Connected . 137,182 Not Connected. 16,955 DeKa lb Co. •••• Cobb Co. Fulton Co. Clayton Co. Gwinnett Co......,.....,._,.,. ~ Atlanta ~ 39,223 . 14,587 ~ ~ 18,332 . 4,116 . 2,384 - 2 3,818 • 18,540 13,986 .8,748 • 10,360 ~ ~Atlanta OPEN SEWERS t • �PROBLEMS OF PROCTOR CREEK

.

ODOR PROBLEM SOLID WASTE DISPOSAL ~ SOIL EROSION DROWNING ~ FLOOD PROBLEM t �Public Health, Budgets, Boundaries and Personnel SUMMARY: THE NUMBER OF PERSONS TREATED WITHIN PUBLIC HEALTH SERVICES, ALMOST WITHOUT EXCEPTION, IS DIRECTLY RELATED.TO THE COUNT OF MANPOWER, FACILITIES, AND POPULATION OF A GEOGRAPHICAL AREA RATHER THAN TO COMMUNITY HEALTH. OF COURSE, THIS IS A CONVENIENT ARRANGEMENT OF OUR MARKET ECONOMY AND JURISDICTIONAL SUBDIVISIONS. IF SERVICES WERE BASED ON MORE EXTENSIVE INVESTIGATION AND DOCUMENTATION OF HEALTH NEEDS RATHER THAN A CAPACITY TO PROVIDE SERVICES, PRESENT RESOURCES AND EFFORTS COULD BE MORE EFFECTIVE. Problem: Programs in Public Health are dependent upon both county and state funds and budgeting policies. While these policies do take into account health needs and demands, they are directly affected by grant-in-aid formula. As grant-in-aid monies are received on a local level, local directors are required to decide on where local (matching) money, furnished by the county governments, will be spent. A thorough analysis of community consumer needs has not been developed. It is patently impossible for the same individual to both operate and objectively evaluate program areas. Confining program operations along county lines has adversely affected certain state health programs. Reciprocity is provided for and is even discouraged by budgets. A planning agency could: Broaden the voice of decision in programs to include lay, governmental, and professional consumers as well as providers. Share the burden of public health officials in allocation decisions. Extend planning and establish communication across county lines in such programs as water and air control, industrial hygiene, sanitation, etc . - 18 - �r Tit le: Emergency Heal th S.e_rvices - The Systems Approach SUMMARY: PRESENT EMERGENCY HEALTH SERVICES DEPEND UPON DECISIONS OF MANY INDEPENDENT LOCAL AUTHORITIES. LACK OF COORDINATION AND COMMUNICATION, AS WELL AS LACK OF INFORMATION ON WHAT CARE IS AVAILABLE AND HOW TO UTILIZE IT RESULT IN OMISSIONS, DUPLICATIONS AND-DISSERVICE TO THE PUBLIC. Problem: There is much adequate emergency health care being planned and provided (especially for disaster and mass casualty) but uncoordinated efforts' are resulting in dynamic deficiencies: NEEDS Unfulfilled in some vital areas Inadequate numbers quality distribution STAFFING FACILITIES SERVICES Incomplete Restricted Part-time INFORMATION Fragmented in-service and to the public who oft en most need to know TRAINING Insufficient for public s e l f-help or s ervice personnel needs TRANSPORTATION Dangerous clogged urban corridors delay help / cause accidents FINANCING Marginal and l e ss i n urban areas COMMUNICATION Infre quent between the private ana public power struc t ures most i nvolve d in health s ervi ces PLANNING Duplications & Omissions uncoor dinated efforts of all 6-county area groups; emergency he alth programs; reluctant public and professiona l acceptance of new methods Unimag inative and often tardy to some classe s .death follows no clock Needed : One comprehensive system administe r e d by one community-wide representative agency. Solution: The Syste ms Approach: The involvement of all health-concerned institutions, organizations -- including governmental units and off i cials, both legislative and executive under the experienced guidance of hea lth profess ionals . The .Goal: One central agency, one overa ll plan, to provide total, adequat e emergency health services and c are throughout the community. Obji.ctives :

Increase staffing and facilities

Provide adequ ate ambul ance serv ice

Tra in the public in first - aid and me dical self-help

Establish hospital affiliate d neighborhood heal t h care centers

Initiate two - way radio communi cation between hospitals, fire,

police, hospitals, and other emergency care units

Hold actual disaster and mass casualty exercises

�EMERGENCY SERVICES 1960 1970 1980 1990 2000 4,000,000 .. .© 3,ooo,oooa-----t----+---+--....,..• § ~ ! 2,000,000.-----+----+-,-·'· ~ & •••• J( --··MORE PEOPLE ...... 1,000;000 0 t Total Population; Atlanta Five-County Source: Atlanta Region Metropolitan Planning Commission Emergency Health Services in the Atlanta Area??? Health care is divided into a number of - categories. One of the most important of these is emergency health care. The following: Hospital emergency room care Emergency care in physicians' offices Emergency care in .neighborhood health centers Emergency care in industrial situations First aid training of the public Accident prevention Ambulance services Marking of evacuation routes Helicopter evacuation and landing fycilities Emergency psychiatric and acute alcoholic care Poison control and poison control centers Blood banks Communications between institutions and organizations providing emergency health care Public information on sources of emergency health care Education and continuing education of personnel prov iding emergency health care Disaster and mass casualty reception are not emphasized and organized in the Atlanta area . �Prevention of Accidents Can Significantly Reduce Area Toll of Deaths and Injuries SUMMARY: ACCIDENTS CONSTITUTE A MAJOR HEALTH PROBLEM, RESULTING IN STAGGERING ECONOMIC AND MANPOWER LOSSES. PUBLIC APATHY, THE MOST IMPORTANT OBSTACLE TO PREVENTION, MAY BE OVERCOME BY WELL PLANNED USE OF RESOURCES AVAILABLE IN VOLUNTARY SAFETY CONTROL, LEGISLATION, IMPROVED COMMUNICATION FOR EDUCATIONAL PURPOSES, AND PLANNING FOR BETTER SAFETY PHYSICAL FEATURES IN THE MOVEMENT OF PEDESTRIANS AND VEHICLES. Problem: An ever-increasing flow of traffic has led to more and more collisions, injuries, and deaths. Nearly 50% of hospital beds are occupied by accident victims. National figures indicate annual economic losses in 132 million days bed-disability, 94 million days work loss, 11 million days school loss, 22 million hospital bed days, and a total estimated cost of 12 billion dollars. Home, traffic, and other accidents are most often incurred by those least able financially and socially to bear the burden. This may chiefly be the result of compounded difficulties -- poor education, hazardous environment, low income. Current Status: Mortality statistics indicate the problem has reached epidemic proportions. Accidents are the leading cause of death to persons under the age of 44, and rank fourth as cause of death in all ages, following heart disease, cancer, and stroke. Obstacles: A major challenge is that of changing the viewpoint of those who still think of accidents as uncontrollable events. Public apathy exists, in this more than any major area, largely as a result of ineffective communication between experts and lay people. Indicative of this is fear of loss of personal freedom when strict preventive legislation is propo·s ed. Solutions: 1. Increased cooperation between safety councils, legislators, and mass media for planning and communication. 2. Increased use and standardization of drivers education in schools and defensive drivers courses in adult organization. 3. Increased financial support for safety-involved organizat i ons. 4. Research into human behavior aspects of safety/accident pr oblems . 5. Better street and highway design in the Atlanta Ar ea . 6. Elimination of unnecessary roads and streets in order to provide for better pedestrian and vehicle movement. 7. Planned program of railroad, street and pedestrian "grade separation " in the Atlanta area. 8. Institution of a streetlighting program. - 24 - �MAJOR FACTS ABOUT ACCIDENTAL INJURIES AND DEATHS-1968 (Statistics provided by: Epidemiology and Surveillance Branch Division of Accident Prevention,State of Georgia) Following are estimates of the annual toll of accidents for the United States: Persons killed Persons killed motor vehicle Persons injured Persons .. injured,moving motor vehicle Persons bed-disabled by injury Persons receiving medical care for injuries Persons hospitalized by injuries Days of restricted activity Days of bed-disability Days of work loss Days of school loss Hospital bed-days Hospital beds required for treatment Hospital personnel required for treatment Annual cost of accidents Annual cost of accidental injuries 112 thousand 53 thousand 52 million over 3 million 11 million 45 million 2 million 512 million 132 million 90 million 11 million 22 million 65 thousand 88 thousand $16 billion $10 billion It is estimated that the prevalence of physical impairments caused by injuries in the non-institutionalized population of the United States is over 11 million. �Medical and Dental Service/Information and Referral SUMMARY: INFORMATION ON THE HEALTH SERVICE NETWORK IN THIS AREA IS FRAGMENTED AND UNCOORDINATED. REFERRAL PROCEDURES LACK STANDARDIZATION. CHANGING POPULATION AND INDUSTRIAL CHARACTERISTICS SUGGEST RE-APPRAISAL OF CURRENT AREAS OF CARE CONCENTRATION AND COORDINATION. MANY OF THE CAUSAL FACTORS ARE BEYOND THE CONTROL OR EVEN THE PURVIEW OF THE PRACTITIONER. A CENTRAL PLANNING AGENCY COULD GATHER, MAINTAIN AND DISSEMINATE THE INFORMATION BOTH CARE PROVIDERS AND USERS NEED. Problem: Direct health care involves doctors, dentists, other health workers, hospitals, health centers, associations, programs and community organizations. The patient enters the system at any point, in highly varied states of health, wealth, intelligence and experience. Both parties suffer strain and are inefficiently serviced due, in part, to incomplete, haphazard information and referral systems. Atlanta Has: Health characteristics that are frequently below National par, consistently below those of Northeast metropolitan areas, but that rate favorably with other parts of the South. Population increases and related rising health service demands that are offsetting past numerical gains in medical personnel, facilities and agencies. Aggravated problems of age, youth and working women arising from rapid urbanization and industrial growth. Complex administrative, educational and personnel procedures resulting from complicated Federal programs and financing. One large hospital supplying ~uality care to a vast but limited number of indigent sick of two counties. Patients needing some types of care cannot be adequately treated, and even normal sicknesses exceed the plant's capacity. Medical societies and voluntary agencies making outstanding efforts in community health planning and implementation for several but incomplete areas. Atlanta Needs: Formal communication between demand s and provisions of services. Increased and more efficient use of existing personnel and facilities. Broader and more intense coverage of community health problems . 26 �SELECTED CHARACTERI8TICS OF METRO ATLANTA WHICH AFFECT MEDICAL SERVIr,Rs Characteristic

More older persons More younger persons Urbanization and industrialization Special groups Affluence Poverty Congestion Suburbanization Formal groups· Mobility Work shifts Working females Primary iffect on Medical Car~ s~rvices ~---------------------------------------Domicillary and extended care, treatm~nt f~~ soecial diseases and impairments, third-party payment Treatment for infectious diseases, i'.ncluding venereal disease, accidents, impairments, handicaps, maternal and child care. Special deliveries of care (migrants, veterans, etc.) Greater quantity and quality of care. Public provision of care. Epidemiological control. Geographical redistribution. Special interests, Fragmented care. Full time availability. Convenience, special diseases. Organization and Bureaucratization Federalization Medical centers, schools special institutions Third-party payment, insurance, prepayment Public programs and financing Personnel demands Technological advancement Development of medical science Greater expectations from public mediums of broader communication 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 - 27 - �Title: Alcohol and Drug Abuse - Causes Human Suffering SUMMARY: RECOGNIZED AS THIRD LARGEST HEALTH PROBLEM, BUT CHARACTERIZED BY NEGLECT, STIGMA AND REJECTION. PUNITIVE REACTION TO PROBLEM MUST YIELD TO A CONSTRUCTIVE APPROACH OF ASSISTING THE PERSON TO RECOUP AND REGROUP HIS PSYCHOLOGICAL RESOURCES FOR A MORE ADEQUATE RESPONSE TO LIFE'S RESPONSIBILITIES AND OPPORTUNITIES. Problem: Atlanta area (SMSA) leads nation in rate of arrests for public intoxication. Largest market in world for bootleg whiskey. Area has est imated 50,000 victims of alcoholism. $5 million expepded annually for local care of victims of alcoholism and their families . $12 ~illion annual loss t o local industry due to alcoholism; absenteeism, accidents, lowered efficiency, etc. Human suffering due to alcoholism cannot be estimated. General Hospita~s · of area reluc t ant to accept victims of alcoholism as patients. Ditto doctors. No facilities for treatment of drug addicts. Current Re sources: Are limited in scope. The Georgian Clinic division of the Georgia Mental Health Institute and limited pr ivate programs, serve the entire state population. This service is incidenta l to the institute 's r e s ea rch and training mission. The Emory University Vocational Re habilitation Alcohol project which has served the chronic court offender alcoholic will probably be discontinued due to expiration of a three-year federal gr_ant program. The Ge orgia Division of Voca tional Rehabilitation provides limited rehabilitation services for alcoholics. A s tart has been made in the Atlan ta Region (SMSA) towa rd preventing alcohol drug abuses through inte grating services for individuals with the plans for comprehensive community men t al health programs. Treatment, care and rehabilitation of victims of alcoholism a nd persons addicted to drugs mus t be incorporated in the serv·ices of the proposed compre hensive mental health centers of the area, including some a~jacent counties. Additional reliable da ta is needed on the extent, nature and scope of the local problems of a lcohol and drug abuse on a basis upon which to plan effective and innovative programs for prevention, control, treatment and rehabilitation of alcohol and drug abuse. ~ Changing attitudes and concerns of communities by information, education and consultation. ~ More effective enforcement of drug l aws and regulation of drugs. Trends: Since most authorities and federal of ficia ls embrace the vie\v that alcohol and drug addiction is a problem of living and probably symptomatic of an emotional illness that should be treated (a non-criminal circumstance) it logically appears that newly developing programs associated with community mental health centers will evolve as well as a thrust toward improving conditions in deprived neighborhoods where addiction is most common. Goals a nd Objectives: The Georgia Legislature has expressly recognized alcoholism as a disease and declared it to be a public health problem with administrative responsibility for alcoholic rehabilitation given directly to the Division of Mental Health of the State Department of Public Health and indirectly to the County Boards of Health and Public Health Departments. Comprehensive programs for a lcohol and drug abusers can be developed in conjunction with or as an integral part of comprehensive mental health programs. The range of services that will be provided by the community mental hea lth programs are very nearly the range of services required for dea ling with alcohol and drug problems. The goals of these programs and services will be: (1) improved he alth and prevention of disease; (2) separation of the alcohol and drug abuser from alcohol and drugs; (3) repairing the physical and emotional damage and preventing further damage; (4) changing community institutions , programs and services to meet the special needs of the alcohol and drug abuser. While federal funds will be helpful in launching programs, state and local governments cannot presently rely upon federa l funds for long-range support, although such continued federal support may well represent the only hope for programs for the alcohol and drug abuser in Georgia, �DRUNKS · DON'T BE~O NG . DRUG AB_USE· The Empty Life - 29 - �Balancing the Costs of Health Care SUMMARY: THE COSTS OF MEDICAL CARE ARE RISING SHARPLY,- EVEN MORE THAN THE COST OF LIVING. ILLNESS, DISABILITY AND PREMATURE DEATHS CREATE DISPARATE COSTS BOTH DIRECT AND INDIRECT - TO FAMILIES ACCORDING TO CIRCUMSTANCES WHICH THEY CANNOT APPRECIABLY CONTROL: INCOME AND OCCUPATION, TYPE OF DISEASE AND TREA 'IMENT. Problem: The costs of health make it prohibitive to some families and ultimately contributes to poorer health and additional costs to the community. CU,Xrent Status: 1. 2. 3, 4. 5. Federal assistance is directed to special groups of persons: Aged, maternal and infant, indigent, etc. Federal programs are developed around certain diseases and disabilities: Crippled children, tuberculosis, blindness, cancer, venereal disease, etc. Middle-income groups use physicians' services at a lower annual rate than other income groups. Certain businesses and industries promote health and coverage from debilitating health expenses. The costs of health insurance rises with the cost of medical care, especially hospital rates. Possible Solutions: The rising cost of health may be stabilized and the entire community brought into its purview within an area plan which can: 1. 2. 3. 4. 5. Review the eligibility requirements of tax-supported health services. Reduce the demand on rare skills by providing information and referral services to providers and consumers. Recommend the wider inclusion of extra-hospital services in insurance policies. Promote the assembling of complex equipment , professional skills and services to provide for extensive, continuous, non-domicilary treatment . Encourage architectural and organizational modernization in hospitals . - 30 - �NUMBER OF DISAB ILITY DAYS* PER PERSON PER YEAR BY FAMILY INCOME, TYPE OF DISABILITY AND AGE In the United Sl1t11, July 1966-Jun, 1987 THE OF COSTS BEING Under All Incomes•• $3,000 UNHEALTHY $3,000· 4,999 $5,0006,999 $7,0009,999 12.3 $10,000 and over RESTRICTED ACTIVITY All ages Under 17 years 17 • 24 years 25 • 44 years 45 • 64 years 65 years and over 15.4 9.6 9.6 13.8 21.4 35.2 27.6 9.2 12.8 24.8 43.5 39.8 16.3 9.f 9.8 17.0 25.5 29.2 13.7 11.9 9.0 14.1 18.0 36.2 34.8 11.9 · 10.1 7.9 11 .3 14.8 29.0 BED DISABILITY All ages Under 17 yeari 17 • 24 years 25 • 44 years 45 • 64 years ~ years and over 5.6 4.3 · 4.1 4.8 6.9 11 .9 9.7 5.1 4.5 9.0 14.3 .,3.2 5.9 4.2 4.4 6.5 • 7.5 9.2 5.3 4.6 4.0 4.6 6.3 12.SI 4.4 . 4.0 4.5 ,4.1 4.6 10.7 4.6 4.2 3.5 3.9 4.8 12.6 7.9 6.7 5.8· 4.4 4.6 4.7 8.1 10.3 7.0 4.5 6.6 7.9 7.9 4.3 5.3 7.3 5.0 _4.2· 3.7 2.7 4.2 5.5 5.7 8.7 WORK-LOSS DAYS AMONG CURRENTLY EMPLOYED* ** 5.4 All ages Under 17 years 17- 24 years 3.9 25 - 44 years 4.8 8.6 45 • 64 years ·65 years and over 6.3 Sl.7 9.3 11 .9 15.9 'Refers to dlsablllty because of acute and/or chronic cond ition,. "'Includes unknown Income. ' "Based on currently ·emp1oyed population 17+ ~ears of age. ' " ' Figure does not meet standards of rellablllty or precision. Sourco: United Statea National Health Survey, United Statee Department of Health, ..,,.,..n-.a4We.1(11ra. INCREASES IN MEDICAL CARE AND OTHER MAJOR GROUPS IN THE CONSUMER PRICE INDEX In the United s11111, 1957-59 - All Items Food 18% 15% Apparel 14¾ Housing 14¾ Transportation 1N7 THE COSTS 16¾ Medical Care Personal Care 16¾ Reading and Recreation Other Goods arid Services• 20 % OF 18% ' Comprl1ee tobacco, alcoholic beverages, legal 111rvlc11, burlal 11rvlc11, banking INI, 1Ic. Source: U.S. Department of Lebor,.Bureeu or Labor Stat11llc1. - 31 - BEING HEALTHY �Coordination of Planners SUMMARY: A COMMUNITY-WIDE HEALTH PLAN CANNOT SUCCEED WITHOUT STRONG COORDINA• TION OF ALL INTERNAL AND EXTERNAL SPECIALIZED PLANNERS. THE VARIETY AND INTERDEPENDENCY OF MODERN PLANNING AGENCIES REQUIRE A CAREFULLY CONSIDERED LONG-TERM BASIS FOR BENEFICIAL INTERACTION AND EXCHANGE WITHOUT LOSS OF CREATIVE AUTONOMY. PRESENT SHORT-RANGE, INFORMAL, INCOMPLETE COORDINATION, WHICH CAN RESULT IN DUPLICATIONS AND OMISSIONS, SHOULD BE STRENGTHENED BY A COMPREHENS·IVE, CONSENSUAL LONG-RANGE PLANNING FRAMEWORK. Text Outline: if. Reasons for coordination: l}The informal, unstructured coordination among local planners are inadequate to the pace of change in the modern community.

Present planning coalitions are arranged around

limited groups and mainly for short range goals.

While there are 60 agencies listed as serving

the physically disabled, the gaps and overlaps are only suggested, the interrelationships are not well established. }}Cities are receiving increasing amounts of federal aid and attention yet no projective framework for land-use, transportation, services, health care, etc., has been adopted oy relevant providers. Physical and population rearrangements are widespread and require accompanying service rearrangements. Jt How coordination could be achieved: }}Provision of channels of communication and programs of active cooperation by: •exchanging of skills and controls (personnel, data, f unds, etc.); •~se of computer based techniques;

interlocking decision-making arrangements;

overlapping of common jurisdictions; ~

•organized contacts on multiple levels of staff; and

meetings, conferences, mailing lists.

- 32 - �PROFILE OF HEALTH AND HEALTH REIATED PIANNING AGENCI ES • .I. •• • • •• •• • •• • • • • • • • Agency (Coded) l 2 13 4 5 6 7 s· Chara cteristi c (Yes= • ) 9 10 Ill 12 13 14 1 5 16 I' • • • ••• ••••• •• • •• • • •• • •• •• •• • • •• • •• •••••• • ••• •• • • • • • • • • • ••• •• • • • • • •• •• • • • •• •• • •• •• • • • •• • • • • • • • • • • •• •• •• • • • •• • • • • • • • • •• • • • • • •• •••• • . Permanen t · Offi c jal I: S P.-ruc c TTll"\ ..,..c i- h ~:n , 1 .... .... ,,,....+, "1 - Dire ct l_y re l ated t o health i Ad v iso ry func tion ' I mplementing f unction Dire ct eva l uation 2rocedure Coll ects hea lth d a t a Re port s _publi s h ed (health) · u ses outsid e consul ta tion s ~ Re ports on r equest I mmed i ate fut u r e pl ans Formal i n t e r age ncy re l a t iQDS Fin ance intera~enc i coord . ·Fo rma l pl annin g: s t r uctu re lll ll l ll l Ul lll lll l1 1I11Jlllllll l ll l tl l ll l ll l l11II 1,,111 1 II 111111 11I I II I Ul lll llll ll l1I II I JI I Jll ll l lll ll l lll hl 1t l l1 l l1 l ll l lo l 11111 111111 1:I I Jl l ll l l, l 'l l ll l tl l ul 11 111 11, l i tl ll l lllll l 11 111 111 111 11111 1111 111 1 EXTENT AND DIRECTION OF I NTERCHANGE AMONG A SELECTED GROUP OF PIANNERS PIANS WI TH PIANNER El m m m (9 [!] [I] 0 G m G] [!] (II [§] III m [[] III G] II] r::, L:.J m @ El Q m Note: CONSULTS Numbers and le tter s are coded for names of agencies. listing ma y be found in the Appendix. A decoded �Suicide Prevent i on - Cr isis Intervention SUMMARY: THE MAGNITUDE, URGENCY AND COMPLEXITY OF SUICIDAL AND PSYCHIATRIC CRISES MAKE 1HEM PUBLIC HEALTH PROBLEMS. THE 'IRA9EDY, CHRONIC RECURRENCE AND OFTEN LENGTHY HOSPITALIZATION CONNECTED WITH 1HESE EMERGENCIES CA'.N BE AVERTED OR ALLEVIATED BY CONSISTENT PREVENTIVE CARE. THE PROPOSED COMMUNITY COMPREHENSIVE MENTAL HEALTH CENTERS COULD EFFICIENTLY PROVIDE THESE NEEDED MULTI-DISCIPLINE SERVICES. Problem: · Past reluctance of the general lay and medical public to openly become i~vol ved in the recognition, research, cooperation and sympathetic treatment these crises demand . Suicide nationally, ranks among the top ten causes of death; is fourth in cause for all male deaths between 20-45, and is second highest cause among college fatalities . In the Atlanta Metropolitan Area, the suicide rate exceeds the National average by about 25% . For each actual death by suicide, 8-10 serious attempts occur. Psychiatric crises--that often end in suicide or physical violence to others, can often be foreseen by _trained personnel in the complex web of social, economic, cultural and health problems that aggravate mental insta- · bili ty . •The essence of time demands quick responsive help. • -1be desperate bewi lderment requires easily available aid . •nie constant danger needs constant service, on a 24 hour basis. •Follow-up of all cases is basic. Curr ent Resources: Only t wo Georgia counties, Fulton and DeKalb, are served b y a suici deprevent i on , crisis- i nterv ention center. Coord i nated with Grady Memor ial Hospital psychiatri c ser vices and the respective County Health Departments, the p r ogr am has t wo multi-discipline crisis ~teams available 2 4 hour s a d ay. A total of 4 , 375 patients were t r eated in 1968 . ...... A un i que telephone service , also manned 2 4 hour s a day, 7 days a week, wa s set up to cover t en counties , on a toll- f r ee basis. The "staff" inc l udes a ps ychi at r ic t, a cli nica l p s ychologi s t, a psychiatric nur se, th re e p ubli c healt h nur se s, two sociologi s ts, and six "l ay coun selors." Soluti on: 1be fa stes t po ssibl e imp lementati on of th e t en proposed Community Mental Health Centers in the Metrop olit an Atlan t a Area, with the ba c kup of Georgia Regional Hospital-Atlant a . JtTo: Prevent crises before th ey occur. Eradicate the social stigmas of the probl ems. Enli s t full support of all medical and political units . Make effective use of current knowledge and resources . - 34 - �DEBATING ith DEATH FULTON-DeKALB EMERGENCY MENTAL HEALTH SERVICE CASES BY COUNTY - FIRST 18 MONTHS Fulton ......... DeKalb ......... Cobb . . . . . . Clayton ........ . .. 1530 622 130 70 44.1% 17.9% 3.7% 2.0% Gwinnett .... . .... 45 1.3% Douglas . . ...... . 10 .3% Other 57 1.6% Unknown . 1009 29.1% ......... ...... PSYCHIATRIC SERVICES GRADY MEMORIAL HOSPITAL January - December, 1968 I II III IV Emergency Patients 4375 Inpatients 1912 Outpatients 40 22 Consultations: A. B. C. V. VI. VII . Medical Inpatient Service Pediatrics Obstetrics 356 166 757 Drug Clinic Opening July, 1968-December, 1968 803 Crisis Service Opening August 19, 1968-December, 1968 421 Psychiatric Day Center Opening November 4, 1968- December, 1968 - 35 - 36 �MENTAL RETARDATION (MR) PROGRAM NEEDS: MORE, BETTER, EARLIER; MORE ACCESSIBLE SUMMARY: MENTAL RETARDATION IS ONE OF THE FOREMOST HEALTH, SOCIAL AND ECONOMIC PROBLEMS IN THE METRO ATLANTA AREA. PUBLIC SCHOOLS PROVIDE LESS THAN 50% OF THE SERVICE NEEDS OF THE EDUCABLE MR CHIID, AND APPROXIMATELY 50% OF THE SERVICE NEEDS OF THE TRAINABLE MR CHIID. MINIMAL SERVICES ·ARE OFFERED THE PRE-SCHOOL AND POST SCHOOL RETARDATE. DIAGNOSTIC AND _EVALUATION CLINICS, EDUCATION AND TRAINING PROORAMS AND ADULT SERVias MUST BE GIVEN PIANNING EMPHASIS. SERVICES ARE WASTED HOWEVER UNLESS . PLANS ARE MADE TO INSURE. DELIVERY OF THESE SERVICES TO THE CONSUMER. A TRANSPORTATION PLAN MUST THEREFORE BE A VITAL PART OF PROORAM DESIGN. The Problem: The MR person is one who, from childhood, experiences unusual difficulty in learning, and is relatively ineffective in applying what he has learned to the problems of life. He needs special training and guidance to make the most of his capacities. Current Status: In Metro Atlanta, there are an estimated 42,647 retarded persons. At the present time, only 6,804 individuals by our survey are receiving education and training, residential services, vocational rehabilitation or other adult services from appropriate community agencies. Needs: While all the metropolitan area school systems offer some services for mentally retarded children, many are not served. Private residential facilities serve only non-ambulatory neurologically impaired children. Vocational Rehabilitation works with retardates enrolled in public school special education programs, and with a limited number of MR from the community at large. Expansion of all these programs is needed. Day training facilities for the severe and moderate pre-school, severe school age, ·and severe and moderate adults should be established. Structure of Planning Organization: The responsibility for area wide mental retardation planning should rest in a 6 county planning body made up of representatives from the 6 local health districts. Each district would appoint 6 representatives, drawn from vocational rehabilitation, the health department, family ·and children's service, public schools, associations for retarded children, and recreation departments. An MR specialist should be employed. - 36 - �Estimated Number of MR Persons in the 5 Co~nty Area•• Chronological Age Range Level of Retardation Mild Moderate Severe Profound 18+ 24506 1375 493 105 6 - 17 9554 537 191 42 0 - 5 5409 305 108 22 Total 39469 2217 792 169 42,647 Grand Total Existing Services in the 5 County Area•• Public Schools Residential Private- Public Pr iva te Schools EMR TMR EMR TMR 5151 377 40 225 106 Voe. Rehab. Adult Act. 703 82 120 Organizational Chart•• I Compr ehensive I Metr o Atlanta MR DEKALB Voe . Rehab. Health Dept . FACS Schools ARC Recreation Health Planning I Planning Connnittee I FULTON COBB One Reoresentative from each Voe . Rehab. Voe . Rehab. Health Dept . Health Dept. FACS FACS Schools Schools ARC ARC Recreation Recreation l I GWINNETT field Voe. Rehab. Health Dept . FACS Schools ARC Recreation CLAYTON Voe . Rehab . Health Dept . FACS Schools ARC Recreation I I MR Specialist Secr etar ia l Sta ff Conce ptua l Vi s ua l Aid: I nt er a ction of Multip le Fa ctor s. (From Richmond , J. B., a nd Lustman, S . L., J Med Educ 29:23 (May) 1954) . Douglas County not included in the above 5 county tables and charts . 1. - 37 - �1960 80,000,000 ~A ~ 1970 1980 1990 40,008,000 ~ 20,000,000 0 NUMBER OF USER DAYS PER YEAR FOR NON-URBAN OUTOOOR RECREATION FACILITIES, ATLANTA FIVE-COUNTY REXHON. Sources: U. S. Study Commission/Southeast River Basins; Atlanta Region Metropolitan Planning Commission.- (1960 figure is based on annual 8 user-days per person , and 2000 figure is based on annua l 2~ user-days per person.) CURRENT STATUS: THE LAST PUBLISHED INVENTORY OF PARKS SHOWED 2,405 ACRES OF PUBLIC PARK LAND. THIS INCLUDED 67 PARKS~AND 98 GREEN SPACES. THE FOLLOWING TABLE SHOWS THE DETAILS OF SIZE AND NUMBER. SIZE NUMBER OVER 100 A 30-100 A 15-30 A LESS THAN 15 A GREEN SPACES TOTAL 7 8 9 43 98 "'T65 TOTAL ACREAGE PER CATEGORY 1233 472 156 390 155 '2405 A A A A A A PERCENTAGE OF TOTAL ACREAGE 51% 20% 6% 16% 7% 1ooi BY NATIONAL STANDARDS, PARK SYSTEM HAS GREAT INADEQUACIES. THESE STANDARDS ARE BASED ON YEARS OF EXPERIENCE IN PROVIDING RECREATION UNDER A VARIETY OF CONDITIONS. ON THE MOST GENERAL LEVEL, THEY CALL FOR A TOTAL .OF 10 ACRES OF PARK LAND PER 1000 POPULATION; ATLANTA AREA SMSA, CURRENTLY HAS ABOur 4. 6 ACRES PER 1000 POPULATION. STANDARDS PROPOSED IN THIS REPORT WOULD INCREASE THE OVERALL CITY AVERAGE TO 7. 2 ACRES PER 1000 POPULATION BY 1983 AND TO 10 ACRES PER 1000, IF FLOOD HAZARD AREAS ARE ADDED TO THE SYSTEM AS PROPOSED. �Title: Parks' and Recreation's Lqg in Facilities, Services and Manpower. SUMMARY: GREATER RECOGNITION, FINANCIAL SUPPORT AND PARK/RECREATION PLANNING SHOULD BE GIVEN THE GROWING DEMANDS FOR RECR:~ TION AND PARK FACILITIES, PROGRAMS AND SERVICES THROUGHOUT THE ATLANTA AREA, (SMSA). IT BEHOOVES LEGISLATOR, RECREATION AND PARK EXECUTiVES TO OBSERVE AND CORRECT THE PRESENT LAG OF FACILITIES SERVICES AND PROFESSIONAL MANPOWER NEEDS IN THE FASTEST GROWING CITY IN THE SOUTHEAST. Problem: Unfortunately, Atlanta does not have the park system and recreation program it needs and deserves. There is: lack of good public relations absence of public information on parks and recreation lack of public and city support inadequate local financing rising cost of land insufficient maintenance insufficient acreage past segregation and apathy of current integration lack of a comprehensive plan to guide park and recreation development lack of standards at the state and local level. staff personnel occupying position without proper training '• Possible Solution: To provide recreation programs and facilities in all neighborhoods of the city. To encourage housing project and apartment owners to include recreation faci lities. To insure close supervision of staff and a good in-service training program for staff members that are not professionally trained. To recruit professionally trained personnel for staff position. To provide a well-balanced program for all ages, with a wide variety of interests. To involve residents in planning and operation of public recreation. To provide minimum standards 'for all recre at ions programs . Trends: These are not theoretical standards. A survey done in 1965 showed that 49 out of 189 cities met the acreage standards. As part of this study, comparisons were attempted with other cities the same size as Atlanta. Overlapping governmental jurisdiction made these comparisons difficult, but it appeared that out of 20 similar cities, 15 to 7 had more park acreage per population than Atlanta, About onehalf met the acreage standards . Inadequate open space. Inadequate Planning. La ck of interest a t t he Boar d of Aldermen l eve l. Diverted funds . �• e• ROBERT T. JONES. JR . FRANC IS M. BIRD ARTHUR HOWELL EUGENE T. BRANCH EDWARD R. KANE ROBERT L. FQqEMAN, JR. LYMAN H. HILLIARD .. LAW OFFICES \ JONES, BIRD FOURTH & HOWELL FLOOR HAAS-HOWELL BUILDING ROBER T P . JONE S FRAZER DURRETT, JR . EAR LE 8. MAY, JR. TRAMME'- L E.VICKERY RALPH WIL LI AMS . JR. J. DO NALLY SMITH WILLIAM B.WASSON C . DALE HARMAN PEGRAM HARRISON CHAR L ES W. SMITH CHASE VAN VA L KENBURG RICHARD A.ALLISON F. M. BIRD.JR. PEYTON S . HAWES.JR. RAWSON FOREMAN MARY ANN E. SEARS ARTH U R HOWE LL Ill VANCE Q. RANKIN Ill CYRU S E.HORNSBY 111 R ICHARD M.ASB I LL ATLANTA , GEORGIA 30303 187 9- 1956 RALPH W ILLIAMS 19 03- 1960 February 28, 1969 TELEPHONE 522-2508 AREA CODE 404 Honorable Ivan Allen Mayor, City of Atlanta City Hall Atlanta, Georgia Re: Dear Mayor Allen: Volunteer Citizens Services (__ _~ ~ -- -·-,, -) I am writing to you as Chairman of the Board of the Connnunity Council of the Atlanta Area. I, and the others who will be with me, appreciate and look forward to talking with you on next Wednesday afternoon, March 5, regarding a plan for the greater use of individual and group volunteers in the Atlanta area. Those with me on Wednesday will be Dede Hamilton, who is the current President of the Atlanta Junior League, and John DeBorde, who is the representative of the Atlanta Chamber of Connnerce working with us on our volunteer project. You perhaps know John. He is the general agent here for New England Mutual Life Insurance Company. Some months ago there was a meeting of representatives of the Connnunity Council, the Atlanta Chamber of Connnerce , and E . O.A . at which we discussed the possibilities of jointly establishing a means of making a more effective use of volun teers . Dan Sweat was also present and is generally familiar with what has taken place . Following this meeting there was a larger luncheon meeting of about 16 or 17 orga nizations at which there was a general discussion of the same subject. A Steering Cormnittee was appointed to formulate a means of ef fectively recruiting, screening, training, and placing of �April 10, 1969 Mr. Eugene T . Branch Chairman of the B oard of Directors Community Council of the Atlanta Area , Inc. c / o Jones , Bird and How 11 H as -Howell Building Atlanta, Georgia 30303 Dear Mr. Branch: The City of A tlant · has been fol"tunate in having many citizens and groups volunt er th ir time and services to h lp resolve important needs in oul" community, A s th City has grown and th inter st and concern of our eitiz ns has increased, it has b come mor and more difficult to efiectively and efficiently utili:t volwit rs in meeting the ne ds of the city. lt is xtremel y ncouraging to s e the efforts b ing put fo:rth by the Community Council, th Chamber of Commerce, the Community Chest and the Atlant Junior L agu in developing vehicl · for providing ordedy ignm nt and utiliz tion of volunteer manpower. It ie s nti l that ther b a c c n b catalogued nd consolid to h lp fulfill the n eds. I b ffort c n the tal nt nd skill mar. hall d ntral point wh r by community ne d ted and volun~ ,rs nli t d nd tr in d 11 ve only through uch coordin t d of Atl nt 's vblunte r citizen be nd utiliz d to th b t dvantag of all th p . ople of th city. Sincer ly yo\U' , Ivan Allen. Jr. Mayor lAJrtfy �r . ( June 2, 1969 Page 2 I am looking forward to meeting wj th you on Jun e 5th, and to fu 1:ure meet ings and activities involving bo t h the Co uncil and the present staff. f{rl~Pfv~ Ra phae l B. Levin e , Ph.D .. Djrecto:Comprehensi ve Areawide Heal th Plannii1g RBL / la enclosures \. �This is an incomplete edition of VOLUME I, PROPOSAL FOR COMPREHENSIVE HEALTH PLANNING All pages considered crucial to the intent of the proposal are included here. Other work, denoted here by missing pages, is in process of completion. �Foreword lo the Proposal THIS PROPOSAL REPORTS WORK SUPPORTED BY AN ORGANIZATIONAL GRANT TO THE COMMUNITY COUNCIL OF THE ATLANTA AREA FROM THE U. S. PUBLIC HEALTH SERVICE , AND CONTAINS RECOMMENDATIONS FOR THE ESTABLISHMENT OF A PERMANENT COMPREHENSIVE HEALTH PLANNING AGENCY FOR THE METROPOLITAN ATLANTA AREA. THE PROPOSAL CONSISTS OF THREE VOLUMES: PROJECT SUMMARY, BUDGET AND STAFF, AND TASK FORCE REPORTS. Agency Responsible he Community Council of the Atlanta Area, supported by organizational grant No. 41008-01-69 from the U. S. Public Health Service, has b e en the age ncy responsible for conducting the work and, with the cooperation of many other offices, groups, and organizations, making the recommendations herein for the establishment of a permanent comprehensive health planning agency for the Metropolitan Atlanta Area. Staff The material was prepared by the Comprehensive Health Planning Project staff , directed by Raphael B. Levine, Ph.D., under the general supervision of Duane W. Beck, Executive Director of the Community Council of the Atlanta Are a. Consultation and Other Assistance A numbe r of persons gave continuing support to the Proj ec t on consultant basis, and several hundred persons from governments, health professions, educational institutions, commerce, and the population of health "consumers" gave invaluab le assistance in the compilation of information and in the formulation of conclusions. The staff tenders its sincere thanks to all these individual s . Funding 50% of the costs of this effort mentioned above. The remainder c ount y g o v e r nments, foundations v olun tary he alth o r g a n i z a tion s , g rati tude to the s e dono rs . were borne by the Public Health Service grant was contributed by iocal sources, including and the Community Chest, public , private , and and individual s. The communi t y owe s muc h Or ganization o f the Pr opo sa l The propo sal is divided into three and tas k force re ports. Each pa i r "story". The gist of each " sto ry " material alone, with details added volumes : projec t s ummary, budge t and s taf f , o f f a c i ng pages makes up a se lf-con tained ma y b e gained from the b ord ered summary in t he text and illustrative material. i �COMMUNITY COUNCIL OF THE ATLANTA AREA Eugene T. Branch, Chairman of the Board Duane W. Beck, Executive Director A. B. Padgett, Chairman, Committee on Comprehensive Health Planning COMPREHENSIVE HEALTH PLANNING PROJECT Raphael B. Levine, Ph.D., Director Alloys F. Branton, M.B.A., Assoc. Director Harriet E. Bush, Director of Research Clifford Alexander, Jr., Environmental Planner Katharine B. Crawford, Organization Liaison CONSULTANTS Mary Lou Ashton, Senior Secretary Mildred W. Thorpe, Secretary ( on continuing basis) Frank A. Smith, Atlanta Metropolitan Mental Health Assoc. Loretta B. Roberts, RN, Community Council of the Atlanta Area Ella Mae Brayboy, Community Council of the Atlanta Area William F. Thompson, Administrator, Cobb County Health Department Carolyn L. Clarke, Health Educator, Gwinnett County Health Department Edna B. Tate, Health Coordinator, Economic Opportunity Atlanta ORGANIZATION OF THE PROPOSAL Volume I. Summary of Project ~ Section 1. Introduction and Supportive Material Section 2. Narrative Project Summary Section 3. Appendices Volume II . Budget and Staff Section 1 . Budgetary Material Section 2 . Personnel Volume III. Task Force Reports ii �. I TABLE OF CONTENTS ·' Forewor~ to the Proposal • • • . i SECTION 1. INTRODUCTION AND SUPPORTIV1': ?vii~TERIAL A. Description of the Area Planning for Planning: TechnicP.1 and Corrnnunity Involvement Aspects . • • , . • . . . • . • • 2 The ,Atlanta Area, the flanning Area 4 Atlanta Area Governmental Units, Current Population . • • • • • . • • • • • 6 Standard Metropolitan Stat5-stical Areas Cl~sc to the Atlanta Area • • • • • • • . • • & 10 Atlanta Area, a Place of Gr~0th and Variation Populati_o n Trends Require Review of Health Needs . . . . . . . . . . . . . . . . . . 12 The Planning .Area · Obs erves Other Programs and Anticipa ted Expansion • • • • • • ll~ Organizatioµa l and Procedural Arrangements for ComprehensiveHealth Planning. • • • 16 Cooierat{ve Arrangements .~ade for Funds, Personnel, -Facilities and Se~vices . • 18 Planning is Ba sed on Corrnnonly Available Date 20 \. B. The Atlanta Area 's Need for and Ability to Support Comprehens ive Health Planning Principa l Teaching and: Service Facilities in the Atlanta Planning Area ~ • • • • • • • • • 22 Implications for Comprehensive Health Planning -in Environme ntal Hea lth Fields • . . • • • • 24 Atl anta 's Ur ban Redev e lopment Project Program -iii- 26 �Atlanta's Model Cities Program 28 Relationships with the_Georgia Regional Medical Program • ' . . . . .. . 30 The Urb an Life Cent er : A Solver of Urban Health froblems for the Future . • . 32 Local Health Departments in the Atlanta Area 34 Major Voluntary Health Groups an0 Profession~l Associations in the Atl2nt3 Area 36 Water and Sewer Districts. . • . 38 Facilities, including Hospitals, Nursing Homes, Outpatient Clinics and Neighborhood tlealth Cent ers . • • • . . . • . . 40 . Existing Manpower Resources Economics of the Atlanta Area as Relater to Health Services . • • • • . • • • • SECTION 2. NARRATIVE PROJECT SUMMARY A. Project Outline Goals and Objectives of Comprehensive_ Health Planning . . . . . . . . . . . . . . . . . 48 Community Council has Extensive Involvement in Health ~rid Planning • • • • • • • • 50 Organi zatibnal History of the Applicant 52 _Scope of Program Health Concerns • • • • • 54 \. Cooperative Arrangements with Participating Agencies • ~. . • • • • • • • • • • • 56 Health Planning P~o~ess: 58 Systems and Retrieval. Information Gather}ng and Anaiysis Techniques 60 The Need for Planning,Programming System for ·_Comprehensive Health Planning • 62 Procedure for Policy Implementation 64 Example of Experience: Cobb County Comprehensive Health Planning . • • • • • • • • • • • • • • 66 _- iv:.:·-·. _I �Corrnnunity Involvement in Comprehensive Health Planning . • • • . 68 Atlanta Area Coordinat{~ri with the Off ice of Comprehensive Health Planning, Georgia Department of Public Health . 70 Facilities and Equipment Available for the Staff of the Applicant Agency~ • 72 -B. Supportin0 Dat a The Plan has Continuing Input from Existing Re Jources . . . . . 74 Personal Publications. 76 C. Work Program ~urrent Problems Carried Over • . First Year Activities . . 78 · 80 Phasing into Systems Analysis 84 Future Deve lopment • 86 D. Agency Or gani za tion Staff Organization. 88 Council Or gani za tion. 90 Council Membership • 92 Nominating Proce dures. 94 Training for Counci~ Effectiveness . 96 By-Laws of the Council • • • • • • • 98 - v- �Planning- for Plann·ing-: Technical and Community Involvement Aspects SUMMARY: IN ORGANIZING THE ATLANTA METROPOLITAN COMMUNITY FOR COMPREHENSIVE HEALTH PLANNING, EXTENSIVE ACTIVITIES IN TWO MAJOR ASPECTS HAVE BEEN NECESSARY: THE TECHNICAL ASPECTS OF IDENTIFYING, PROJECTING AND SEEKING POSSIBLE SOL"UTIONS TO HEALTH PROBLEMS AND THE COMMUNITY INVOLVEMENT ASPECTS OF BRINGING TOGETHER THE VARIED ELEMENTS OF THE COMMUNITY INTO A PARTNERSHIP FOR HEALTH PIANNING AND POLICY-MAKING. Technical Aspects The technical objectives of this project have been (1) to identify the community·' s principal heal th problems and the probable, most urgent planning efforts which will have to be undertaken by the permanent organization during its first year of existence - 1970; and (2) to specify the r>.umbers and qualifications of the technical staff whe\, will be needed to carry out such planning. Some of the activities bearing on these objectives have been: identification and scoping of health problems through the medium of technical "task forces;" some 25-30 of these groups have worked up descriptions of problem areas, trends, resources, obstacles and suggested solutions to the problems; identification of planners and planning groups whose work is directly or indirectly in health areas; some 50 of these have been named and approached for fuller understanding of their work; a major portion of the technical task of the metropolitan planning staff will be to coordinate the activities of these planners to avoid duplication and to "cross-fertilize" their activities; developing a "systems approach to planning for the health field;" this involves cost-benefit analyses, the building of community health "system"models, etc.; education of as many citizens of the community (and being educated by them) about heal th problems and comprehensive heal th planning a.s possible; Community Involvement Aspects The organizational objectives of this project have been (1) to develop the largest possible degree of community involvement in establishing and operating a comprehensive health planning organization and (2) to formulate an organizational structure for such operation, including corporate identity, policy c~uncil and its selection,and by-laws. Some of the activities bearing on these objectives are: identification of community interest and de.c ision groups involved in health activities; holding small and large meetings of such groups and se.lection of a "steering committee" to recommend detailed structures and policies; working with the steering committee in the development of a corporate mechanism capable of operating a comprehensive health planning agency; working with the steering committee in the formulation of a policy Council and methods for naming its members, together with the various health interest and action groups in the comrnuni ty; writing- by-laws; obtaining acceptance and endorsement of these plans by the interest and action groups in the community - governments, health a,gencies , consumers' groups , other planning groups, etc. selecti ng and convening a council for action on this proposal. - 2 - �- • ESTABLISHMENT OF METROPOLITAN COMPREHENSIVE HEALTH PLANNING AGENCY •111 :1111111111111111111111111•1111111111111111111111·111111111111 111111111· .1111111 1111111•11 11 1111111111111111 1 1111111111111111111111 "Organizational" funding Local Sources DHEW Community Council ' of the Atlanta Area Oct 68 Community Invol vement Aspect s 20 Jun 69 Proposal Review 1 Funding_ Met r o CHP Council 5 Jun 69 1 Jan 70 METROP0LITAN CHP AGENCY - 3 - �The Atlanta Area SUMMARY: THE ATLANTA AREA, PRESENTLY INCLUDES SIX COUNTIES, THIS IS NOT IDENTICAL WITH THE OFFICIAL BOUNDARIES OF THE CENSUS BUREAU, WHICH DEFINES THE ATLANTA AREA AS A STANDARD METROPOLITAN STATISTICAL AREA CONSISTING OF FIVE COUNTIES. TO MAKE THIS DISTINCTION THESE BOUNDARIES ARE DEFINED. BOUNDARIES: At lanta Area: Douglas, Clayton, Cobb, DeKalb, Ful t on and Gwinn ett counties. Atlanta Area (SMSA): Gwinnett counties. Clay t on, Cobb, DeKalb, Ful t on and PRESENTLY: ATLANTA AREA IS: • the "regional capital" of the Southeastern United States resulting from continued growth and a central transportation network; • the"major growth c e n ter" in the ·s t ate of Georgia; and • the central "regi onal city" f or the ATLANTA AREA and contiguous counties . • t he "medical center" for t he surrounding counties. \. THE ATLANTA AREA COMPREHENSIVE HEALTH PLANNING DESIGN: permits additi on of contiguous counti~s or other planning areas whenever feasibility or desirabili ty are indicated. (Douglas County, the newest member of the ATLANTA AREA has shown initiative and set a precedent for non-SMSA's joining its sister counties for health planning.) �SOUTHEASTERN UNITED STATES STATE OF GEORGIA SIX COUNTY ATIANTA AREA ~ �Atlanta Area Governme ntal Units and Current Population SUMMARY: BESIDES THE SIX COUNTIES, THE ATLANTA AREA CONTAINS APPROXIMATELY 50 INCORPORATED MUNICIPALITIES, OF WHICH 10 HAVE POPULATIONS OF MORE THAN 4,500. THE LARGEST CITY, ATLANTA, COVERS PORTIONS OF FULTON AND DEKALB COUNTIES, AND HAS A POPULATION IN EXCESS OF 500,000. THE TOTAL POPULATION APPROXIMATES 1,300,000. The Atlanta Area, Compared with the Standard Metropolitan Statistical Area The Atlanta Area SMSA is comsposed of five counties: County Fulton DeKalb Cobb Clayton Gwinnett Population (1968) 605,400 353,500 174,600 78,700 59,800 Douglas County, with a population of 23,900, is the sixth county that makes up the entire six-county ATLANTA AREA for purposes of comprehensive health planning. Principal Cities in the Atlanta Area The largest city, Atlanta, extends into Fulton and DeKalb counties and had a population of about 500,000 in 1968. Other principal cities, their counties, and size are as follows (See Appendix for complete list of munic i pal itie s and populat i on distribution.): NOTE: MUNICIPALITY COUNTY College Park East Point Hapeville Decat ur Forest Park Marietta Smyrna Lawrenceville Douglasville Fulton Fulton Fulton DeKalb Clayton Cobb Cobb Gwinnett Douglas POPULATION (1 ~68) \. 20,691 39,257 9,268 20,943 18 , 766 28,003 16,365 4 ,561 6,000 These figures are estimates made by the Atlanta Region Metropolitan Planning Commission, 1 April 1968. -6- �ATLANTA AREA GWINNETT ,--' COBB .... ' \ ~L...-i[IIQ[\IILLI[ V ..-,.. ,.,,.- ..... t \LIL ...... ' I I ' ...,.._.,,., ' ,

. f,... \\ ,,, \COJGi..t.SVILL[ ...... ,, ) DOUGLAS \. -7- ......, ',, . .\ 1Ga'.A't'IOII tllllLLVILLf �Ne arby Citi e s Af f ec t t he Marke t and Service Pa tt erns of t he Atlan t a Area STANDARD METROPOLITAN STATISTICAL AREAS CI.OSE TO THE ATLANTA AREA: Within a 100-mile radius of the ATLANTA AREA (SMSA) there are 14 smaller SMSA's which are close enough to affect the economy, commerce and health service trade patterns of the ATLANTA AREA. These are: Macon Columbus Chattanooga Albany Augusta-Columbia Birmingham-Tuscaloosa Montgomery Huntsville Gadsden Greenville Asheville Charlotte Knoxville Nashville \. - 8 - �Atlanta Area, a Place of Growth and Variation SUMMARY: THE ATLANTA AREA IS A RAPIDLY GROWING METROPOLIS WITH BOTH URBAN AND RURAL TERRAIN AND WAYS OF LIFE. THE MAJOR DEMOGRAPHIC CHARACTERISTICS INDICATE A CONTINUING PRESSURE AND A GREAT CAPACITY FOR INCREASED AND APPROPRIATE SERVICES. Ma j or Characteristics: AGE of the population is young: The number between 20 and 29 will double between 1960 and 1980, DENSITY of population covers a wide range: 5 to 52 persons per acre . SIZE is expanding: 27% increase from 1960 to 1967, passing 2 million by 1980. CLIMATE is warm and humid: 48 inches annual precipitation. URBANIZATION is increasing moderately: 6% from 1960 to 1967. EDUCATIONAL opportunities are numerous: About 175 schools, nine 4-yr. colleges, 6 special purpose institutions, 3 area technical schools. OCCUPATION's largest demand is in retail and wholesale trade, government, se r vice business, manufacturing. INCOME va r ies greatly: One county with 36% over $10,000 another with 25% below $3,000. CAPITAL I NVESTMENT was near 300 million from 1963-1967, much of this for transportation equipment . TRADE is active: 3 interstate highways intersect, 8 airpo r ts with 800 dail y flights , 13 railroad lines of 7 systems. FINANCIAL headquar t e r s of Sixth Federal Reserve District . OFFI CE SPACE abunda nt : Fi fth in nation , ~ COMMUNI CATIONS e x ten sive v i a telephone s , mai l, 4 dai l y and 20 we ekl y news paper s, 5 t elevision and 19 radio st ations . Note : This information taken from "Atlanta Silhouettes," ARMPC, Atlanta, Georgia n , d . ; "The Georgia Piedmont Regional Economic Investme nt Plan," State Planning Bureau, Office of the ,G overnor, Atlanta, Georgia, n.d . - 10- �1960 - 1980 Population, Estimates a nd Proj e ctions 1960(l) County (1) (2) (3) 1975 1970 1980 556,326 256,782 11 4,174 46,365 43,541 16,741 599,300 350,400 150,900 66,000 54,600 21,339 649,425 485,5 41 209,722 93,483 58,077 29,700 704,046 658,520 281,481 135,988 66,192 36,500 829,163 757,518 337,019 161,126 76,094 45,000 1,033,929 1,242,539 1, 525,948 1,882,727 2 , 205,920 Fulton DeKalb Cobb Clayton Gwinnett DouglasC 3 ) Total 1965 <2 ) U.S. Census Long-Range Plan, Hospital and He alth Planning Dept., CCAA, Atlanta, Ga., J an . 1968, p. 6 (mimeographed). Douglas County Figures, 1965-1980, interpolated from Land Needs, 1968, Douglas Count y, Ga., ARMPC, Table ;D, DIRECTIONS OF POPULATION GROWTH ATLANTA 1960-1968 SMSA FOR SY Tt-' BA RTO W ,- ... , t,_.,,JSJ'ft "- l i ([ GWI NNETT ' ---',_ \ ~ t\~L- 'M RC: NC( Vt LL [ V 17 ·. 9 % ()c.p:. ,so'1 . ~, ' ~S,.(LV,111,.L [ \r .....'• PAU LDI NG ,-, .. ' \ 0. ,111 ,ui u,1.., ~ -, ,-, ,__

~ £:ir)O~ H ENRY COW El A CL AYTON NOTE: Perce n tages show s h are of SMSA ( jnc l uding Dou g l as County) growth t h at h as occ u rred in each direction . SPALDING - �Po pulation Trends Require Continuous Review of Health Needs. SUMMARY: THE NUMBER OF PEOPLE IN THE AREA IS GROWING AT A RATE OF 2.8% ANNUALLY. THERE IS ALSO A MARKED INCREASE OF YOUNGER AND OF OLDER PERSONS. THE MIGRATION OF PERSONS INTO THE AREA FROM NEARBY TOWNS AND PLACES IS ACCOMPANIED BY A GROWTH TOWARD THE OUTER COUNTIES. Text: The needs for health facilities, manpower and services must be anticipated well in advance. Present information allows a reasonable prediction of the size, constituency and settlement patterns of groups of people. An increase in numbers of people indicates a greater demand on the amount of facilities, manpower and services. A change in the proportion of people in certain age groups indicates a change in the need for particular types of care - home care, impairments, maternal and child care, etc. A change in the geographical distribution of people indicates a need for review of environmental health, communicable diseases, etc. - 12 - �t' 5 & 85 & o ver ov er 1960: U. S. Census 1975: Rand Corp. FEMALES MALES 60-6 4 25- 29 5-9 THOUSANDS 90 75 60 45 30 15 0 15 30 45 60 75 00 �The Planning Area Bounda ries Observe other Programs, Anticipate Expansion SUMMARY: THE STATE OF GEORGIA IS DIVIDED INTO MANY DIFFERENT AREAS, DISTRICTS AND REGIONS FOR SPECIAL PLANNING OR IMPLEMENTATION OF PROORAMS AND ACTIVITIES. SOMETIMES THE FIVE COUNTY "STANDARD METROPOLITAN STATISTICAL AREA" OF ATLANTA IS USED AS A UNIT. SOMETIMES PROORAMS ARE SUBDIVIDED BY COUNTIES OR COUNTIES ARE COMBINED IN OTHER WAYS. THE SIMILAR JURISDICTIONAL AREAS ARE CONVENIENT AND THERE IS A TENDENCY TOWARD MAKING BOUNDARIES OF RELATED PROORAMS IDENTICAL. IN ANTICIPATION OF THIS TREND AND EXPANSION OF ATLANTA (SMSA) BY THE BUREAU OF CENSUS, THE COMPREHENSIVE HEALTH PIAN WILL HAVE ADJUSTABLE BOUNDARIES. (1) AREA G R O U P I N G S - - - - - -~~ \. (1) Much of this material taken from An Atlas of Multi-County Organizational Units , Department of Geography, Univ. of Ga . , 1968 - 14- �PH0 13LEMS IN DELINEATING REGIONS C, t 0 C C, ~ ,... (D

OS:

,_.

,

,

Ill ,_. Ill (D CJ" <l1l PROGRMTS , REGIONS, AREAS , AND DI STRI CTS o; en rlrl- ';!,_. (")I ,_. , rl- ~o i: 0

,

I 2 Supe r i or Court Circuits 35 19 34 I ndust-rial Development Division (G a . Tech. { . ) Ca A A 7 7 7 7 Ci\· il Def ense : Operationa l Area s St a te Nurses As soc. Districts Contro l Ce nters 2 0 C CJ" CJ" rl- (D Ill

,,

rl- '1 (D co en Ill 2 2 2 Q lfl A A A ves 7 7 ves ··- - 13 9 5 5 4 13 yes 10 8 X ves St a te Re pre sent a tive Districts 27 22 1 19 110 Lou- 4 7 St ate Senat orial Distric ts 31 Coopera ti ve Extension Service Distric ts 6 Geor g i a Hospital Assoc, Di s tricts ~8- 6 7 44 ~5 yes 6 6 6 6 ves A A A A ves p p ye s ve" 4 4148 43 NW NE 1101103 ves yes 9 6 141 35 5 Economic Deve loome nt Regions~ A A p p St ate Hi g hway Deoartme nt Divi s ion 6 1 6 6 3 6 Vocati o na l Reh a bilitation Services (m ( 0) A D D A D A yes Voc at iona l (Medic a l / Be haviora l) Areas A A A A A A ves WC N N N WC N ve s A A A A A no 8 7 7 8 7 ves Geo rgi a Reg iona l Medical Prog r ama>CO> A ~letro Atl a nta Counci l l oc a l r. ov ts Soil & 12 Wate r Conservation Districts 23 3 3 3 117 2"1 ves Off ic e of Economic Opportunit y Commu nit y Council Soc i a l Pl a nning Are as T A D A Cl X X 29 gf 1g ves no St at e Deo t . of Famil v & Childre n Services Districts 7 9 5 5 4 7 ves 1 2 2 1 1 1 yes Ca n n n T) T) V P" • Farmers Home Administra tion Districts So il Cons e r va tion Dis t ricts Feder a l Judi c i a l Districtsa> \. State Hi ,r hwav De na r t me nt Div isi~n° Fed e r a l La nd Ba nk Association Districts Voc at i o na l-Te chnic a l School Area Fo r e s t r y Dis t ric t s • ..

' l I I lff l.,- State Emo l ovm ent Servi c e Dis t ricts ce> ' no 23 Cong ression a l Distric ts (D C. '1 Conununi t y Act ion Agenc ies Il l 7- 0 en -c ,...

, I

I 2! 2 ..\re :i Pl :i nnin!! and Dev elooment Commis s ion (") 0 Ill I §g- l:l9- N N N N N N ves 6 1 6 6 3 6 2 9 9 Cl .A 9 9 Ca 9 Cl ves yes G M yes 4 9 9 4 7 yes 9 I I I i I ! Georg i a Bur eau of Investiga t ion Districts 9 2 Medica l Fac ili ty Serv ic e Ar ea s D2 R3 Pu blic Hea l t h Dis t r ict s 28 29 X (<*> -::r, (0) Does not part i c ipa t e Appa l achia & Piedmont A At l anta Di stric t D Decatur Dist r ict <•> (¢ ) (.) N WC Ca Cl M No r thern Di s t ric t Wes t Cent r a l Distr i ct Carrollton Distri ct Cl ayto n Dist r ict Mar i etta Di s tric t 1 Dl n"I 1 Bl D3 9 D2 ves yes 36 38 30 28 ves ce, T 1 Ta ll atoon a - 15 I �Organizational and Procedural Arrangements for Comprehensive Health Planning SUMMARY: THE PROPOSED COMPREHENSIVE HEALTH PLANNING AGENCY WILL BE STRUCTURED SO AS TO BE IN CLOSE COORDINATION WITH THE METROPOLITAN ATLANTA COUNCIL OF LOCAL GOVERNHENTS AND WITH THE COMMUNITY COUNCIL OF THE ATLANTA AREA THE ARRANGEMENT ALSO ENCOURAGES COOPERATION AND COORDINATION WITH THE ATLANTA REGION METROPOLITAN PLANNING COMMISSION, THUS INVOLVING ALL THE AREA'S MAJOR PLANNING AGENCIES. OTilER PLANNERS IN HEALTH OR HEALTHRELATED FIE1IY: \.JILL BE INVOLVED TO VARYING DEGREES. 0 Applicant: In order to facilitate interaction of the major planning groups in t he metropol i t a n area, the Metropol i tan Atlanta Counc i l of Local Governments (MACLOG) will be the applicant agency for comprehensive hea lth plan• ning. In order to do this, MACLOG is taking action to change its status as a voluntary association and become an incorporated entity. In the event that the necessary legal arrangements require more time than is available prior to submission of this proposal, the interim applicant agency will be the Community Council of the Atlanta Area, Inc. (CCAA). The organization f or supervising and conducting comprehensive health planni ng is indi cated herein as the Me tropolitan Comprehensive Health Planning Council (Metro CHP Council). Relationships among MACLOG, Metro CHP Council, and CCAA: Using as a model t he r e l a tionship be tween the Georgia Regional Medi ca l Program and the Medica l Asso c iation of Georgia, in which the l a tter is the a pplica nt agency , and t he f ormer a ctua lly conducts the program , inc luding final policy f ormula tion, the proposed relationship is that MACLOG will be the applicant agency, Metro CHP Council conducts the program and formulates poli cy, and a dministrative support is provided by the CCAA. There wi l l be ind ividua ls serving on the CHP Council who are also members of MACLOG or the Boar d of CCAA . To i ns ure coopera t i ve efforts and join t p lanning in over lapping proj ec ts , it is planne d to e s tablish a "Met r opol itan Conference o f Pl anning Chairmen", bring i ng t ogether the Chair men of MACLOG, CCAA , CHP Council, and Atlanta Region Metropolitan Planning Commi ssion ARMPC) . In addition, t here wi l l be a "Metropolitan ConfereIJ,ce of Planning Directors", bringing t oge ther the execut i ves of the f our a genc ies. Fr om t i me t o time, other planners wi ll be invit ed t o participate i n these conferences . It is anticipa t e d that j o int staff a c tivit ies will occur where proj ects involve physica l pla nning (ARMPC), social planning (CCAA), he al t h pl anning (CHP) , and other f orms of planning such a s crime and delinquency (MACLOG). Of cour se , ma jor portion s of he al t h planni ng wil l con tinue to be done i n other plann i ng staffs, such a s hospital aut horities, city and county planning offices, etc. These wi ll be coordinated , insofar as healt~ aspec t s ar e concerne d, by t he Me tro CHP staf f . Facilities : MACLOG, CCAA, ARMPC, and CHP wil l be hous e d in t he same bui l ding . Thi s clos e prox i mi t y wil l make possible sharing of numer ous f a cilities, s uch as l i br a r y , public i nforma tion , dupli ca t ion and mail ing, e t c. For additiona l informa t ion, s ee the s ect ion on Facilitie s in t he s econd Section of this proposa l vo l ume. - 16 - �ORGANIZATION FOR COMPREHENSIVE HEALTH PLANNING e,o n tnu:-fu.Q.. I t'el~tiov-i " ~fAC LOG; Loccd Mea.lH, / ' Cou."c.iils ' ccAA Bd. o.dvn1n .--- .I CCAA S·b++ - - - - - - - - -· ~ Abbreviations: ARMPC CCAA CHP DREW MAC:WG Bd Conf Dir's Chmn Plng \. = Atlanta Region Metro. Planning Commission = Community Council of the Atlanta Area = Comprehensive Health Planning = (U.S.) Department of Health,Education & Welfare = Metro . Atlanta Council of Local Governments = Board = Conference = Directors = Chairmen = Planning - 17 - �Title: Cooperative Arrangements made for funds, personnel, services, facilities SUMMARY: THE COMPREHENSIVE HEALTH PLAN IS AND WILL BE LINKED FORMALLY WITH THE APPROPRIATE ORGANIZATIONS TO ASSURE THE JOINING OF ALL HEALTH EFFORTS TO COMMON RESOU~CES. - 18 - �I C:OOPERATI·VE ARRANGE MENTS WITH OTHER PROGRAMS nur111rmrmmmmmmmmmmmm11m111·111111111mmmm11111111111mm1mm11111111m1111rnu1111murm111mmm11111111111111 1111m111m111111m111111111mmuu11111111111111111 1r \· -~ DHEW Dept . . Heal th, Education & Wel fa re

•----~.,,,_o.".~___ <'/y1- """--.,,"·11111111~-·C,. 00 ~0 ~ 0"'.j Local Health Ag encies Community Council ' of the Atlanta Area; MACLOG ,Ietro Atlanta Council of Local Gov ts. Metro Comprehensive Health Planning Council Personnel Ancillary library, mailing, \. policies* Services-duplicating, etc. . Comprehensive Health Planning Staff

See Append ix for Details .

I �• Planning is Based Upon Commonl y Available Da t a SUMMARY : THE LOCAL RESOURCES FOR QUANTITATIVE DATA IN THE HEALTH CARE FIELD ARE RATHER LIMITED BOTH IN AMOUNT, AVAILABILITY, AND COMPARABILITY, THE COMPILATION OF INFORMATION IN A CENTRAL CENTER WARRANTS PRIORITY FOR FUTURE PROBLEM-SOLVING. SOCIAL, ECONOMIC, AND DEMOGRAPHIC STATISTICS ARE MORE FULLY DEVELOPED THAN HEALTH DATA. BOTH ARE OFTEN SCATTERED AND FAR FROM IDEAL. INFORMATION ALONG THESE LINES IS AVAILABLE AND COMMONLY USED FROM MORE THAN A DOZEN SOURCES. \. - 20 - �Implications for Comprehensive Health Planning in Environmental Health Fields SUMMARY: THE METROPOLITAN ATLANTA AREA HAS MADE NOTABLE STRIDES TO IMPROVE ENVIRONMENTAL FACTORS IN RECENT YEARS. NEARLY EVERY AREA CONCERNED HAS HAD SOME PREVIOUS WELL-PLANNED PROGRAMS. THE ROLE OF COMPREHENSIVE HEALTH PLANNING WILL BE THAT OF COORDINATING EFFORTS, ENCOURAGING I MPLEMENTATION, AND INCREASING EFFICIENCY IN OPERATION. Text: Environmental Health programs being developed or reconnnended for the Metropolitan area include: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15 . Water and sewer plan implementation - a natural follow-up to current water and sewer planning should include recommendations for long range pollution control systems and management of water resources. Up-dating open space and recreation plan and program for the metropolitan area . Capital improvements progrannning: a continuation of the work ARMPC is doing now . Metropolitan Solid Waste Plan - MACLOG. Mobile Home Park - ARMPC - Study of requirements on location. Vector Control Program - EOA - Demolition Project . Comprehensive study of problems and possible long-range solution for solid waste and garbage collection and disposa l. Development of a long-range plan for industrial and off ice parks throughout the area - ARMPC . A study of future housing requirements: as they relate to population forecasts, income, employment, and location. This study i s now being held in abeyance. Up- dating of Ai r port Plan - ARMPC. Study , up- da t e and r evise all element s of l and deve lopment and fa c i lities p lans . ARMPC - The need for nature preserv~s and r~lated outdoor r ecre ation fac i l i tie s has been e s tablished. Implementation is now neede d . Fl oo d cont r ol project by Cor ps of Engineers . Atlanta Housing Authority : re-deve l op pub lic housing area; rat control; health clinics for proj ect area; and neighborhood renewa l proj ect (year ly basis) . Georgia Safe ty Council: organizing Teen Safety Councils in all high s chools in t h e sta t e of Georgia ; conducting industry safety seminars throughout the s t ate; driver improvement for t r uck dr ivers ; dr iver improvement through the defensive driver cour s e ; conduct ing injury contr ol program. - 24I l. �• .DEAD END ~ ONE OF THE great community benefits of urban renewal is the removal of unsafe, unsanitary and inadequate buildings. \. ATLANTA HOUSING AUTHORITY Auditorium-Convention Hall Complex �The Urban Life Center - A Solver of Urban Health Problems For the Future SUMMARY: THE NEWLY ORGANIZED URBAN LIFE CENTER AT GEORGIA STATE COLLEGE, WHEN FULLY OPERATIONAL, WILL PROVIDE A DYNAMIC INSTRUMENT FOR SOLUTION AND PREVENTION OF HEALTH AND HEALTH RELATED PROBLEMS. IT FOCUSES THE RESOURCES OF THE MAJOR EDUCATIONAL INSTITUTIONS IN THE ATLANTA AREA AND THE STATE OF GEORGIA ON BROADENING THE INTELLECTUAL BASE OF THE POPULATION, ENHANCING THE PROFESSIONAL AND CULTURAL COMMUNITY, INTENSIFYING . AND DIRECTING MOTIVATIONAL POTENTIAL AND PROVIDING SERVICES INVOLVING PEOPLE AS INDIVIDUALS AND GROUPS. Purpose: Early in January, .1969, the Urban Life Center and the City of Atlanta were designated one of six national research centers on urban problems. · (These. centers were selected by the National League of Ci ties act,ing under contract with Departments of Housing and Urban Development and Health, Education and Welfare.) This network of "Urban Obs.e r"'.atories" represents an effort to concentrate efficiently and economically the resources of higher education in the assault on urban problems. Concept: The guiding concept is that the new problems of the cities necessitate new approaches to academic organization and operation. An important feature is the inter-disciplinary approach to the study and solution of urban problems. Emphasis is placed upon the concentration and coordination of talents from all relevant disciplines and organizational units to effect sound solutions to urban problems. The Urban Life Center embodies four basic organizational components: <) The School of Urban Studies which provides the academic training and research foundations. <) The Urban Public Service Division :hJ:, structured to provide specialized activities, including short courses, institutes, conferences, public seminars, lecture series, workshops, community extension service activities, etc. <) The Inter-University Urban Cooperative seeks to coordinate and direct the resources of all the institutions of higher learning, in the surrounding area, aiming for cooperation with a minimum of effort duplication. <) The Observatory will facilitate the effective operation of the other components of the Urban Life Center. Data col lected by the Observatory will serve as one of the bases for training programs in the School of Urban Studies and those conducted by the Division of Urban Public Service. It is de.signed to work systematically with community agencies and organizations to coordinate data and develop meaningful working relationships relevant to urban problem - solving . - 32 - �THE URBAN LIFE CENT ER SCHOOL OF URBAN STUDIES \. INTER-UNIVERSITY URBAN COOPERATIVE DIVISION OF URBAN PUBLIC SERVICE URBAN OBSERVATORY HEALTH AND - 33 - �Local Health Departments. Atlanta Area CENTERS AND CLINICS Fulton County Cobb County (cont'd.) Main Center & offices Adamsville Alpharetta Ben Hill Buckhead Center Hill College Park Collins East Point Fairburn Hapeville Howell Mill Jere Wells Lakewood Roy W. McGee Neighborhood Union Northeast Palmetto Red Oak Rockdale Roswell Sandy Springs South Fulton Techwood Austell Mableton Powder Springs Smyrna Clayton County Main Office Forest Park College Park Fayetteville Gwinnett County Main Center Buford Norcross Duluth Douglas County Main Center, Douglasville DeKalb County Main Center & offices Doraville Kirkwood Lithonia North DeKalb Scobtdale Southwe s t Dekalb Stone Mountain Tucker \. Cobb County Marie tta Acworth - 34 - �(\)Un t y l•'in:rnc ing- St ate Allotments Jul y '67 - June '68 J,'111 t nn $ 403,181 DeKa lb Cnbb Cla yton G1d nn ett Doug las Centers Manpower 24 9 6 4 4 1 269,127 122,271 52,049 18, 760 • 21, 119 - Admission by Service Mental Health V.D. 425 199 47 38 21 8 7,479 2,925 2,169 964 484 83,109 63 128 6 4 14

T.B. 6 , 91:.) 3,36 3 1,080 51 7 59:;

no t readil y available

... .....,. -r~~-;t.~..n.____.A._ _ _--fl ...... ~ ~.h.1f ~.tiCWO,ITH • GWINNETT COBB ,--'LIL.... ,, I ... _. , '. I

DOUGLAS • PUBLIC HEALTH CENTERS • i( Metropo lit a n At l a n ta Area 19 68 - 35- HEALTH CENTERS SINCE 1967 HEALTH CENTERS �WATER AND SEWER,... .1:1ISTRICTS IN THE ATIANTA ARFA .. • SYMBOL SECONDARY e PRIMARY sEWAGE LEGEND T SE REATMENT Q UNTREATED WAGE TREATMENT SEWAGE m:::;> POTABLE WATER INTAKE

-~::. ~·:·...c:.,-..,

,.,1..... o:.; :~i!':'o~ •tllOPOUIAN "ANNINO �State Health P lanning Council Advises 11 A 11 Agency in carrying out its goals Comprehensive State Health Planning ·Agency - 11 A 11 Agency Develops comprehensive state health plan. Identifies health problems. Recommends policies and programs. Provides consultation and coordinates programs. I Areawide Planning Agencies 11 B" Agencies Relates health programs in an area within a comprehensive framework. Liaison with appropriate health agencies in an area to help carry out goals. Conduct periodic evaluations and stu1ies. Revi ~w local grant applications. Gathers and analyzes data.

I I Public liealth agencies (local) Voluntary health agencies (local) \. - 71 - �C om)1:im-au n n:~~r c~~'J.."R·1:ac il 0 ~ t h e At lanta A r ea inc. EUGC::NE T . B R ANCH , Clw irn ri m of rlzi.• l l< 111n l ,,/ l Ji1,: L'f r, r .\ CECIL AL EXAN DE R , ' ' i1:t! Ch .:1in ;,·,•, ,, JO_HN 17. ARD. l'/ca Ch a i ri11 ,1r, MRS . THO MA S H . GI BSON . S ,:cn::1ar_,. DONALD H . GA RE I S , 1" ri •u 111r,•r DUANE W . BEC K . ON E THOUSAND GLENN BUILDI N G , 120 MARIETTA ST. , l'I. W. £ r ern1i1·,• Direc:or ATLANTA, GEORGIA 30303 TELEPHONE 577-. May 23, 1969 Donald F. Spille, Ph.D. Executive Director of Metropolitan Atlanta Mental Health Association 209 Henry Grady Building Atlanta, Georgia 30303 Dear Dr. Spille: As ·you know a proposal will be sent to HEW, Washington, in early June, setting up a mechanism for comprehensive health planning in the metropolitan Atlanta area, and requesting a 5-year grant to assist with such planning. HEW must be assured that the proposed comprehensive health planning will have cooperation of all parties and agencies involved. This is to request that you write us a letter, as soon as possible, assuring us of your cooperation in this project . Sincerely yours, !r!dL~k. . Director , Comprehensive Ar e awide Health Pl anning RBL:az Encl. "".6 9- �Community Involvement in Comprehensive Health Planning SUMMARY: DOCUMENTED HEREIN (SEE APPENDIX) ARE INDICATIONS OF SUPPORT FOR COMPREHENSIVE HEALTH PLANNING FROM COMMUNITY ORGANIZATIONS AND GOVERNMENTAL AGENCIES. IT IS ANTICIPATED THAT COMPLEMENTARY RELATIONSHIPS OF MUTUAL BENEFIT WILL BE SOLIDIFIED IN THE EARLY STAGES OF PERMANENT OPERATION. Note: Letter of the opposite page has been sent to following groups in the six-county area: County Commissions Mayors of Cities Medical and Dental Societies Nursing Associations Hospital Council Nursing Home Association Chamber of Commerce Colleges and Universities Health Care Centers Voluntary Health Agencies Representative Organizations of the Poor and Near-Poor - 68 - �ORGANIZATI ONAL CHART OF COMMUNITY DEVELOPMENT IN COMPREHENSI VE HEALTH PLANNING w E Key: D 25-member core of planning efforts t o direct task force assignments. 0 Chamber of Commerce Board of Directors. + Local County communities. These communities will be analyzed and local citizens (with a wide range of representative types) will be asked to participate in discussions. Some representatives to consider will be age, race, sex, income, geographic location, etc. The basic philosophy is to establish task force and community involvement simultaneously and then pool these thoughts into final recommendations. This obviously is an oversimplification of the process and many problems will have to be overcome if efforts are to be successful. -67- �Sub-Areal Healtn Councils. Cobb County: Example in Experience SUMMARY: COMPREHENSIVE HEALTH PLANNING EFFORTS IN COBB COUNTY, AS IN OTHER AREAS OF METROPOLITAN ATLANTA, ARE IN THE NEOPHYTE STAGE. ORGANIZATION OF A COBB COUNTY HEALTH COUNCIL HAS MET WITH ENTHUSIASTIC COMMUNITY SUPPORT. COOPERATION AND EFFECTIVE COMMUNICATION WITH THE METROPOLITAN COMPREHENSIVE HEALTH PLANNING COUNCIL WILL PRODUCE AN EXEMPLARY RELATIONSHIP IN EFFORTS TO MEET HEALTH NEEDS OF THE AREA. History of Cobb County Health Council: While in recent years much progress has been made, gaps in Cobb County's health services have been dramatically evident. For example, a new family found the nearest physician twenty miles away. One hospital is often overcrowded while another has many available beds. Solutions to these and other problems are necessarily a task for large scale cooperative planning. The present twenty-five member CCHC had its beginning in February, 1969, with a meeting of five health-oriented connnunity leaders under auspices of the Chamber of Connnerce. Health problems were recognized in four basic categories: Services Facilities Manpower Financing Task forces of the Council and other connnunity members have been assigned to determine needs, resources, and possible solutions in these areas. Implications for Success: 1. The Chamber of Connnerce has had a leading and beneficial role in organizing the CCHC. Support and participation have already been secured from major segments of the community. 2. Planning involves government officia~s, health providers, and consumers working together to improve the total health system. 3. From the beginning, members of the CCHC have recognized the potential for inter-relationship with the Metropolitan Council. Understanding and coordination of efforts will combine resources leading to the solution of health problems. Implications for Overall Local Liaison The Cobb County Health Council is farther advanced than those in other counties and neighborhoods, although beginnings have also been made in Gwinnett and Clayton Counties. Basically, these local Councils serve two major purposes: (1) they extend the capability of the metro Council to spotlight special needs in local areas, and (2) they bring into participation additional citizens who generate citizen information activities and buil support for CHP . - 66 - �POLICY - RECOGNITION - SUPPORT - ACTION FEDERAL, STATE $ FOR PROJECTS $ FOR PROJECTS RECOGNITION $ FOR $ FOR PLANNING ) PLANNING COUNCIL, STAFF LOCAL (RECOMMENDATIONS ~ TECH. ASSISTANCE CHAMBER OF COMMERCE FOUNDATIONS BUSINESS INDUSTRY COMMUNITY CHEST $ FOR PROJECTS ACTION ETC. PROJECTS ACTION PROJECTS -6~- �Pr ocedure for Po l icy Implementat ion SUMMARY : FUNCTIONS OF THE ME TROPOLITAN CHP AGENCY WILL I NCLUDE RESEARCH, COORDINATION OF VARIOUS GROUPS, AND POLIC Y DECISIONS IN THE HEALTH FIELD. AS A PLANNING BODY, THE COUNCIL AND STAFF WI LL DEPEND UPON ACTION GROUPS FOR IMPLEMENTATION OF ITS POLICY. FEDERAL, STATE AND LOCAL GOVERNMENT RECOG NITION OF THE AGENCY WILL BE KEY FACTORS IN THE ABILITY TO INFLUENCE ACTION WH ICH WILL I MPROVE HEALTH FACILITIES AND SERVICES . The f ollowing functions a nd rela t ionships will provide a basis for ensuring implementation of polic y . Func t ions o f t he CHP Ag ency (Polic y Boa rd and Staf f ): 1. 2. 3. 4. 5. 6. 7. 8, 9, Conduct research in communit y health problems. Dev elop background for policy-ma king; use systems analyses, cost-benefit analyses, etc. Coordinate acti v ities of all health planners in the community. Review health action projects originating in the community. Pro ide technical assistance t o action agencies. Orig inat e health a ction projects where needed, Conduct communit y liaison and education in health matters. Give adjacent areas assistance in health planning on contract basis. Make policy decisions f or the community in health matters, Rel at ionships between t he Agency and other groups: 1. 2, 3. 4. 5, 6, The CHP policy Council will be representative of all health concerns in the Metrop olitan Atlanta area, Recognition of CHP Agenc y responsibility and authority in planning areas is e x pected on all levels of governmental and health-concerned group involvement . Funds . for e x ercising agenc y functions will be sought from federal, state and local governments . Their support will indicate recognition and delegation of health planning polic y decisions to this agency. Foundations , business and v olunt ary heal t h organizations may be expected to provide some f unds f o r planning. Loc a l g ove r nments and independent health agencies will receive benefits from CHP th r oug h t echnic al assistance in planning, coordination of efforts and recommendat i on o f p r iori t i e s . Fede r al fund s f or an y given project will need approval of the CHP Agency fo r alloc at ion . The abov e b eing f a c t ors , r e s pect a n d pres ent f or imp l e men t a t i on of other pl a nning ag e ncies , hos pi ta l groups wi t h des ired assistanc e o f f or the CHP Agency will be an inherent t r ait necessar y polic y dec i sions. Recommendations made to gov ernments , author i ties and the like, will be carr i ed out b y thos e the CHP staff . ~ Ef fectiveness o f comprehensive he a l th pla nn i n g : The interre lationships amo ng CHP and o ther local gov e rnments and agen cies i s designed to ins ure mutual respe ct and depe n den c e. Where a s t he CHP Agenc y d e pen ds for its e x istence on the recognition and financia l suppo r t of t h e o ther groups, the y, in t urn, d e p e nd on the existence and r e cognition by Stat e and Federal offices o f t he CHP Agency for much of the Federal funding they req u ire. And whe reas the CHP Agency d e pe nds on t he respe ct for its competence and fairness by local gro ups for its effec t ive nes s in originat ing new plans, the local groups depend on the CH1> Agency review for implementation of plans which they or i ginate. Thus , it is in the interest s of all that r e lationships begin a n d continue on a harmon ious and mu tually helpful bas i s . - 64 - �CHOICE o OF PR'OGRAM CHOICE OF FUNDING ALTERNATIVE L E VEL t l

~ PROGRAM RESOURCES •M ONEY • PEO PLE •FA~I LI TIE$ EFFECTIVENESS* OUTPUT

--- IMPACT -- PROGRAM GOALS EFFICIENCY = OUTPUT INPUT ACTIVITY LEVEL DETERMINANTS* • REQUIREMENT •NEED • DESIRED LEVEL COMPREHENSIVE HEALTH SERVICE. AREAWIDE PLANS : ~ z z -.<.. z< 0 u, w ~ Fl NANCI AL PLAN Ill ACTION HEALTH PRO GRAM -63- ~ 0 a. z <

...... V -.( ... u N z z ;;: < ~ 1111 0 �The Ne ect for Planning Program~ing Sy stem for Compr e hensiv e He alth Planning SUMMARY: PLANNING AND PROGRAMMING SYSTEMS OFFER GREAT PROMISE TO AREAWIDE PLANNING AND OTHER GOVERNMENTAL ORGANIZATIONS AS A MEANS OF SYSTEMATICALLY RELATING PROJECT OR PROGRAM PLANNING WITH FINANCIAL PLANNING. IT IS A METHOD OF OBTAINING THE MAXIMUM BENEFIT AND EFFECTIVENESS FROM RELATED HEALTH PROGRAMS THROUGH THE EFFICIENT GOAL-ORIENTED APPLICATION OF AREAWIDE RESOURCES. Basic Purpose: The basic purposes of a planning and programming system are to: •permit rational choosing between objectives, •uermit rational choosing between programs, •facilitate selecting rational levels of programs, •facilitate review and evaluation of program accomplishment. Major Characteristics are: •the identification of the fundamental goals and objectives of the area; •systematic analysis of alternative ways of meeting the areawide goals and objectives; •the presentation of alternatives to the decision-maker; •explicit consideration of future year fiscal implications (5-year program goals) at; - preferred funding level, or - stringent funding level~ and •that proposals and decisions are properly supported by documented evidence. Benefits: In general an integrated system of planning, programming, offers: An improved process for decision-making, policy formation and for analyzing major issues. A systematic method of exploring alternative ways (more effective or less costly) for getting the health and health related business done. A procedure for coordination of health programs in the light of identified common or single goals and objectives. An examination of fundamental goals and objectivas of the Atlanta Area and the role of individual programs in meeting those goals and objectives. A strengthening of the initiative of the areawide and local governments in policy formulation. A method of relating areawide planning and programming to the financial process of the State and loc al communities . - 62 - �-- I I - .· I I I ,~.'.J.~ --~ . Type o:f trainii:ig education ~ i -Source o;f · recruitment --;> R I e.. c.. Y' tt. .· , ,/ · I .., _.~. h "'r ·l'\ .'n C\ · ct.. 1 J / ,...a,

·{;. d

, ·. I • -~ --·:;-...__....:..._J/' -.. C. A.~ I O ~ 1 + rt\ -e. l'\+ _ / / ./ �Title: Information Gathering and Analysis Systems and Techniques to be Used SUMMARY: THE BASIC INFORMATION SYSTEM WILL INCLUDE THE (A) COLLECTION, (B) QUANTIFICATION, (C) STORAGE, AND (D) UTILIZATION OF DATA PERTINENT TO THE OTHER PHASES OF THE PLANNING PROCESS, PROBLEM AND RESOURCE DETERMINATION, IMPLEMENTATION, AND EVALUATION. EVALUATION OF THE PLANNING ITSELF SHALL BE DONE BY THE COMMUNITY AT LARGE THROUGH ITS EXERCISE OF SUPPORT. EVALUATION OF PARTICULAR PHASES OR OPERATIONS WILL BE BUILT INTO COSTS-BENEFITS ANALYSIS AND SUPPLEMENTED BY INDEPENDENT INVESTIGATION. Research Technique Data shall be organized according to a total functional model; i.e., under a scheme which takes into account units, their relationship to each other, and their relationship to a larger whole. The units or subsystems of the health system, the entire health system, the total environment, and the "functional flow" of the user through it is suggested in the diagram on the opposite page. This technique provides a basis for costs-benefits analysis of alternative plans for action. Evaluation Technique: A baseline for measurement of impact will be the purpose of an initial collection of information. A systematic, continuous feed-back on effectivenss of programs will be built into each program in a simple manner. Elaborate evaluations of particular phases or troublesome operations will be conducted. ' Both the subjective and objective appraisal of efforts in terms of their impact upon the particular problem and the long-range goal will be made. The entire planning process will be subject to the periodic evaluation of the organized corrnnunity in the form of their extending or withdrawing financial and cooperative support. The decision makers themselves will be subject to evaluation by "recall" or failure to election to the CHP Board by their respective groups. The "public" will be an implicit evaluator through its use and non-use of programs. - 60 - �PRIORITY AREAS FOR COMPREHENSIVE HEALTH PLANNING EFFORTS Loading on health manpower - quantity and utilization, Loading on health facilities - quantity and utilization. Discrepancy between needs and care received by the poor. Maternal and child health; family planning. Mental Health Environmental sanitation; pollution, waste disposal. Public health and prevention; vector control. Emergency health services. Injury control. · Dental problems. Drug abuse and alcoliolism. Degenerative and chronic diseases. Citizen role in prevention and care. Costs of health care; insurance patterns. - 55 - �Scope of Program Health Concerns SUMMARY: A PRINCIPAL EFFORT DURING THE ORGANIZATIONAL PERIOD HAS BEEN TO IDENTIFY THE HEALTH PROBLEM AREAS OF THIS COMMUNITY WITH SUFFICIENT PRECISION TO BE ABLE TO PROJECT THE SCOPE OF THE PERMANENT PLANNING AGENCY'S FIRST YEAR OF OPERATIONS, AND DETERMINE THE STAFF NEEDS THESE OPERATIONS ENTAIL. OF THE MORE THAN 40 SUCH PROBLEM AREAS IDENTIFIED BY THE STAFF, 27 WERE STUDIED IN SOME DETAIL WITH THE ASSISTANCE OF AS MANY "TASK FORCES", DRAWN FROM THE COMMUNITY AT LARGE, AND INCLUDING HEALTH CONSUMERS AS WELL AS HEALTH PROVIDERS. SOME 14 PROBLEM AREAS HAVE BEEN IDENTIFIED AS MOST LIKELY TO DEFINE THE SCOPE OF THE FIRST YEAR Is PROGRAM. Need for Identification of Health Problem Areas Although the staff during this organizational period is not in a position to perform actual planning for this community, and therefore does not need the detailed information about community health proble ms and preve ntion and care mechanisms which will be necessary for a systems analytical approach to planning, it was necessary to identify the health problems with sufficient precision to be able to project the scape of the permanent planning agency' s first year of operations. This scope, in turn, determines the size and skills which will be needed in the permanent staff. Study of Health Problem Areas During initial staff conferences, augmented by consultants from a number of health fields, and through the mechanism of two large · community"technical aspects" meetings, more than 40 problem areas were identified as needing attention and improvement in the metropolitan health picture. These were divide d into priority categories on the basis of the impressions developed to that time, and about half o f them were designated as needing further st udy. This, in turn ; was accomplished through the mechanism of problem area "task fo rces". Problem Area Task Forces Gr oups of interested and knowledgable persons in the community were asked by the var ious staff members to form "task forces", each of which was to study one of the assigned problem areas in the detail necessary for determining the scope of the 1970 comprehensive health planning effort. The task f o rces rang e d in size from two or three individuals to more than 20. They were given i nstructions as to how to go about gathering their data and how to report t hei r findings ( see Appendix ), and were assisted and encouraged by one of t he s taff . Some 27 of the s e task forces we re e v e ntually formed, and the ir reports, in many cases quite voluminous, are presented in Volume III of this proposal (in condensed form). A grea t deal of thanks is due to these hundreds of people, health providers and consumers alike, for the insight which the y c ontr ibuted to the understanding of t his commun ity 's problems. Scope o f the 1970 Ef f o rt The 14 problem a reas s h own on the fa c ing page now seem likely to define t he scope of the fir s t year 's effor ts of the pe r man ent compr ehe ns i ve health p lanning agency. - 54 - �- ~---------~~---~___,_ COMMUNI TY INVOLVEMENT HOUTE FOH BUILDING A POLICY BOARD BY COI,J,oENSUS • El I C~A CCAA CC.\.-\ ~ me e ti n gs FCMS ·- FC'~lS mee tings JCAHPA CCAA ,ti} 0 At .COC C's o f C l me et ing 2 me etings Communit y Invo l veme nt Pa n e l

1 0

mee ting Community Involv e ment Cl Communit y Involv e me nt .__ _ _ _ _. . SCXC 1-------t~Steering Committee 1--+"""la:::~ St ee ring Committee • lf-io mee ting meeting Ad Hoc Nominating Groups • 20 6 mee t i n g s Sm,n 11 Groups (many) Compre h e nsive Hea lth Planning Council 50 Org s. 1 mee ting 1 mee ting each. 10 Local Governments 3 Major Planning Agencies 2 0 He al t h Provide rs 2 Busine ss a nd Labor 17 Poor a nd Nea r - Poor CCAA Communi t y Council o f t he At l a nta Area , Inc. At.COC Atlanta Chamber of Commerce CISCXC Community Involveme nt Steering Committee Executi ve Committee FCMS Fulton County Me di c a 1 Socie t~· 52 Not e s: • ind i c a te numbe r of p e ople at mee ting ( s ) . o s e ve ral me mbe rs p e r organiza ti on -53 - C's of C Chamber's of Commerc e JCAHPA Joint Commit t ee of Area He alth Profe ssional Assoc i ations �Organizational History of the Applicant SUMMARY 'IHE COMMUNITY COUNCIL OF THE ATLANTA AREA , INC., A NON-PROFIT CORPORATION CHARTERED UNDER THE LAWS OF THE STATE OF GEORGIA WILL ACT AS THE APPLICANT AGENCY FOR COMPREHENSIVE HEALTH PLANNING. POLICY IN THE HEALTH ACTIVITIES WILL BE FORMULATED BY THE COMPREHENSIVE HEAL'lll PLANNING COUNCIL (CHP COUNCIL), WHICH WAS BROUGHT INTO BEI NG BY A COMMUNITY INVOLVEMENT PROCEEDURE RESULTING IN SUBSTANTIAL CONCENSUS. THE STAFF WILL CONSIST OF THE CHP ORGANIZATIONAL STAFF, AUGMENTED BY ADDITIONAL PROFESSIONAL AND SUB-PROFESSIONAL MEMBERS. COMMUNITY COUNCIL OF THE ATLANTA AREA, INC. The Community Council of the Atlanta Area, I~c . , was established as a community planning agency :in 1960; previous to that date it was the Planning Division of the Atlanta Uni ted Fund. I n 1963, the Council Launched the West End Demonstration Project with the purpose of find i ng "new ways of solving economic dependency (poverty)"; the activities of thi s Project let to the design of the initial application by Atlanta and Fulton County for funds from the Office of Economic Opportunity. The resu l t was the Economic Opportunity Atlanta (EOA) agency was established . In 1965, the Council entered i nto a contract with Atl anta to develop a long r ange pl an for Urban Renewal under the Community Improvement Project (CIP) which produced.the information, development plan, and method of "grass roots" resident partici pation in urban renewal planning . In 1965 , the Council applied for and received a Hill-Burton facilities planning grant of $112,000 for a three year period. COMPREHENSIVE HEALTH PLANNING COUNCIL (CHP) The CHP will come i ~to existance on June 5, 1969, and will assume the active role of policy making in health matters when the permanent agency is establi shed January 1, 1970. This Council was brought i nto being t hrough an ext ens i ve pr ocess of community involvement and concens us- seeki ng. Af t er several pr el i m:inary meeti ngs of possible sponsors, a group of "convenors" brought t ogether a "Communi ty I nvolvement Panel " repr es enting 170 offi ces, agenc ies , and organ iza t i ons c on cerned wi th hea lth. This Panel on March 13, 1969 elected a "community I nvolvement Steering Committee" of 36 members , and an Executi ve Committee. Thus the devel opment of organiz a t i onal gui delines , the methods of r eaching t hem , .t he nomi n ation and selecti on of permanent members of the Counci l became the goa l of t his St eering Commi t tee, which in t urn resul ted in the f orma t i on of a Comprehensive Healt~ Planning Council on June 5 , 1969. 'lbe membership (as shown on the opposite page) is drawn from five broad categories of community groups; well- distributed by geographic are as, s oci oeconomic status, ethnic backgroup, providers and consumers, public and private sectors. (Members of CJIP, representation, organiza tions and functions are on pp. 80- 85 . ) STAFF Members of t he Organizational Staff and titles and descripti ons to staff to be recruited to become the permanent staff of the planning agency are l i sted on pages 78 and 79. - 52- �BACKGROUND OF HEALTH PLANNING EFFORTS (1) Health Planning with: Economic Opportunity, Atlanta, 1964. Hill-Burton and National Institute of Mental Health, continuous. Georgia Regional Medical Program, continuous. Home Health Care Service, 1969. Nursing Homes, 1967 Ga. State College, Kennesaw College, DeKalb College, Clayton Junior College, medical personnel training, 1967. Fulton County Medical Society: Southside Comprehensive Health Center, Vine City Health Services. 1967. Appalachian Funds, 1967. Model Cities Program, 1968. Areawide Comprehensive Health Planning, 1969. Studies: hospitals, nursing homes, services, patients, physicians, senior citizens. (1) Related Planning: Community Improvement Program: Atlanta Urban Renewal Senior Citizens Agency Alcoholics Program Information and Referral Recreation: Atlanta · Parks and Recreation Community Participation organizations Neighborhood Central Information Files . (1) See Appendix for more complete descriptions . ... 51 - �Community Council Has -Extensive Involvement in Health and Planning SUMMARY: ONE OF THE PRIMARY INTERESTS OF THE COMMUNITY COUNCIL, ATLANTA AREA, INC., IS THE HEALTH OF THE COMMUNITIES, THE FAMILIES, AND THE INDIVIDUALS OF THE METROPOLITAN AREA. ACTIVE SUPPORT AND PARTICIPATION IN PLANS AND PROGRAMS RELATED TO HEALTH HAVE BEEN CONDUCTED SINCE 1960 . THE COUNCIL HAS WORKED CLOSELY WITH FEDERAL, STATE, AND COUNTY AND CITY AGENCIES, PROFESSIONAL AND VOLUNTARY GROUPS AND INDIVIDUALS TO RAISE THE LEVEL OF HEALTH. Current Status: The following paragraph taken from Health Planning" by which the Governor of Public Health as planning agent for the capacity of the applicant planning "Narrative Plan for Comprehensive designated the G0 orgia Department the S1ate of Georgia attests to group: "There are only three staffed organizations in the state directed by boards adequately representative of the total community which are engaged in human resources-heal. th planning . These are the Community Council of the Atlanta Area Inc. t h e United Community Service of SavannahChatham County, Inc., and the Georgia-Tennessee Regional Health Commissi..on. The Department has maintained liaison with these agencies throughout their existence because of their broad interest in human resources planning . This rela t ionship is e x pected t o continue." ' - 50 - �Goals and Aims of the Planning Project: SUMMARY: THE PRINCIPAL GOAL OF AREAWIDE COMPREHENSIVE HEALTH PLANNING IS THE SAME AS THAT FOR STATE AND NATIONAL LEVELS: "PROMOTING AND ASSURING THE HIGHEST LEVEL OF REALTH ATTAINABLE FOR EVERY PERSON". LOCALLY, THIS MEANS DEVISING AND ADOPTING STRATEGIES FOR THE USE OF HEALTH RESOURCES WHICH WILL MATERIALLY RAISE THE LEVEL OF HEALTH, PROGRESSIVELY, IN THE ENTIRE COMMUNITY. SUCH A TASK IS SEEN AS A PROBLEM IN "SYSTEMS" ANALYSIS AND DEVELOPMENT, BY WHICH BACKGROUND FOR POLICY DECISIONS MAY BE GENERATED. MAXIMUM PARTICIPATION BY ALL CONCERNED ELEMENTS IN THE COMMUNITY WILL BE NECESSARY FOR SUCCESSFUL IMPLEMENTATION OF POLICY. In 1966, the United States Congress enacted Public Law 89-749, the "Partnership for Health" act. · Under thi s law, the Sta tes, and .through them, are as within the States, must a•sume responsibility for comprehensive health planning. The Congress declared that "fulfillment of our national purpos e depends on pranoting and assuring the highest level of health attainable for every person, in an environment which contributes positively to healthful individual and family living; that attainment of this goal depehds on an effective partnership, involving close intergovernmentai collaboration, official and voluntary efforts. and participatio~ of individuals and organizations; th&t Federal financial assistance must be directed to support the marshalling of all health resources--national, State, and local--to assure comprehensive health services of high quality for every person, but without interference with existing patterns of private professional practice of medicine, dentistry, and related healing arts". Th e term II COillprehensive II means that every aspect of the health picture in the six-county metropolitan area must be taken intQ account in the planning process. This includes not only the treatment .of illness and injur y, but their prevention, and the canpens ation for any lasting effect s which they may leave . Thus, in addition to the manifold activitie• of medical and paramedi cal pers onnel in the variety of health treatment facilities, plannillg Jr.ust cons ider envir onme!ltal cont r ols of the air, water, soil, food ,· disease vectors, housi ng c odes and constr uction, waste d isposal, etc. It must c ons i de r nee ds for the training of he alth per sonnel , for the impr ovement of manpower and fa c i l it ies u til i za tion, and for the a ccess t o health c are . It inc l udes the fields of ment a l hea lth, dental health, and rehabi l i t ation. It must be conce rned with the means of paying for prevent ive mea~.~ es and for health care. The term "planning" means , fi rst , t hat problem areas and pot ential problem areas in the entire field must be identified,and their magnitudes assessed. The trends of the problems must also be aase•aed, and projected for future years. Technical and organizational bottlenecks must be identified and "planned around" . Second, the community's resources ·in meeting its'healtb needs must be equally carefully identified and projected, in term• of professional and •ubprofessional akilla, facilities, and financial resource•. - 48 - �Third, since a considerable amount of planning is already being done for a num b er o f projects, hospital authorities, counties, and municipalities, which aff ec t s the c ommu ni ty ' s healt h picture, ways must be found to make maximum us e o f t h is c ap ability , a nd coordina te it into a community-wide comp rehens ive p lann i ng e ff ort. F inally , pl a nning must preserve and encourage t he highe st l e vel o f pr o f ession al competence in the entire health system , a nd must make use o f the i nsights of all con cerned in the community h e alth s y st e m. T he over a ll task of putting together such an organization is thus seen to be a problem in "systems" analysis and development. Since the total resources of t he community a r e likely to remain smaller than the demands which an idea l h ealth system wil l place on the resources, r ational and just methods of a ssi g ning p r iorities t o the various needs must be developed. A cost-benefit anal y sis is e ssential to any such decision process, and, considering the lite ra ll y hundred s of specific health needs in the community, it i s l i ke l y th a t t he cost-ben e fit model mu s t rather soon ma ke use of modern compute r t ec h n i ques . The Pa rt n e r ship for Health law requires that such planning be done with pe o ple r a t her than for people. Therefore, maximum participation of health "consumers", health professionals, governmental units and agencies, and other community organizat i ons is a necessity. The law ~s telling the States and communities that t hey will be given increas i n g resp~~sibility and power to determine their own be s t hea lt h interests. In o r der to e x ercise this power mo st ef f ect i ve l y, a max imum degree of concensus must be attained among thos e community elements c oncern e d with heal t h. To t his end, participation of s u c h ele men ts is mandat ory , so that a true" partnership for. heal th" among governments, healt h p r ov i de r s and consume rs, rich and poor, black and white, urban and rura l , may ' b e ac hi e v ed .

GOAL FOR 1975: WIMBLE, I HAVE CALLED TH IS MEETING TO INFORMYOU THAT THE CLAUDE CLAY UNDERTAKIN G PARLOR SELDOM HAS MY POST MORTEM PALACE SEEN BLACKtR DAYS!. .. LOCALSHOOT- OUTS ARE DOWN 73% ... THE ACCIDENT RATE HAS IS IN THE THROES OF DROPPED TO AN ABSURD LEVEL!... A SEVERE PLAGUES ARE AT AN ALL-Tl.ME RECESSION! LOW! IN SHORT, ATLANTA IS IN THE CLUTCH.ES OF A GLOW OF H.EALTH OF NEAR EPI DEMIC PROPORTIONS' from Atlanta Journal and Cons titutio n 25 May 1969 "Tumbleweeds" by Tom K. Ryan - 49 - �government STATE OF GEORGIA NUMBER OF FEDERAL AGENCIES SERVING STATES FROM ATLANTA REGIONAL HEADQUARTERS . - 36 -46 - 31 -35 - 6-12, Rapid Transit Is A MUST ... ' ATLANTA POPULATION 1940 1950 1960 NEXT 25 YEARS 2 MILLION • SUTIQNS Wll!i • ST A TtONS W I Ttl OUT PAlh.!HQ P .\ IIIKt -. c 2 11/a ½ Number Of People (In Millions) l( O, l I' , ,11 1 ~ l!UU • REGIONAL CAPITAL OF THE SOUTHEAST - 47 - u ;cc • • 11 • o • Ol •I • • . , ... H • • •• IIH • �- provides jobs for over 13.5 percent of all non-agricultural wage and salary workers; - capital for the State of Georgia; - houses federal and state, regional and district governmental offices; - military ins t allations such as Third Army Headquarters, Dobbins Air Force Base, Naval Air Station, etc.; - U.S. Federal Penitentiary. Wholesale Trade - Concentration of wholesale trade is the most important single index to metropolitan status - 4 billion dollar business - ranks 13th in the nation; the big four in wholesaling are: motor vehicles and automotive equipment groceries and related products drugs, chemicals and allied products · machinery, equipment and supplies Manufacturing Atlanta's production activities have been growing rapidly. Atlanta is second only to Louisville, Ky. in the southeast in the number of production workers or in value added by manufacture. - Durable goods employment has risen 39% of the 1952 total to present 47.5% - Major items in transportation are automobile (GM & Ford) and aircraft (Lockheed). Communications Atlanta Area is one of the largest telephone switching centers in the U.S. - Only Class I toll center in Southeast - Headquarters for Southern Bell Telephone & Telegraph Co. which serves nine states and Southeastern headquarters of American Telephone & Telegraph Co. · - Atlanta Western Union office is one of 15 automatic high speed switching centers in the nation (it handles approximately 2 million telegrams a month) - Gross postal receipts amount to 25 million per year - Atlanta has 3 commercial, 2 educational TV stations; over 19 radio stations, news coverage by 3 national TV networks, 20 weekly newspape rs and regional operators of AP, UPI, Wall Street Journal, New York Times , Time Magazine, Newsweek and Business Week . Higher Education A major r egional function of the Atlanta Ar e a (SMSA). - Headquar ter s of the Southern Regiona l Edu cation Boar d and f or t he Southern Association of Col leges and Secondary Schools . - There are a number of r ecognized co l l ege s and universi ties in t he Ar ea of gr ea t impor tance to i t s economic pot entia l. - 46 - �The Economic Status of the Atlanta Area SUMMARY: THE ATLANTA AREA HAS MANY SPECIFIC URBAN PROBLEMS. WHILE GENERALLY PROSPEROUS DUE TO ITS GROWTH AS AN INDUSTRIAL, BUSINESS, FINANCIAL, EDUCATION, COMMUNICATION AND TRANSPORTATION CENTER, THERE ARE SIGNIFICANT AREAS OF BLIGHT, UNEMPLOYMENT AND INADEQUATE COMMUNITY FACILITIES. THE VARIETY AND QUANTITY OF INTERNAL TRAFFIC FLOW PROBLEMS IN THE VITAL MOVEMENT OF GOODS AND PEOPLE CONTINUOUSLY REQUIRE THE DESIGN AND CONSTRUCTION OF MASS TRANSIT AND CIRCUMFERENTIAL HIGHWAY SYSTEMS, POPULATION INCREASES, I HMIGRATION OF WORKERS FROM RURAL AND OTHER URBAN CENTERS, LONGER LIFE SPAN, TECHNOLOGICAL INNOVATION AND MEDICAL ADVANCEMENTS HAVE CREATED HEAVIER BURDENS ON HEALTH AND HEALTH RELATED SERVICES AND FACILITIES, BOTH SHORT AND LONG TERM. THE ATLANTA AREA PRESENTLY NEEDS APPROXIMATELY 1800 BEDS FOR l~DICARE, MEDICAID AND TREATMENT FOR THE "MEDICALLY INDIGENT". AS TRENDS INDICATE. CONTINUED ECONOMIC GROWTH WITH RELATED POPULATION INCREASE, THERE WILL BE EVEN GREATER NEED FOR ADDITIONAL HEALTH FACILITIES AND MANPOWER RESEARCH TO SOLVE UNEMPLOYMENT, LABOR AND HEALTH RELATED PROBLEMS, Topography: The Atlanta Area is centrally located in the Southeast and stands alone as the only metropolis in its population class south of Washington and east of Dallas and Houston. - Economically similar to other inland regional centers such as Kansas City, Minneapolis, St. Paul and Dallas. - Developable land areas abound in every direction. - Physically, the Atlanta Area is: --located in the Piedmont region which lies south of the Appalachian region and north of the Coastal Plains region; --north of Georgia's :fall line and bisected to some extent by the Brevard fault; --characterized by low rolling hills containing metamorphic and igneous type rocks; --generally blessed with a warm, humid climate (average winter low=45°; average sunnner high=77°) --ideally suited for impoundment of almost any size lakes due to its annual average precipitation of 48 inches: - Pine and a few other hardwood trees are found throughout the Area. - Water for the Area comes from the Chattahoochee River , severa·l cr eeks and lakes. --Lake Lanier and Allatoona Lake are within 50 miles of Atlanta - The reddish clay- soil of the Area is moder a t ely fertile, but sus cep t ibility to erosion has dive r t e d much of the land to less demand ing us es s uch as pasture and fore s t s . - 44 - �- Notable Features: --Stone Mountain (a granite peak and State Park), reputedly the world's largest granite monolith --Kennesaw Mountain, an historic Civil War battle site Transportation Key to the Area's economic growth. -Railroads - 13 main lines of 7 railroad systems radiating in all directions. -Interstate Expressways - Six legs scheduled to go through the area -Air Transport - Six major airlines serve the area; two of the airlines are headquartered in Atlanta. 800 scheduled arrivals and departures daily. -Waterway Transport - has potential for both recreation and trade. Finance One of the most significant forces in the ATLANTA AREA (SMSA) is its economic growth as a financial center. Factors effecting the financial growth are: - selection for Federal Reserve bank (based on flow of trade in 1914) - headquarters for Sixth Federal Rserve District - growth in Atlanta's correspondent bank relationships Business ATLANTA AREA (SMSA) is an office "Headquarters c~ty" with continued business growth indicated for the future. - since WW II more than 8 million square feet of rentable office space has been built - leader in advertising, blueprinting, photocopying, research, and development, etc., in Southeastern United States. Manpower (See chart page 42 , Health Manpower Resources, 1968) (See chart page 13 , Population Distribution by Age and Sex) Major problems in the Area's working population will arise from: - inexperienced individuals, in large numbers, born in the 40's and 50's who will enter the job market in the 60's and 70's; - women, who increasingly tend to accept regular employment; - middle-aged males, industry's supervisory personnel pool, who will scarcely increase in number; - older people, gr owing in numbers, who will cr eate a demand f or ret ire~ent homes, medical care facilities and passive re crea tion equi pment; this will affect constr uction and indus tria l production ; - i mpact of automation which will accelerate competition f or available jobs. Government Government is big business in t he ATLANTA AREA. - 45 - �SELECTED RANKINGS & CHARACTERISTIC OF GEORGIA (From State Data & State Rankings, Part 2 of 1966-67 edition of Welfare Trends) HEALTH MANPOWER U. S.Rank Physicians 38 Dentists 48 Professional Nurses 43 General & Special Hospital Admissions 48 Mental Hospital Admissions 19 Tuberculosis 27 Expenses (total) 47 Expenses (General Short-term) 39 Expenses (General Long-term) 2 Expenses (Mental) 46 - 43 - �- - ----~-- - - - -~- - -- - - - - -- -- - -- -- - - -- - - -..! ! • Existing Ma npower SUMMARY: THE NUMBER OF PRIVATE PHYSICIANS AND DENTISTS AVAII.ABLE TO THE PATIENT IN THE 6-COUNTY AREA IS AIMOST THE SAME AS THE NATIONAL RATIO. OTHER PARTS OF GEORGIA HAVE REIATIVELY FEWER PHYSICIANS AND ABOUT HALF AS MANY DENTISTS FOR THE POPUIAT ION. REGISTERED NURSES ARE CONSIDERABLY MORE ABUNDANT IN THE ATI.ANTA AREA THAN NATIONALLY OR ELSEWHERE OVER GEORGIA. THE NUMBER OF SANITARIANS ALSO COMPARES FAVORABLY WITH OTHER AREAS. THE COMPARISIONS MADE HERE ARE NOT REIATED TO NEEDS, WHICH IN MANY CASES IS GREATER IN METROPOLITAN AREAS, THAN IN SMALLER AREAS. HEALTH HANPOWER RESOURCES, 1968 A I Physicians Dentists Private !Persons '. Registered ! Persons Practice ! per Phy •. : per I 1I Dentist 6 Dougl as 3983 \. 7 3314\ Area Registered Nurses Active Persons per Active Nurse Sanitar.ians· 1- -~ ____ _ __ 34 493 1 538 3 Gwinnett 16 3738 9 6478 \ 81 Clayton 20 3935 14 5564 \ 125 371 - - 2 135 1294 52 ~3242 ! 358 319 7 3452 : 1,571 164 1 1440 1 730 2152 3744 3,899 12,368 322 266 502 35 49 2157 909,131 329 324 Cobb ·, DeKalb 216 1637 109 Fulton 864 6 County 1257 Georgia 3165 701 1031 1143 419 603 1296 u.s. 1036 188772 National & i State data are taken from Health Resources Statistics,1968,U.S. Dept. HEW Sanitarians: Provided by Mr. Furman B. Hendrix, R.S., Ga. Society of Professional Sanitarians, May, 1969. Nurses: Roster of Registered Prof. Nurses, Board of Examiners of Nurses for Ga . ,1968. Dentists: Physicians: Office of Dental Health, Ga. Dept Public Health, June, 1968. Bio-Statistics Service, Ga. Dept. Public Health Fo r mor e complete table see Appendix. - 42 - �:;o G, t-<

r-

j

j

ro Ill o' t-'• I-' t-'· rt Ill rt t-'• 0

l

t:) t-'• Ol ro ro OQ OQ

j

Ill H 0 11 rt !-'· 'i I-'

r

0 en 'O t-'• rt Ol I-' 0 ro s 0 Ill 11 ro en

PROFILE OF PERCENTAGE OF NEEDS MET AND UNMET FOR HEALTH FACILITIES IN HILL-BURTON SERVICE A.ilEAS, ATLANTA, SMSA, 1968 () Ol

j

0.. % Me t Needs KEY H 11 ro % Unmet Needs Ol rt sro Po:eulation

j

rt MARIETTA AREA 209,200 Cobb , Paulding, Douglas o---t-+--+-.,.........._,_-t--1,........,...-; SOUTH FULTON AREA South Fulton, Clayton Coweta, Fayette DECATUR AREA DeKalb, Rockdale North Fulton CITY OF ATLANTA AREA 221,700 437,200 460,000 LAWRENCEVILLE AREA 95,800 Gwinnett, Barrow, Walton

Based on the Georgia State Plan for Hospitals and Related Facilities, Revised 7/1/68, Branch of Medical Services and Facilities Planning, Georgia Department of Public Health - 41 - • D �Facili lie s: Indluding Hosp ital s, Nursing Hom es , Outpatient Clinics and Neighborhood Health Centers SUMMARY: THERE MUST BE DESIGNED A COMMUNITY PLAN FOR THE USE OF FACILITIES IN AN ORGANIZED ARRANGEMENT OF MEDICAL RESOURCES SO AS TO BRING THE INDIVIDUAL, WHEREVER LOCATED, INTO CONTACT WITH HIS PHYSICIAN AND OTHER MEMBERS OF THE HEALTH CARE TEAM AT THE LEVEL OF CARE THAT HE REALISTICALLY NEEDS. Problem: 1. General shortage of medical and surgical beds and a corre spondin g underutilization of obstetrical beds and pediatric beds 2. Need for development of rehabilitation services which pre vent or lesson the demand for acute health care. (see Profile) 3. Lack of extensive diagnostic and treatment centers, and of night clinics to serve the poor who work during the day. 4. Lack of agreement on providing expensive facilities such as a £Ommunity radiological treatment center. 5. Lack of geographical distribution of 24 hour emergency care services; need for an independently powered radio communications system between hospitals in the event of a major disaster. 6. Lack of nursing home facilities (2-3000) in the medium price range, and particularly in counties outside Fulton. Current Status 1. Utilization of general hospitals has far exceeded the population trend; particularly in metropolitan areas have increased population brought additional demand for services. 2. The average patient stay has increased since 1962 due to Kerr-Mills and Medicare programs. 3. The cost per patient day (average) has increased from $12.95 in 1950 to $43.97 in 1967 and still going up. Trends 1. At least six major hospitals are building or planning nursing h ome units and two are planning ambulatory care units. 2. Organized Home Care and Homemakers services are beginning to be sought. 3 . Hospitals are developing emergency care 24 hour services with f u l ltime paid physicians. 4. Utilization committees in hospitals and nursing homes are gaining status. Obstacles 1. Traditions in patient management which waste manpower and facilities. 2. Lack of money for major changes in the health care system. 3. Underutilization of manpower and delegation of f unctions to lesser trained patient care personnel. 4. Distorted insurance benefit structure which require inpatient st a tus to pay for diagnostic services. Possible Solutions 1. Build new hospital and nursing home beds only based on effective demand. 2. Give greate~ attention to r ehabi litation of patients. 3. Develop progressive care facilities such as ambulatory self care. 4. Develop - "Day Hospitals" diagnosti c outpatient services, night clinic s . 5. Operate full services of the hospital on Saturdays and Sundays, or "round the clock" double shifts for surgery etc. 6. Remove the stipulation that the patient occupy an inpatient b e d in order to get insurance coverage for diagnostic and minor treatment services. - 40 - �The Plan Has ContinJl.'.:,5!. In-Put from Existing Resources SUMMARY;. NOT ONLY HAS THE INVOLVEMENT OF RELATED GROUPS REDUCED THE THREAT OF CHANGE, BUT IT HAS BROUGHT INTO REALITY THE BASIC THEME OF THIS PROPOSAL: PAi{TNERSHIP -- SOUGHT AND DEVELOPED. THE COMMUNITY COUNCIL'S HOSPITAL AND H'.:<:ALTH PLANNING STAFF HAS BEEN IN CLOSE TOUCH, BOTH FORMALLY AND INFORM..A.LLY' w:;xt{ 0'I'HER RS:i:,~TED PROGRAMS, PROJECTS, ACTIVITIES AND RESOURCES. NUMEROUS PRIVATE AND I'UBLIC ORGANIZATIONS HAVE CONTRIBUTED IN SIGNIFICANT WAYS TO THE PREP/1RA-' TION OF TI-ri S PLAN 1\ND HAVE BEEN INCORPORATED INTO TI-IE DESIGN FOR A CONTINDING PLANNING PROCESS TO IMPROVE -THE LEVEL OF HEALTH IN THE ATLANTA AREA. F J..> _ ' e Methods of Involvement: Joint board members (mandatory and voluntary) 3t;ff exchange Review procedures Referral arrangements Information exchange · Consultation (formal and informal) (l) Umbrella organizations Staff meetings (regular and calle.d) (l) Committee and Task Force memberships (L) See Appendix for Chart of INTERAGENCY RELATIONSHIPS: HEALTH PLANNING, which lists some specific contacts. - 74 - �. ~._;-,:;--:::-,..,..,--. Curr ent Resou rces: -~ ~\\.l 11ic REGION ~ . . ........l. •:., , · !·'· ' ;+ I olJt~ ~~ • u::;.;c::r: . 1De pt. ~. , . . , .-..e "7~ ; ~ 3 ; - n--::::::::::,,r:-~"*< ',, 4 _ .;s"i--"+ Office Economic Opportunity (inf o. exch an.;e ) Dept . Hea l th, Education , We l fare ( in fo . exc k1.11ge , con s u 1tation) De pt. of Labor, Dept. of La b or St at i s tic s ( consult at i on , in fo exc h a n ge ) J Emory Un i ~ .' ~~ ~.,,,,...,.....- ~..co~.: u ~_t a~i~ ....:...==.!.= ity l\lecli..s_~! -, ~.~ -; • ..-~r::::::;::::;:::;::::.; ' ' "T"'l-::-r--·=--:;;;z-~ ....... ., . -.b;..~,r::::;;:::;----.-:::;;:;:J':".:':tt=;:,7 ~ o f Publ~c He a l t~ : Plann~ng Oi f ~ce'. Ofl'ice of Com 1~rt.: l_1c ns h·L ~ .1 Health Planning , Off ice of Bio-S tatistics , Branch o l t nv1ron -' . m~n~a~ He a ~th , Facil iti es and Con st r\1c t i on Division, Lic cn s ~1re 1 . Divi s ion (info . excha n ge , -consu l t a t1on , b oa rd memb e r s, revi ew) Univ . of Ga . Cente r for l\Ianageme n t S ystems , (in fo . exch n ng-c , consultation), Georgia St ate Co ll ege ( consultation ), Ga . Tec h , School of Sa nit ary Engineering ( con s ul tation , in fo . exch ange ) Georg ia Hospit a l Association (consultation) 1 l\Iedic a l Association o f Georg ia ( cons ult at i o n) Ga . Stat e Leagu e for Nursing (st a ff exc h a ng e ) Ga , Nursi ng Home Assoc . ( staff exch a nge ) Health I ns uranc e Cou nc il (info. exch ange ) ~7e AREA -~ a1~~-~~;:.143.215.248.55 12:57, 29 December 2017 (EST),i_~~-~,=-~~-~~J f';!'.:::.;i::;:!,'.;:z:;:-,li · c:z;;:,,: i : ; . : : ~ : : ; ~ ~- ~ · STATE . .. • _Dept . ll e a lth, Educ at ion , Wc lJarc, Community FEO.E_RAL ] Profil e Ce nt er (i nfo . exch a nge , c ons ult at i on · Atlant a Reg i ~ n · t r :;-~l i t a {{ ' p'1~1~ i 1~~ ' C~n;~i'i cxc il a n;;- ~ ~ ~ sult ation, board members ) Georg i a Reg ion a l Med ic a l Prog r a m (umb rella org a ni zat ion,r cv i e~ ) Georg i a District Hos pital Associ at ion (c onsu lt at ion, j oint bo ::1rcl ) Atlant a Are a Soci ety of Registered Profe ss iona l Sanitarian s (i ~Io . e x change , consultation) l\letro. Atl anta l\Ienta l Hea l th Associat i on ( staff exchange ) Ga . Soci e ty for Crippl e d <;;hilclren & Ad ul ts (c onsu l tat i o n, in fo . exchang e, sta ff exc h a n ge , join t b oa rd) Visiting Nur ses Association ( staff ex ch a nge , joint board) Ga. St ate Nurses Assoc i a tion Tr a ining Prog r am ( staff exchange ) Blue Shi e ld & Blu e Cross (info . excha nge , cons ult at ion) American Ca nc er Soci ety , Georg i a Di v . (j oint b oa rd, con s ult at ion) Ga. Heart Assoc i at ion, Inc. , (join t board, c onsultation) Com~unity Chest , Age ncy Relations & Al l ocations Division (j oint board/staff ) Se nior Ci tj_ z ens Serv ic e of l\Ietro Atlanta I nc . (staff exchange ) 1 ~ ~G~-c'l ~f~- ~ LOCAL .Mode l C-i ties ( consultation , s taff e x chang e) Atlant a Univ e r s ity (c onsultation) Economi c Opport u n i ty Atl a nta ( staff exc hange , c ons ul ta tion, joint board ) County Pub li c Hea l th Depts. ( staff exchange ) Fulton Coun ty Med ical Soci ety (c onsu lt ation , join t boards ) Cobb County Med i ca l S oc i ety (c onsu l tat i on) City o f At l anta, Air Pollution Control Divisi o n (consultation, joint b o ::1rcl ) Atlanta School System, P . T.Associati on and Adu l t Educ a t ion (info. exc! 1:;.n ~e ) .... �The Comprehensive Health Plann ing Staff r;~~; ··-:··· ' ·~ TI-ill FUNCTIONS OF THE COMPREIIENS I VE HEALTH PLANNING STAFF ARE (A) TO CONDUCT RESEARCH IN COMMUNITY l-IEALTI-I PROBLEMS, (B) TO DEVELOP BACI<GROUND FOR POLICYMAKING THROUGH SYSTEMS ANALYTICAL METHODS , (C) TO COORDINATE THE ACTIVITIES OF ALL-HEALTH PLANI'IERS IN THE AREA', AND (D) TO PERFORM CONTMCT SERVICES AND TECHNICAL ASSISTANCE ACTIVITIES. Tl-IE STAFF INCLUDES A DIRECTOR OF COMPREHENS I VE AREAVHDE HEALTH P LANNING A~rn OTHER P ROFESSIONAL AND S UB-PROFE38IONAL PERSONS . ' ==~:2z,~::::-cl:1:;;;,-::;;;·;=::::::::::::.::;;;11:::;,;-':7lrt:C.::;:;,.:::;,:.::;!f\-==-=:::u ..::;.-;:-:c:=-c:;_,;:•::;:;<::=::;;.;:.::.!:S::i:;a~

-::::;;:;;:::E:"'.:':$

. ~ ; ; ! £»*., y ;

7:!rr::¥:i g,; !,$ .,,

5

..

o,

«'t r:~ . ~ C !3 -: ....;, . ' J - Planning Ftmctions The planning functions of the staff consist of two major sections: ( a ) the coordinat ion and r ev iew of plans orig ina-:: j_ng j_n t h e hc2.l th and h ea l th- re l a ted offj_ces _ throug hout the com1mmj_ ty, and (b) the or i g j_natj_on of plans in are::::. not covered b y other offj_ces and agencies . The l a tter is expected to consist in large part of systems- analytical studies, :iLnc lud:ing c ost- benefit a naly ses , which cover the entire r a nge of health problems a nd possible solutions. I .r

.: .,

88 �.< COMPREHENSIVE HEALTH PLANNING STAFF INITIAL ORGANIZATION Director Secretary 4 II Associate Director Admin. & Organ iz at ion a l Li aison Associ~tc Direc tor Syst ems Re8earch & Evalua"~ion Organiza tion Li a i son Sy stems An a ly st Resear ci1/Eva luat ion Pl a nner Enviro nmenta l Hea lth Planner Liais on Planner Stat istician Secre tary 3 Secretary 2 l'Ie ighborhoocl Liaison Plan Review/ Techni cal Ass i s tanc e Secret a ry 3 ' - 89 - �The ·Me tropolit a n Atlanta Cow1cil for Health (Comprehe n s ive Health Plannin g Counci l) SUMMARY : ,THE FUNCTIONS OF THE METROP OLITAN ATLANTA COUNCIL FOR HEALTH ARE (A) TO l\'1AKE POLICY FOR TI-IE METROPOLITAN _.COMMUN ITY IN HEALTH MATTERS AND (B) TO SET POLICY FOR GUIDANCE OF STAFF ACTIVITIES. THE COUNC IL· REVIEWS HEALTH ACTION PROJECT PLANS ORIGINATING WITHIN THE COivTivIUNITY, AND ORIGINATES I-IEALTH ACTION PLANS WI-IERE NEEDE D . THE C0UNCII, . IS HESPONS IBLE FOR COlWUCTING COMMUNITY LIAISON AND EDUCATION IN HEAL':'.'H .MATTERS, Cow1eil Structure As provided in t he By-Laws, the Cotmcil is struc tured as a '\-wrking bo2.rd" . All policy matt e :rs are decide d by the ftill CounciJ.. To facilitate such activity, the Council will form several groups of committees for spec ific tasks, e a ch group supervised by a vice preside nt, The cornmit te,es will r e port to the Council, and recommend actions in their areas of competence. A number of the committees will work clo se ly with the s t a ff in such areas as project review and community liaison . I N C O MP L E T E - 90 - ,., �COMPREHENSIVE HEALTH PLANNING COUNCIL - STRUCTURE Qouncil President r-Vice-:Pre siden t Project l;8vj ew Vice- President Counc. Function Vice- President Speci a l Needs Vice- President Vice- President Liaison & PR Administration Facilities proj. rev. Organi z a tion revj_ew J~eighborhood 1 i2. j_ " 011. State & Fed. liaison Bud get & Finance Environmental proj. rev. Program & orientation Needs of the d isadv2.,. t::1.e,;ed Local Council 1 iaison Personnel Mental Health p roj . rev. Long-:tange planning Needs of youth Public rel ations & information Fund Raising .Legal counsel Manpower proj. r ev .

Earh crn~mittee is chaired by a Council member; Vice-Presidents

of Coun ci l oversee and encourage activi t ies of the groups of committees shown. Nominating Committ e e: Executive Committee : President of Council ' Vice-Presidents (5) Secretary Duti es : Carry on activiti e s betwee n Council mee tings; recomme ndations subj e ct to Council revi e w S e l ected from memb e rship of Council, with due regard to makeup of the Council. Duti es : Nominate a slate .of offic e rs prior to the annual me eting Nominate a new nominating committee prior to the annual meet.ing Nomin ate organizat ion s, on a ro t ating basis, whtch will name me mb e rs of the Council to take offic e at th e next annual me e ting Nominat e replac eme n t s for vacancies as th e y occur P e rsonn e l Comm itt e e Select e d from Council me mb e rship and community at large . Duti e s: Re commen d s e l ection a nd salary of Director for Cou nc il act i on Formulat e p e rsonne l polici e s, including s a lary rang es _ 91 _ �Membe rship on the Council ~ - .. SUMMARY: MEMBERSHIP ON THE COUNCIL SHALL BE DRAWN F ROM TWO Ivl4.JOR GROUPINGS: THOSE WHO WILL SERVE DY VIRTUE OF OFFICE HJ ,A MAJOR PLANNING ORGANIZATION OR LOCAL GOVER.N1VIBNT, AND THOSE WHO SERVE THROUGH BEING NAMED BY APPROPRIATE ORGA.t'fIZATIONS OF HEALTH PROVIDERS AND CONSilliffiRS . MEi\'lBE:tSHIP IS DRAWN FROM SOURCES BROADLY REPRESENTING THE ECONOMIC, ETHNIC , AND C:EOGR/1.PHIC BACKGROUND OF' THE COM:AIUNITY. ~ I N C OMP L E T E ' 9~ - - �I IIIBMBERSHIP ON COUNC IL - Sche me G Number 3· Group Select ed/e l ected by

"-------- MACLOG, CCAA, ARMPC virtue of office (chairmen ) Count y commis sions virtue of bffice 1 City of Atlanta virtue of office (mayor ) 3 Mun ic ipal governments of counti es municipal a ss ociations 0r count y commissions ( in rotation ) 20 I~e:- 1 t h provid e rs: 4 !Ill's 1 ivw , psychiatry 2 DDS's 2 Public h e alth 2 Heaith faciliti e s 1 Me di cal educator 1 Parame dic a l e duc at or 1 RN 2 Voluntary health agencies 1 Social worker 1 Skill e d parame dic a l 1 Se mi - Skill e d parame dical '\ 1 He alth ins. industry 17 Atl - Gw i nn ett , Clayton, DeKalb-Rockdal e 3 PTA's Cabbagetown, Cobb, Doug l as (othe rs in rotation ) NWRO, Sout h side He al th Ce nt e r,. TUFF, NAACP, Urban Leagu e (1 each ) ( others in rot at ion) Chamb ers of commerce , union s (in rotati on) 5 other org anizations 52 ' medical societi es (in r ()tation) Ga. Psychiatric Assoc. dental soci~ties (in rotation ) public h ealth d e p artments (in rotatiun) (recommended : 1 MD , 1 other special ty ) - hospital, nursing home associations, etc . (both private and authori ty -- in rotation) school o f me dicine I alli e d scie nces schools, etc . ( i i, rotac"o:, I nursin~ associati ()n S (in. rotation) CCAA P erman ent Confe r e nce and State Association of v oluntary agencies (in ro tat ion) NASW local cha pt e r t e chnic a l associations ( in rotation) o rgan ization s , · if any; otherwis e nomina ted as an individuat He alth Insurance Council Poor and n ear-poor 7 EOA' s 2 Mod e l Cit ies 2 (qhairmen) Busine ss and labor TOTAL Th e ·term of "vir t u e of office" membe rs to coincid e with oc cupancy of of f ice . Te)rm of othe r me mbe rs , thre e years, one -t hird rotating off eac h y e ar. "I n rotation" indicat e s that at s u cc e ssive e l e ction s d i ff e r e nt org a n i z ations or group s wit h i n · the same cat eg ory will b e aske d to s e l e ct me mbe rs . A nominating committee of the Counc il will b e responsible for assur ing s u ch rotation. For the first el e ction ad hoc nominating committ e es in the major categ orie s above are b e ing aske d to submit name s of org anizations, for r e vi e w by CCAA Exe cuti ve Committ e e . - 93 - �Title: Working to Ensure Effectiveness of the CHP Council E12:57, 29 December 2017 (EST);143.215.248.55;;~;;143.215.248.55;~E::;;143.215.248.55 12:57, 29 December 2017 (EST);;~;~~;:;~;143.215.248.55 12:57, 29 December 2017 (EST):;:7i . EXTENT TO WHICH MEMBERS PERFORM SPECIFIED FUNCTIONS OF BOARD }fENBEL SHH. A WIDE RANGE OF COMMUNITY RESOURCES WILL BE USED IN TRAINING FOR BOARD ACHIEVEMENT. -r• • w;.o · I S ' ~ ,. , . t; "'c .i:.'1', .., .._ ; ;:, ~ .? 11LY:,s j' .· 1 t,

$ ·' ~., · f_"i",j '>'r•:t:' .. •;, 'A~:f ;;;:1 f:q , 15.- ;>½ -·,.;;.e1r1 ~ : _ n n : ~ ~ ~

-?f54t•@9a£ .,g Chara~t e ristic s of the CHPC Board:

,/. \;,;}---------~--~-Consume rs and_ providers, 0 <> economic and ethnic mix, geosraphic distribution. Ve ':eran policy-makers and persons with little group and no policy-making experience. Wide range of educational and social backgrounds. Traditionally, health providers and consumers (particularly low inc0 ~~ ~roups) have not planned together or worked as equals. Perception of health problems will be influericed by the special interest which each mernb~r represents. Thus, succes~ful functioning of the Board will depend upon effectiv~ participation of members both as representatives of suhgroups ard a8 citizens in the community of solution. Some Specific Training and Familiarization Activities After the Council's initial action of accepting responsibility for the policy aspects of comprehensive areawide health planning in this metropolitan commLmity, beginning 1 January 1970, some 6½ months .will elapse before the Council is called on for official functioning. During this pe riod, a number of activittes are planned for . the purpose of familiarizing the Council members with the extent of the he a lth planning actions which they wil~ be called on to evaluate and guide. The period will also be used to acquaint the CoLmcil membe.rs, one with another, so that they can select Personnel Conunittee and Nominating Committee members most effectively, several months prior to the Annual Meeting in January, 1970. Some of the traini~g and familiarization activities contemplated are: o introduction to principal hea lth problems in the area o field trips to health facilities and areas of severe health need o training in effective Council and committee participation o e x perience (with Community Council staff) in reviewing plann ing projects o introduction to systems analytical procedures, and methods of basing decisions on cost-benefit analyses, etc. o joint meetings with other planning groups and with health activity s taffs - 96 - �IMPLEMENT LEARNING EXPERIENCE EVALUATE EXPERIENCE THROUGH COUNCIL BEHAVIORS DETERMINE NEEDS (ASSESS STATUS OF COUNCIL MEMBERSHIP FUNCTION 97 - • .z. - . , ·-~ _,._ �By-Laws of the Council KE , . tr

s f-J.,

! F SUMMARY : THE BY-LAWS OF THE COUNCIL ARE DESXGNE D TO FACILITATE MAXIMUM POSSIBLE PART I CIPATION IN I-IBALTH POLICY MATTERS BY THE MEMBERS OF THE COUNCIL, AND TO "BUILD BRIDGES II TO LOCAL ORGA.t'l"IZAT IONS CONC'ERNED WI TH HEALTH MATTZRS. T HEY SPECIFY TI-ill BROAD FUNCTIONS OF TI-ill COUNCIL AND STAFF , BUT ARE INTENDED TO PROVIDE FOR SUFFICIENT FLEX I BILITY TH~T THE COUNCIL CAN COPE WI TH CHANGING AREA CONFIGURATIONS AND HEALTH 1'iT'EDS . 1 . The By-Laws consjst of 13 Articles: I. Name and Location II. Purpo se III. Membe r s hip IV. Duties and Powe rs of the Council V. Meetings Officers a nd Executive Committee VI. VII. Committ ees VIII. Legal Com1Se 1 IX . Audit Genera l x. Adoption XI. Assoc;: i ate and Affiliate Memberships XII. Ammendments XIII. Import ant Provisions£ · Some of the principal by-law provisions are shown on the facing page {9 9). Other By-Laws : Current By-Laws of the Me_tropo li tan Atlanta Council of Loca l Governments of the Community qounc il of the Atlan~a Area, Inc. are inc luded in the Appendi c es to this vo l ume of the propos a l . . 98 - and �CHP COUNCIL - PRINCIPAL BY -LAW PROVIS IONS ., A. Council Membership and Terms 1. Chairmen of major agencies (3) and of cc-unty commissions shall serve for the duration of their terms 2 . . Representatives of organiza t ions shall serve three-ye ar te~ms ( excP~~ for some elected at the first election); 1 /3 Jf these shall be selected each year. 3. Two three-year terms, maximum 4. · Majority shall he health "consumers" 5.. Approximately 1 / 3 shall be poor and near ··poor consume:rs 6. Selection process shall ~.:.~e into account g;eographi.c and ethnic distribut.i. 01,s in the community 7. Selection process shall be determined by a nominat~11g committee mad e up of Council members. In selecting organizations and groups who will name members to the council, the nominating committee shall achieve rotation arnong eligible groups and organizations.Typical eligible organizati0ns or g~ol ·s ai ~ 1~jicated in the following: a. municipal governments group: municipal a~sociations b. health provid e rs g rou_p: medical societie&, d en~i:tl scci.?ties , ho s pitals and other facilities, mental health professional organizati~,s , public health . d epartments , · v·oluntary hea l th organizations, nursing associations, skilled· paramedical- associations, unskilled ;,aramedical groups, social work aienc ies, educational institutions, insurance councils. c. business an.cl labor groups: chambe rs of c01mnerce, labor organiza ti ons d. poor and near-poor: EOA's , PTA's, HUD projects (e.g. Model Citi e s), volun tary agencies (e.g. Urban Leagu e , Legal Aid), spontaneous organizations ( e .g . Welfa~e Rights, TUFF, etc.) 8. Alternat es may be designated; specifically und erst ood that they act for r egular members B. Council Meetings 1. 2. 3. 4. C. At l east six p er year (contempla't;e ·monthly) Quorum is 20 vo~ing _memb ers Majority of voting memb ers shall ·decide Roberts Rules govern Council S truct ure 1. 2. 3. 4. 5. Officers nominated by nominating commi ttee, or from floor; elected by majority vote of Council Executive Committee shall con.sist of the officers ( 7 ) h andl es business b etween Council meetings action s su~ject to review by Council at ne xt meeting Nominating Committee selected from me mbers of the Council Personnel Committee s e l ect e d from Council me mb e rs and o t h e rs Othe r standing and ad hoc committees as n eed e d . .... -~ - 99 · - �. BY-LAWS ARTICLE I - NAME AND LOCATION 1. The name of this orga niza t ion shall be "The Met ropolitan Atlanta Cou nc il for Health", h e reinaft e r referred to as the "council". 2. The Council's principa l office shall be located in the City of A~~anta, Ge orgia. ARTICLE II - PURPOSE 1. The principal objective s and purposes of the Council are: A. To es tab lish and ma intain compre h e nsive areawide health plannin g activities, id ent ify ing hea l t h needs - and go a ls of the ove rall communit y and its sub-areas to stimulate ac t ion to coordin ate and · make max imrnn use of existing and planne d facil it ies, servic es and manpower i.n ·the fielc1 s of physical, mental and environmental he a l t h. B. To establish a system for gathering and analyzing data on the characteristics of h ea lth problems in this area. C. To recomme nd goal~ and methods of achie v ing them, and to make policy decisions for the community in heal t h planning matters. D. To coordinate activities . of all h e alth plann e rs· in the community. E. To collabor a te with adjac e nt h ea lth planning areas, and t-0 p e rform h e alth planning s e rvices on a con t ract basis for adjacent area units, as requested. F. To review h ealth action project plans -Originat ing in the community. G. To provide technical assistance t o public and voluntary action a ge nci es in preparing pl a ns and p ro c ed u res for the at ta inmen t of h ea lth goals; to p rovi d e similar assistanc e to Georgia State heal th pl anning efforts. H. To origin ate health action project plans where n e ed e d. I . To provide c ontin uin g li aison a nd information a l s e rvices to ensure communication of planning p r og r e ss to the general public and the appr op ria t e a ge ncies and organizations involved in carry in g out the int e nt of Congress a s s e t forth in Public L aw 89 - 7 49 r e latin g to compre hensi ve areaw id e hea lth p l a n ning . - 100 - l �ARTICLE III - MEilIBERSHIP 1. The Council shall be composed of not l ess than thirty-five(35), nor more than fifty-five (55) members. Members sha ll be drawn from the following organizations and conwunity g roups, broad ly reflecting ecohomic, ethnic, and geog raphip , backg round distribution of the area: A. Membe rs by virtue of office shal l serve f6r tte duration of their terms of elective office : 1) 2) 3) B. Chairmen of County Commission s Chairmen of major planning agencies Mayor of the City of Atlanta Memliers named by ~:.unity agencies and organ i.z ut ions 1) Organizations naming membe rs shall be 8asi g nated in the fo l lowing categories: a) b) c) d) 2) 3) Municipal governments Health providers Business and labor Poor and near-poor consumers At the first election, the term of office for one-third of these me mbe rs shall !:le fixed at three years; the term of a n addi tional one -:-third of these members shall be fixed at two years; and the term o f the fina l one-third of these members shall be fi x ed at one year . At the expiration of the initial term of office of each r espect ive me mbe r, his successor shall b e named to serve a term of three - years. Member s sha ll serve until their successor s have b een e l e c ted and qual ified. No member shall ser\(e more tha n two (2 ) conse cutive three-year terms. The selection process for these memb ers shall b e determine d by a Nominating Committee of Council members. In ~e l ecting o rganizations and groups who will n ame members to the Council, the Nominating Committee shall achieve rotation among elig ible groups and organiz ations. C. A major i ty of t he Council members shall b e non-providers o f h ealth service s. D. Approx imat e ly one-third of Council members shall b e poor and n ear-poor consumers. E. Each organizati on sha ll b e authori zed to file wi t h the S ecretary of the Council the name s of alternat e me mbers , not to exceed the numbe r of r e pre sentatives to which it is entit l e d. Any regul ar me mbe r of the Council may call upon alterna te ( s ) from his organizat ion to attend and - 101- J I' t ! �to vote in hi s s tead at any meet ing which the regular member is un a bl e to attend. F •· Organ iza tion s othe r t han t h ose con st ituting the Council at the time thes ~ rul es and r egul at ions are adopted may be invited ~o n~me r e ~Tesentatives in a sta t e d number to the Council up cr1 r e commend at ion by the Nominating Committee and approval by t l-,0 Council at any me eting of thP. Council, provid e d that ten (10) days advan~ ~ notice 0f such propose d action is mail 8 d to each me1.1b er at h ls l ast known post office addres~. ARTICLE IV - DUTIES AND I\,\\'ERS OF THE COUNCIL 1. The Council shall be the final authority for approval of activiti es pr oposed in plann i n g actions, and on all matters o f p olicy related to comprehe nsive areawide health pl a nning. 2. The Council shall consid e r the annu2l Lud get rrres c:1t. c d by the Budget and Finance Commi ttee , and after any r ev isi on , it may det erm in e to be advis abl e , i t shall adopt the s ame . I t shall ma: .c suci.i subs~ quent revision on the bud get as it may d eem advisabl a after c onsult ation with the Budg et and Fina.nee Cornn:iit tee and t h e Dir8ctor of Comprehe nsive Are aw id e He a l th Planning. 3 . It shall have the powe r of a pproval of the Presiden t_ ' s appointme nts of committee cha_irmen and l ega l counsel. 1. It sha ll app oint the Dire c tor of . Comprehe nsive Areawide Hea l th Planning , and fix the terms of his c ompe nsati on, tenur~ , and responsibilities, givin g due con sid e:r; at ion t o the recomme nda ti ons of the President and the Personnel Cammi ttee. ' 5. It sha ll appoin t t.he auditor as provided in Article IX of the se BY-LAWS . . 6. I t shall r e quire p e riodic r e ports on ope r ations from the variou s commi ttees and_ from ._the Dire ctor of Comprehensive Areawide Heal th Planning. 7. It sh a ll fix t h e time and place of the Annual Mee t ing of the Counci l. · 8. It shall pass on appli c a~ions for admission to the Council of addition a l a dj a c e n t are a s d e~ iring to p a rticip a t e in c ompre h e nsive h e al t h planning with the metropolitan Atlanta a r ea . ARTICLE V MEETINGS 1. The Counci l shall hold at l east si x ( 6 ) r egul ar meet i n gs p e r y e ar , to b e c a ll e d for t h e f i rst Thur s d ay i n the s chedul e d mon t h, o r on s uch o t h er con ve ni e n t d ay as may b e d e cid e d fr om t im e to time by ma j ority v ote. 2 . Spe ci a l mee tings may b e c i ll e d by the Pres ident a nd shall be c a ll e d by t h ~ Se c r e t ary a t t h e r e que st o f . f if teen (1 5 ) memb e rs of the Counci l . - · 102 / �3. Notice of each meeting shall be mailed to each member of the Council at his last known post office addre ss at leas t ten (10) d a ys in advance of~ the meeting. 4. Twenty {20) member~_of the Council shall constitute .a quorum for the tiansaction of business at a~y meetin g of the Council; the presence of less than a quorum P.18}' adjourn a meeting until such time as a quorum is' pre .sent. 5. A majority in number of members present and voting at n meeting at which a quorum is present shall be . required for approval of any ar. t io:1 by the Counc j l . f, , Each ;,1ember of the Council is entitled to one (1) vote at any meeting at which he is pre s~nt. 7. lfo proxy votes shall be allowed. A duly appointed al t e~-,1~ te member, however, may vote in the absence of a regular member representin~ the organization for which h e is designated alternate. In such case, the alternate me mber shall be considered a member for the purpose of determining a quormn. 8. The Council may act by mail, wire, or telephone between regular ms etings, but in such case the concurrence of a majority in nmnber of membe rs shall be necess a r y and shall be subject to conf irmation a t t h e nex t meet i n g of the Council so tha t such action shall b e r e cord e d in the minutes. 9. The first meeting of the Council, after Janua ry leach year, shall be considered the Annual Meeting for the seating of new members named by organizations,and election of office rs and nominating committee me mbers. 10. The Administrative Year of the Cotmcil sha ll e xt e nd from Annual Mee ting to Annual Mee ting . ' ARTICLE VI - OFFICERS AND EXECUTIVE COMMITTEE 1. 2. Office rs A. Of f ice rs of the Coun cil sha ll b e a Pres id e nt, five (5) Vice -- P_r e side n ts , a nd a S e cre tary , who sha ll b e e l e ct e d annually from among memb e rs of the Council by a majority _ vote of memb e rs pre s e nt and voting a t the Annual Meetin g . B. Of f ice r s so el e cte d s hall s e rve f or on e y e ar, or un t il t h e ir succe ssors have b een e l e ct e d. No o ffi c e r s h a ll hold t h e s a me o ff ice f or more than thr ee ( 3 ) c on s e c utive terms . C. Vacanci e s in office s occuring b etween Annu a l Meet ing s o f the Council ma y b e fill e d by el e c t ion b y a ma j or i ty vote of me mb e rs p r e s e n t and vot ing at a n y mee ti n g of the Co un c il . Of ficers sfo e l e 8 t e d ~h a ll s e rve u nti l t h e n ext Ann ual Me e tin g o t h e o un c i l. Pres i d e n t A. The P res i d e n t of the Coun c i l s hall b e t h e c hief o ffi c e r - 103 - �of the orga11izat i on a nd sha ll pre s id e at all me e t ing s of the Council a nd Exe cutive Conuni t t ee. The Preside nt shall, subject to the approval of the Council, appoint the chairme n of all conunittees, except the Nomir.ating Committe e , and shall b e a me mbe r, ex-officio, of all conuni tt ees ; and shall, with the Secre tary, sign all obligations authorized by the Council which may be beyond the authority of the Director of Comprehe nsive Areawide Health Planning ; and shall, with the approval of the Council, a~point legal counsel. 3. Vice Presidents A. 4. There shall be five or more vice -r,resi<lents, ·wi10 shall assist the Presid e nt , and shall c0ordinat~ the activities of groups of conuni ttees of the C0uncil. These oli' cers snall be designat e d Vic e -i)resident for Council F'unct:l.0n, Vice President for Liaison and Public Relations, Vice President for Special Needs, Vice P~esident for Project Revi~w, Vice President for Administration, and such othe rs a-s the Council may designat e . Vice Presidents may preside A~ B. 5. A Vice President shall pres1J0 at any fue eting of the Council or Exe cu ti ve Comm i ·~ tee in the a.bsence of the President, and in such case sha ll h a ve all the r e sponsibilitie s and perform all the du t i e s of thq P re sid e nt. The ord e r of pre c e d e nce for th ' s . func t ion sha ll b e : Vice Presid e nt for Council Fun~tion, Vice Presid e nt for Liaison and Public Relations, Vice President for Special Needs, Vice Presid e nt for Proje ct Re view, and Vic e President for Administration. The Vic e P re sid e nt s shall have and p e rform s uch oth~r duti~s as may be assign e d b y the President or by the -Council ; Secretary A. The S e cre tary of the Council sha ll handl e the gen e r a l corres pond e nce o f the Council a nd sha ll c a u se not ice s to be sent of all regular or special meetings of the Council. B. He sH~l~ cause minute s t o b e k e p t of all meet ing s 6 f the Council",,_ and f sha llcsee t ha t . these min u tes 2.re d ist ribut e d to me m5~rs o t h e o uncir w1tn1n a r ea sonable p eriod OL time a fte r e ach meet ing . ! C. He · shall pre side at me etings of the Council in the absence of t h e Pre side nt and the Vic e P re side nts and in such c ase s h a ll h a v e all the r e spons ibili t i e s and pe rfor m . all the duti e s of the Pres id e nt. 10 4 �D. 5. The Secret ary sh a ll h a v e and p e rform such other duties as · may be a s s .i g ncd by the Pres ident or the Council. Executive Committee A. The Execui;.tve Committee shall consist of the President, Vice Presidents and S~cretary of the Council. B. Duties of the Exe cut ive Committee shall be to handle matters pertinent to Co1mcil business during intervals between meetings of the Cou~~il . C. Act:i.c,ns and r c conunendations of the Executive Conuni ttee ,. shall be subject tr Council review and , approval at the riext .meeting of thC:; Council . ARTICLE VII - COMMITTEES 1. Statutory Conunittees A. B. A iiominat i n : C.>m; , :, -:i..t:e shall be elected from members of the c~:mnci ... , with due regard to the makeup of the Cotmcil. The duties of the Nominating Committee sh a ll inc,ucle : 1. Nominating a slate of officers prior to the Annual Meeting. 2. Nominat _ing a new Nominating Cammi ttee prior to the Annual Meeting . 3. Nominating ·organizations, on a rotating basis, which will name members of the Council to take office at the ne~~ Annual Meeting. 4. Nominating replacements for vacancies as they occur. A Personnel Cmnmittee shall be elected from Council membership and the. community at large. The duties of the Pe rsonnel Committee shall include: 1. Recommending selection and salary of Director for Council aciion. 2. Formulating personnel policies, including salary ranges. The Chairman of the Personnel Conunittee shall b e a member <;>f the Council. 2. Other Comm ittees _A. Other standing and ad hoc committees may b e d e sig na te d, elected or appointecf:- 'iis""ne e ded . Ch a irmen of all s t a n din g committ ee s sh a ll be me mbe rs of the Council. - 105 - �ARTICLE VIII- LEGAL COUNSEL 1. Legal counsel shall be appoin t ed by the President with the approval of the Council . All matt ers involving interpre tation of State and Federal law, loc a l ordinances, and tax questions shall be promptly referred to such counsel for opinion and ~dvice. ARTICLE D~ - AUDIT J.. The fiscal records of the ccrnprehe nsive areawide health planning activities shall be audited Annually ~Ya certified public accountant, appointed by the Council. The auditor's r e port sha ll be filed with the records of the " organization. ARTICLE X - GENERAL 1 0 Waiver A. 2. Any notice require d to be given by these By-Laws may be waived by the person entitled thereto. Contravention P.. 3. Notlii.ng :in these By-Laws shall contravene applic a ble rules and r e gulRtions, proce dures, or policie s of th~ U.S. Public Health Service, or of the Georgia Office er£ Comprehensive Heal th Planning. Parliame ntary Procedure A. 4. Publicity A. 5. The latest revision of Robe rt's Rules of Order shall cove r the parliam~ntary proce dure at all mee t i ngs of the Council and of the Committees, where not in conflict with these By-.J.,aws. No publici t y r e l e a se s to the me dia shall b e mad e or authoriz e d by any organiz ation r e present e d on t h e Council, or by any member of the Council without prior clearance by the Director of Comprehe nsive Areawide Health Planning. Acc e ptance of By-La ws A. Any org ani za tion acc e p t ing invit a tion to d esign ate me mbe r s hip on the Council sh a ll by the ir a c ce p tanc e attes t to their active participation and to their agreeme nt to abid e by the se By-Laws. ARTICLE XI · - ADOPT ION 1. E ffe c t ive d ate A. The s e By - Laws s h a ll b ecome e f fe cti ve imme di ate ly u pon adop t ion by the Coun cil. - 106 - �ARTICLE XII 1. 2. - ASSOCIATE AND AFFILIATE MEIIIBERSHIPS Associate Membership A. At the d_i._scretion of the Council, sub-areal compreh ensive ' hea lth councils may be admitted to associate membership in the Council. The Council shall fix general qu a lifications for such associate membership. B. As a condition of associate membership, sub-areal comprehensiv e health councils shall admit to membership all members of the Council residing in the area of the s4bo.real coun c'i l. C. Each associate member council is entitled to send an observer to meeting ."' o · the Counci-1. Affiliate Membersh ip A. At the discretion of the Council, organizations other than sub-ar.cal. comprehens i.ve h ea l th councils may be admitt ed tu 9ffiliate membership in the Council. These may include such organizations as voluntary health agencies, p rofes sional socie ties, citizens' associations for h ealth concerns , etc. The Council shall fix general qualifications fo£ su ch affiliate membership. B. Each affiliate member organization is entitled to send an observer to meetings of the Council. ARTICLE l. XIII - AMENDMENTS ·Method A. These ,By-Laws may be amended or r epe::i led by a majority vot e of the members of the Council present, and voting at any meeting of the Counci l at which a quorum is present, provid e d tha~ written notice of such proposed changes shall have been sent to all members not less than ten (10) days prior to the d ate of such meeting . - 107 - �I' I STEERI NG COMM ITTEE Mrs. Thelma Abbott 521 W. Columbia Avenue College Park, Georgia Dr. Napier Burson, Jr. Baptist Professional Building 340 Boulevard, N. E. Atlanta, Georgia 30312

s.

Hon . S. Abercrombie, Chairmai1 Clayton County Commission Clayton County Courthous e Jon esboro, Ge orgia 30236 Hon. L. H . Atherton, Jr. "Mayor of Marietta P.O. Box 609 Marietta, Ge orgia 30060 Mrs. Mary Jpne Coft'l' 443 Oakl~nd Avenue Atlanta, Georgia 30312 Miss Dorothy Barf i e ld, R. N. Chief Coordinator of Nursing Services Geor gia Department of Public Health 47 Trini ty Avenue Atlanta, Georgia 30334 -~ Mr. G. x.·Barker, Ex. V. P. Interna tional Brotherhood of Electrical Workers Fifth Dis trict Office 1421 Peachtree Street, N. E. Atlanta, Ge~rgia 30309 Hon. Ernest Barrett, Chairman Cobb Coun ty Comfuiis ion P. 0. Box 649 Marietta, Georgia 30060 ' Dr. J. Gordon Bariow, Director Georgia Regional Medic~l Program 938 Peachtfee Stre~t, N. E. Atlanta, Georgia 30309 Mr. M. L_inwood Beck,_ Executive Director Georgia Hea rt Association 2581 Piedmont Road, N. E. Atlan ta, Ge orgia 30324 Mr. Herschel ·T. Bomar, Chafrman Douglas County Commission Doug las County Courthous e l Douglasville, Georgia 3ql34 . Hon. William H. Breen, Jr. Mayor of Decat ur c/o First National Bank Building Decatur, Ge orgia 30030 Appendix E-1 ---~ ., Hon. T. M. Callaway , ~r. DeKalb County Commission c / o Callaway Motors 231 West Ponce de Leon Avenue Decatur, Georgia 30030 Mr . Gary Cu tini, Regional Rep. Health Insurance Council Life uf Georgia Building 600 W. Peachtree Atlanta, ~corgia 30308 Dr. F. William Oowda 490 Pe achtree Stre et , N. E. Atlan ta , Gecrg{a 20308 Mr. J . Wm. · Fortune Mayor oi Lawrencevill e 290 Old Timber Road, S. W. Lawr encevi lle, Georgia 30245 Mr. Drew Fuller Fuller & Deloach 1726 Fulton National Bank Bldg. Atlanta, Georg ia 30303 Miss Jo Ann Goodson, R. N. Wesley Woods 1825 Clifton Road, N. E. Atlanta, Georgia 30333 "Mr. Fted J. Gun ter, Administ~ator Sou th Fulton Hospital 1170 Cleve land Avenue East Point, n eorgia 30344 Dean Rhodes Haverty Ge orgia Stat e Coll ege School of Allied Sciences 33 Gilmer St., S. E. Atlanta, Ge orgia 30303 �Pag e 2 - St ee ring Committ ee Mr. Lyndon A. Wa d e , Fxecutive Dir. Ai lanta Urban Leagu e 239 Auburn Avenu e , N. E. Room 400 Atlanta, Ge orgia 30303 Mr. Maynard Jackson Emory Community Law Firm 551 Forr e st Ro a d, N. E. Atlanta, Ge orgia 30312 Mr. Purch L. Jarrell Route # 1 Box 24 Duluth, Ge orgia 30136 Dr. Robert E. Wells, 1938 Peachtree Road, N. W. Atlanta, Ge orgia 30309 . Hon. Walter M. Mitchell, Chairman Fulton County Commission 409 Administration Building 165 Central Ave nue, S. W. . Atlanta, Georgia 30303 Mr. John L. Moore, Jr. Attorney-at-Law C & S National Bank Building Room 1220 Marietta and Broad Streets Atlanta, Ge orgia 30303 Dr. William W. Moore, Jr. Suite 616 1293 Peachtre e Street; N. E. Atlant~, Ge orgia 30309 Mr. A. B . Pad g ett, Trust Officer Trust Company of Ge orgia P . 0. Drawe r 4655 Atlanta, Ge org ia 30302 ' Mr. Dan Swe at Assistant ~o Mayor City of Atlanta City Hall Atlanta, Ge orgia 30303 Dr. Charl e s B. T ~al, Jr. Gwinnett Co~nty He alth De partment 300 South Clayton St. Lawrenceville, Ge orgia· 30245 Mr: Bil~ Traylor _ 1397 Ox ford Road, N. E. Atlanta, G~orgia 30307 Dr. T. 0. Vinson, Dir e ctor DeKalb Coun t y He aith De partm e nt 4 4 0 Winn Way De catur , Ge or gia 30033 Appe ndi x E-2 . Joseph A. Wilbur, M. D . 615 Peachtre e Stre et , N. E. Atlanta, Ge orgia 30308 Mrs. Dal by Bigsby 585 dibbons Drive Scottdale, Ge orgia �MEMBERS OF EXECUTIVE COiV!MITTEE OF COMMUNITY INVOLVEMENT STEERING COMMITTEE ., FOR AREAWIDE COMPREHENSIVE HEALTH PLANNING:. NA.ME Hon. Howard Atherton · Mr. Linwood Beck Hon. Thomas Callaway AFFILIA'l 'ION Mayor of Marietta Director, Georgia Heart Ass::, c. Commissioner, DeKalb Ccutlty Mr. Drew Fuller Chmn. Health Committee, A.tl. C. of C. Mr. Fred Gunter Administrator, So. Fulton Hospital Hon. Walter Mitchell Chmn., Fulton County Com..111is 1:: iu'c Mr. A. B. Padgett Chmn, CHP Steering Committee Dr. Osbar Vinson · Director, DeKalb Boa rd of Health Mr. Lyndon Wade Director, Atlanta Urban League Dr. Robe rt Wells Chmn. Fulton County Me d. Soc. Board "\ ~ppendi x E-3 VIEi','.POEiT municipalitles voluntary agencies Maclog commerce hcispit a ls COlli"l"t.Y govts. Commun:;ty Council Public Health conswne rs medical professions �Honorable Ivan Allen Page - 2 February 28, 1969 volunteers, both individuals and groups. Since that time the Steering Committee has been at work and we have now come up with a specific proposal for the establishment of such a volunteer agency . As it now stands, it appears that the sponsors will be the Atlanta Junior League, the Community Council of the Atlanta Area, Community Chest, the Atlanta Chamber of Corrrrnerce, and E.O.A. We simply want to talk with you and Dan and get your suggestions and reaction to the plan. We believe that volunteers constitute the largest untapped resource for help on our urban problems. Making this resource truly effective is not an easy task, but it has been done in other cities and there is no reason why we can't do it here. Also, we feel that a permanent organization of this type will provide a means for injecting newcomers to Atlanta into activities involving their interests which will help us to maintain a sense of community as Atlanta expands . I understand that our appointment is for 2:00 o'clock, and we look forward to seeing you. Best personal regards. Sincerely, .,ETB:hm Enclosures cc: Mr. Dan Sweat JONES. BIRD & HOWELL -~ Eugene T . Branch �I. < . DRAFI' A VOLUNTEER COORDINATING AGENCY -•,r Purpose: To provide a central point where volunteer activities could be co- ordinated, developed and organized so that the vast reservoir of man and woman -power who are looking for ways to make constructive, significant contributions to the community can be utilized. than the traditional volunteer bureau. This would be more It would not only work with exist- ing programs but also devel~p new areas of service for individuals and groups and be innovative in its approaches. be organized, administered and operated by volun

i:::~ according to the group; o ~ ~ n x

1. AGENCIES REGISTER ~~-I ~q · F o r ~ tmo\; h e ~{ t' } ,~ would _~ 143.215.248.55ts f~~ ~;~P~_-._,.... .. a ; ~~; ~ \~ be @ ~ a \ ~ i e n c i e s can register t h ~ ~ i n d i v i \ l 5 . ~ s and group projects. 2. VOLUNTEERS RE%~~ -~~b~ place where individuals .or groups can reg~ster ~~com~~n to an agency or program where his capabilit~i~erests can be used to best advantage. 3. SCREENING - it would conduct an initial screening of volunteers to protect the agency from clearly unsuitable applicants, while the agency retains its right to select its o wn volunteers. 4. EFFECTIVE - It would offer leadership on the effective use of volunteers . Develop innovative programs and provide new areas of service . 5. TRAI NING - It would provide orientation and training to volunteers o f , both a general and spe cific nature so that volunt eers would be - 1 - • �better prepared for and have a clearer understanding of their assignments and how they fit into the health and welfare picture of Atlanta. 6. O)UNCIL OF CIVIC ORGANI~~TION - It would provide a framework for communication among civic organizations regarding their own areas of connnunity participation. 7, EDUCATE PUBLIC - It would conduct regular programs to educate the ~ public about projects and problems in the fields of health, welfare and enrichment. 8 WORKSHOPS - It would develop as part of its educational program the following workshops: a. Workshops with supervisors of volunteers. b. Workshops with "administrative volunteers" (policy making boards, etc.) . c. Workshops designed to acquaint new-comers (and others) with programs and agencies, problems and opportunities in the fields of health, welfare, enrichment and educatiun. d. Separate workshops for volunteers in the areas of 1. arts 2. health 3. education 4. poverty 5, recreation Organization: It would be staffed by a full-time, well qualified paid Executive Director · and a full-time p a id secretary at the, out set , Staff would be added as necessary to take care of the expanding program. (See Job Description) - 2 - �The Executive Director would be assisted by volunteer chairmen of Recruitment, Screening .Education, Job Development,. Agency Relations and Public Relations.

···- ,. ' They would serve for a two year term. ,;.-. The agency would be government by a Board of Directors with a total membership of 25. It would be composed of the above mentioned volunteer chairmen; representatives of agencies, serviDg on a rotating basis; a representative each !J:om the Community Council of the Atlanta Area, Inc, and the Chamber of Commerce; people who are representative of volunteer programs (Model Cities, Economic Opportunity Atlanta, Urban Training, VISTA); people who are representative of organizations (Junior League, Council of Jewish Women, Junior Chamber of Commerce, Kiwanis, Women's Chamber of Commerce, United Church Women, etc.);· people who are representative of labor and the business ai-: ·~rofes~ional community. These Board members would be selected as individuals by the agency's nominating committee to be representa~ive of a certain sector, interest or expertise rather than to represent their own organization. Sponsors: The following agencies and organizations have shown interest in it and indicated support. Repre.sentatives have been meeting as a Steering Committee and have helped shape this proposal. 1. Atlanta Junior League 2 .' Community Council of the Atlanta Area, Inc . 3. Community Chest 4. Atlanta Chamber of Commerce �Location: Preferably the physical facilities should include the following: 1. Office space for a minimum of seven people (four staff and three full time volunteers), 2. Adequate parking nearby for a minimum of fifty cars. 3. Be in an area that is well lighted, and where staff and volunteers would feel comfortable when attending meetings at night. 4, A large meeting room in the building or nearby that could be utilize d for trainin g s e ssions or confe r e nce meetin gs . - 4 - �BUDGET Personnel Total Cost Cost $12,500 5,000 1,900 Project Director Executive Secretary Fringe benefits Minimum · staff $19,400 Permanent Equipment 6 desks, executive @ $150 6 chairs, executive@ 90 l desk, secretarial 1 chair, secretarial 7 side chairs @ 30 1 electric typewriter 3 manual typewriters @ 220 4 file cabinets, 5 drawer@ 100 equipment maintenance 900 540 150 80 210 550 660 400 500 $ 3,990 1,150 1,200 $ 2,350 $ could be donated Consumable Supplies $ Office supplies and postage Educational materials minimum necessary to train 300 volunteers Travel Local, 15,400 miles@ .10 per mi. 1 out-of-town trip $ 1,540 300 $ 1,840 to reimburse 6 people for travel and public relations Miscellaneous Expenses Rent - 1,200 sq. ft.@ $3.00 per $ sq. ft. per year Telephone Insurance and bonds ·Promotion and publicity Auditing Organization dues Publicatio n s Meeting space for training classes and board meetings, 80 day s @ $30 per da y could be donated 3,600 900 150 1,000 600 250 75 could be donated could be donated could be donated 2,400 Total Costs - 5 - $ 8,975 $36 , 555 �Staff - (Job Descriptions) The Project Director will be responsible to the Board of Directors. a. Duties and Responsibilities (1) Administration of the program. Guidance and supervision of all staff engaged in the project. (2) Promote the Volunteer Project in all necessary areas particularly public and voluntary agencies, and to the general public. Interpretation of the goals to the Volunteer Project. (3) Responsible for all publicity of the program. Review all assignments for speaking engagements. (4) Supervisor of volunteers who will organize, plan and develop all training classes . (5) Select and work with volunteers and agencies in developing curriculum for classes. Edit training manual and select all materials used in course. (6) Work with Board of Directors of the Volunteer Project and sub-committees in operation of program. (7) Work with volunteers to d eve lop contracts with agencies and organizations for training programs for other volunteers. (8) Program planning and d eve l opme nt for future expansion of the Volunt eer Project. b. Qualifica tions (1) Executive ab i lity necessary for the administrationr promotion and imple me ntation of the Volunt ee r Proj e ct. (2) Ab i lity to relate to individuals and groups both professionals and volunteers. Good judgemen t ·and trainee s . - 6 - in selection of staff, faculty �(3) · Experience and skill in community organization. A thorough knowledge of the health, welfare and education resources of the community. (4) Understanding of the needs of lower income people in order to plan training programs that will equip volunteers to make significant contributions toward meeting some of these needs. Background and academic degree in Education, psychology, (5) social work . or a related field. Administrative experience. (6) 2. Secretary The secretary of the Volunteer Proj e ct shall be responsible to the Director of the Volunteer Project. a. Duties and Responsibilities (1) Personal secre t a ry to the Project Director, i.e. appo i ntments, . telephon e c a ll s , p e rso n a l fil e s, e t c . '\ (2) Supervision of all office cle rical work. Should be capable of prope rly coo r dinatin g all work; insure prope r di s tribution o f wo rkloa d a nd re lie ve the Dire cto r of t asks which come with supe rvi s ion of cle rical work. (3) Persona lly -r es ponsible for a ll documenta ry typ i n g , p r o g~am d e velopme nt, e va lua tio n, proposal s , budge t s , e tc . (4) All dict a tion and tran s cription for entire d e pa rtme nt. (5) All typin g f or re c r uitment and publicit y . (6) Re c o r d a ll s e ssion s i n conne ction with e va luation and in r e gular t ra ining sess i o n s wh e n n e c essary. (7) Mi nutes o f a l l me e t i ngs r e qui r ing t he use of shorthand. - 7 - r: �(8) Direct supervision of all filing procedures. See that all records are filed regularly and properly. (9) Keep complete records of all supplies and postage charged to the Volunteer Project b. Qualifications (1) Good typing speed. (2) Excellent shorthand speed to enable her to take verbatim notes at all conferences and teaching sessions where necessary. (3) Good overall understanding of office procedures and policies. (4) Ability to work well with people, with initiative to do a job on her own without involved instructions. Ability to supervise additional clerical staff . . MG : ja -2/ 13/69 - 8 - - ::: .. r �l f:.1·:.!. lI I 'I I ·! NEW SLOT FOR THE VOLUNTEER A Talk With Joyce Black and Dr. Timothy Costello Waiting for a bus or subway th~t · role in city government. To find out and what the Board of Estimate does, never comes, sending a child ·off to a if similar bureaus could be used to adbut the subtle kinds of things: Why school that doesn't open, or trying to does it take so long to get things done? . vantage in Detroit, Chicago, Los Ankeep warm in an apartment that has Why can't you always solve a problem geles, or even in Waterloo, Iowa, we in the most ration~! way? Sometimes no heat is all part of everyday life in met with Dr. Costello and Mrs. Black there are community blocks and politiNew York City. But, a new form of in the Deputy Mayor's office, and we cal considerations that are quite legitigovernment, which New Yorkers have asked them: come to· think of as " the Lindsay mate but keep you from doing things Why do you11se volunteers in New York's style," has emerged. By efficiently in what my wife would say is the city government? common-sense way. using an almost untapped resource Dr. Costello: I think there is a simple known as "volunteer power," the naDo volunteers need any special skills? answer and a. subtle answer. The simtion's largest and most problem~prone Dr. Costello: Volunteerism is a very, ple answer is that we need to render city is surviving the urban crisis. perhaps ten times as many service.s as very sensitive activity requiring proBack in 1965, when the Federal govwe're able to with the amount of civil

ernment first launched its "war on

fessional skills. One of the skills re- . quired is learning to build a demand service people w~ have. Beyond that, poverty," New York City's Economic for volunteer help that doesn't outdo Opportunity Committee (the local advolunteers bring something that you your-supply, and that doesn't produce ministrative anti-poverty agency) cannot get from the person whose serfound itself inundated with offers a demand in agencies where volunteers / vices you're buying. They bring spirit, of help from numerous individuals and don' t belong and won't be properly I a sense of dedication, freedom from used. The desirable thing would be to organizations. Mrs. Ruth Hagy Brod, j being captured by procedures, motivathen an EOC staff member, was asked have a Director of Volunteers in every 1 tion and willingness to wor_ k - someto channel these offers into neighboragency of city government who would I times under conditions where you hood anti-poverty agencies. report to us on what the agency is l couldn't pay someone else to work. The complexities of the city made looking for. We're flooded with deI don't know if this concept is origMrs. Brod'3 task a monumentally commands from agencies, many of which inal with me, but for a little while, for '.·plicated one and an advisory comwe don't want to meet because they're a long while maybe, many people felt mittee of community leaders was soon not suitable, and many of which we that New York was such a big, sophis'.f ormed to assist her in conducting a can't meet because we just haven't got ticated, cosmopolitan town, that it was study of the patterns and potentials of an adequate s~pply of volunteers. nobody's home town. But that's not /volunteerism in New York City. The the way people feel now. They're beHow does the VCC work with city · result of their study was this: Antiagencies? ginning to feel that it ·is their home poverty agencies were unable to absorb town ; they want to be involved in it; Mrs. Black: We tried to divide the any significant number of volunteers, they want to do something for it. This Council's activities into two sectors, but there was a great potential for is true of big business and it's also true with program development in _b oth the them in almost every d~£i!!~ent of of the people living in Staten Island, public- sector and in the private, nonci_!¥__$0Vemment. Out of this study, the Queens, or Manhattan. They want to profit sector - better known as the VE!.u,n~ C:02@.~at~ _g Co1:1_~~!1.- the say "I'm doing something for my city." volunteer sector. If an agency desires - f!!_~ cent~al vo~n~er bureau_to_be coMrs. Black: We hope this kind of proour advice in developing volunteer si:onsored by city__ g!)verz.:,.men,t..ill.d..th_e gram will be duplicated in other cities programs, we 'a re available, and we voluntary sector - was born. for similar reasons. Once you're in· - rn December 1966, the VCC was also will seek them out if we feel that volved with a city in the public s·ector, officiaily inaugurated by Mayor Lindthere should be a use of volunteers you understand many things that you say. Deputy Mayor Timothy Costello there. We've been very fortunate in never understood before, and you can was named Chairman, and Mrs. Hiram New York because we do have an uninterpret th em to the community in a D. Black (AJLA's Director of Region derstanding administration and a Depmuch· better way. · III) was named Co-Chairman. Mrs. uty Mayor who took us under his Brod was appointed Director. Dr. Costello: Maybe the point that wing. The Council h as to fi t into a slot During the first two years of its is being made is a lesson in civics. I \ 1 in the city; this type of program -just operation, the VCC h as played a vital don't mean just where City Hall is, 11 c°an't--be off bii"its ""'o~w=n~.- -- - - l 14 �I Dr. Costello: That's right, you simply What docs the VCC do? th Mrs. Black: It does two things. It re· can't graft it on to something at is not receptive to it. It won't work. The . emits volunteers interviews them and

'CC is kind of a prototype; we're try-( ) ) re~h~~tot~i!ditiqnal ;;;-no~t~a~

m~ to :~courage c~llege st~dents _a nd '---' ditio~~l ·settii'-i~, d;pencling on what umvers1hes to contribute their services, k.m d o f service · th ey wan t t o d o an d , but this won't work unless you ve got -. . __ w h a t th e1r · h ours are. Bu t 1·t a1so 1s · a receptivity in the top level of admini-' d I t k " d f · 1 r;z_ program- eve opmen m o agency. • • strahon all the way down. the ~ D.___ - M · ay b e th e term ;,-mar~ . lme. r. C_os t-e1·-1o: riage maker" ought to come into this Does the VCC suggest projects or placement for volunteers in other agencies? picture, too, because Ruth Brod and the Dr. Costello: Yes . It creates them. people around her are frequently matchmakers. There might be some You've got a creative gro~p of volu'~group who have ideas for something to teers who suggest things either because they have an idea or because I do, but they haven't got the resources. somebody comes in and says: "Look, _, 1 They may not have a .bus to provide this is what I can do; is there any place I transportation, they may not have the I can do it?" That's how VCC promoney to . underwrite something, or grams begin. You look for some place they may not have access to somewhere the volunteer can do what he thing. So Mrs. Brod finds somebody wants to do. That's pretty much what who has what the group needs and happened with Riker's Island_ am I puts them together. For example, in correct, Joyce? Operation Suburbia, she put the famMrs. Black: Yes. When men are reilies in ghettos .and the families in leased from prison _ from Riker' s suburban areas together, and she put Island - very often they come out the coffee house people (See Junior without anything: withouf a family, League Magazine, Sep t.I O ct. '68) towithout funds, without a heavy winter gether with some people who had coat. Ruth Brod was telling me the money. The Council is always trying other day that she had to get a winter to spin programs off. _j__ _ coat for one of the men. He couldn't Mrs. Black: We act as a ~atalyst. And I think this is a word that we should get a job either, because no one wants use more and more because volunteer to give a job to a newly-released pris, organizations are not going in where oner. In a sense, the volunteer involved they're not wanted. Not only do we with these men is going to be involved have to be asked to participate J:mt we in the buddy system. Each prisoner, also work with the people in the innerwhen he is released, is now being met city by not inflicting or imposing any by one of our staff people and taken of our thinking upon them. This is to a place where he is employed or certainly the way of the future, and trained by a union. We also find a it's the way they want it. place for him to live, and give him pocket money obtained from private Many city agencies are· ' troubled with sources to supplement him until he gets quick changeover of personnel, money difficulties, and a host of other problems. his welfare check, which isn't for two Does this make it more difficult for you weeks after. he is released. to find volunteers to work with them? Dr. Costello: This is exactly where vol-: unteerism comes in. There is no com-i ivlrs. Black: Not really. We do not put bination of services that the city can 1 volunteers into a situation wher·e there I is no one to supervise and train them. provide which would do all of these The Council doesn' t actually train volthings: that is, reach out and obtain a unteers; the t_raining is. done in the job, worry about whether the man has individual agencies.· If we went into a coat or carfare, worry about where , t~ n~g, wi?d have to have a couple he is going to sleep or eat. Because 1 of hundred people on the staff. W e these men sometidies fail - they don't give them only a ~11 .o rientation to report for duty, or they goof off - the volunteers go back and talk them into .' the fiel~ _of volunteerjsm: . trying again. There's no service like _.Dr. Costello: Som~times the word "volthat. You simply can't buy that kind of unteer" applies to a group of people service anywhere. who are part of the target population 16 ... _ _ ~-I. i:' ...--. ,' ·~: ' I ·-, ./: ,, themselves. That is, they have an idea, and they want to do something. So you don't send white middle-class people into that neighborhood to help those people. They are already there, they just need a little support, a little money, a little access, a little building, a little equipment, or whatever, to continue their own volunt~ry efforts in their community. And that's · a new kind·of volunteerism. I know Ruth was very upset one day when I suggested that maybe you couldn't ask poor people to volunteer; they are too busy. And she said, "You can't deny them the opportunity to be part of a volunteer program. Now you may have to provide carfare occasionally, or a little baby-sitting money, but you've got to give them the chance to give something as well as to take something." Have any of your volunteers had problems in the inner-city areas? Mrs. Black: We haven't had trouble because we simply don't send anybody unless they're truly wanted and 9 sked for. Of course, the other thing is that if. we were sending some volunteer for a specific reason - into part of the Haryou complex, for example we would most likely send a black person in who probably would be acc-epted. This is a complex situation. Dr. Costello: No p sychiatrist would ever attempt to treat a patient unless II �all over the place: in the Rent and Rehabilitation Department; in the Po~ lice Department, in the M ayor's Action Center - everyplace. _ ,r~ What do you see for the future? In what direction do you see the Council moving? -t Mrs. Black: One of our goals is to have ' .

'r it move into other. cities. Our first phase of operation is over - th~p_h_ase · - in the publi~ sector.- Now--;-·t1:1.e second / --phase is to more fully develop prog) am.s in ~ hich the volun_'.eer sector ' '---/4.nd t ti[""puolic;__sector. cooper_<!te. I see ·· -· · the -VCC moving more and more in / the direction of coop erative prog~~s. r' I also see it moving into more programs in the inner-city and into areas where no one has ever before thought of using volunteers. In the future, we want a main office in the heart of the city at City Hall, the patient wanted help, and I think and then we plan to d·ecentralize. We'll the same rock-bottom principle applies keep our central off.ice, but we also to volunteer assistance - you don't hope to have Borough offices. Our impose it on anyone who hasn't asked most recent proposal asks for fund s to for it. That is not to say that yoi:t don't establish the Borough. oJfices on a mocultivate the demand . You don't sit with a fubile ~'nit going bile basis, back in your ivory tower and wait for around recruiting and int ervie~ ng . people to come. It wouldn't happen We feel° thatthis .. would be less· exlike that. Nor would we send anybody pensive than opening an office in each down to Harlem and say, "Here are Borough. We've got a lot "of people in some people; they' re eager; they talk Queens 0 ho don't want to volunteer English. Can't you use them?" No in Brooklyn or in Manhattan and vice good, it wouldn't happen that way. versa. We need Borough offices .in Does the Council do a lot of work with order to reach all the people who really any of the new-line poverty agencies such want to volunteer. Maybe next year as the Urban Coalition? we can tell you that we have decenMrs. Black: We h ave been working tralized. Or maybe in a couple of years . with Urban Coalition, and Mrs . Brod Do you feel that the Council has become ha.s been developing volunteer proa fairly needed component in dty govern~ grams with them. Because it's just ment? (You probably can't call it essential getting off the ground, the Urban Coabecause volunteers are certainly not an lition hasn't been as involved with essential component.) volunteers as they wished to be, or Dr. Costello: If y ou talk about good hope to be in the future. _Eventu ally government in the largest sense - inthey want to have a pretty strong volving people, and reducing the guilt volunteer program, and they've recentthat people feel, giving them the ly hired a D~ :_ctor of Volunteers. chance to contribute. things that you WJiat about MEND or UPACA or any of can' t buy - then -it's essential. N ow the grass roots community organizations? if you're talking abou t the minimum society, where you just get a minimum Mrs. Black : Yes, we h a"e worked with of services, and minimum involvement t he comm uni t y organ i zati on s from citizens, then of course it's not UPACA is one. But don't forget we are essential. But in terms of good spi rit, also working within th e city in public people for departments . When we started, we morale, and the capacity getting to know the other side cif life only had volunteers in the hospitals and in the schools . Now we have them both sides - then I think volunteerism ,~ \ .;;: 6 of is essential for the health of society. No doubt about it. Would it be safe to say that you think volunteers are becoming a more important part of society? Dr. Costello, I certainly do. I've been reading Herman Kahn's book, The Year 2,000, and he says that increasingly we are not only developing primary occupations and secondary occupations, but also tertiary occupations. Woman's prime role is becoming less central to her life, and less capable of satisfying her full range of interests. Mgst of us are going to have to find volunteer activities in order to fulfill all the capacities and needs we have. It's going to become Increasingly important, not only in terms of what the city needs, but in terms of what the individual needs. People are getting less personal satisfaction than they used to because they're becoming mechanized or automated; the human element is taken out of them. You have that kind of a job; so you earn your living that way. But you really satisfy yourself on what you plan to do on a voluntary basis, because you've got some command of what is going to take place there. Do ·you think the role of the volunteer in government will be increasing - not just in New York City, but in other cities, and possibly on the national level? Dr. Costello: We distinguish ourselves from the. national level because certainly it' s hard to bring volunteers from all over the country to Washington. And the · Federal government · doesn' t get represented in any dramatic way at the city level. I think the cities are the places where you can r eally do ~ - I -~-;uld °"s-ay that ihvecanget other cities to do what we've been doing, and if we can continue to build relationships between different segments of society by h aving volunteers from these various groups work together, then we've made a mighty contribution. You can legislate integration. You can kind of force it by housing. But the real integration comes wh en people ch oose to work together on a problem and solve common goals. And, this is something th at can be accomplished by volunteerism alone. Barbara Bo nat and Christine Rodriguez 17 I �l JAMES L. MCGOVERN l i E X ECUTI V E D I RECTOR I ' METROPOLITAN ATLANTA COMMISSION ON CRIME AND JUVENILE DELINQUENCY, INC. 52 FAIRLIE STR EE T A TLA NTA, G EORGIA 30303 524-3869 April 10, 1967 Honorable Ivan Allen, Jr. Mayor of the City of Atlanta 204 City Hall Atlanta, Georgia

Dear Mayor Allen: - --2 - - - ---· The Community Council of the Atlanta Area, Inc. ----a.n~ the Metropolitan Atlanta Commission on Crime and Juvenile Delinquency, Inc. are co-sponsoring a meeting to be held Tuesday, April 18 at 3:00 p.m. in the conference room of the Trust Company of Geor g ia to discuss the problem of the chronic a lcoholic court o f fender. We feel that such a conference at this time is imperative in view of the recent decisions of the federal Courts of Appeal which held that the chronic alcoholic should not be confined as a criminal but rath e r should be t re at e d as one in need o f me dic a l a ss is tanc e . Enclosed is a l ist o f tho se pers o ns invi t e d to attend this meeting as well as some materi a l relating to the problem { of the alcoholic and a tr e atment plan prepared b y the Communit y Council. We are hop eful t h a t a n ov e r a ll pl a n in whic h t h e repr e sent a t ives o f the City, County a n d S t a t e will pa rti cipa t e wil l be f o rt h coming . Your s L. McGovern JLM: ls Enclosure �r C C A A Choirman of the Board of Din •ctms Vice Chairman MRS . RHODES L. PERDUE, Secrerwy w . L. CALLOWAY. As .. ocrare ,S'ecrerary A. B. PADGETT, Treasurer JAMES P. FURNISS ommunity ouncil o:f the tlanta rea inc. CECIL ALEXANDER . DUANE W . BEC K. ONE THOUSAN D G LE NN BUILDING, 120 MARIETT A ST., N. W. Exenuhe Director ATLANTA, GEORGIA 30303 TELEPHONE 577-2250 Report 67-1 March, 1967 TREATMENT PLAN FOR THE CHRONIC ALCOHOLIC COURT OFFENDER This report is the result of the work of the Advisory Committee on Alcoholism of the Community Council of the Atlanta Area, Inc., and was compiled and written by staff of the Council. Approved by the Executive Committee of the Community Council on March 2, 1967. Paul Cadenhead, Chairman Mrs. Marian Glustrom, Staff, CCAA Eugene Branch, Chm., Permanent Conferenc e Mrs. Inez B. Tillison, Assoc. Dir., CCAA Committee Members Asa Barnard, Division of Vocational Rehabilitation Paul Cadenhead, Atlanta Bar Association Chaplain Joseph Caldwell, Candler School of Theology T. A. Carroll, Alcoholics Anonymous Grover Causby, Georgia Department Family & Children Services Dr. Sheldon Cohen, Fulton County Medical Society Mrs. Marian J. Ford, Travelers Aid Dr. Vernelle Fox, Georgian Clinic s. C. Griffith, Jr., Atlanta Hospital Council Bruce Herrin, Emory Univ, Alcohol Vocational Rehabilitation Pr oject Dr . Sidney Isenberg, Fulton County Medical Society Henry Jackson, St. Jude's House, Inc. Wilbu r Stanley, Georgia Department of Education Mrs . Nita Stephens, Fulton County Dept. Family & Child r en Se rv ices Ma jo r John St ra ng , Salvation Army Reve r end Russell St r ange, Atl a nt a Union Mission Ernest Wr i ght , Geo r g i a De pa rtmen t of Labor �• TREATMENT PLAN for THE CHRONIC ALCOHOLIC COURT OFrENDER I. Background The problem of the chronic alcoholic court offender is not a new one in Atlanta. The courts and many other agencies have been aware of it for many years, and attempts have been made to meet it. Over 10 years ago, Municipal Court judges became concerned with the problem because it was occupying an increasing amount of the court's time. It became increasingly evident that repeatedly arresting these individuals, trying them, sentencing them, and having them pay fines, serve time or both, was not allev iating the problem. Even turning these individuals over to a higher court as habitual drunkards helped only to the extent that men spe nding 12 months in prison could no t be rearrested and appear in court during that time. A large percentage of those who did serve 12 months in prison were back in jail for "plain drunk" within days and sometimes even hours after being released from prison. At a bout this time, the judge s were approached by several individual s , some o f whom were ex-alcoholics, who volunt e ered their services a s a Helping Hand Society to do wha t they could to help t hese individuals c a ught in what is regarded as the "revolving door of drunkenness"--arrest-jail-release-drunkenne s s-arrest, etc. At this same time, Mr. He nry Jackson, who had 18 years of e x tensive e x p e rience working with alcoholics, was added to the Municipa l Court staff as the Director of the Alcohol i c Rehabilitation Prog ram. Jud ge J a mes E. Webb a cce pt e d the offers o f h e lp a nd se t up a sys tem where b y ind i v iduals who were brought to court for pla in public intoxication could, by request , be probated to the Helping -Hand Soci e ty. At the discretion o f the judge and r e pre sentatives of the Helping Hand Society, a n individual wa s acce pte d on the p r og ram, and for a probation per iod o f 60 d a ys h e was e x p ected t o coope r a t e with the Soci e ty. The program cons i sted o f t h ree e s sentia l things: 1) b ei ng a friend to t h e i n d i v i du a l wi t h a d r inking p rob l em; 2 ) he l ping him find f ood, clo t h i ng a nd s h e l ter ; 3 ) p rovid ing fe l lowship for the ind i vidual in a new envi r onment away from drinking establishment s. Because o f the l ack of p r oper f a c i l i t ies to carry out the f u nction s of the Helping Hand Society, t he pro gram, a l thou gh s u c c es s f u l with s ome, was u nab l e to reach the majori t y o f the chro nic court offenders, a n d t h e Municipal Court caseload continued to grow at an a l arming rate. In 1961, Ju dge Webb and the lea d er s of th~ Helping Ha n d Society decided that if an increase in facil it ie s for the treatme nt of alc o holism we re at their disposal, they could do a better j ob of rehabilitating larger numbers of chronic alcoholic court offenders. They approached the Community Council of the Atlanta Area, Inc. The Council re~ommended that further study be done. The City of Atlanta, Fulton County, and a group of business leaders agreed to provide the funds for a one year study to be made by the Department of Psychiatry of Emory University. The study was designed to gather data, �Page 2 analyze the data, and make recommendations based on this data to better deal with the problem of the chronic alcoholic court offender and his family. The study began on July 1, 1962 and ended June 30, 1963. The following is a summary of the committee's recommendations: 1. That a new facility, an Intensive Treatment Center, be established with City and County funds to provide inpatient and outpat i ent services using a multi-discipline approach. That these services be coordinated with all other treatment and rehabilitation services for alcoholism. 2. To continue the present Helping Hand Halfway House, with some City and County funds made available for this facility, as a model for the establishment and development of other halfway houses in the community. 3. That at least one Alcoholic Information and Referral Center be established on an experimenta l basis, in one of the neighborhood areas of particularl y heavy drinking, this Center to be staffed primarily with volunteers. 4. To provide better training to policemen in the recognition of "intox icatio~' and its various causes. 5. That there be medical screening in the City Jail of all intox icated p r i s oners immediately following the arrest of these persons. That t hose in need of any medical attention be immed i atel y transferred to Grad y Memorial Hospital for this medical ca r e. 6. Tha t the lega l procedures now e x isting be r evised so that an individual can be processed from the time o f his arrest un t il disposition o f hi s case h a s been mad e by the multi-Qiscipline team previousl y mentioned . 7. Tha t some of t h e approaches to alcoholics at the Cit y Pri s on Fa rm be mod i f ied so that trea t ment and rehabilitation can be c a rried out in this setting. Tha t an effort be made in the Ci ty P r ison Fa r m to eva lu a t e the mental a nd phy sic a l condition of the alcoholic prisoners and a p r og ra m o f re h a b i li tat ion be ins t ituted for e a ch of these pe r sons. Some st ride s have bee n made in implementing these r e c omme nd a tio n s , bu t we s t ill have a l o ng way to g o a s wi l l be s e en i n ot h e r sectio n s o f this repo rt. Lack o f funds , s hortage o f sta f f a nd publ i c apa thy have combine d to hi n der pro gre ss. Recent events, ho wever, have mad e it i mperative t ha t we deve l o p and carry o ut plans f o r the chronic alc o h ol ic c ourt offender. There have been two court case s c o ncerning the chronic alcoholic which have grave implications for Atlanta. On e decision, in the Easter Case, was handed down by the U. s. Court of Appeal s in Washington, D. C., and the other, t!~e Driver Case, by the Fourth U. S. Circuit Court of Appeals in Richmond, Virginia . Both decisions were similar and indicative of what path other courts will take. �-- - - - - -- Page 3 The decisions stated that chronic alcoholics could not be charg ed with drunkenness because they have lost the power of self-control in the use of intox icating beverages. In Washington, the judge said that a 1947 federal law on rehabilitation of alcoholics described chronic drinkers as sick people who needed proper medical and other treatment. However, commi t ment for treatment of chronic alcoholics as contemplated b y Congress was not mandatory. The accused may be released but he may not be punished. It was a l s o the judge's decision tha t chronic alcoholism is a "defense t o a cha rge of public intoxication and, therefore, is not a crime, however, this does not absolve the voluntarily intoxicated person of criminal responsibility for crime in general under applicable law." The case is now coming up bef o r e the Supreme Court a nd there is every reason to _b e liev e that the deci sion will be upheld. Therefore, it is o n ly a matt e r o f t i me b efore At l a nt a is fa c e d wi t h t he p r oblem a nd some planni ng mu s t be done so that facilities for rehabilitative services for the chronic alcoholic will be available, otherwise, there will be chaos and confusion with wa sted effort, time and money . The p r oblem is a compli ca ted one. Trea tment of the a lcoholic--to b e effec t ive and l ast ing --requ ire s coordinat ion of se rvic es a nd a combi n ation o f many resources and practices. A multi-disciplinary, as well a s a f a mily centered and reaching out approach, must be used. Trea tment should be dire cte d to thr ee mai n g oals : 1. Pe rma n e n t sep ara tion o f t h e a lcoho l i c f rom alcohol. 2. Repa iring the physical and emotional d a mage a nd preventing f u rt her d a ma ge . r 3. Chang i ng c o mmu nity institu t ion s, p rog rams and services t o meet the s pecial n e e ds a nd p robl e ms o f t h e a l coholic. Communi ty r e sou r c e s shou ld b e ma d e as r e adi l y a vailabl e a nd easi l y accessibl e as ot h ers . In a ddition, a n y pla nning f o r the chronic a lcoholic cou r t be integrat e d wi th the pl anni ng b ei ng done f o r a l l o the r f o r other phases of mental h ea l th and physica l i l lness . p art o f the s a me problem and should not b e s egme nt e d, i f II. o ffe nd er shou ld a lcoholics and They are a ll a at a ll po ssibl e . Target Populati on in Atlanta A. Ove r half o f t he arre sts ma de b y the At l a nta Polic e De pa r tme n t i n 1 9 6 6 for non-traff ic o ffe nses i n v olve d pu b l ic i ntoxi cation. 1. Total non-traffic arrests - 79 , 092 ( does not include juveniles) 2. Arre s ts involving dru nken ness - 47,305. These consist of approximately 1 2,000 ind ividua ls and that about one-half, or 6,000, of these individuals were arrested on this charge from 2 to 20 times �Page 4 during the year. It is difficult to say how many of these can be rehabilitated fully or t o some e xtent. From the experience of the staff of the Emory University Alcohol Project in their three and a half years of operation, it is their belief tha t with the proper a pproaches, facilities and staff, a conside r able number of these persons might be at least partially rehabilitated. They a r e not willing to dismiss the poss i bility of assisting even t he mos t ha r d-core chronic alcoholic. It is sometimes extremely difficult to determine accur~tely in advance just who can be helped or how long it might take. They . believe that it is essential to at least make a sincere effort to treat each one of these individuals. It is rea lly only through giving e a ch of them an opportunity for t reatment and rehabilitation t hat we c a n determ i n e whether or not they can be helped. I t is conceivable that approximat ely 10,000 of thi s g roup o f 12,000 alco hol i c off ende rs can be as sisted to improve their total well-being significantly. B. Characteristics of the Chronic Alcoholic Court Offender 1. 2. Gene r al Characteristics: a. Produc t o f a limited social envi r onment who has never a t ta ine d more than a minimum of integration within the community. b. Depe ndent p e rsonali t y without much individua l r esourc e f ulness . c. Ind i vidu a l who has di ffi cul ty in communicati ng with others . The following specific data has b e en taken from the original s t udy { done by Emory Universit y : a. Average age of white ma l e - 48. 0 year s Negro ma l e - 42.9 years b. Ra t e o f t u b e r c ulo s i s in thi s group was fou nd t o b e t e n times g reat er than the ra te i n the genera l popula tion . c. 1 0 % of the white males and 3 . 6 % of t h e Ne gro ma l es had been hospita l ized in a me nta l ho s pita l p reviou sly. d. 50 % o f the whi t e mal es we n t b eyond the eigh t h grad e in schoo l. In t hi s grou p, there wa s no corre l a tion b e tween the number of court appearances and l e vels of education . e. The Negro ma l es did d e mo nst rate a c or re l ation of the lev e l of e ducation with the numb er o f court appearances. 1) 50% of the Negro males in the 1-2 court appearance group went throu gh the n i nth grade. �Page 5 f. 2) 50% in the 3-6 court appearance group went through the eighth grade. 3) 50% in the 7 or more court appearance group went only through the seventh grade. Employment 1) 77% of the Negro males were classified as unskilled labor; while 32% of the white males were in this gr.map. 2) 40.9% of the white males had had special job training; while only 24.8% of the Negroes had. 3) 52% of both races were unemployed. 4) 26% of the white males and 14% of the Negro males were receiving some type of financial assistance. 5) At the time of arrest, 42% of the white males and only 6% of the Negro males had money available to pay a fine. r III. Elements to be considered in a Treatment Plan for the Chronic Alcoholic Court Offender A. Legal and Legislative 1. Legislation to give city authority to spend funds for local alcoholic rehabilitative measure s. The city of Atlanta is in a peculiar position. Under the Reorganization Plan of 1951, health functions were made the responsibility of the county and police functions were made the responsibility of the city. Therefore, city police can arrest an alcoholic for public drunkenness, but the city cannot spend tax money to rehabilitate him, since rehabilitation is a health function. The FultonDeKalb County Hospital Authority says alcoholism is a chronic illness and it assumes no responsibility for chronically ill. The Fulton and DeKalb County Health Departments have no outpatient clinics for the alcoholic. The State Health Department feels that it has no responsibility for the alcoholic until reasonable rehabilitative measures have been made at the local level. 2. There must be a change in the police handling of chronic inebriate offenders. The following quotation from Peter Barton Hutt, the attorney who presented the appeal in the Easter Case in the Distric of Columbia, gives an indication of some of the problems involved: �Page 6 "With regard to the police handling of chronic inebriate off enders , it is my opinion that it is not a false arrest for a pol i ceman to charge an unknown inebriate with public intoxication, even after the Easter and Driver decisions. The police should not be required, at their peril, to make a judgment on the street as to whether an intoxicated individual is or is not a chronic alcoholic. "In the case of known chronic alcoholics, however, this problem raises a far more difficult legal issue. To some, the a vailability of the defense of chronic alcoholism still seems more properly an issue for the courts than for the police . "But more impor ta nt, the community should not place the police in j eopard y in thi s way. There is no reason why the police should be bu r dened with the ignominious task o f swee pi ng chronic inebria tes off the public streets. I was recently called upon in the District of Columbia to assist a man who had been arrested 38 times since the Easter decision. When you take into consideration the amount of time he spent incarcerated in jail and in various hospitals, this amounted to 1 arrest for every 2 days that he appeared on public streets. Certainly, the a nswer to the Easter and Dri ver decisions is not just to arre st dere lict alcoholics every day, duly bring them to trial and then immediately release them back on the streets without assistance, only to repeat the process over and over again. This succeeds only in speeding up the "revolvi ng door," a nd in further pe rsecution a nd deg rada t ion of chr onic inebriates . It c a nnot contribute to the elimi na tion o f these a bu ses , a s the Easte r a nd Dr iver de c i sions de ma nd . "In my opinion, the police can .and should take t wo immedi a te steps to end the revolving door process, pe nding de velopment of a br oad er community p r og r a m tha t I will d iscu s s l a ter in this t a lk. Fi rst, they should assi s t a ny d r unken person t o hi s home , whe ne ver that i s possible . Se cond, where a n indi vidua l i s u nable to take care o f himself , the poli ce s hould as.sist hi m to an appr opriate public heal th faci l ity where he can r ec eive the ne c e s s ary a tte n t ion. Under no cir cumsta nces should they arre st known a lcohol i c s time a nd time again . "The question arises, o f c ourse, whether the police may properly assume responsibility f or intoxi cated individuals and escort them to an appropriate public health facility to receive proper medical attention. If t he ineb riat e does not consent , would the police incur liability for a fal s e arrest? I have l ong been o f the view that the police have duties o f a civil nature, in addition to their responsibility for enforcing the criminal law. ~hen a policeman escorts a heart attack victim to the hospital, he certainly is not arresting him. Thus, in my opinion, the police have both a right and a duty to take unwilling intoxicated citizens who appear to be unable to take care of themselves, whether or not they are alcoholics, to appropriate public health facilities. And I might �Page 7 add that, in the oral argument in the Easter case, all 8 of the judges indicated agreement with this proposition. Nevertheless, law enforcement officers have expressed considerable apprehension about the possible liability of policemen for false arrest under these circumstances. Certainly, this question should be resolved immediately, preferably by enactment of state statutes, in order to lay the necessary legal foundation for the proper medical handling of alcoholics." 3. The court procedure must also be modified. Peter Barton Hutt: Again, the quotes are "With regard to the judicial handling of chronic court inebriate s , once a judge becomes aware, through any information of any kind, from any source, that a defendant charged with public intoxication may have available to him the defense of chro_nic alcoholism, he is, in my opinion, clearly obligated to make certain that the defense is adequately presented. Cases in the District of Columbia, involving the analogous defense of mental illness, hold that even if the defendant protests, the judge is required to inject the defense into the case sua sponte, which means of his own motion, to make certain that an innocent man is not convicted. Failure to do so is reversible error, as an abuse of the judge's discretion. And a decision handed down by the United States Supreme Court in March of this year is wholly consistent with this position. There is no reason why these precedents should not be equally applicable to the defense of chronic alcoholism. "This means, of course, increased responsibility for the judicia ry . Under the Easter and Driver d~cisions, each trial judge is obligated to take affirmative action to bring an immediate end to the traditional "revolving door" handling of the chronic court inebriate in his court. No judge, in my opinion, may properly remain neut r al, simply waiting for a defendant to raise the defense of alcoholism. "Indeed, statistics I have reviewed suggest that, throughout the cou nt r y, a ppr oximately 90-95 per cent of the drunkenness o f fende r s who appear before the courts have serious d r inking problems . In my judgment, this statistic in itself places upon trial judges an obliga tion to inquire into the possibility of the defense of chronic a lcoholism fo r virtually eve r y dr unkenness offender who a ppear s i n the courts . A fa i lu r e to u nderta ke this inqu i ry amount s , in my vi ew, to a de r ogat i on of judic ial r espon sibi lity. "Thi s al so me an s t he d emi se o f t he so- cal l e d court honor or probationary programs f o r al coholics which have s prung up all over the country as the judiciary 's ad hoc answe r t o the failure of public health officials t o treat alcoholism as a disea s e. If a defendant is found t o be elig ible f or a court alcoholic program, then obviously he should not be convicted in the first place. The Easter �Page 8 and Driver decisions are, in my judgment, fundamentally in conflict with any type of judicially-sponsored post-conviction program for the treatment of alcoholism. However benevolent such programs may be, constitutionally they are a thing of the past. For my part, I shall be very happy to see the courts step aside in this area, and to see public health officials take over problems which the y should have taken over many years ago." B. 4. Legislation to provide for involuntary commitment of alcoholic until rehabilitation process is complete. Should be on a health and treatment basis rather than through courts with penal approa ch . 5. The responsibilities of the state and local communities must be defined and clarified. 6. The responsibility of after-care when the patient has been rele a sed from the hospital should be determined. Who follows-up--the state or local community? Treatment Facilities 1. Intake Center and Detoxification Unit Before any kind of evaluation, diagnosis or therapy can beg in , it is necessary that the individual be detox ified as quickl y a nd as safely as possible so that the effects of acute intox ific a tion are no longer present. There is no doubt that the hospital is t he best setting f or such treatment. Eme r genc y measures a re a t h a nd , the staff is av ailable a nd all necess a r y equipment is the re . In Fulton and DeKalb County, Grady Memorial Hospital seems to be the logical place for a Detox ification Cente r . It is authorized to t a ke care of e me r gencie s , it has spa ce and is convenientl y l oc at ed . I t does t ake c a re of alcoholics in i ts emergency clinic. Ex pe r i ence h a s shown that there is v ery little difficult y encoun tered i n t r ea ting a lcoholics . Recor ds of hospitals that h a v e a dmi t t e d the s e pa t i ents wi ll con fi r m t he re port that most of t h e se p a tients of fer no mo r e d i f fi culty t han an y o t her s i ck pe r son . I t is d i ffic u l t to es tima t e how many b e ds At l a nt a would need t o take c are of the probl em to a f a i r l y adequ a t e d e g ree. St. Lou is , Mis souri, o pened a 30 - bed unit t o s erve the en t i r e c ity. Officia ls r e p o rted t h a t in the fir st two mo n t hs o f op e r ati on , the s t a t ion ope rated a t or near capa c i t y wi th o n l y the al coh o lics fr om t wo p olic e districts. It i s o b vi ous t h at if fa c i l ities e x i st the y will be used. Based o n the St. Louis experience, which was c o ncerne d with a lower rate of arre sts than Atlanta has, it is felt that approximately 100 beds would be needed. Staff f o r 24 hour duty would be required. This would mean: 9 regist e red nurses, 9 licensed practical nurses, 15 attendants (nurses aides or orderlies) . Exact plans would have to be worked out in detail with Grady Mem- ori al Hospital and other professional people who are concerned and working with the problem. I �Page 9 2. Inpatient Diagnostic-Evaluation Center Following the individual's detoxification, he could be transferred to an inpatient diagnostic-evaluation center where a complete work-up could be prepared on his medical, social, occupational, family and other personal history. This could conceivably be the present City Prison Farm, which, when alcoholics can no longer be incarcerated there, would have room. Alterations and modifications in the structure would have to be made, but this would not present much of a problem. The Center should have a multi-disciplinary team approach . Its staff should consist of medical, psychiatric, psychologica l, soci a l work, vocationa l, and rehabilita tion personnel. The individual would stay approximately 5 or 6 days or until plans were complete for future treatment. It is hoped that as much as possible treatment would be on a voluntary basis and that commitment would be only used when absolutely necessary. Full coopera tion a nd willingness of the individ~al to under go treatment would f a cil i tate the rehabili t ative process. 3. Outpatient Rehabilitative Treatment The s u c c es s o f the Emory Universi ty Voca tiona l Rehabilitat i on Alcohol Proj e c t d emonst r ates tha t these me n can be tre a t ed s uccessf ully in an outpa t ient setting. Even those who will become only partially self-sustaining should be treated as those who eventually wi ll be fully rehabili t ated. The most i mpor t a nt a nd unique f eatu re o f t he p r oposed method o f treating t he chronic a lcohol ic cou rt o ffend er is based on the recogniti on that t hese i nd i vi duals are to ta l l y d e pe nd e nt upon o t her s to ta ke care of them. Knowing a nd accepting this ma kes the t ask o f r e ha bil ita t i on l ess d iffi cult a nd more cer t a i n. Any outpatient service should be based on t he Emory Pro j ect and its experience should be f ull y ut i lized. The servi c e should use a multi-disciplinary approach. Represented on the staff should be vocational re habilitation counselors, social workers, clinical psyc hol ogists, chapl ains, physicians and psychiatrists. The main emphasis in rehabi litation should be on "reaching out" for the clients rather than the traditional waiting for the client to request services. This reaching out is necessary because of the passive, dependent nature of the alcoholic. Once he is involved in the rehabilitation process, he must be continuously supported until his total dependency can be changed so that he is sufficiently independent to function in society and to maintain employment. �Page 10 4. Inpatient Extended Care Program-Rehabilitative Service The Georgia Health Code Act No. 936 (H.B. 162) 1964 session of the General Assembly, 88-403, states: "The administrative responsibility for alcoholic rehabilitatio~ as provided herein shall be vested in the Department of Health. The Department of Health shall study the problem of alcoholism, including methods and facilities available for the care, custody, detention, treatment, employment, and rehabilitation of alcoholics. The Department of Health shall promote meetings for the discussion of the problems confronting clinics and agencies engaged in the treatment of alcoholics and shall disseminate information on subject of alcoholism for the assistance and guidance of residents and courts of the State. The Department of Health is hereby authorized to establish and maintain hospitals, clinics, institutions, outpatient stations, farms, or other facilities for the care, custody, control, detention, treatment, employment, and rehabilitation of alcoholics, and is further authorized to accept for care and custody alcoholics voluntarily applying for treatment or or dered hospitalized by court order as hereinafter provided, and is further authorized to confine and detain such alcoholics for treatment and rehabilitation," This, then, definitely places the responsibility on public heal t h and any planning should be done with this in mind. Also, as with all othe r phases of the plan, this should be inte grated and coo r dina ted with the state and local plans for me ntal he alth . In a conference Community Councilr staff had with the State Mental· Health Di vision, it was pointed out that it was the policy of the Menta l Health Division to require that all local mental health pr ogra ms should include some provision for the care o r ha ndl i ng o f chronic alcoholic s . The e xact me thods to be uti lized are no t s pecifi ed , but t hi s proble m must be considered a nd pr o vided for in some manner in any mental health program at the local l e ve l, Dr. Donald Spille, Executive Director of the Metropolitan Atlanta Me ntal Health Associa tion, Inc., is a member of t he Community Counc il's Committee on Alcohol i sm a nd wi ll help keep the Committe e advi s ed on me ntal hea l t h program p lans. The inpatient extended care rehabi l itative service could be part of a reg i onal ho spi t a l or a center by itself. The s t re ss s hould be o n rehabilita t i on t o prepare t he individua l to be a selfsustaining member of soci e ty . Treatment techniques should include: a. b. c. d. Counseling and e valuation Physical therapy Work therapy Group therapy �Page 11 e. f. g. h. i. Self government Lectures and films Drug therapy Recreation therapy Pastoral counseling Specific plans should be developed by experts in the field. At present, we have the Georgian Clinic located in Atlanta and supported by the Georgia Department of Public Health. Fees charged to the patient are based on income. It is a 50-bed resident patient hospital and also provides day care and night care, This serves all residents of Georgia and the patient must be free of alcohol for 24 to 48 hours, There are also a few private · hospitals or sanatoriums that accept chronic alcoholics but facilities are extremely limited and almost nonexistent for those who cannot pay. C. Supportive Services 1. Housing - a great many of these individuals have no place to live. Some need temporary shelter while undergoing treatment. Some place must be provided for them which will give them support and keep them from drinking. Others will need more permanent arrangements if they cannot return to their own homes or live independently. The following are some of the kinds of housing that are recommended: a. Hostel - a semi-institution preferably in town. Should have a structured program with some medical personnel in attendance. Can be large, serving several hundred individuals. There is nothing like this in Atlanta. b. Halfway homes - smaller , more individual, less structured. St. Jude's Hou s e, Inc,, is at present the only halfway house i n Atlanta. It is supported by r ents from residents, contr ibutions from churches, individuals and foundations . I t has b eds fo r 40 r esidents and provides meals fo r an i ndefini te pe r iod of time in a protective setting . The men must be 20 year s a nd older , must ha ve an a rrest r ecor d fo r drunke nnes s , mu s t be s creened psychologically a nd phy sical l y by the Emory Univer s i t y Alcoho l Pr oject , The y mu s t also be sui t a b le for employmen t . c. Shelters for homele ss men that include alcoholics. The Atlanta Union Mission which i s supported by individual c ontributions and f e e s . The Mi s sion provides shelter , food, �Page 12 clothes, Christian counsel and employment for indig~nt men. On the average, 200 men are taken care of per night. Approximately 85% of these are alcoholics. The Salvation Army provides over 700 men with shelter a week. About 90% of these are alcoholic. It does not accept anyone in a severe drunken state since no medication or special treatment is available. These are sent by cab to Grady Hospital or turned over to the police. The men from the Emory Project will occupy a special section. The Army staff is responsible for giving the medication prescribed and will see that the men cooperate with treatment. Women alcoholics are housed at 242 Boulevard, N.E. Since August, 1966, there have been 4. Women are always referred to Grady Hospital, the Emory Project or the Georgian Clinic. d. Individual rooming houses or hotels. The Emory University Alcohol, Project now has a staff member developing these facilities. With help and supervision, many of these places could be made acceptable, kept from deteriorating and provide pleasant places to live. In most of the "flop houses" and cheap hotels, the man is exposed to other drinkers and the atmosphere is not conducive to a healthy state of mind. e. Social clubs where individual can go when not in treatment or when not working. A.A. meetings provide a form of this. f. Facility for individual who cannot be rehabilitated but will always remain partially depend~nt on treatment. Social improvement, even if it implies dependency upon the hospital, is perhaps the most that can be expected as a goal of therapy for this group. 1) Farm where he c an be self-sup porting. 2) Work outside of facilities with aid of treatmen t, but return to facility f o r night a nd free time. Atlanta Union Mission Rehabilitation Farm for alcoholics and the aged will open in May. It will house 32 alcoholics to begin with and the master plan calls f or 64. In order to be accepted , the client must be without a d rink for at least 48 hours, sign a statement of his own free will of intent to stay a minimum of 60 days, to cooperate with the staff and i ts program of worship, work and education. The client will not be permitted to leave the mission farm for the first 2 weeks and afterwards only when accompanied by Mission Farm personnel~ There will be a charge of $62.50 per month for every man. However, his ability to pay will not determine his acceptance. �Page 13 2. Financial Assistance - part of society's basic obligation is to provide for the destitute. This allows them income while undergoing treatment and supplements income of those who need permanent care. The Fulton County Department of Family & Children Services cooperate completely with the existing facilities for treatment of the chronic alcoholic. The individual receives temporary financial assistance as long as he is cooperating and undergoing treatment. The Special Service Section, which carries a reduced caseload, takes care of most of the alcoholics so that they can be given more intensive case work. When an individual applies for financial help and is an alcoholic, every attempt is made to get him to treatment. D_ Public · Educa tion Public apathy ha s been one of the most severe obstacles in working with the chronic alcoholic court offender. As a rule, he is a forgotten man, relegated to a flop house or prison and given up as a hopeless case. He remains a burden to society a nd is one of the most important contribut ors to the rese rvoir of poverty in this country. Once the public underst a nds and its intere s t is arou s ed, the resul t ing action c an become a powerful force in accomplishing a constructive objective. A public education program should concern i tself with the following aspects: 1. Deve lop community leade rship to alert people to the need s and pot e nt ial of a n a dequa t e a nd sympa thet i c a ppr oa ch to the pr oblem. 2. Ac knowledging that alcoholism is a public health problem and, the r ef o r e, a public r e sponsibility . 3, Showing t hat the penal appr oa ch t o the publ i c alco holi c is expensive and inhumane. I t has only perpe tuated t he pr oblem and in no way eased it. 4. Demons t rating t ha t the re is no s i mple so l ut i on. That t rea t ment o f the public alcoholic to be effec tive and lasting requires c oordination of s e rvices and a comb ina t i o n of many resou rces and programs. 5. Unde r stand i ng of the pub lic alcoholic and home l e ss i nd i vidu al. 6. Expl aining of problems a r ising in developing programs and service . a. b. c. 7, Legal and l egi s l ative Economics or fu nd ing Facilities and services tha t have t o be developed Describing and explaini ng kind of comprehensive plan Atlanta needs, element s involved and how we go a bout implementing such a pl an. �Page 14 A public education program should be directed at public officials, special interest groups, as well as the general public. The Metropolitan Atlanta Council on Alcoholism, working with the Community Council, could be the motivating force behind an education program. E. Central Registry and Information Retrieval The full extent of Atlanta's alcoholic problems is not known. The United States Public Health Service considers alcoholism the fourth most serious health problem in the country and the picture in Atlanta is most likely no different than that in any other city. According to the national average, it is estimated that there are from 20,000 to 25,000 alcoholics in Metropolitan Atlanta. This is far from a complete number for statistics are not available for those using private facilities and for those that never come to the attention of the public. We know that in 1965, 48,783 arrests were made in Atlanta involving drunkenness. We have these isolated figures but nothing complete , and some agency should be charged with the responsibility of keeping accurate statistics on alcoholics and facilities available for rehabilitation. In addition, the need for a central clearing house has been felt by many agencies. Alcoholics seek help in many places and often at the same time, and there is no way of knowing where they have been or what treatment they have received. A central clearing house or central registry cannot succeed, however, unless it rec e ives the full cooperation of all participating agencies. The Metropolitan Atlant a Council on Alcohol i s m might be a ble to orga nize one under a special grant so that mone y would be available for trained staff. { F. Staff Training Befor e a ny k ind o f servic e o r program c an be i n s tituted, personnel on a ll levels must be available. At the prese nt, the r e is a sever e short age of staff and there is a pressing need for training in the field. Inducements must be made so tha t individuals will be interested in working i n the are a o f a lcohol ism. All facil i t ies and p r ograms conc erned with t he t reatment o f the a lcoholic s hou ld be i nvolved with the training program and this should ag~i n be coor d inated wi t h the St ate ' s comprehensive plan for ment al il l ness o f which training is an i mpor t a n t part . The Geor g i a n Clini c ha s a n extensive training program which could be e xpanded. The Clinic cou ld po s sibly act a s t he c oor d ina t ing agency for a training program. G. Evaluation For a program of this kind, there should be a built-in system of evaluation of services. Only on the basis of such an evaluation would we be �Page 15 able to strengthen and develop the program, accomplish any worthwhile long-range planning, and establish accurate guidelines for the further development of the program. The Research Division of the Community Council will help develop the evaluation and the plan for it will be incorporated in the final report, Community Council of the Atlanta Area, Inc. �"IMPACT OF THE EASTER DECISION ON THE DISTRICT OF COWMBIA" by Richard J . Tatham (D.C . Department of Public Health) This is Richard J . Tatham, Chief of the Office of Alcoholism and Drug Addiction Program Development, for the District of Columbia Department of Health. I've been asked to relate to you some of our recent experiences in the District of Columbia which have resulted from a U. S. Court of Appeals decision last March 31, 1966, in the case of DeWitt Easter vs the Court of Columbia. As many of you know, the result of this court decision was a reversal of court decisions which found DeWitt Easter to be guilty of the crime of intoxication, in spite of the fact that he had clearly established that he was a chronic alcoholic . This decision was appealed to the US . Court of Appeals and it was found that alcoholism is an illness and that it would constitute cruel and unusual punishment for a sick person to be convicted and punished for exhibiting a symptom of his illness in public, and it was further established that the essential comm.on law element of criminal intent is lacking when an alcoholic becomes intoxicated. As a result of this case, the Court of General Sessions began utilizing the Alcoholic Rehabilitation Act of 1947, which authorized that court, in the District of Columbia, to suspend criminal. hearings whenever a defendant was suspected of having an alcoholism. problem and to commit that person to the Department of Public Health for diagnosis, classification, and treatment. The 47th Statute had been used on the average of 100 times each year between the years 1950 and 1963, and was , therefore, nothing new to the court or to the Health Department . However, in more recent years its use was discontinued as the court began to develop its own probation program for alcoholic offenders . Last year the U. S. Court of Appeals strongly urged the District of Columbia to use its 47th Statute once again and as a result of t his admoniti on some 3500 indi viduals have been adjudi cat ed under the 47th Statute to be chronic alcoholics and the majority of these have been committed to the Health Department for t r eatment . At the time of the Easter Decision , the D.C. Health Department operated t hree alcoholism t reatment facil i t i e s; namely, an outpatient clinic , known as the Alcoholic Rehabilitati on Cl i nic ; a hospi t al unit for intensi ve medical care at the D.C. General Hospital; and, a brand new comprehensive i n-patient, out-patient uni t at our Area C Mental Heal.th Center. However, the l atter faci l i ty was only in i t s begi nning phases with a skeleton staf f and was not really able to participate appreciably to handle a court alcoholic pr oblem. Likewise , the in-pat ient f acility at D.C . Gener al Hospit aj concentrat ed on t he shor t -t erm i ntensive treat ment f or del irium t remens, hallucinosis, and ot her serious complicat i ons of alcoholism, and so ver y few of the court- committed alcoholics were eligi ble f or t his service. The only remaini ng t reatment facility i s our out-patient clinic. Now in the month immediat ely following t he East er Deci sion , only s i x patient s were commi tted to t he Health Department. In the month of May, the number jumped up t o 100 and by June, 300 new patients were committed to us . By this t ime, patients were being t r ansported from the court t o t he out -pati ent cl i nic by the busl oad with as many as 50 or more arriving at a time. The out-patient clinic had no choice but to accept these in spite of the fact that the clinic was not designed t o accommodate the needs of the patients we were receiving. Utter chaos followed. All attempts to utilize existing Health Department resources resulted only in the addition of a few parttime people on an over-time basis in order that the clinic could operate evenings and Saturdays. Now, nine months after the Easter Decision, the same situation prevaiis ~Tith one exception - we now have an additional facility - a 425-bed, extended-care rehabilitation center located just outside the District of Columbia in Occoquan, Virginia. This facility opened November 14, 1966, and was filled to �-2- capacity in less than six weeks, so once again the Health Department is unable to accommodate all the patients who require in-patient treatment and these patients are once again going to our out-patient clinic. A recent article in the Washington Post indicated that the Director of this outpatient clinic is threatening to leave the Health Department unless the situation is alleviated somehow . The patients are still coming to clinic in droves. While they are there, they have entered into fights with other patients, members of the clinic staff have been assaulted, patients have urinated and expectorated in the clinic and this has created a situation which threatens the entire survival of a treatment program that has been in existence since 1949 . .. The solution of this problem is not a simple one. One mlght believe that the Health Department had not anticipated the reversal in the Easter Case; however, this is not true. Well in advance of the Easter Decision, the Health Department, along with representatives from Vocational Rehabilitation, Correction, Administration, and Welfare Departments prepared an ad hoc report dealing with the possible impact of an Easter Decision, This report clearly pointed out same of the problems which might arise and also outlined certain new services and facilities which might be needed. However, no action was taken by our Board of Commissioners. The reason for this included the fact that the Commissioners had no assurance that the Easter Case would be reversed and even if it would be reversed they had no assurance that the impact would be great. For example, even though the Easter Case would be reversed, the judges in our local courts might insist that the question of alcoholism would have to be introduced by the defendant himself and many alcoholics appearing in court, of course, would choose not to introduce the problem of alcoholism. By avoiding the question of alcoholism they could return to their workhouse where they have been long-time residents - they lmew that they would serve an average of 21 days and the9 could be released without any pa.role or any other obligations . However, if they should bring up the question of alcoholism, they might very well be committed to the Health Department for 90 days with a possibility that a second 90-day committment would follow. With this in mind, there was much speculation that the courts would not use the Easter Decision as a base of future action in very many cases. In addition to this, the problem was complicated by the fact that the corporation counsel, lmown in other cities as a prosecuting attorney, felt very strongly that according to the definition of our 1947 Statute, there could not possibly be more than 20 or 30 chronic alcoholics in the entire District of Columbia. Activities since then have proven quite the contrary. The pr oblem has become so great that it was necessary to set up a court-coordination program and patient control system in order to just keep track of the ~ultitude of patients being committed to us by the court. The situation became so bad that the Health Department was instructed that it must cut off all voluntary patient admissions at its treatment facilities in order to make room for the court-co!filllitted patients. In evaluating the problems that have occurred since the Easter Decision, the Department has consistently fallen back on its basic comprehensive community mental health plan, which points out the needs for various facilities ranging f'rom the extended care rehabilitation center we now operate to mental health center alcoholism units providing both in-patient and out-patient treatment to detoxification centers to residential facilities such as hostels and half-way houses. The big problem, obviously, is the magnitude of the program which we have proposed and the fact that one or two components of the program still do not alleviate the problem of handling court-committed patients. Until a. complete �-3system is available and operating which can provide all of the services needed by this particular patient population, there will be chaos in treating the chronic court offender. If we do not have community based residential facilities, then we will either have to expand our in-patient hospital at Occoquan, Virginia., or we will have to substitute out-patient treatment with all its inadequacies for this homeless pat'ient group. The District of Columbia is presently spending approximately $3,000,000 per year on the alcoholic patients seen by the Health Department. Of this figure, approximately $1,000,000 a year is expended on the care of alcoholics having psychosis who are admitted to St . Elizabeths Hospital and paid for by the Health Department on a contract basis. The other $2,000,000 accounts for our present services at the rehabilitation center, at the Area C alcoholism unit and at our out-patient clinic. Also, the figure includes the cost of providing our court coordination and patient control system, a small alcoholism TB Program at Glendale Hospital, and our new demonstration detoxification unit. As we are busily trying to expand our services to accommodate the needs of the court-committed patients, we are faced with a new problem which has come to light within the past few weeks in Washington. Our information indicates that two new bills are to be introduced to Congress this session. One by the administration, a second by Congressman Hagan from Georgia. Each bill would introduce a new concept in law enforcement as each would remove intoxication from the criminal code entirely. This would mean that if either of these bills wa.s passed, an individual could not be arrested for being intoxicated only in the District of Columbia. It would mean that if an intoxicated person is helpless, has no place to go, he could be escorted by a police or Health Department official to a health facility for detoxification. He would be kept in such a detoxification faciltiy until his blood alcohol content returned to the legal limits of sobriety and then could be continued in treatment for alcoholism as a voluntary patient or released outright. This would mean that our att~ntion to the problems of getting sufficient hospital care resources for court-committed alcoholics would shift almost immediately to the problem of obtaining sufficient in-patient detoxification resources within the community itself. I think this is an excellent example of bow dynamic the field of alcoholism bas become as a public health problem and indicates the importance of planning coupled with flexibility; and, above all, it impresses with the importance of the ma,enitude of the problem. Most communities have never accepted the f'ull impact of the statement that alcoholism is the nations third or fourth public health problem. We have mouthed this saying without real izing the financial impact that it carries . As I said earlier , our community is eX]?endir-g approximately $3,000,000 a year on alcoholics. Now I'm talking about the Health Departments budget - I'm not adding to this figure what the Police Department, what the courts, what the Department of Corrections , and other departments are allocating to the care of alcoholics - just the Health Department. This $3,000,000 figure, in our estimation, will probably have to be doubled to a $6,000,000 annue.l. figure just to take care of the immediate emergency problems arising from the Easter Decision and the possible new legislation which would remove intoxication frcm the criminal code. Now, in creating these new services, of course we would hope any new program would be considered an additional resource for voluntary patients also; but, it's interesting to note that our 1947 Statute and the Easter Decision and the possible new statutes removing intoxication from the criminal code, all focus on the alcoholic who is a. law offender and quite often the most important patient in this group is the chronic drunkenness offender with fifty or more previous arrests for drunkenness. This means that today, alcoholism, even though a public health problem, is reaching the public's attention through the judicial activities of the community and of the nation; that a complete �-4revision of some rather well established principles is being questioned; and that new approaches are being encouraged; and that these new approaches will require new funds of considerable magnitude unless the community is satisfied that the treatment of the chronic alcoholic offender should consist of removing him from the streets only - and I think this is a very real problem that we face in firmly maintaining that alcoholism, the skid row alcoholic, the chronic drunkenness offender, is to become truly a public health problem. That the high quality treatment, the high standards of services that we provide other alcoholic patients are made available to the chronic drunkenness offender - now this does not mean that the chronic offender necessarily can benefit from the same type of treatment that our other alcoholic patients are involved in; but it does mean that whatever services are provided for them, they are the highest possible quality of services to meet the needs of this important patient population. I have been impressed as I have visited many alcoholism facilities throughout this nation with the fact that even though the Easter Decision is more than nine months old and that a similar decision in the case of Joe B. Driver in the Fourth Circuit Court of Appeals at Richmond, Virginia, have established a new legal precedent, and that these precedents have been set on both a constitutional and common-law basis and there is no doubt that tbe precedent will spread from state to state and circuit to circuit; yet in spite of all these things, many alcoholism programs do not seem to be planning to take care of this situation when it inevitably happens in their own state and community and I was, therefore, very pleased to see that in Atlanta there is planning being initiated and that the Community Council here in Atlanta is drafting a proposal which will be submitted as an answer to the problems that can arise here; that there are a number of people interested in the chronic alcoholic offender; and that services are being demonstrated now which can be extremely important in meeting the treatment, the rehabilitation, the residential, and other needs of this impoverished group. We fe el quite strongly in the District of Columbia that we have been bogged down in our own problems for over a year and that it's now perhaps our responsibility to communicate our experiences and observations to others throughout the country and Canada in order that some of the problems, the mistakes, and the frustrations experienced in Washington can be minimized elsewhere and it has been with this thought in mind that I have shared these comments with the staff of the Georgian Clinic and others who might come into contact with this tape recording. Richard J . T~tham , Chief Office of Alcoholism & Drug Addict i on Program Development Government of the District of Columbia Department of Public Health Washington, D.C. RJT: 2-24-67 �C C A A Cl,uirman of the Board of Dirt•cton hce Chairman MRS RHODES L. PERD U E, Secrewry w. L. CALLOWAY, A.,.\OC!Gtt• Se,reran• A B PADGETT, Treasurt'r JAMES P . FURNISS om unity ouncil o:f he tlanta rea inc. CECIL ALEXANDER. DUANE w. ONE THOUSAND GLENN BUILDING, 120 MARIETTA ST., N. W. BECK . Exe,111i1e Direc/or ATLANTA, GEORGIA 30303 TELEPHONE 577-2250 INVITATION LIST FOR MEETING ON THE CHRONIC ALCOHOLIC COURT OFFENDER Co-sponsored by Community Council of the Atlanta Area, Inc. Metropolitan Atlanta Crime Commission Tuesday, April 18 3:00 P.M. Conference Room, Trust Company of Georgia 1. Dr. John Venable, Director State Board of Health 47 Trinity Avenue, S. W. Atlanta, Georgia 2, Dr. P. K. Dixon, Chairman State Board of Health Gainesville, Georgia 3. Dr. Addison Duval, Director Division of Mental Health Department of Public Health 47 Trinity Avenue S. w. Atlanta, Georgia 4. J . William Pinkston, Executive Director Grady Memorial Hospital 80 Butler Street, S. E. Atlanta, Georgia 5. Mr. Edgar J. Forio, Chairman Fulton - DeKalb Hospital Authority P. 0 . Drawer 1734 Atlanta, Georgia 6. Dr. John Hackney, Commissioner of Health Fulton County Health Department 99 Butler Street, S. E. Atlanta, Georgia 30303 - �-2- 7. Mr. P. D. Ellis, Chairman Fulton County Health Department 3230 Peachtree Road, N. E. Atlanta, Georgia 30305 8. Dr. T. O. Vinson, Director DeKalb County Health Depar tment 126 Trinity Place West Decatur, Georgia 9. Dr. John R. Evans, Chairman DeKalb County Board of Health Stone Mountain, Georgia 10. Mayor Ivan Allen, Jr. City of Atlanta 204 City Hall Atlanta, Georgia 11. Ri chard C. Freeman, Chairman Police Committee Board of Aldermen, City of Atlanta 1116 First National Bank Building Atlanta, Georgia 12 . John M. Flanigan, Chairman Prison Committee Board of Aldermen, City of Atlanta 245 Third Avenue, s. E. Atlanta, Georgia 13 . He nry L. Bowden, City Attorney Wi lliam Oli ver Building Atlanta, Georgia 14. Judge Robert E . Jones 165 Decatur Street, S. E. At lant a, Geor gi a 15. J udge E.T. Brock 165 Decat ur Street, S . E. Atlanta , Geor gi a 16, Judge T. C. Little 165 Decatur Street, Atlanta, Georgia s. E. Judge Robert Sparks 165 Decatur Street, Atlanta, Georgia s. E. [ 17. 18 . Police Chief Herbert T. Jenkins 165 Decatur Street, s. E, Atlanta, Georgia �-3- 19. James H. Aldredge, Chairman Commission of Roads & Revenues, Fulton County Fulton County Administration Building 165 Central Avenue, S.W. Atlanta, Georgia 30303 20. Charles Brown, Fulton County Commissioner Fulton County Administration Building 165 Central Avenue, s.w. Atlanta, Georgia 30303 21. Walter M. Mitchell, Fulton County Commissioner Fulton County Administration Building 165 Central Avenue, S.W. Atlanta, Georgia 30303 22. Harold Shea ts, County Attorney Fu l ton County Court House Atlanta, Georgia 30303 23. James P. Furniss, Chairman Board of Directors Community Council of the Atlanta Area, I nc. C & S Nationa l Bank Atlanta, Ge or gia 30303 24. Brince Manning, Chairman Board of Commissioners, DeKalb County DeKalb Building Decatu r , Geo rgi a 30030 25. Geor ge Hearn, Assistant At t orney Genera l St a te of Georg ia r J udi cial Bu ilding At l a n ta , Ge o rgia 30303 . 26. Paul Cadenhead, Chairma n Community Council Advisory Commit t ee on Alcoholism 2434 Bank of Geo rg ia Building Atlant a , Geo rgia 30303 27. Eugene Branch , Chairman , Permanent Conference, CCAA, Inc, 401 Haas-Howell Building Atlanta, Georgia 30303 28. Charles Methvin, Di rector State Alcoholic Rehabilitation Unit 1260 Briarcliff Road, N.E. Atlanta, Georgia 30306 29. Jack Watson King & Spalding Trust Company of Georgia Building Atlanta, Georgia 30303 �-4 30. Captain Ralph Hulsey City Prison Farm 561 Key Road, S.E. Atlanta, Georgia 30316 31. Dr. James A. Alford Alcohol Rehabilitation Project 41 Exchange Place, S.E. Atlanta, Ga. 30303 32. Mrs. Marian Glustrom, Planning Associate Community Council of the Atlanta Area, Inc. 1000 Glenn Building Atlanta, Ga. 30303 33. Duane w. Beck, Executive Director Community Council of the Atlanta Area, Inc. 1000 Glenn Building Atlanta, Ga. 30303 34. James L. McGovern, Executive Director Metropolitan Atlanta Commission on Crime & Juvenile Delinquency 52 Fairlie Street, N.W. Atlanta, Ga. 30303 �March 16, 1967 RECENT COURT DECISIONS ON ALCOHOLISM: IMPLICATIONS FOR ATLANTA AND THE STATE OF GEORGIA Skid Row has long been recognized as the bilge of our communities. And the derelict inebriates who reside there represent perhaps the lowest form of humanity. For centuries, these derelict alcoholics have been virtually ignored, not only by the average citizen, but indeed by the very public officials who are charged by statute with caring for them. Instead of receiving the attention and help that they deserve and so urgently need, they have received nothing but private disdain and public condemnation. They have been herded mercilessly through our courts and jails, in every city in this country, and especially in Atlanta, in an endless and futile parade. Early last year two United States Courts of Appeals sought to put an end to this senseless parade. These courts recognized, as anyone who stops to think about it must recognize, that this was a parade as much of our nation's blind stupidity as it was of the serious affliction -- chronic alcoholism -- from which these unfortunate people are suffering. It is these legal decisions, and the ramifications that they will inevitably have upon Atlanta and the entire State of Georgia, which I will discuss t oday. I will be as forthright as I can be in my r emarks . And I trust that you, in turn , will be forthright in your comments and criticisms of my suggestions. I I t is appropriate to begin by asking whether Atlanta has a problem of this kind . A~t er all , i f you are f ortunate enough to have no Skid Row, to have no derelict alcoholics , or to provide humane an(\, enlightened treatment for your chronic inebriate population , then we need proceed no further. The f acts that have been made available to me da~onstrate t h at Atlanta doe s , i ndeed , have a very grave pr oblem. Both a Georgi a statute and an Atlanta or dinance prohibit public i nt oxication. I n At l ant a, t here were 40, 811 arre sts f or dr unkenness during 1966, and an additional 6,494 arr ests f or "drunk and dis orderly , " making a grand total of 47,305 arrests for intoxication. And this figure would be substantially i ncreased if arrests for other offenses closely related to intoxi cat i on , such as vagr ancy and loiter ing , wer e included . The recent Report of the President' s Commision on Law Enforcement and Administration of J ustice, released~. t o the public just l ast month, has singled out Atl anta and the District of Columbi a as the two jurisdict i ons where chronic inebriate offenders ar e most harshly persecuted with constant arrest and convict i on f or public intoxicat ion. On a per capit a basis , the District of Columbia seems to have outstripped Atlanta slightly i n i t s zeal to put these men in jail, according to the 1965 statistics used by the President's Commission. As a result of the Easter case, however, Atlanta may by now have taken over from the District of Columbia the dubious distinction of being the Nation's leading exponent of the theory that sick men should be arrested and convicted for displaying the symptoms of their illness in public. During one sample month, November 1966, approximately one-thi rd of the persons arrested for int oxication in Atlanta paid a $15 fine before coming to court. By paying this fine, they avoided the distasteful experience of appearing �-2- in Drunk Court. The remaining two-thirds apparently could not raise $15 and therefore had no choice but to be brought before the Court. I have made no study of the Atlanta drunkenness offenders, and therefore can only extrapolate from national data and rely upon local data obtained from your State officials. But a national sur-vey conducted during the past two years has indicated that between 9(f/o and 95°/o of the drunkenness offenders who are not able to pay a fine upon arrest, and who therefore are forced to appear in Drunk Court, have very serious drinking problems. As I shall describe later, these statistics have been confirmed with a vengeance in our District of Columbia Drunk Court during the past 12 months. ,And I would imagine that the situation is no different in Atlanta. In a study conducted by Emory University during 1962 and 1963, it was found that 6,000 chronic alcoholics accounted for 30,000 arrests. More recently , the Emory staff has concluded that Atlanta has a population of up to 12,000 individual chronic inebriate offenders. Whether the correct figure is 6,000 or 12,000, or somewhere between, it is readily apparent that the problem is staggering. It could be dismissed only by assuming what the President's Commission on Crime in the District of Columbia has described as "a callous disregard for human life." And it can be attacked onlycy- what that Commission has characterized as "a determination for the first time to grapple with the deep-seated disabilities of the City's derelicts." Now let us look at the kind of help given to these people by the City of Atlanta. Again, I rely upon information that has been furnished to me. It is my understanding that , as a result of the first Emory study, a comprehensive plan to attack the problem of the chronic inebriate offender in At lanta was drawn up. Although bits and snatches have been implemented, it has basically gone unheeded. Drunken derelicts who are arrested receive no routine medical treatment, and are t aken to Grady Memorial Hospital only if they exhibit a serious medical p.robl em. Nor is medical help or rehabilitation services available at the Stockade, where they are sent after conviction. Paradoxically, Atlanta has a reput ation throughout the country of progres s ive t reatment f or alcohl ics. The Georgian Clini c is frequently cit ed f or its work -but I was dist ressed to learn just a few days ago that it has only 50 beds , and is expected to serve not just Atlanta, but the entire State of Georgia. The Emory Universit y Alcohol Pr oject has also been r eceiving nation-wide at tent ion -but , again, I was distressed to l earn t hat its pat ients apparent l y come onl y from prison, not from t he streets, and only f or vocational rehabilitation, not f or general treatment f or their alcoholism. Finally, your Stat e Legislature has enacted a statute for t he r ehabi l i t ation of alcohol ics. But a perus al of that statute r eadi ly demonst rat es that i t is far more punitive than any criminal statute could be. Upon determination that an individual is a chronic alcoholic who is in need of hospitalization, and upon agreement by the Department of Health to admit the individual as a patient, that man can be held against his will for an indeterminate length of time. There is not even a r equirement that the court find that he is dangerous to the public safety, or that the Department of Health has adequate and appropriate treatment programs and facilities for him. Ant it is readily apparent that in Atlanta and the State of Georgia today, there is no adequate and appropriate treatment program or facilities for derelict alcoholics. �·3Thus, there is no question but that Atlanta and the State uf Georgia do have a problem. There is good reason for a.1.1. of you to come here today to consider this matter. II The problem of public -drunkenness has been with us for centuries. Under early English common law, public intoxication was not considered criminal. activity. Drunkenness was considered entirely proper unless it resulted in an illegal breach of the peace. Mere public intoxication was first made a criminal offense by an English statute in 1606. And, today, it remains a criminal offense, with varying penalties, in virtually every part of the United States. We need not trace, today, the history of the criminal law as it has applied to alcoholism from 1606 to the present. Suffice it to say that the early courts concluded that, because alcoholism is a voluntarily-acquired disease, an alcoholic's drinking must be deemed to be voluntary as a matter of law. And since it is a well-established legal principle that an individual is responsible for all of his voluntary acts, alcoholics have been held criminally liable for their public intoxication, and any anti-social behavior it has caused, down through the years. The health professions have recognized, of course, that an alcoholic does not drink voluntarily. In 1947, the United States Congress enacted a District of Columbia statute, based upon the best available medical testimony, which explicitly recognized that an alcoholic has lost control over his drinking. In 1956, the American Medical Association officially recognized chronic alcoholism as an illness which should properly be treated by physicians. And in 1966, the courts caught up to the legislatures and to the medical profession. III { I would like to take a moment to describe the two recent court decisions because of their fundamental importance to the subject we are considering today. Both cases were based upon the conclusion that chronic alcoholism is no,;-, universally accepted as an illness. In Easter v. District of Columbia, the United States Court of Appeals for the District of Columbia Circuit held that because a chronic alcoholic drinks involuntarily, as a result of the disease with which he is afflicted rather than as a result of his own volition, he cannot be branded as a criminal. The Court recognized that public intoxication is only a symptom of the disease of chronic alcoholism, and ruled that common law principles preclude criminal conviction merely for exhibiting a symptom of a disease in public. In Driver v. Hinnant, the United States Court of Appeals for the Fourth Circuit reached the same result, but on Constitutional. grounds. The Fourth Circuit held that to convict a chronic alcoholic for his public intoxication, which is merely the inherent symptom of a serious illness, would violate the prohibition against cruel and unusual punishment contained in the Eighth Amendment to the United States Constitution. �These decisions represent rare unanimity in our Federal courts. A total of 11 judges considered these t wo cases -- the f u l l ~ ~ court of 8 judges in the Easter case, and a panel of 3 judges in the Driver case. Not one judge dissented from the conclusion that an alcoholic may no longer be convicted for his public intoxication. It makes no difference whether this result is reached by the Constitutional approach used in the Driver case, or by the common law approach of the Easter case. The conclusion is the same. No longer may the age-old problem of the chronic inebriate be handled by the criminal process. A new method of handling this problem must, under these decisions, be found by our local communities. The Easter and Driver decisions are not legally binding in the courts of the State of Georgia. But it is just a matter of time before the results of those cases will become applicable here. Unlike public officials in the District of Columbia, you still have a little time to head off a real crisis before it occurs. Georgia has the choice whether to take advantage of· the time le:f't before action is fol'ced upon it, or simply to sit back and ignore the problem. I would certainly urge that immediate action be taken, that intelligent long-range plans be formulated, and that the type of chaos that has followed the Easter decision in the District of Columbia thereby be avoided. I will now turn to discuss the planning and the new procedures that should be instituted in Atlanta and the State of Georgia. IV No individual, and no single group, can possibly undertake a program to replace the present revolving door handling of indigent inebriates thr ough the courts and j ails of Georgia, by a modern program of rehabilit ation end public health faci lit i es . I t will t ake a community of effor t, among all public offi cials and all interested pr i vate groups , to make a revoluti onary pr ogr am of this kind become meaningful. I will therefore discuss the role that I believe the police , the pr osecuting attorneys, the judiciary, ahd public health personnel should play in undert aking new procedures f or handling t he chr onic court inebriat e pr oblem. In discussing this, I shall rely heavily upon t wo aut hor itat i ve reports just recently issued: t he Repor t of the Presi dent 's Commission on Crime in the District of Col'l:.mbia , rel eased ·t o t he public on January 1 of t his year, and t he Report of t he President 's Commission on Law Enfor cement and Administ rat i on of Justice , rel eased on February 19. I acted as a consult ant t o both Commissions, and I am happy to state that the Commissions and I were in virtually complete agreement on the recommendations t hat they should make with regard to the handling of public i ntoxication by local communiti es . The t wo Repor ts are, in my opinion , essential reading f or anyone inter ested in the chronic court inebriat e problem. A. Let us first examine the police handling of chronic inebr iate off enders. I n my opini on, it is not a fals e arrest for a policeman to charge an unknown inebri.at e wit h public intoxication, even a:rter the Easter and Driver decisions. The police cannot be required , at their peri l, to malte a j udgment on the street as to whether an intoxicated indivi dual is or is not a chronic alcoholic. In the case of known alcohol ics, however, thi s problem raises a far more difficult legal issue . To some , the availability of the defense of chronic alcoholism still seems more properly an issue for the courts than for the police. But to a growing number of responsible lawyers, who have watched the District of Columbia police persecute chronic inebriates by daily arrest a:f'ter the �-5Easter and Driver decisions, any police detention of a lmo·wn chronic al.coholic for his public intoxication should be condemned as illegal, as well as unconscionable. This is therefore still an unresolved l egaJ. issue. But more important, the community should not place the police in jeopardy in this way. There is no reason why the police should be burdened with the ignoI!lJ.m.ous taslc of sweeping chronic inebriates off the public streets. Last September I 1-ras called upon to assist a man who had been arrested 38 times for drunkenness in the District of Columbia just since the Ea.ster decision . When you take into consideration the amount of time he spent incarcerated in jail and in various hospitals, this amounted to 1 arrest for eveey 2 days that he appeared on the public streets. Cert a ~ , the answer to the Easter and Driver decisions is not just to arrest derelict alcoholics eveey day, duly bring them to trial, and then immediately release them onto the streets without assistance, only to repeat the process over and over again. This succeeds in speeding up the revolving door, and in the persecution and further degradation of chronic inebriates. It cannot contribute to the elimination of these abuses, as the Easter and Driver decisions demand. In my opinion, the police can and should take two immediat e steps to end the revolving door process, pending development of a broader community program which I will discuss later in this talk. First, they should assist any drunken person to his home, whenever that is possible. Second, where an individual is unable to talrn care of himself, the police should assist him to an appropriate public health facility where he can receive the necessaey medical attention. Under no circumstances should they arrest known al.coholics time and time again. The question arises, of course, whether the police may properly assume responsibility for intoxicated individual.s and escort them to an appropriate public heal.th f acility to received proper medical attention. If the inebriate does not consent, would the police incur liability f or a false arrest? ,{ I have long been of the view that the police have duties of a civil nature, When a policeman escorts a heart attack victim to the hospital, he certainly is not arresting him. Thus, in my opinion, the police have not only a right, but indeed a duty , to talce unwilling intoxicated citizens, who appear to be unable to take care of themselves, whether or not they are alcoholics, to appropriate public health facilities. Certainly, this question should be resolved immediately preferably by enactment of a state statute, in order to lay the necessary legal foundation for the proper medical handling of alcoholics. i.a addition to their responsibility fo1· enforcing the criminal l aw . I am confident of one thing about our police personnel. Once new procedures are instituted for handling the chronic court inebriate as a public health problem, the police will be only too happy to cooperate. The police have long suffered under the public's command that they daily sweep this human refuse from the streets, a task which provided no possible benefit for their unfortunate victims. They will be only too happy to see the old system replaced by procedures which will allow them to help these people back on the road to recoveey, rather than just push them further down into their sodden Skid Row environment. B. With regard to the handling of chronic alcoholics by prosecuting attorneys, it is instructive to refer to the Canons of Ethics of the American Bar Association. Canon 5 provides that "the primary duty of the lawyer engaged in public prosecution is not to convict, but to see that justice is done." �-6This does not mean, of course, that a prosecutor is obligated to defend the man that he is prosecuting. It does mean, however, that he is obligated to make certain that an innocent man is not convicted. And in the context of the Easter and Driver decisions, this means, in my judgment) that a prosecuting attorney is obligated either to drop the charges, or at the very least to inform the judge of the relevant facts , whenever he has reason to believe that a defendant may have available to him the defense of chronic alcoholism. It is then up to the judge to protect the defendant's rights. A truly responsible prosecutor, moreover, would take it upon himself to review the defendant's record prior to any court proceeding, and to make appropriate recommendations to the court on his own motion. The prosecutor is, after all, an arm of the court and a representative of the community. As such, he cannot properly remain neutral . He should therefore take affirmative steps to make recommendations for the non-criminal handling of ar.y chronic alcoholic he is assigned to prosecute. Of course , prosecutors are not qualified to diagnose alcoholism. In most instances , however, the defendant's past record will readily demonstrate a drinking problem, and will be quite sufficient to lead a prosecutor to recommend to the court that an appropriate medical examination be made. The problem, in short, is not to devise ingenious methods by which the prosecutor may responsibly exercise his public duty . Rather, the problem is to educat e prosecuting attorneys about alcoholism, and to persuade them to take time from their demanding duties to assist the alcoholics with whom they come in contact in their daily work. C. Let us now examine the judicial handling of chronic court inebriates. Once a judge becomes aware, through any information, of any kind, from any sour ce, that a defendant charged with public intoxication may have available to him t he defense of chronic alcoholism, he is , in my opinio~clearly obligated to make cer tain that the defense is adequatelf presented, Cases in the District of Columoia, involving the analogous defense of mental illness, hold that even if the defendent protests, the judge is required to inject the defense into the case on his 01-m motion, to make certain that an innocent man is not convicted. Fai lure to do so is reversible error , as an abuse of the judge's discretion. And a decision handed down by the United States Supreme Court in March of last year i s l1holly consistent u ith this position. There is no reason why these pr ecedents dealing with t he insanity defense should not be equally applicable to the defense of chronic alcohol i sm. The D.C. Crime Commission concluded that they are applicable and that they compel the t r ial judge sua sponte to protect the alcoholic defendent 's legal rights . This means, of course , incr eased r esponsibili t y f or the judiciary. Under t he Easter and Driver decisions, each t r i al judge i s obligated to take affirmative action to bring to an immedi ate end the tradit i onal "r evolving door" handling of the chronic court i nebriate in his court . No judge , in my opini on, may properly remain neutral, s imply wai t ing f or a de fendant t o r aise t he defense of alcoholism . I have already ment i oned r ecent i nformat i on which suggest that, throughout the country, approximately 90-95% of the drunkenness offenders who appear before the courts have serious drinking problems. In my judgment, this statistic in itself places upon trial judges an obligation to inquire into the possibilit y of the defense of chronic alsoholism for virtually every drunkenness offender who appears in the courts. A failure to under take this inquiry amounts, in m..v view, t o a der ogation of judicial responsibility. �-7Some will contend that, because the Easter and Driver decisions are not binding upon the courts of Georgia, it is neither permissible nor desirable for local judges to apply these decisions in their own courts, even though they may believe them to be a proper statement of law. Some trial judges believe that, until an appellate decision is handed devm in their jurisdiction, they are compelled to follow the old view of the law even though they disagree with that view. In my opinion, this is an erroneous concept of a trial judge's responsibility to the community. A trial judge has an obligation, usually stated in his oath of office, to uphold the Federal and State constitutions. That obligation is far deeper, and far more important, than the principle of stare decisis. If a trial judge is convinced that the Easter and Driver decisions are correct statements of the law, he is in my opinion obligated to implement them in his O'\lm court without waiting for an appellate court to order him to do so . A municipal court judge in California recently took it upon himself to declare the local intoxication law unconstitutional, as applied to a chronic alcoholic, and I have not heard it seriously suggestai that he overstepped his judicial authority . The second way in which local judges have avoided applying these decisions is by refusing to raise the defense of alcoholism on their own motion. It requir es lit tle imagination to realize that the average Skid Row dereli ct does not read the Federal Reports, much less the newspapers , and has absolutely no knor:1ledge whr-i.t ever about his legal rights. Even if he did understand, in some vague wa:y, ';hat he might have a defense to the charge of intoxication, he probably could not begin to understand the ramifications of raising that defense. And of course, none of these derelicts are represented by counsel. Thus , unless the t r ial judge assumes the obligat ion of protecting this man 's rights , those r i ghts never 'Hill be protected. In those areas wher e the j udges have not r aised the def ense of alcoholism on t heir own motion, it has only very s~ldom been r ais ed by t he defendant s . Joe Driver, himself, has been convi cted for public i ntoxication in Dur ham on more than one occas i on after the Fourth Circuit handed down t he decision which bears his name. I find this perversion of l aw enfor cement intolerable. Many of t he j udges who have chosen not t o follow the Easter and Driver decisions have done s o because of a s i ncer e convicti on t hat i t would be more inhumane t o t hr ow derelict alcoholics back out i nt o the st reet s, to an uncertain fate, than it would be to throw t hem into jail , where t hey will at least be cared for . I have no quarrel with the sincerity and humanit y of' these judges . But I :firmly believe t hat what passes f or humanity in the short run becomes the worst f orm o:f cruel and unusual punishment in the long run. Acquiescence in the criminal handling of alcoholics virtually precludes ever breaking out of the revolving door method of handling alcoholics i n our courts. To the extent that the judici ary and the local Bar permits t he community t o handle derelict alcoholics as criminals, the communi ty may have l ittle or no incentive to change that procedure . Edmond Burke once said that "All that is required for the triumph of evi l is that good men remain silent and do nothing." If the good men in the judiciary and t he Bar remai n silent and do nothing, the Easter and Driver decisions could go do~m i n Georgia history as a theoretically intriguing, but practically meaningless, judicial aberration. And the evil of handling alcoholics as criminals could be perpetuated in this State. �7 -8One example of what a vigorous and conscientious local court can accomplish may be seen in the activities of the District of Columbia Court of General Sessions since the Easter decision was handed down on March 31 of last year. A majority of the judges in that Court concluded that they are obligated to raise the defense of alcoholism sua sponte for virtually all of the defendants who apeear in the Drupk Court charged with public intoxication. As of March 9, 1967 , 4,382 individuals had been adjudged chronic alcoholics, and therefore can never again be convicted of public intoxication in the District of Columbia. And I would estimate that only a handful of those 4,382 individuals raised the Easter defense by themselves. In vir tually all cases, the trial judge raised the issue on his own motion and referred the defendant to a court psychiatrist for diagnosis. The response of the District of Columbia Government to the Easter decision had initially been one of disint erest and disinclination ·to act. Our Court , by making it clear that the decision would be implemented vigorously, soon forced public officials to abandon this posture of indifference. These public officials then attempted to put into operation wholly inadequate procedures 1·1hich > in effect, would have done no more than change the sign over our local Workhouse to read "Hospital" rather than "Jail." Again, our courts responded by refusing to commit any adjudicated alcoholics to this new so-called heal th facility, when testimony proved that adequate treatment fo r alcoholics was not available there . As a result, comprehensive treatment programs and moder n facilities ~.... a now coming into being. These programs and facilities could not have been r:.ade possible ,-,ere i t not for the courage and sense of community responsibility of our local judges . This was judicial integrity at i ts pinnacle. Our communit y , and judges thr oughout the country, can t ake great pride in t hese men . Some of you mi ght think that the press and the citizens ' groups in the Distri ct of Columbia would have heaped a~us e upon our judiciary f or r eleasing this tremendous number of derel i ct alcoholi cs upon the community . These derelicts certai nly did not present a pleasing s i ght to the eye, and some undoubtedly died who might have lived had t hey been s ent t o jail . But the publi c di d not blame t he j udiciary . Just the opposite was true. Our judges have been publicl y praised f or r efusing to continue t o puni sh intoxi cated alcoholi cs, i n spit e of t he community prob.1_ems thi s has raised . But the publ i c press, citizens' groups, the Bar As sod a.tion , and the Pr esident ' s Crime Commission, have severely 1..: r.1. tj c>i !7.ed the District of Columbia official s who have faile d to provide public health facilities f or derelict alcohol i cs . And I believe that the same at titude would prevail in any communit y in the United States i n which the judiciary and t he Bar similarly had the courage t o l ead the wa:y t o new, more humane procedur es fo r t he handling of its chr onic inebr iate population. D. Correctional officials should have little or no r esponsi bili ty f or t he t r eat ment of chronic alcoholics. If the prosecuting att orneys and t he judiciary adequat ely perform their funct ions , chr onic alcoholics will no longer populate our prisons , as they curr ently do . And it i s quite clear that a prison set ting is hardly t he atmospher e i n which t o att empt to persuade a chronic inebriate offender to change his ways . There will remain in our prisons , nevertheless, some who have been properly convicted of more s erious crimes , who have a drinking problem unrelated to those crimes. It would obviously be wise for public health personnel to suggest to correctional officials that some form of appropriate treatment be provided for these people while they are still in jail~ in order to head off :future alcoholism problems . �-9E. The primary responsibility for developing practicaJ. programs for helping our chronic inebriate population necessarily rests, however, with professional public health personnel: doctors, nurses, social workers, and others working in the area of alcoholic rehabilitation. A judge can find an alcoholic not guilty of a given crime with which he is charged, but he cannot develop an effective rehabilitation program, nor can he order state or federal health officie.ls to build facilities and develop ad.equate programs. A prosecutor can, similarly, only exercise his discretion to prosecute or to drop charges. And lawyers can defend chronic alcoholics charged with crime but cannot offer them the treatment necessary to prevent s:i.Jllilar court appearances dey after dey after dey. In the last analysis, therefore, we must all rely upon public health personnel to initiate changes in the present procedures. They ,;-d ll readily find that when new procedures for handling chronic inebriates are presented, the police, the courts, and local attorneys will offer their full cooperation. But the point that concerns me most, I must admit, is that up to nm-r the health professions have not greeted the Easter and Driver decisions vrith the sense of challenge and responsibility that I had hoped for. Now is the time for them to step fO!"l•r ard with imagination and dedication to present new procedures for handling inebriates, new treatment programs designed to rehabilitate alcoholics, and new legislative proposals to develop an appropriate legal structure under which these new objectives mey be properly pursued. Unless this happens in the State of Georgia, the opportunity afforded by the Edster and Driver decisions may be wasted, and the efforts that have been made to adopt an enlightened :i..egal approach toward the chronic inebriate offender may be in vain. One would hope that these new procedures will come voluntarily from the health professions. If they do not, however, then all law enforcement personnel in the State -- the police, the prosecutors, the judiciary, and the local Bar -should take every step possible to force these new programs into existence. The legal profession ha.s long assumed the du~y of a public protector of the rights and liberties of all citizens. We must be as zealous in protecting the rights of our derelict population as we are in protecting the rights of those citizens who are more fortunate in life. I have already described what we have accomplished in the District of Columbia in just one year. Comparable humane results can be obtained in Atlanta. In an article that appeared in the Atlanta Constitution on March l of this year, a representative of the Atlant a Area Community Council was reported t o be pleading for time, and to be making efforts to forestall legal action in Atianta that would push f or adoption of the Easter and Driver decisions as binding law in Georgia. I most sincerely hope that there is no deley here, and that plans for a test case move .ahead rapidly . Such a case would be a necessary catalyst to speed up the reforms that are so badly needed in Atlanta's handling of its chronic inebriates. Of course, police and lawyers are not competent to decide exactly what type of non-criminal publj_c health procedures are most likely to result in rehabilitation of chronic inebriates. But 1·re are competent, and we do have the duty, to make certain that the present criminal procedures are not continued. The public cannot be expected to respect a system of criminal justice that condemns sick people to jail because they are sick. We need drastic changes in the handling of chronic inebriates in our local courts , and the legal profession has the power and the duty to make those changes. �-10- v Because of my interest in this problem, I have discussed with a number of public health authorities the type of new procedures that might be adopted for handling chronic inebriates. I will now outline, for your consideration, my mm conclusions, and those of the two Crime Commissions appointed by the President, about appropriate new procedures • For pur:Poses of my analysis, I separate what we might refer to as the derelict, or Skid Row, or homeless inebriates, on the one hand, from the inebriates who do have homes, families, and personal resources upon which they can rely. Although the derelict inebriates represent a relatively small proportion of the total alcoholic population -- ranging from 3 to 15 per cent, depending upon the statistics on which you choose to rely -- they obviously represent the vast bulk of the chronic inebriate problem in our courts and jails. I would begin by suggesting, as I already have above, that any inebriate who has a home and family to take care of him should be escorted promptly to that home by the police, rather than arrested. Of course, if it appears to the policeman that the inebriate is in medical danger, he should either be taken directly to a medical facility or his family should be informed that medical help would appear to be required. Perhaps at. some future time, when we have completely solved the problem of handling drun:.rnn derelicts, we will be able to provide public facilities and programs also for in8briates who are not direct public charges. But at this time, when we cannot even begin to handle our drunken derelict population, I see no reason why we should also attempt to take charge of those who do have resources of their own, beyond making certain that they do get back home safely. Thus, I would concentrate ourpublic resources almost completely upon the chronic inebriate derelict. And my init ial suggestion is that the old criminal method of handling this population should be discarded and replaced by civil procedur es. This should be done, in my opinion , regardless whether all or only part of the derelict inebriates found on the streets may have available to them the defense of chronic alcoholism provided by the Easter and Driver decisions. Let us examine for a moment whether there is any valid public policy reas on why a legislatu?e should brand an intoxicated person who is causing no public disturbance as a criminal. We must f ace r eality. The public intoxication laws in the District of Columbia never have been , and never will be, enforced uniformly upon the public as a Hhole . And I doubt that the situation in Atlanta is different. Police do not pick up intoxicated party-goers emerging from elegant dinner parties or our suburban country clubs. I will not be the firs t to point out that there are as many intoxicated people on the streets of the exclusive residential areas of our cities as there are in the Skid Row areas, and you will not be surprised that very few of the prosperous drunks are arrested. Public intoxication statutes are enforced against the poor , and in particular, the homeless man. Should we as a civilized nation enact criminal. laws aimed solely at a very small, virtually defenseless, esthetically unac.c eptable segment of our population, with the intent of simply sweeping them off the street and into oblivion? In my opinion, the public intoxication statutes now on the books have no redeeming social purpose, regardless of the issue of alcoholism, and they should not be retained. Even worse, by substituting criminal sanctions for public health measures, these statutes preclude the use o£ preventive techniques to head off �-ll- incipient alcoholism problems. Disorderly conduct statutes are quite sufficient to protect the public from harm and these statutes should both be retained and fully enforced. The two Crime Commissions appointed by the President have, for these reasons, recommended that the·· present public intoxication statute be amended to require disorderly conduct in addition to drunkenness. And the President's Commission on Crime in the District of Columbia has explicitly recognized that the usual manifest ations of drunkenness , such as staggering, or falling dmm, or noisiness, do not constitute any threat of harm to the public, and should not be considered illegal disorderly conduct. What, then, should be done ·with derelict inebriates found intoxicated on the streets? I 1·1ould suggest a three- part program. First , an i nebriate who, in the judgment of the poli ce or authorized public health personnel, is unable to take care of himself, should be brought to a detoxification center that is staffed with public health personnel, to receive whatever medical help for his acute intoxication may be necessary. This should be a voluntary facility. The individual might be required to r emain there for some specified period of time in order to make certain that he will again be able to t ake care of himself when he leaves. But be will not have been arrested, and could not be detained f or a longer per iod against his will. Second, those inebriates who have a drinking problem will be encouraged to remain for a longer period of time in an in-patient diagnostic center, wher e a complete work-up can be prepared on his medical , social, occupational , f ami ly, and ot her personal history. In my view, this should also be a completely voluntary f acility. A genui ne offer of meani ngful ass i stance should be the only inducement used to persuade an inebriate to make use of it. And I might add that , never befor e in our hi story, has any community reached out to these unfortunate people wit h such an offer. Third, a net work of after-care facilities should be establi shed t o provide f ood, shelter,. cl othing , vocational rehabi l itation, and appropriate treatment , rather than simpl y dumping t he derelict back onto Skid Row. Perhaps t he most important aspect of this pa.rt of the program would be residential facilities, to pr ovide an enti r ely new at mosphere that will, hopefully, reverse the process of degradation that has graduall y f orced t he dereli cts d°"m to their present posit i on. As with the other facilities, these should, in my judgment, be entirely voluntary. I would like t o emphasize that a new program of this nature should not, in opinion, contain a long-term residential in-patient treatment facility of the type now used to house the mental}S' ill. I would oppose any such facility on both medical and legal grounds. my First, the public health authorities with whom I have conferred have convinced me that long-term involuntary commitment to a residentiaJ. facility makes effective treatment for alcoholism more difficult. From their viewpoint, incarceration in a health facility has the same degrading effect on the derelicts as incarceration in jail. Both rob the inebriate of any willingness to attempt to find his we;y out of his present situation in life, and make him more passively dependent upon institutionalization. Those who are currently running programs inform me that voJuntary out-patient care, when supported by residential facilities, has been highly successful. If the community will only reach out to the derelict a1coholic with adequate and appropriate help, he will respond. Once the crutch of jail is removed, derelict inebriates voluntarily ask for assistance with their problems. �-12My second reason for opposing involuntary commitment procedures is on constitutional. grounds. We can aJ.1 agree, I believe, that the derelict inebriate poses no threat of actual. harm to society. And he poses no greater threat of harm to himself than do airplane test pilots, epileptics, mountain climbers, cigarette smokers, Indianapolis Speedway drivers, and any number of people who may refuse medical. as~istance for their non-communicable illnesses. None of these people are involuntarily committed to institutions, nor could they be. I therefore see no constitutional. basis for depriving chronic alcoholics of their freedom . against their will. The type of program that I have outlined is not a Utopian dream. It has been recommended by both Presidential. Crime Commissions, And although there was some dispute among the 28 members of these two Commissions, there was no dispute whatever on these recommendations. In his February 6th message to Congress on Crime in America, President Johnson specifically singeld out these recommendations for public attention. And Congressman Elliott Hagan of Georgia has now introduced a bill in the House of Representatives, H.R. 6143, that would adopt this approach for the District of Columbia. It is, therefore, an entirely realistic and _practlcal objective, and not just an idealistic hope. Of course, a program of the type that I outline will not eliminate the problem of the chroni c inebriate. There will undoubtedly be a significant number of hard-core inebriates who will not change their ways regardless of what type of treatment program is offered voluntarily or forced involuntarily upon them. We must, therefore, forthrightly face the question of what should be done with them. Since we can no longer handle them as criminals, as a result of the Easter and Driver decisions, we are left with two choices. We can either warehouse them forever on some type of an alcoholic farm, or we can process them thr ough the type of pr ogram I have descr ibed above. In my judgment, it would be unwise to institute a warehous ing system. Those who are close to the treatment of al.coholics tell me that they are not willing ever to write ~ff the possibility of helping even the most hard- core chronic alcoholic. They cannot determine ahead of time who can be helped, or bow long it will take. In their judgment, warehousing of alcoholi cs , r egardless of bow incalcitrant they may seem, is not medically warr anted. And a. warehous i ng operation is, in my opinion, clearly indefensible f rom a constitutional. viewpoi nt. The President's Commission on Crime in the District of Col umbia squar ely faced this pr oblem, and came to the following conclusion: "For t hese unf or t unate people, humani t y demands that we stop treat ing them as crimi nals and provide volunt ary supportive services and resi dential. facilities so that they can survive i n a decent manner. " This would require, of course, a complete overhaul of the present civil commitment system in the State of Georgia. And it should, in my opinion, begin immediately. VI The alcoholism movement has too long suffered, I believe, from a. defeatist attitude. In the District of Columbia we have shown not only that the public will accept the Easter decision, but al.so that it will not tolerate a Government that refuses to help derelict alcoholics. �-13Today , in Atlanta, you are t aking a major step forward. But a conference like this one is just the beginning . What we need now are man- to-man confrontations among public officials, without fanfare or publicity, in whi ch pr actical solutions to pr essing problems are worked out on a sensible basis. If I have one message to leave with you today, I would urge you to st art the job immediately. TaJ.k Presented By Peter Barton Hutt To The Atlanta Bar Association, Atlanta, Georgia, March 16, 1967. �June 4 , 1969 · mfr. Raphael B . Levine, Director Comprehensive Area Wide Health Planning . Community Council of the Atlanta Area, Inc. 1000 Glenn Building 120 Marietta Street, N. W . Atlanta, Georgia 30303 Dear Dr. Levine: Thank you £or your letter outlining the organization and function of the Metropolitan Atlanta Council for Health . As you know, the Fulton County Department of Health is the official agency £or health matters affecting the City of Atlanta and , normally, programs involving health and health planning would be the responsibility of the County Health Department as far as the City of Atlanta is concerned. I understand, however, that the Comprehensive Area .. wid Health Planning Program which will be carried on by the new Metropolit n Atlanta. Council for Health will involve re responsibility for developing policy and all the broad aspects of health including environmental sanitation, water pollution; etc. I Since the City of Atlanta does have major responsibility for production and distribution of potable w ter and for collection and dis po l of solid w st and also sew ge treatment nd disposal, I can understand why th City of Atlant should hav a representativ on th Health Council. Since both th Sanitation Division nd the Wat r Pollution C ontrol Division fall within the rea of r sponsibility of th Public Works Commltt e of th Board of Ald ~m n,. I am asking Alde:l!"man G. Ev rett Millie n, Ch lrm n of this C ommitt , to repr sent th City on the Council. Sincer ly yours, Ivan Allen, Jr. Mayor �October 22, 1969 Mr . R . H . Phillips President Council of Greater Atlanta,, Inc. 151 Spring Street,, N. W . Atlanta, Georgia 30303 Dear Bob: Please excuse me from making any decisions concerning additional responsibilities at this time . I will be glad to discuss the matter of the Council with you .a fter the fir t of the year. { Gratefully. Ivan Allen. J,:. Mayor IAJr:ja �USO COUNCIL OF GREATER ATLANTA, lNC. 151 Spring Street, N.W. • Atlanta, Georgia 30303 • 525-4976 Executive Director Lloyd R. Hoon Honorary President Hon . Ivan Allen, Jr. President Mr. Robert H. Phillips October 17, 1969 Vice Presidents Mr. James R. Brown Mr. Hampton L. Daughtry Mr. J. lee Morris Secretary Mrs. Harold Marcus Treasurer Mr. James C. Blyth e Past President Brig. Gen. J. R. Ranck, ret. M<emben Mr. Bernard Abrams Mr. Ashton J. Albert Mr. Carter T. Barron, Jr. Mr. Jame, S. Briggs Mr. E. R. Brooks Mr. John S. Candle r II Mr. Walter Cates Mr. Rodney Cook Rev. Howard W . Creecy, Sr. Mr. Richard Culberson Mr. Richard Dolson Col. Harold Dye Mrs. John 0 . Eichler Mr. Jerry Fields Mr. Hilton Full e r Mr. Nip Galphin Mr. R. Ellis Godsha ll Dr. Marvin Goldste in Mr. Ha rry Goodma n M r. Donald M. Hastings, Sr. Mr. Robe rt D. He nnessey Mr. M. L. Howell Mr. Howard Kle in Mr. David L. Kun kler Mr. C. D. l e Bey Mr. P. Harvey Lewis Mr. Marti n Libowsky Mr. Seymour W . Liebman n Mr. E. A. McGuire M r. Robe rt Marti n Mr. W . R. Masse ngale Dr. Harmo n D. Moore Judge Sam Phillip McKenzie Brig. Alfred J. O sborne Mrs . Louis Rege nste in, Jr. Rev. James Sche re r M r. M ichae l Sert ich Mr. l. M. Shadgett Mr. Donall y Smith Dr. Horace Tate Mr. Lyndon Wade M r. William Waronke r Mr. J. R. Wi lson, Jr. Mrs. P. Q . Yancey Advisory Council Mr. Clayton Cosse' Mr. James Dodd Dr. Harry A. Fifield Mr. W ill iam Fran kel Mr. Ra lph H. Garrard Gen. Alvan C. Gillem, re t. Dr. W illi am S. Jackson Mr. Irving K. Kale r Mr. Hugh Mercer Rabbi Jacob Rothsch ild Mr. C. l. Sneed Gen . (Lt.) John L. Th rock mor to n Mr. T. Clack Tucker Mr. Robert B. Wallace, Jr. Mr. Horace T. Wa rd The Honorable Ivan Allen, Junior Mayor of Atlanta City Hall Atlanta, Georgia 30303 Dear Mayor Allen: As you know, you are the We regret your departure from and congratulate you for your contributions to this city as Honorary President of our Council. the office of Mayor, but recognize wonderful accomplishments and its Mayor. We would hope your departure from that office might be our gain as we would like very much to have you as a member of the Council for 1970. The Council meets at a simple lunch four times a year with a good deal of the work done behind the scenes by key people and corrnnittees. We wou],d be honored to have you as a member of our Council. We have some very enthusiastic people supporting it . Incidentally, Blanche Theabom is just joining us and will be a new member for next year. We are trying to make our Council more representative of major and important segments of our corrnnunity. Won't you let us have your acceptance? great job you have done for a g reat city. Again, thanks f or the Cordially yours, R.H. Phillips, President Copy to Mr. Llo yd R. Hoon USO MEMBER AGENCIES THE YOUNG MEN'S CHRISTIAN ASSOCIATION ° THE NATIONAL CATHOLIC COMMUNITY SERVICE • THE NATIONAL JEWISH WELFARE BOARD THE YOUNG WOMEN 'S CHRISTIAN ASSOCIATION • THE SALVATION ARMY O THE NATIONAL TRAVELERS AID ASSOCIATION • USO IS SUPPORTED THROUGH UNITED FUND �I ', C O P Y L AW O FF I C ES ROBERT T .1JON'ES . JR. FRANCIS M. BIRO ARTHUR HOWELL EUGENE T .·BRANCH EDWARD \c?IKAN E JONES , BIRD PO BER T' L .fOREMAN, JR. FO UR TH LYMAN H. H'f.LLIARD FRAZER DURRETT, JR . EARLE B . MAY.JR. TRAMMELL E .VICK E RY RALPH WIL LI AMS . J R . J. DONALLY SMIT H WILLIAM B.WASSO N C. DA L E HA R MAN PEGRAM HARRISON CHARLES W. S M ITH CHASE VANVALKENBU R G RICHARD A. ALLISON F". M.BIRD. JR. PEYTON S. HAWES. JR. RAWSON FOR E MAN MARY ANN E. SEA RS ARTH U R HOW EL L Ill VANCE Q. RANKIN Ill CYRUS E . HORNSBY Il l RICHARD M . ASBILL FLO O R & HOWELL HAAS - H OWEL L BU IL D I NG ROBERT P. JONES ATLANTA , GEORGIA 30303 RALPH WI L LIAMS 1903·1960 January 20, 1970 T E LEPHON E 5 2 2-2508 AR E A CODE 404 Honorable Sam Massell Mayor, City of Atlanta 68 Mitchell Street , S. W. Atlanta, Georgia 30303 Dear Mayor Hassell : It gives me genuine pleasure to enclose a courtesy copy of the 1969 Directory of Community Ser vices published by the Conmunity Council of the Atlanta Area,. Inc . We have been very pleased with the reception given this publication and trust th t it will be of value to you . Yesterday I chatted briefly with Dan Swe t about our com.,. munity center in the hippie district and the work the Council is doing in the area of alcohol and drug abu e . A council w s formed a short time ago composed of organizations concerned with the problem of alcohol and drug buse . Bee use of the tremen• dous interest in this rea, I und r t nd that now approxim -t ly 150 organization h ve expre ed a desire to work through some ort of council . The Community Council has b en providing st ff as istance end guidance to the proj ct . I told Dan that w would get up a su ry of wh th s been don nd th present propos d plan for continu d coordin ted effort on thi pt-0blem. I am aw re of the many critic 1 problems with which you ar now concern d and 1 told Dan that we would beg d to it down with both of you nd discus som of our ctiviti t your con• venienc . Be t p raon 1 reg ,:d ·- . Siner ly, Eug

je

nclo ur T n at T. Br nch �I L C C uncil A tlanta A rea inc. DUANE W, BECK. ONE THOUSAND GLENN BUILDING, 120 MARIETTA ST., N. W. £,ecuti,·e Director ATLANTA, GEORGIA 30303 TELEPHONE S77-2250 January 8, 1970 Mr. Dan E. Sweat, Jr. Chief Administrator Office of the Mayor City Hall . Atlanta, Georgia 30303 Dear Mr 0 Sweat: The Interagency Council on Alcohol and Drugs is composed of 150 public and private agency and organization representatives who are concerned and interested in the problem of alcoholism and drug abuse. It is chaired by Dr. James L. Goddard whose background in Public Health and Pure Foods and Drugs has lent immeasurable support and knowledge to the Council. The Interagency Council was established to carry on a program of · e ducation, coordinate existing services and stimulate the developme nt of new ones . At present there is a tremendous amount of public interest in drug abuse and many groups are eager to do something about it . There are now 4 proposals rf or Drug Treatment Centers which the Interagency Council is e valuating in order to make recommendations f or implementation. The se pl ans all require support from the city administration. Since the Council is composed of and has access to most of the drug specialists in the area the judgment s it makes s hould be valid and obj e ctive . We wi ll be glad to supply you with our findings and act as a clearing house for all drug treatment proposals . In this way we can be sure that the city gets the best kind of services and the kind it really need s. Sincerely, k<«Y1 tt! A(lL Duane w. Beck Executive Director Copy to: DWB:cfh Clarence L. Greene Office of the Mayor �• { BOARD OF DIRECTORS Cecil Alexander Ivon Allen, Ill Rolph A. Beck Eugene T. Branch Ben1omin D. Brown Charlie Brown W. L. Collowo, Campbell Dosher Albert M. Dov,-, , M. D Roy J Efird J Rufus Evans, M. D Robert L. Foreman, Jr. Jomes P. Furniss Donald H . Goreis Larry L. G.ellerstedt, Jr Mrs. Thomas H Gibson H. M Gloster Elliott Goldste,n Allen 5. Hardin Vivion Henderson Mrs Helen Howard John Izard Ira Jackson Joseph W. Jones Alex B. Locy Mrs Maggie Moody Mrs John L. Moore Jr . A. B. Padgett Mrs. Rhodes L. Perdue Les H. Persells J William Pinkston, Jr. L D. Rizk J Randolph Taylor Nat Welch Allison Williams John C. W,i5on John E. Wright ADVISORY BOARD J. G. Bradbury Jomes V. Corm,chael R. Howard Dobl1s Jr Edwin I. Hatch Boisfeu,llet Jones Mil is B. Lone, _ r William W. Moore, Jr., M D W. A. Parker, Sr. Richard H. Rich J ohn A Sibley Lee Tolley P. cston Upshaw William C Wardlow, Jr. George V\' Woodruff �EU G ENE T . BRANCH. C..:Ju.:irm:l rl E !...L I O TT G O LD STE I N , 1:ic,: C/::1i r m an A. 6 . P AD'SETT . t' : {:r Cl:::in,:.:'1 M ns . T H O t-.1 A S H . GI O S ON . Si·c r,·ra ry R A LPH A. BC:CK . lr,:,t\ ttr r r DU ANE O ME TH O U AN D GLENN B UILD IN G , 120 MARIET TA ST., . J. w. BEC K, £\·e(·urivc D ireC({}1' ATL • T A , G EO IA 3 0 3 03 ·;-:• 2L c P H ONE 577-2~50 19 January, 1970 Members of the Metropolitan Atlanta Council for Health TO: . FRO.ii: A. B. Padgett, Chairman pro tern Meeting Notice SUBJ: The. annual meeting of MACHealth will be he l January 1970. Pl a ce of the meeting will be Room 409, 101 Marietta Street Building. Time wi 1 be 12:00 Noon. Principal business of the meeting will be the election of officers for the year 1970. Persons elected will s erve until the next annual meeting in January, 1971, or until their successors are qualifj_ed. Enclosed with this meeting notice is the r e port of the Nominating Committee . Persons have been nominated for each of the seven offices, and for a replacement on the Nominating Committee in case Dr. Wells is elected preside nt. (The president serves, ex officio, on the Nominating Committee.) The s e 'p ond page of the Nominating Cammi ttee report indicat es the d istribution of oner , two-, and three -year terms for persent members of the Council. This is to insure that one -third of the elected members of the Council are elected each year in the future. The selection f or l e ngth of term was done by drawing number s out of a hat, but assuring that specific groups (such as medi cal society members, h ealth providers as a whol e group, et c.) have a reasonable di stribu t ion of 1-, 2-, and 3-year terms. With the .possible exce ption of our first meet ing last June, this is. like ly to l;>e the most important meeting of MACHealth's history. Your attendance i s urgently requested. If you c annot make it, be sure your a lternate at tends~ A. B. Padgett, Chairman pro tern .JP/RBL/la I s.. P. , I regret to ha ve to tell you that, becau se of budgeta'ry. probl ems , we will 'be unabl e to hold our " getting to know you" me eting on ·7 February. Vie shall try to schedul e it for March. ABP �REPORT OF THE NOMINATING COMMITTEE - JANUARY 1970 The Nominating Committee, consisting of Hon, L. H. Athe rton, Rev. E. B. Broughton, Mr. A. B. Padge tt, and Dr. R. E. Wells, present the following slate for consid erati on of the Metropolitan Atlanta Council for Health: For President: Dr. Robert E. Wells For Vice Presid ent Council Func t ion: Mr. Lyndon A. Wade For Vic e Presid e nt Liaison & PR: Hon. Thomas M. Callaway , Jr. * For Vice President Spe cial Needs: Re v. Ervin B. Broughton For Vice Presid e nt Project Review: Dr. Luthe r Fortson For Vic e President Administration: Mr. Gary Cut ini For S ecretary: Mrs. Loretta Barnes

Has not signifie d acceptance of the nomination as of 19 January 1 970.

�o .µ .µ rl o C ro C ~ µ

>, ,0

Cl:l r-1 Cl) .a rl Cd b() , :-J ~ ~J QJ ~ ~ ~

-;

I Q) C .µ 4__:, c:i: ,I ,,-1

, ?,::

• C l 2 3 MUNICIPALITI ES o o o •r=i rr., o 3 z - Ma r~i-e-. 1:-.i::-a-_------1- - - i - - , - - - - - - - - - - ______X__ ,_____\ ___ _ 0 Bree 11 - Dec a tur - Fo::ceE, t ?a r·k - - - - - - - - '· - - - - - - · - - - - - - - , - -- ct> • 0 ~ 0 X ·

--- X x - - - - -1-- - - 1-- - - x - -- +--- •----!-""--- PROVIDERS ff"o l' t SO-n-----=C-0...,...b~O-ll C:: ct ~ · • X X McLe ndon - Atl. Me d. , X X Vinton - D:e ka l b Me d XI X X Wells - Fulton Ne d X x I Miller· - Ga. Psychi a t.

'>?---',- - - - _><_ _ _ _ N __ X

H X Gulley - No. Ga . Dent X. X X Hamby - No. Dist. Dent X }! Cantrell - Fulton P.H.D. X ) -_Vinson - De Ka lo P-:lCD'-. - X: X X X ~urg e - Atl. Hosp. Di s t X ' X )( Pinkston - Grady Hosp X X ~icha rdson - Emory Me d Sch X N X ) ·Lane - Ga . Stat e H. Sci. x x x 5 Lott "' - 5th Dist Nur s ~ ~ X H ~eek - Ga. Heart As s o c

¥ X - Am.-- Soc. H. Assocs ..,,.-,,,McFall- - - ~ ~- ~ -- 1 - - - - - - - " - - - - - + - - - - + - - - l-l--'----+------i- ---1-..c..-~ . .~ade - Na t Asso c S oc Work I X X X Joc ke rs - Me d. Te c h. Soc x X X )( Robinson - Gra d y (s e mi-sk11: X Cutini - Hea lth Ins. X X' l ~ ~ 1 .. . POOR & 1':EAR ? OO R "°o a. rc1ne r - A tl EOA-- - - - - - - , - - - - - . - ,--x---,1---x-t·--t+-X--J,----1----+~1---Fre e ma.n I- A tl EOA X x ,'-<,.,...,.. x .Moo n e y ~ A tl EOA , >c ~ X · ' I ' I _Gl e n n _ - Cl ay_t_o_n_E~c_·._f\ _ _ _ _ _ 1_X~ 1 ___, ----t-----,.\{c-1---1-t----.~X~--~,~ l- - S ouder - Cla y t on EGA X i X X J San d er:-s-D e Ka l b - Ro c kda l e EOA )(' X 1v_/4,,.r k µ I Broug hton - Gwi nne tt EOA x x. X H I -~-9hns on - MOd e l Ci ti e s X X x I ,L.ov e tt · - M,odel Ci t j_e s x X X J Cof e r - Gran t Pa r k ?TA " x X H Ha wth orne PTA ,c I IJ )t-· µ ,__Qr if f in - sO • Dou g 0-;;:s:;-;-_p:-;,m

-1A;---i------,'r-'-x_ _ --1..c...x_ _+-- --H-----i-~- .:.._..:..X,__+-t-'--I_ __

"Ma th ew s - Na t. Welf Righ ts I )( X N X !-\ 1 ,... B~ rn es - Sou th s i d e Co:np H. x _ x . . X I Gri g g s - Te r.a n ts Ur. i ted FF >;x X 1 __ fvla :r'sha.1 7 - At'-l_._.:t..c.cAJ -'A'--=C.-=P ---- - -+---- -' _ _X_· - +-- - ')(..:+---H--..:.X_:___1_ _-'i- - -.!.....-!-.l_ _ _ I Ki mp s on - At l Urba n Le a g ue X x X H I i $ l �C C A A ~mmunity ouncil of' the tlanta rea inc. EUGENE T. BRANCH, Chairman of the Board of Directors DUANE W. BECK, Executive Director 1000 GLENN BUILDING, 120 MARIETTA STREET, N.W. ATLANTA, GEORGIA 30303 ALENE F. UHRY, Editor TELEPHONE 577-2250 January, 1970 SPECIAL EDITION LOOKING AHEAD Eugene Branch, Chairman of the Community Council's Board of Directors, has carefully reviewed our activities of the year just ended, and now looks ahead to 1970. We believe Communique readers will be interested in the following program Mr. Branch envisions: The beginning of a new year is a good time for an organization to pause long enough to consider where it is in the achrevement of its goals and where it is going. Since others are due the credit, I think it not immodest of me to say that I believe the Council did a good job in 1969. However, rather than dwell on the 1969 activities, it would seem more helpful to mention some of the activities which will be given priority in 1970. In addition to the normal and on-going activities of the Social Research Center and Permanent Conference, the following illustrate the activities which will be given emphasis in 1970: 1. Community Coordinated Child Care (4-C) The 4-C program is a federal program designed to develop a coordinated program to provide services to childre n--and thus make better use of the community's funds and resources in providing such services. Atlanta was named a pilot community and the Council was named the delegate agency. A Steering Committee composed of parents, representatives of day care agencies and organizations has been elected and is at work. Much of our staff time will be devoted to this activity. This is an outgrowth of our Child Development Project. 2. Day Care Action Subcommittee ~he very fine work of this Subcommittee will be continued in 1970. Its function is to stimulate interest in day care and help develop new day care resources. In 1969 ,the Subcommittee published a Day Care Manual which provides a step-by-step guide to those interested in planning and developing a day care center. The response has been so enthusiastic that we are swamped with requests by church groups and others for technical assistance. This important activity also arose out of our Child Development Project. �3. Coordination of Services and Planning One of the most important on-going activities of the Council is that of bringing together planning and service agencies in an effort to provide coordination of planning and services. The existing funds and resources for dealing with our urgent urban problems are extremely limited and all agencies have an obligation to jointly plan and coordinate their activities in dealing with the problems which are their major concern. Space does not permit an adequate description of the Council's work activities in coordination but.. periodic reports will be given in Communique. 4. Emergency Assistance Every effort to identify the most urgent problems in our five-county area has resulted in high priority being given to the need for developing more resources for emergency assistance. There are many aspects of the problem. An Emergency Assi8tance Committee has been organized and has begun to function. It has determined to work first on developing resources to deal with the problems arising out of evictions. Hundreds of families are evicted each year and there is no organized program to help the evicted families with such needs as storage space for furniture, temporary shelter, f ood etc. 5. Other Special Activities (a) Welfare Committee. Practically everyone agrees that our entire welfare program must be overhauled. A Welfare Committee is studying various income maintenance programs, including the Administration ' s Family Assis tance Act, and will make periodic reports. {b) Advisory Committee for Information and Referral. This Committee was formed to a s s i st in the improvement of information and referral service in the metropolitan Atlanta area and to devise means for improving servi ces to meet the most urgent ne eds identi f ied by such s e rvice. Among o t he r things , thi s Committe e will he lp f ocus attention on t he most serious ummet needs in our area. (c) Fourte enth Street Mult i -Purpose Cente r. The Council ha s leased a hous e on Juni per Street to be used as a community cen ter f o r t he Four t eenth St reet area . I t is funct i oning and has been well -receive d . The foc u s will be on a volunt a r y medica l clini c, a counsel i ng c enter and a t wenty-four hour informati on and ~eferral service . This facilit y is being operated at t he pre sent t ime entire ly by volunteers . The Center can meet a great neea a nd we 'l l keep you up to da t e on i t s activi ti e s i n Communique. (d ) Interagency Counc il on Al c ohol a nd Drugs . Th is Council is simply a " coming together ' of establ ished agencies concerned with problems related to the use of alcohol and drugs. It provides a means by which such agencies can work together. The Council has divided itself into the following five Task Forces: Resources and Exis ting Facilities and Services, Education, Treatment and Counseling, Speakers Bureau, and Legal Aspects and Legislation. You've received some information on this important and interesting activity and more will be forthcoming. - -- (e) Expanded Public Information Service. We have improved our methods of get·ting valuable information to the general public and will give greater emphasis to this activity. The information gathered by our Research Center and through our various programs, if properly and attractively passed on to the general public, will provide our area with a better informed citizenry. This greater understanding of our problems will in time result in an improvement in services and funds to meet the problems. �ll The above are simply illustrative of the variety of activities in which the Council is engaged. The Child Development Project revealed the need for further work on such problems as retardation of children, the need for twenty-four hour child care, learning difficulties etc. Volunteer Atlanta The Council is a .sponsor of Volunteer Atlanta and will continue to assist this project. As you may recall, Volunteer Atlanta was brought about largely by the Council and is sponsored by the Council, the Atlanta Chamber of Commerce, the Atlanta Junior League, the Community Chest, and E.O.A. Its object is to recruit, train and place volunteers in public and private agencies throughout the five-county area. We think this can be one of the most important projects begun in the Atlanta area during recent years. Assistance to Groups The Council is receiving an ever increasing number of 1·equests for technical assistance from agencies, neighborhood groups, and civic organizations. Agencies are requesting assistance in reviewing their programs; neighborhoods are seeking assistance in the drafting of proposals for resident-determined programs; and civic organizations are asking for suggestions as to the type of programs in which they might be effectively involved Thus, technical assistance to neighborhood groups and direct service agencies is becoming a major role of the Council. We think this role should be emphasized and that means must be devised to adequately provide such assistance. The Council is.basically a collection of staff, accumulated information and experience, and skill, and whenever its assistance can make agencies, neighborhood groups, churches and civic organizations more effective in their work, we add to the funds and resources being put to effective use in our community. This type of . assistance is one of the most important functions the Council can perform. t Program Development During the early part of 1970, we expect to organize a Program Development Committee for the Council. This Committee will be made up of Board members and individuals who are n~t on the Board. Its function will be to provide a means for continually reviewing the work activities of the Councii and assisting in the establishment of priority for its programs. The Council is a social planning organization which can be an important resource in the community only if it retains its vitality and flexibility. If the Council had become rigid in devising its programs, its people and resources would not have been available to engage in some of the activities described above which maintain a balance between continuity in those activities which look to long range improvement and flexibility sufficient to give the community the benefit of the skill and information available through the Council's resources. The Program Development Committee will provide a means for retaining the Council's vitality and balance in its work activities. Obviously there is a great deal to be done to make our five-county area a better place in which to live. I think it equally obvious that there is a great deal with which to do the job if we plan and work together with imagination, enthusiasm and a sense of urgency. So let's roll up our sleeves and see what we can accomplish together in 1970. �C C A A ommunity ouncil 0£ the tlanta rea inc. EUGENE T. BRANCH, Chairman of the Board of Directors DUANE W. BECK, Executive Director 1000 GLENN BUILDING, 120 MARIETTA ST•REET, N.W. ATLANTA, GEORGIA 30303 ALENE F. UHRY, Editor TELEPHONE 577-2250 January, 1970 SPECIAL EDITION LOOKING AHEAD Eugene Branch, Chairman of the Community Council's Board of Directors, has carefully reviewed our activities of the year just ended, and now looks ahead to 1970. We believe Communique readers will be interested in the following program Mr. Branch envisions: The beginning of a new year is a good time for an organization to pause long enough to· consider wher·e it is in the achi-evement of its goals and where it is going. Since others are due the credit, I think it not immodest of me to say that I believe the Council did a good job in 1969. However, rather than dwell on the 1969 activities, it would seem more helpful to mention some of the activities which will be given priority in 1970. In addition to the normal and on-going activities of the Social Research Center and Permanent Conference, the following illustrate the activities which will be given emphasis in 1970: 1. Community Coordinated Child Care (4-C) The 4-C program is a federal program designed to develop a coordinated program to provide services to children--and thus make better u se of the community's funds and resources in providing such services. Atlanta was named a pilot community and the Council was named the delegate agency. A Steering Committee compos ed of parents , representatives of day care agencies and organizations has been elected and is at work. Much of our staff time will be devoted to this activity. This is an outgrowth of our Child Development Project. 2. Day Care Action Subcommittee The very fine work of this Subcommittee will be continued in 1970. Its function is to stimulate interest in day care and help develop new day care resources. In 1969 ,the Subcommittee published a Day Care Manual which provides a step-by-step guide to those interested in planning and developing a day- care center. The response has been so enthusiastic that we are ~wamped with requests by church groups and others for technical assistance. This important activity also arose out of our Child Development Project. �3. Coordination of Services and Planning One of the most important on-going activities, of the Council is that of bringing together planning and service agencies in an effort t o provide coordination of planning and services. The existing funds and resources for dealing with our urgent urban problems are extremely limited and all agencies have an obligation to jointly plan and coordinate their activities in dealing with the problems which are their major ooncern. Space does not permit an adequate description of the Council's work activities in coordination bµt periodic reports will be given in Communique. Emergency Assistance 4. Every effort to identit'y the most urgent problems in our five-county area has resulted in high priority being given to the need for developing more resources for emergency assistance. There are many aspects of the problem. An Emergency Assi8tance Committee has been organized and has begun to funotion. It has determined to work first on developing resources to deal with the problems arising out of evictions. Hundreds of families are evicted each year and there is no organized program to help the evicted families with such needs as stor age space for furniture, temporary shel ter, f ood etc. 5. Other Special Activities (a) Welfare Committee. Practically everyone agrees that our entire welfare program must be overhauled. A Welfare Committee is studyi ng various income maintenance programs, including the Administration's Fami l y Assist ance Act, a nd will make periodic reports. (b) Advisory Committee for Information and Referral. This Commi t tee was formed to a s sist in theimprovement ofinformation and referral servi ce in the metropolitan Atlanta area and to devise means f or improving s ervices to meet the most urgent needs i dentifi e d by such service. Among other thi ngs , thi s Commi ttee wi ll help focus a ttention on the mos t seri ous ummet need s i n our a r ea . (c) Fourteenth Street Multi-Purpose Center. The Counci l has leased a house on Jun i pe r Street to be used as a community c en ter f or the Four t een th Street area . I t is functioni ng a nd has bee n well -received. The focu s will be on a vol un tar y med i c al c linic, a c ounseling c ent er a nd a twenty-four hour information and referral serviceA This facility is being operated at the present t i me entire ly by voluntee r s. The Center c an meet a great need and we'll keep you up to da te on its a ctivities in Communique . . This Counc il is simply (d ) Interagency Council on Alcohol and Drugs . a " coming toget her of establ ished agencies c oncerned with problems related to the use of alcohol and drugs. It provides a means by which such agencies can work together. The Council has divided itself into the following five Task Forces: Resources and Existing Facilities and Services, Education, Treatment and Counseling, Speakers Bureau, and Legal Aspects and Legislation. You've received some information on this important and interesting activity and more will be forthcoming. - -- (e) Expanded Public Information Service. We have improved our methods of get·ting valuable information to the general public and will give greater emphasis to this activity. The information gathered by our Research Center and through our various programs, if properly and attractively passed on to the general public, will provide our area with a better informed citizenry. This greater understanding of our problems will in time result in an improvement in services and funds to meet the problems. �The above are simply illustrative of the variety of activities in which the Council is engaged. The Child Development Project revealed the need for further work on such problems as retardation of children, the need for t wenty-four hour child care, learning difficulties etc. Volunteer Atlanta The Council is a sponsor of Volunteer Atlanta and will continue to assist this project. As you may recall, Volunteer Atlanta was brought about largely by the Council and is sponsored by the Council, the Atlanta Chamber of Commerce, the Atlanta Junior League, the Community Chest, and E.O.A. Its object is to recruit, train and place volunteers in public and private agencies throughout the five-county area. We think this can be one of the most important projects begun in the Atlanta area during recent years. Assistance to Groups The Council is receiving an ever increasing number of requests for technical assistance from agencies, neighborhood groups, and civic organizations. Agencies are requesting assistance in reviewing their programs; neighborhoods are seeking assistance in the dr--dfting of proposals for resident-determined programs; and civic organi zations are asking for suggestions as to the type of programs in which they might be effectively involved Thus, technical assista nce to neighborhood groups and direct service agencies is becoming a major role of the Council. We think this role should be emphasized and that means must be devised to adequately provide such assistance. The Council is · basically a collection of staff , accumulated information and experience, and skill, and whenever its assi s tance can make agencies, nei ghborhood groups , churches and civic organizations more effective i n their work, we add to the funds and res ources being put t o effecti ve use in our communi ty. This type of . ass ist ance is one of the mos t important functions ~he Counc i l can perform. Program Development Duri ng the e arly part of 1970, we expect to organize a Program De ve l opment Commit tee for t he Council . This Commi ttee will be made up of Board members and i ndividuals who are n~t on t he Board. Its f unction wi ll be to provide a means f or c onti nual ly reviewing the work a c t i vit ies of the Councii a nd assi s t i ng i n the est a bli s hment of priori ty for i t s programs. The Council is a s oc ial pl anning organization which can be an important resource in the community onl y if it ret ains i ts vital ity and flexibility. If the Council had become rigid in devising its programs, its people and resources would not have been a vailable to engage in some of the activities described above which maintain a balance between continuity in those activities which look t o long range improvement and fl exibility sufficient to give the community the benefit of the skill and information available through the Council ' s resources. The Program Development Committee will provide a means for retaining the Council's vitality and balance in its work activities. Obviously there is a great deal to be done to make our five-county area a better place in which to live. I think it equally obvious that there is a great deal with which to do the job if we plan and work together with imagination, enthusiasm and a sense of urgency. So let's roll up our sleeves and see what we can accomplish together in 1970. �C C A A omni.unity ouncil of' the tlanta rea inc. EUGENE T. BRANCH, Chairman of the Board of Directors DUANE W. BECK, Executive Director 1000 GLENN BUILDING, 120 MARIETTA STREET, N.W. ATLANTA, GEORGIA 30303 ALENE F . UHRY, Editor TELEPHONE 577-2250 January, 1970 S P E' C I A L E D I T I O N LOOKING AHEAD Eugene Branch, Chairman of the Community Council's Board of Directors, has carefully reviewed our activities of the year just ended, and now looks ahead to 1970. We believe Communique readers will be interested in the following program Mr. Branch envisions: The beginning of a new year is a good time for an organization to pause long enough to·consider where it is in the achievement of its goals and where it is going. Since others are due the credit, I think it not immodest of me to say that I believe the Council did a good job in 1969. However, rather than dwell on the 1969 activities, it would seem more helpful to mention some of the activitie~ which will be given priority in 1970. In addition to the normal and on-going activities of the Social Research Center and Permanent Conference, the following illustrate the activities which will be given emphasis in 1970: 1. Community Coordinated Child Care (4-C) The 4-C program is a federal program designed to develop a coordinated program to provide services to children--and thus make better use of the community's funds and resources in providing such services. Atlanta was named a pilot community and the Council was named the delegate agency. A Steering Committee composed of parents, representatives of day care agencies and organizations has been elected and is at work. Much of our staff time will be devoted to this activity. This is an outgrowth of our Child Development Project. 2. Day Care Action Subcommittee ~he very fine work of this Subcommittee will be continued in 1970. Its function is to stimulate interest in day care and help develop new day care resources. In 1969 -the Subcommittee published a Day Care Manual which provides a step-by-step guide to those interested in planning and developing a day care center. The response has been so enthusiastic that we are swamped with requests by church groups and others for technical assistance. This important activity also arose out of our Child Development Project. �3•. Coordination of Services and Planning One of the most important on-going activities of the Council is that of bringing together planning and service agencies in an effort to provide coordination of planning and services. The existing funds and resources for dealing with our urgent urban problems are extremely limited and all agencies have an obligation to jointly plan and coordinate their activities in dealing with the problems which are their major ooncern. Space does not permit an adequate description of the Council's work activities in coordination but periodic reports will be given in Communique. 4. Emergency Assistance Every effort to identify the most urgent problems in our five-county area has resulted in high priority being given to the need for developing more resources for emergency assistance. There are many aspects of the problem. An Emergency Assistance Committee has been organized and has begun to funotion. It has determined to work first on developing resou1·ces to deal with the problems arising out of evictions. Hundreds of families are evicted each year and there is no organized program to help the evicted families with such needs as storage space for furniture, temporary shelter, food etc. 5. Other Special Activities (a) Welfare Committee. Practically everyone agrees that our entire welfare program must be overhauled. A Welfare Committee is studying various income maintenance programs, including the Administrationts Family Assistance Act, and will make periodic reports. (b) Advisory Committee for Information and Referral. This Committee was formed to assist in the improvement of information and referral service in the metropolitan Atlanta area and to devise means for improving services to meet the most urgent needs identified by such service. Among other things, this Committee will help focus attention on the most serious ummet needs in our area. (c) Fourteenth Street Multi-Purpose Center. The Council has leased a house on Juniper Street to be used as a community center for the Fourteenth Street area. It is functioning and has been well-received. The focus will be on a voluntary medical clinic, a counseling center and a twenty-four hour inform~tion and referral· service. This facility is being operated at the present time entirely by volunteers. The Center can meet a great neea and we'll keep you up to date on its activities in Communique. (d) Interagency Council ~ Alcohol ~ Drugs. This Council is simply a "coming together' of established agencies concerned with problems related to the use of alcohol and drugs. It provides a means by which such agencies can work together. The Council has divided itself into the following five Task Forces: Resources and Existing Facilities and Services, Education, Treatment and Counseling, Speakers Bureau, and Legal Aspects and Legislation. You've received some information on this important and interesting activity and more will be forthcoming. (e) Expanded Public Information Service. We have improved our methods of getting valuable information to the general public and will give greater emphasis to this activity. The information gathered by our Research Center and through our various programs, if properly and attractively passed on to the general public, will provide our area with a better informed citizenry. This greater understanding of our problems will in time result in an improvement in services and funds to meet the problems. �The above are simply illustrative of the variety of activities in which the Council is engaged. The Child Development Project revealed the need for further work on such problems as retardation of children, the need for twenty-four hour child care, learning difficulties etc. Volunteer Atlanta The Council is a .sponsor of Volunteer Atlanta and will continue to assist this project. As you may recall, Volunteer Atlanta was brought about largely by the Council and is sponsored by the Council, the Atlanta Chamber of Commerce, the Atlanta Junior League, the Community Chest, and E.O.A. Its object is to recruit, train and place volunteers in public and private agencies throughout the five-county area. We think this can be one of the most important projects begun in the Atlanta area during recent years. Assistance to Groups The Council is receiving an ever increasing number of requests for technical assistance from agencies, neighborhood groups, and civic organizations. Agencies are requesting assistance in reviewing their prog1·ams; neighborhoods are seeking assistance in the drafting of proposals for resident-determined programs; and civic organizations are asking for suggestions as to the type of programs in which they might be effectively involved Thus, technical assistance to neighborhood groups and direct service agencies is becoming a major role of the Council. We think this role should be emphasized and that means must be devised to adequately provide such assistance. The Council is·basically a collection of staff, accumulated information and experience, and skill, and whenever its assistance can make agencies, neighborhood groups, churches and civic organizations more effective in their work, we add to the funds and resources being put to effective use in our community. This type of . assistance is one of the most important functions t _he Council can perform. Program Development During the early part of 1970, we expect to organize a Program Development Committee for the Council. This Committee will be made up of Board members and individuals who are not on the Board. Its function will be to provide a means for continually reviewing the work activities of the Councii and assisting in the establishment of priority for its programs. The Council is a social planning organization which can be an important resource in the community only if it retains its vitality and flexibility. If the Council had become rigid in devising its programs, its people and resources would not have been available to engage in some of the activities described above which maintain a balance between continuity in those activities which look to long range improvement and flexibility sufficient to give the community the benefit of the skill and information available through the Council's resources. The Program Development Committee will provide a means for retaining the Council's vitality and balance in its work activities. Obviously there is a great deal to be done to make our five-county area a better place in which to live. I think it equally obvious that there is a great deal with which to do the job if we plan and work together with imagination, enthusiasm and a sense of urgency. So let's roll up our sleeves and see what we can accomplish together in 1970. �unity of'the EUGENE T . BRANCH. Chairma,1 ,;j 1hr: Boctr,J ,;/ f)irt!1..'l<'r.\ CECIL ALEXANDER . t ' 11:r:" Chair1111/t1 JOHN !ZARO . ~ Vice Chainn,w MRS. THOMAS H. GIBSON. S,:cr.:1ar.1· DONALD H . GAREIS. frea1ur,:r DUANE W. BECK. ONE THOUSAND GLENN BUILDING, 120 MARIETTA ST., N. W. f ~ E,e,utiv,• Director ATLANTA, GEORGIA "{t--6 r ~rl/) A _ ~ i, ,'(-4/.fP ~ 30303 TELEP.fc!~ ~ ~ 6 November 1969 ~ The Honorable Sam Massell, Jr. Pryor Street, S. W. Atlanta, Georgia 40 Dear Mr. Massell: We would like to add our congratulations to the many you have been receiving, on your election. We should also like to add our pledge of support and cooperation in your efforts to keep Atlanta a great and evolving city. As you know, the Community Council of the Atlanta Area has had an organizational grant from the Department of Health, Education, and Welfare to bring into being a new agency for "comprehensive areawide health planning" for the six-county metropolitan area. The basic work is larg ely complete. A 52-member " Metropolitan Atlanta Council for Health" has been established, a detailed proposal for a five-year work program has been prepared and submitted, and an organizational structure for carrying out comprehensive health planning has been created. However, a number of new r and rather bold departures from tradition have been made , in an effort to implement, fully, the vision of Public Law 89- 749, the "Partnership for Health" act. Th ese involve, in particular, an enhanced role for MACLOG in coordinating health planning with other major planning activities, and real and meaningful participation in planning and decision-making by poor and black citizens of the community . Your g uidance and help in both these areas are urgently needed. It is not an exaggeration to say that two or three decisions by you, now, can have an extremely important impact, not only on the success of health planning in this metropolitan area, but also on race relations in all aspects of community life, and even on the threatened "abolish Atlanta" movement. Howard Atherton is giving his full backing to the proposals we would like to place before you. �{ BOARD OF DIRECTORS Cecil Alexander Ivan Allen, 111 Luther Alverson Rolph A. Beck Eugene T. Branch Napier Bur,on, Jr , M. D W . L. Calloway Bradley Currey, Jr. Campbell Dosher • Albert M. Davis, M. D. Rav J. Efird Jock P. Etheridge Rufus J. Evans, M D. Robert L. Foreman Jr. Jomes P. Furniss Donald H Gore1s Lorry L Geller~tedt, Jr. Mrs. Thor,10s H. G1b,;,1n H. M. Gloster John Godwm, M. D. Elliott Goldstein Vivion Henderson Mr,. Hc-len Howard William', Howland Mrs. Edmund W Hughes Horry E. Ingram John Izard Joseph W Jones Wolter M. Mitchell Phil Normore A B Padgett Mrs. Rhodes L Perdue J Will am Pinbton, Jr W R. Pruitt T O Vinson , M. D. Rev. Allrsor, Williams John C. Wilson ADVISORY BOARD J. G. Bradbury Jomes V. Carmichael R. Howard Dobbs, Jr Edwin I. Hatch Boisfeu i Ilet Jones Mills B. Lone Jr. William W Moore, Jr., M . D. Lucien E Oliver W. A. Porker, Sr. Richard H R,ch John A. S,bley Lee Tolley Elbert P Tutt le William C Wardlow, Jr. George W. Woodruff �- 2 - If at all possible, we would like to see you for about 45 minutes some ti me during the next ten days to fill you in on the details. You may recall that one of us (RBL) at your September 17th talk to the Emory-Grady Family Planning Clinic staff brought up the question of planning versus crisis-meeting. Your answer stressed the importance of planning to prevent crises. We believe this is such an opportunity. Sincerely yours, A. B. Padgett, hairman pro tem, Metropolitan Atlanta Council j f /~°f Health ~ l~Me~e~~or Comprehensive Areawide He alth Planning Encl : statement on compreh ensive areawi de health planning n ews letters (Nos. 1 apd 6) �·February, 1969 CCMPREHENSIVE AREAWIDE HEALTH PLANNING In 1966, the United States Congress enacted Public Law 89-749, the "Partnership for Health" act. Under this law, the States, and through them, areas within the States, must assume responsibility for comprehensive health planning. The Congress declared that "fulfillment of our national purpose depends on promoting and assuring the highest level of health attainable for every person, in an environment which contributes positively to healthful individual and family living; that attainment of this goal depends on an effective partnership, involving close intergovernmental collaboration, official and voluntary efforts. and participation of individuals and organizations; . that Federal financial assistance must be directed to support the marshalling of all health resources--national, State, and local--to assure comprehensive health services of high quality for every person, but without interference with existing patterns of private professional practice of medicine, dentistry, and related healing arts". The Atlanta metropolitan area was the first in Georgia to apply for and receive an "organizational grant" for the purpose of defining and developing an organization which will be capable of doing comprehensive health planning and obtaining community participation and support in the planning effort. This grant, from the U.S. Public Health Service, through the Georgia Office of Comprehensive Health Planning, supports the Community Council of the Atlanta Area in the professional and organizational effort necessary to instigate such an organization. Dr. Raphael B. Levine, of the Lockheed- · Georgia Company Systema Sciences Research Laboratory, has been named Director of the Comprehensive Areawide Health Planning, to accomplish these organizational objectives. r The term "comprehensive" means that every aspect of the health picture in the five-county metropolitan area must be taken into account in the planning process. This includes not only the treatment of illness and injury, but their prevention, and the compensation for any lasting effects which they may leave. Thus, in addition to the manifold activities of medical and paramedical personnel in the variety of health t reatment facilities, planning must consider environmental controls of the air, water, soil, food, disease vectors, housing codes and construction, waste disposal, etc. It must consider needs for the training of health personnel, for the improvement of manpower and facilities utilization, and for the access to health care. It includes the fields of mental health, dental health, and rehabilitation. It must be conc e rned with the means of paying for preventive measures and for health care. The term "planning" means, first, that problem areas and potential problem areas in the entire f i eld must be identified,and their magnitude s assessed. The trends of the problems must also be assessed, and projected for future years. Technical and organizational bottlenecks must be identified, and "planned around". Second, the community's resources ·in meeting its health needs must be equally carefully identified and projected, in terms of professional and subprofessional skills, facilities, and financial resources . �- 2 - Third, since a considerable amount of planning is already being done for a number of projects, hospital authorities, counties, and municipalities, which affects the community's health picture, ways must be found to make maximum use of this capability, and coordinate it into a community-wide comprehensive planning effort. Finally, planning must preserve and encourage the highest level of professional competence in the entire health system, and must make use of the insights of all concerned in the community health system. The overall task of putting together such an organization is thus seen to be a problem in "systems" analysis and development, Since the total resources of the community are likely to remain smaller than the demands which an ideal health system will place on the resources, rational and just methods of assigning priorities to the various needs must be developed. A cost-benefit analysis is essential to any such decision process, and, considering the literally hundreds of specific health needs in the community, it is likely that the cost-benefit model must rather soon make use of modern computer techniques. The Partnership for Health law requires that such planning be d o n e ~ people rather than for people. Therefore, maximum participation of health "consumers", healthprofessionals, governmental units and agencies, and other community organizations is a necessity. The law is telling the States and communities that they will be given increasing responsibility and power to determine their own best health interests, and that the current Federal practi~e of funding health-related projects through specific project-type grants (such as for specific facilities and specific disease processes) will phase into a system of "plock" grants to the states for use as local emphasis requires. Eventually, only communities which have organized themselves for comprehensive health planning may be eligihle to receive Federal support. The current Atlanta area project is a pioneering effort. No other communities in the country have progressed far enough along these lines to provide patterns as to what~ should do (or avoid). We have an opportunity to be of service not only to our own community, but to others as well. �