Dr. Gary Nakao, director of the Division of Services to the Handicapped, will step down Monday to become a regional director in California's system.

In his six years as director, Nakao said the division has evolved from a developmental to a delivery agency, and the native Utahn leaves with some regret."Over the years, we have put the types of services out that meet the state's needs. We've started family support services, but we haven't matured enough to know what we can really do. The focus has been on day treatment and residential options," he said. "The structures are in place but they need some refinement. There are still things I'd like to be a part of finishing before I go."

The division focuses primarily on helping those who are mentally retarded, autistic, or have epilepsy, spina bifida, cerebral palsy, head trauma injuries or "those disabilities that require similar treatment" to mental retardation, he said. It serves some with physical disability, but each client must have severely limited ability to function. Because there is no entitlement, all adult programs are funded at the prerogative of the state.

Nakao said the tax limitation initiatives that will appear on the November ballot in Utah threaten the division's future. Historically, he said, Utah's programs for the disabled have been plagued by long waiting lists and underfunding. The initiatives would make it worse.

"We can translate cuts into people because we have a fairly simple system. We have few programs and all are essential, so we can't cut whole programs. So when you decide you have to make cuts," he said, "the tough question is `Who?' Of 60 people, what 10 do you drop? Do you cut those with the highest function? Those are the people with whom we have the most success. If we do, they'll just go home and sit. But the low-functioning need more services. Do you have a random drawing?"

Nakao brought years of hands-on experience to his position. As a college student, he worked at the Utah State Training School, and over the years held a variety of positions including management of a unit there, and assistant and acting superintendent. He said he logged a lot of hours bathing and feeding clients, and he loves the training school. "The thing I'll always remember about being here is the clients," he said. "They're what all the programs and work are for."

The years have held victory and defeat. Under his guidance, the training school overcame a threatened decertification that could have cost $14 million in federal funds. The census has dropped significantly as part of a three-year plan to place clients in the community. DSH has established specialized models - although not enough, he said - that other states look to for guidance.

The defeats have typically revolved on funding - like the inability to get money to build group homes for the mentally retarded that would meet fire codes and allow some of the more severely retarded to live in the communities. He was never able, he said, to get enough money for community-based service programs. And watching programs lose ground to funding cuts and inflation has been hard.