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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
........
........
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....
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,,
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COMMUNITY
HEALTH SERVICES
,,,,
,,
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........
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�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
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ADEQUATE SEWAGE TREATMENT IN GEORGIA
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POLLUTED STREAMS
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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 .
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