treatment but also assistance in obtaining welfare benefits, help in structuring daily activities, psychosocial education, vocational rehabilitation, and housing. Delivering such services requires a point of focused responsibility and accountability on a continuing basis, and the ability to direct funding to ensure that patients receive the care they need. An example of this type of service delivery is the Training in Community Living Model developed in Madison, Wisconsin, and adopted in other localities (Stein and Test, 1980a, 1980b, 1985). In most communities, however, responsibility and authority for mental health rehabilitation are diffused across many agencies, and many patients suffer from neglect and inappropriate care.

and efforts to disseminate these results through consensus guidelines for preventive services, the standard practice of clinical medicine is slow to change and incorporate these approaches. Because of the complexity of chronic diseases and their interactions, optimal treatments that will lead to the highest levels of quality of life and functional outcome are not well standardized and evaluated.

Both standardized protocols for the management of chronic diseases and mental disorders, and guidelines for preventive services need to be developed and widely disseminated with the goal of preventing disability.

The increased life expectancy for persons with developmental disabilities, chronic diseases, or injury-related conditions, for example, mandates an emphasis on their inclusion in the national disabilities prevention program. For example, while most persons with Down syndrome used to die before age 40 only two decades ago, many now live into their sixties and seventies. These individuals have both social (residential, work, retirement) needs as well as health needs.

Additional study is needed of the relationship between chronic disease, disability, and aging in terms of health promotion, quality of life, and access to services. Such study should include issues related to age-related disability, as well as aging with a disability.

Composition and Organization of Services

The preceding discussion described some of the promising avenues leading to the goal of disability prevention among the elderly and among younger people with chronic disease. By themselves, however, individual preventive strategies—whether in health care or in social services—are not likely

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