In the fall of 1978, field visits--involving facility tours and interviews with administrators, school and library personnel, and patients--were made to institutions run by the Maryland Department of Health and Mental Hygiene. This department includes the Aged and Chronically Ill, the Juvenile Services, the Mental Hygiene, and the Mental Retardation Administrations. A survey of representative staff members in all administrations was also conducted by written questionnaire. The need for substantial improvements in institutional library services for both staff and residents was noted at most institutions visited. This report describes standards for institutional library services, study methodology and background, and summary findings for each institution. Four alternatives for providing Maryland institutional library services are also described. It is recommended that adequate professional library services, integration of library services at each institution, and trained library staff and volunteers be provided; that the role of the departmental library coordinator be broadened; and that funding for library operations be a budget line item. Further recommendations are made regarding library organization, funding, administration, facilities, staff, and services, and a discussion of implementation costs is provided. Appendices present, on sample forms, a summary of interview and questionnaire responses. (ESR)