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THE REGIONAL MEDICAL PROGRAM IN CALIFORNIA:
ITS CHANGING NATURE
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IN THE EARLY PART OF ITS FIFTH YEAR OF FUNDED SUPPORT.
THE CALIFORNIA REGIONAL MEDICAL PROGRAM IS CONTINUING TO
EVOLVE, TO ASSESS ITS PROGRESS, ITS OBJECTIVES AND ITS
MANNER OF CARRYING OUT THE PHILOSOPHY AND INTENT OF THE
LEGISLATION AUTHORIZING WHAT 1S IN MANY WAYS AN UNUSUAL
FEDERAL PROGRAM. ALONG THE WAY THERE HAS BEEN PRAISE FOR
THE STATE'S ACCOMPLISHMENTS, DUE TN GREAT PART TO THE STRONG
SUPPORT FROM BOTH PROFESSIONALS AND LAYMEN IN MEDICINE AND
HEALTH IN CALIFORNIA, AND THERE HAVE BEEN DISAPPOINTMENTS.

CHANGES IN PROGRAM DIRECTION HAVE NOT BEEN LIMITED TO
CALIFORNIA, BUT HAVE BEEN ACCELERATED BY THE NATIONAL
ADMINISTRATION'S RECENT ADOPTION OF PRIORITIES FOR HEALTH
AND A CONSEQUENT DESIRE TO PURSUE THESE ENUNCIATED HEALTH

GOALS THROUGH EXISTING HEALTH PROGRAMS.

 

# Executive Director of the California Committee on Hegional Medical Programs.
Submitted to California Medicine January 15, 1971.
THE GUIDELINES FOR THE ORIGINAL LEGISLATION ESTAB-
LISHING REGIONAL MEDICAL PROGRAMS (PuBLIC Law 89-239)
DESCRIBED A MAJOR PURPOSE OF RMP as A “CREATIVE PARTNER-
SHIP” AMONG PRACTICING PHYSICIANS, HOSPITALS, MEDICAL
SCHOOLS, NURSES, PUBLIC AND VOLUNTARY HEALTH AGENCIES
AND OTHER HEALTH RESOURCES. NEW “COOPERATIVE ARRANGE-
MENTS” IN THE PARTNERSHIP WOULD HELP TO BRING NEW KNOWLEDGE
MORE RAPIDLY TO THE PATIENT'S BEDSIDE, NO MATTER WHERE HE
Livep. THE ATTEMPT WAS TO BE MADE TO BRING HIGH QUALITY
MEDICAL CARE MORE QUICKLY TO EVERY AMERICAN CITIZEN. As
THE GUIDELINES PUT IT» THE PROGRAM WAS “INTENDED TO PRO-
VIDE A MEANS FOR CONVEYING TO THE MEDICAL INSTITUTIONS
AND PROFESSIONS OF THE NATION THE LATEST ADVANCES IN MEDICAL
SCIENCE FOR DIAGNOSIS, TREATMENT AND REHABILITATION OF
PATIENTS AFFLICTED WITH HEART DISEASE, CANCER, STROKE OR

RELATED DISEASES.” ALTHOUGH PREVENTIVE MEDICINE WAS INTEDED

AS PART OF THESE PROGRAMS » THE CONCEPT OF PREVENTION RECEIVED

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STRONG ENDORSEMENT IN THE RENEWAL LEGISLATION PASSED in 1970-
TOWARD THE CLOSE OF THE NINETY-FIRST CONGRESS. THE NEW
taw, P. L. 91-515, ALSO ADDS KIDNEY DISEASE AS A CATE-
GORICAL EMPHASIS. AND BRINGS IN REQUIRED PARTICIPATION. BY
THE VETERANS ADMINISTRATION.

As THE PROGRAM DEVELOPED IN CALIFORNIA, THE EMPHASIS
WAS VERY HEAVILY IN FAVOR OF CATEGORICAL INTERESTS, AND
CONCENTRATED PRINCIPALLY ON ACHIEVING THE DESIRED IMPROVE-
MENTS IN HEALTH MANPOWER AND FACILITIES THROUGH REGIONAL

COOPERATIVE ARRANGEMENTS AMONG EXISTING PROFESSIONAL AND
LAS TF Pee FF ae ok eet

EE ARO AGT SAEM EEE

eS OURCES, AND CONTINUING EDUCATION. WHEN THE RECOMMENDED
NATIONAL PRIORITIES FOR HEALTH WERE PUBLISHED IN THE SPRING
of 1970 BY THE DEPARTMENT oF HEALTH, EDUCATION AND WELFARE,
THERE EMERGED A CONCERTED EFFORT TO CHANGE THE GENERAL
DIRECTION OF THE PROGRAM, THE EMPHASIS ON IMPROVING QUALITY
OF MEDICAL SERVICES WAS CONSIDERABLY RELAXED, AND EVEN 10
SOME EXTENT DISCOURAGED, AND THE EMPHASIS ON IMPROVING THE

QUANTITY OF CARE WAS GREATLY INCREASED.

3
As THE ADMINISTRATION PREPARED TO INTRODUCE ITS BILL
TO EXTEND REGIONAL MEDICAL PROGRAMS, NATIONAL LEADERS
BEGAN TO SPEAK FAVORABLY OF DEVELOPING “PRIMARY CARE” IN
AREAS WHERE AVAILABLE MEDICAL AND HEALTH SERVICES WERE
INSUFFICIENT TO MEET LOCAL NEEDS, HAD THE PROPOSED ADMINS-
TRATION BILL PASSED, IT WOULD HAVE ELIMINATED THE CATEGORICAL
EMPHASIS OF RMP, TURNING INSTEAD TOWARD CREATION OF NEW
HEALTH CARE SERVICES AND DELETING THE PROHIBITION AGAINST
INTERFERING oa EXISTING PATTERNS OF PATIENT CARE. ALTHOUGH

its final version continued

THE NEW LEGISLATION Sssemenspes THE “CATEGORICAL EMPHASIS
retained “

WITH THE ADDITION OF KIDNEY DISEASE AND BEB&nWS’ THE PROSCRIP-

TION AGAINST INTERFERING WITH PATTERNS OF PATIENT CARE,

LEADERS IN BOTH DHEN AND THE OFFICE OF MANAGEMENT AND BUDGET

HAVE RECENTLY EMPHASIZED THE NEED FOR THE PROGRAM TO PROMOTE

NEW PATTERNS OF MEDICAL CARE” AND TO ENGAGE IN THE DEVELOP-

MENT OF NEW AND INNOVATIVE LEVELS OF MANPOWER. THEY PARTI-

CULARLY DISCUSS THE PHYSICIAN ASSISTANT CONCEPT:

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SPOKESMEN FOR THE ADMINISTRATION HAVE ALSO EMPHASIZED
THAT RMP SHOULD ENGAGE. IN. THE TASK OF OBTAINING PHYSICIAN
ACCEPTANCE OF THE NEW FORMS OF DELIVERY AND SHOULD HELP
DEVELOP THE TRAINING PROGRAMS THAT. WOULD MAKE NEW LEVELS
POSSIBLE, ONE OF THESE OFFICIALS POSED THIS QUESTION TO
THE Program: “Is (RMP) PROVIDING A VEHICLE FOR PHYSICIAN
ACCEPTANCE OF NEW FORMS OF MEDICAL PRACTICE, SUCH AS PRE-
PAID GROUP PRACTICE OR IMPROVED REFERRAL PATTERNS THAT MAY
a TO HIGHER QUALITY OR LESS EXPENSIVE CARE?” THIS coM-
MENT, FROM A WHITE HOUSE AIDE IN THE OFFICE oF MANAGEMENT
AND BUDGET, APPEARED TO SOME TO BE MORE OF AN INSTRUCTION
THAN A QUESTION, AND IS THE ONLY RECENT CONTEXT IN WHICH
THE TERM “HIGHER QUALITY” HAS APPEARED, THE CONCLUSION
SEEMS INESCAPABLE: THE ORIGINAL PURPOSES OF THE PROGRAM
HAVE BEEN ALTERED,

N SOME YY

THIS ALTERATION HAS UNSETTLED OR DISTURBED “MARGIN THE

PROGRAM, BOTH ON STAFF AND VOLUNTARY LEVELS. SINCE THE

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PLANNING FOR OPERATIONAL PROJECTS REQUIRES A LENGTHY PERIOD
OF TIME, THE PROJECTS ON WHICH PLANNING SEGINS ON ONE DAY
MAY BE INAPPROPRIATE FOR THE PRIORITIES THAT EXIST ON THE
DAY THE PLANNING HAS BEEN COMPLETED. AND THOSE WHO MAY

HAVE JOINED THE PROGRAM ON A VOLUNTARY BASIS IN THE SEGIN-
NING, AND WHO HAVE A DEEP INTEREST IN ONE OF THE CATEGORICAL
PURSUITS. MAY NOT FIND THE PROGRAM TO THEIR LIKING WITH the

implied change in emphasis...

Leta cirictepecpdit > £04 ais tree Ae aee tate”

ONE RESULT 1S THAT THE PROGRAM HAS HAD A CERTAIN AMOUNT
OF TURNOVER IN VOLUNTARY PARTICIPATION, IN THE BEGINNING
IT ATTRACTED THOSE WHO WERE DEEPLY INTERESTED IN THE QUALITY
OF MEDICAL CARE AND IN THE CATEGORICAL APPROACH TO IMPROVED
HEALTH SERVICES. LATER THE PROGRAM ATTRACTED INDIVIDUALS
MORE INTERESTED IN DEVELOPING A GREATER QUANTITY OF CARE»
ESPECIALLY FOR THOSE AREAS WITHOUT IT TODAY. THIS CHANGE
IN PROGRAM DIRECTION ALSO REQUIRED A CHANGE IN THE STATED

OBJECTIVES OF THE CALIFORNIA REGION.

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BUT THERE HAVE BEEN OTHER PERHAPS MORE SUBTLE
INFLUENCES ON RMP PROGRAM DEVELOPMENT. THE PROGRAM BEGAN
WITH THE EXPECTATION THAT IT WOULD EVENTUALLY BE FUNDED
AT LEVELS AS HIGH AS $500 MILLION ANNUALLY. IN VIEW OF
THIS EXPECTATION, MANY REGIONS BEGAN TO DEVELOP PLANS FOR
AN OVERALL PROGRAM THAT WOULD REFLECT THIS LEVEL OF FUNDING,
CORE STAFFS WERE RECRUITED AND BEGAN EXTENSIVE PLANNING |
EFFORTS POINTED TOWARD $500 MILLION FUNDING LEVELS IN THE
THIRD OR FOURTH YEAR OF THE PROGRAM, THIS ACCELERATED
PLANNING PACE COULD NOT POSSIBLY BE RATIONALLY MAINTAINED
WHEN IT BECAME CLEAR THAT AVAILABLE FUNDING SUPPORT WAS NOT
EXPECTED TO BE EVEN AS MUCH AS ONE-QUARTER OF THE ORIGINALLY
ANTICIPATED LEVEL.

Since RMP EFFECTIVENESS IS BUILT UPON VOLUNTARY RELA-
TIONSHIPS, THIS UNEULFILLED COMMITMENT ALSO HAD A RETARDING
EFFECT ON THE LEVEL OF PARTICIPATION AND ENTHUSIASM AS THE

MONTHS WORE ON. MANY VOLUNTEERS WHO HAD BEEN EXTREMELY

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ACTIVE IN THE BEGINNING BECAME DISENCHANTED ee THE SLON
PACE OF FUNDING, OR THE LACK OF FUNDING, FOR THE PROJECTS
THEY HAD HELPED TO DEVELOP, SOME WITHDREW FROM RMP INVOLVE-
MENT ALTOGETHER, OR TURNED TO OTHER ACTIVITIES PROMISING
LESS FRUSTRATION, THE UNCERTAINTIES OF FEDERAL FUNDING HAD
A DELETERIOUS EFFECT ON RMP CORE STAFFS AS WELL. SOME AREAS
iN CALIFORNIA WERE UNABLE TO STABILIZE THEIR STAFFS, LEADING
TO UNEVEN DEVELOPMENT IN THE COOPERATIVE ARRANGEMENTS NECES-
SARY FOR A DYNAMIC AND SUCCESSFUL PROGRAM. AS A RESULT,
some AREAS MOVED FASTER IN DEVELOPING PROPOSALS TO MEET THE

| — , developed more slowly
NEEDS EXPRESSED LOCALLY, WHILE OTHERS UXEGRGHINE. IN
THE LONG TERM THIS SUBSTANTIAL CUTBACK IN THE EXPECTED
FUNDING LEVELS FOR PMP MAY HAVE BEEN THE MOST DAMAGING DEVEL-
OPMENT IN TERMS OF PROGRESS AND SUCCESS FOR THE PROGRAM.

DURING THE EARLIEST MEETINGS oF RMP IN CALIFORNIA, iT

BECAME APPARENT THAT STRONG FEELINGS oF TERRITORIALTEM imperatives
EXISTED WITHIN EACH AREA. SINCE EACH AREA HAD BEEN ASSIGNED

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A GEOGRAPHIC TERRITORY FOR PLANNING AND SINCE THE AREA
OFFICES WERE ADMINISTRATIVELY BASED WITHIN THE STRUCTURE

oF CALIFORNIA'S EIGHT MEDICAL SCHOOLS, IT WAS NATURAL THAT
THERE WOULD BE HEALTHY COMPETITION AMONG THE AREAS. To A
CERTAIN EXTENT THESE rEELINGS WERE EXPRESSED IN THE PROCESS
OF ESTABLISHING OBJECTIVES AND GOALS TO MEET LOCAL NEEDS.

BUT THE MOST PROLONGED EXAMINATION OF THIS SENSITIVE SUBJECT
CAME AT MEETINGS OF THE CALIFORNIA COMMITTEE ON REGIONAL
MEDICAL PROGRAMS, PARTICULARLY WHEN THE CCRMP was CONSIDERING

PROPOSALS FOR OPERATIONAL ACTIVITIES. THE PROJECT REVIEW

 

PROCESS WAS CLUMSY AND INEQUITABLE AND SATISFIED Ucaaet

THIS WAS PERHAPS THE NATURAL RESULT OF A BODY OF SO DIVERSE

A NATURE, NEWLY CREATED, TRYING TO GAIN AN UNDERSTANDING OF
ITS RESPONSIBILITIES AMONG UNFAMILIAR OR UNSETTLING SUR-
ROUNDINGS. THE LAW WAs A NEW KIND OF SOCIAL LEGISLATION,
SEVERAL OF THE MEMBERS oe CCRMP WERE STRANGERS AT FIRST.
AND CERTAINLY MOST OF THE MEMBERS HAD NEVER SAT ON A COMMITTEE

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WHERE LAYMEN WOULD REVIEW MEDICAL MATTERS. AFTER TWO YEARS
A SPECIAL SUBCOMMITTEE WAS ESTABLISHED TO REVIEW THE ORGANI-
ZATION AND PROCEDURES OF THE CCRMP, A DETAILED SERIES OF
RECOMMENDATIONS TO IMPROVE THE TECHNICAL REVIEW OF PROJECT
PROPOSALS WAS DEVELOPED AND FINALLY ADOPTED IN OcToBer, 1970,
THE REVIEW MECHANISM NOW IN EFFECT HAS BEEN THOROUGHLY TESTED,
1S WELL UNDERSTOOD THROUGHOUT THE REGION, AND APPEARS TO BE
WELL ACCEPTED, It has been highly praised nationally.

ESTABLISHMENT OF OBJECTIVES FOR THE CALIFORNIA’ REGION
ALSO TOOK MANY MONTHS AND REFLECTED SOME OF THE STRESS THAT
GREW OUT OF THE COMPETITIVE FEELINGS BETWEEN AREAS AND
BETWEEN AREAS AND THE REGION. THE OBJECTIVES FINALLY AGREED
UPON HAVE ENJOYED AN UNUSUALLY HIGH LEVEL OF INPUT FROM THE
VOLUNTARY ASSOCIATIONS, THE PROFESSIONS AND OTHERS INTERESTED
IN THE PROGRAM. BECAUSE OF THE CHANGING DIRECTION oF RMP
NATIONALLY, CALIFORNIA HAS DEVELOPED TWO SETS OF OBJECTIVES.
THE FIRST SET FOLLOWS THE ORIGINAL INTENT OF THE PROGRAM,

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DESCRIBING CONCEPTS A ACTIVITIES INTENDED TO LEAD TOWARD
AN IMPROVED QUALITY OF MEDICAL AND HEALTH SERVICES, ALONG
CATEGORICAL LINES. THE SECOND SET OF CALIFORNIA RMP oBJEC-
TIVES REFLECTS THE MORE RECENTLY ANNOUNCED NATIONAL HEALTH
PRIORITIES, EMPHASIZING MORE THE QUANTITY OF SERVICES, THE
DEVELOPMENT OF DIFFERENT LEVELS OF MANPOWER AND THE IMPROVE-
MENT OF THE ORGANIZATION AND DELIVERY OF MEDICAL CARE,

STATED ANOTHER WAY, THE ORIGINAL OBJECTIVES APPLY TO CONTINUING
EDUCATION FOR EXISTING HEALTH TEAM PROFESSIONALS, FOR INNO-
VATION, DEVELOPMENT AND TESTING OF DELIVERY SYSTEMS OF HEALTH
CARE OR TRAINING PROGRAMS, ALL EXTENDING OVER A PERIOD OF
VEARS, THE NEWER LIST OF OBJECTIVES IS MORE MODEST IN COST
AND SCOPE, INTENDED FOR SHORTER PROJECTS, IN A FRAMEWORK
WITHIN WHICH DEMONSTRATION OR FEASIBILITY PROJECTS MAY BE
ATTEMPTED TO STIMULATE CHANGE IN THE ORGANIZATION AND DELIVERY
OF HEALTH SERVICES. PARTICULARLY HEATH SERVICES FOR THE POOR,

ALTHOUGH THEY REPRESENT A MORE MODEST APPROACH AT THIS TIME,

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IT WOULD APPEAR THAT THEY FORECAST THE DOMINANT COURSE OF
THE PROGRAM IN THE IMMEDIATE FUTURE.

THE NEWER OBJECTIVES HAVE BEEN AGREED UPON BY THE
CALIFORNIA COMMITTEE ON REGIONAL MEDICAL PROGRAMS IN PRE~
PARATION FOR ADMINISTRATIVE CHANGES EXPECTED TO BE ESTABLISHED
cor CALIFORNIA BY THE REGIONAL MEDICAL PRogRAMS SERVICE OF
DHEN, THE ADMINISTRATION HAS ANNOUNCED ITS INTENT TO DECEN-
TRALIZE AS MUCH OF THE GRANTMAKING POWERS AS POSSIBLE, TP

As PART OF THIS MOVE, A LIMITED NUMBER

 

oF RMP REGIONS WHICH HAVE DEMONSTRATED ADMINISTRATIVE AND
FISCAL MANAGEMENT SKILLS, AND CARRY ON PROGRAM ACTIVITY
THOUGHT TO BE WORTHY OF STRONG SUPPORT, WILL BE PLACED ON AN
ANNIVERSARY REVIEW BASIS. THIS WILL MEAN THAT REQUESTS FOR
OPERATIONAL SUPPORT FUNDS WILL BE MADE ONLY ONCE A YEAR, AND
THAT THE RMP REGIONAL ADVISORY GROUP (IN CALIFORNIA'S CASE
tHe CCRMP) WILL HAVE GREATER RESPONSIBILITY FOR THE MANAGE-
MENT AND THE EFFECTIVE REDIRECTING OF AVAILABLE RMP FUNDS

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WITHIN THE REGION, AS PART OF THE ANNIVERSARY REVIEW CON-
CEPT, A DEVELOPMENTAL COMPONENT WILL BE AWARDED FOR SHORT-
TERM EXPERIMENTAL OR INNOVATIVE ACTIVITIES THAT CAN BE
CONSIDERED AND BEGUN AFTER A VERY BRIEF REVIEW PERIOD.

THE SECOND AND MORE RECENT SET OF OBJECTIVES FOR
CALIFORNIA WAS ESTABLISHED FOR THE DEVELOPMENTAL COMPONENT,
THESE OBJECTIVES HAVE TWO MAIN PRIORITIES OF EQUAL IMPORTANCE,
THE FIRST 1 TO STIMULATE EFFORTS TO IMPROVE AND INCREASE THE
HEALTH MANPOWER POOL, FOCUSING ON PROFESSIONAL, SUB-PROFES~
SIONAL AND PARA-PROFESSIONAL PERSONNEL. THE SECOND IS TO
STIMULATE CHANGE IN THE ORGANIZATION AND DELIVERY OF HEALTH
SERVICES, PARTICULARLY FOR THE URBAN POOR, STRESSING PREVEN-
TIVE MEASURES, PREPAID GROUP PRACTICE, USE OF SUB-PROFESSIONAL
AND PARA-PROFESSIONAL PERSONNEL, AMBULATORY CARE SERVICES AND
NEIGHBORHOOD CARE DELIVERY UNITS. OTHER GOALS AND TARGET
GROUPS IN THE SECOND PRIORITY CATEGORY INCLUDE IMPROVED CO-
ORDINATION OF FEDERAL, STATE AND LOCAL EFFORTS TO BENEFIT

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MIGRANT EARM WORKER FAMILIES, INDIANS AND CHILDREN DURING
THE FIRST FIVE YEARS OF LIFE, AND PROVISION OF ADEQUATE
FAMILY PLANNING SERVICES BY 1975 To WOMEN OF CHILDBEARING
AGE WHO CANNOT PRESENTLY OBTAIN OR DO NOT HAVE KNOWLEDGE

OF SUCH SERVICES. PROJECTS OF THIS SHORT-TERM NATURE SHOULD
STIMULATE THE DEVELOPMENT OF PROPOSALS FOR MUCH LARGER SCALE

\ Built into these long-term, __-
EFFORTS TO SERVE THE NATIONAL PRIORITIES« “Fete Donal PRES ————"

  

— lerge-scale efforts should be the eventual”

*RRELTANCE ON THE SOURCES OF HEALTH CARE FUNDING TRADITIONALLY

 

WHILE FEDERAL FUNDING LEVELS HAVE BEEN A DISAPPOINTMENT
TO MANY, THERE HAVE BEEN SEVERAL INSTANCES WHERE ALTERNATE
SOURCES OF FINANCIAL SUPPORT HAVE BEEN DEVELOPED AS A RESULT
OF THE ORIGINAL STIMULUS FOR PLANNING UNDER RMP LEADERSHIP.
SINCE IT DOES APPEAR THAT THE ADMINISTRATION INTENDS TO FOLLOW
THE CONCEPT OF LEVEL FUNDING FOR REGIONAL MEDICAL PROGRAMS

DURING THE IMMEDIATE YEARS AHEAD, THE USE oF RMP STAFF TIME

~|4-
TO SEEK ALTERNATE SOURCES OF FUNDING WILL BECOME MORE
AMOUNT OF EFFORT IS EXPECTED TO BE DIRECTED BY RMP TOWARD
SUCH CATALYTIC ACTIVITY.

ONE MORE INDICATION OF CHANGE IN RMP PROGRAM DEVELOP-
MENT IS BECOMING MORE APPARENT. IN THE FALL oF 1969 THERE
WAS THE FIRST ORGANIZED ATTEMPT TO BRING TOGETHER REPRE-
SENTATIVES OF RMP OFFICES AND COMPREHENSIVE HEALTH PLANNING
REPRESENTATIVES FOR THE PURPOSE OF DISCUSSING ISSUES OF
COMMON INTEREST. FROM THIS MEETING THERE DEVELOPED A MORE
FORMAL EFFORT TO DEFINE WAYS IN WHICH THE TWO PROGRAMS COULD
WORK MORE CLOSELY TOGETHER. THE LEGISLATIVE MANDATE FOR
COMPREHENSIVE HEALTH PLANNING IS FAR BROADER THAN IT IS FOR
RMP, AND THE CHP OFFICES THROUGHOUT THE STATE WILL BE HEAVILY
BURDENED DURING THE COMING MONTHS WITH HEALTH FACILITIES
PLANNING, LARGELY BECAUSE OF CALIFORNIA Law A.B, 1341, It

HAS BEEN PROPOSED THEREFORE THAT RMP ASSUME AS MUCH AS POSSIBLE

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OF THE CHP RESPONSIBILITY FOR PERSONAL HEALTH SERVICES AND
MANPOWER PLANNING. THIS PROPOSAL IS BEING DEVELOPED WITH
UNDERSTANDING AND AGREEABLE RELATIONSHIPS AMONG RMP anp A

AND B AGENCY REPRESENTATIVES OF COMPREHENSIVE HEALTH PLANNING.
THE CALIFORNIA COMMITTEE ON REGIONAL MEDICAL PROGRAMS HAS
ASKED THE STATE HEALTH PLANNING COUNCIL TO DESIGNATE AN
OFFICIAL REPRESENTATIVE TO BE A MEMBER oF CCRMP, To SPEAK

FoR A AGENCY INTERESTS, AND 1S ALSO SEEKING AN OFFICIAL B
AGENCY REPRESENTATIVE. THE TWO PROGRAMS APPEAR TO BE MESHING
WITH A REALISTIC APPRECIATION OF THE RESPONSIBILITIES INHERENT
IN EACH. MEANWHILE, RMP In CALIFORNIA I$ ALSO SEEKING SIMILARLY
PRODUCTIVE ARRANGEMENTS WITH MopEL CiT1ES, OFFICE oF ECONOMIC
OPPORTUNITY, MIGRANT HEALTH AND LOCAL AND COUNTY PROGRAMS AND

ACTIVITIES IN HEALTH.

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