Activity #1: Continue to arrange and/or deliver learning experiences on developmental disabilities to medical students and nursing students at UNM/HSC, throughout the fall and spring semesters. This activity will be directed to the departments of Family Practice, Psychiatry, Neurology and Pediatrics as well as the College of Nursing.

• Continuum of Care continues to contract with Parents Reaching Out, Families As Faculty Project to assist with the Family Practice rotation on DD for Phase II medical students. PRO has assigned a new project director, Marilyn Fuller for this initiative as of 8/21/00 and she came to meet with Jennifer Thorne-Lehman on 11/2/00 regarding this transition and refinements of that curriculum. In addition, our new medical regional consultant for Metro, Toni Benton M.D. has recently replaced Kerrie Seeger M.D. as faculty for this rotation. This rotation occurs every 8 weeks, with 10-15 medical students in each rotation. The rotation consists of an orientation to family centered care and a discussion of biases or pre-conceived ideas the students may be bringing with them about different types of disabilities. The students are then matched with a family who has a child with DD, with whom they schedule a home visit. Following the home visit the students must write a reflection paper, which describes what they learned from the home visit experience, including family strengths, coping skills and implications for their future practice. All students then participate in a "debriefing" discussion regarding their visits so they can expand their learning by sharing the variety of experiences with each other. At this session Ms. Fuller and Dr. Benton can reinforce key competencies which are:
• Demonstrate a communication style that is sensitive and responsive to the family,
• Articulate the strengths and individualities of the family you visited, and describe some of the family’s coping strategies,
• Recognize and acknowledge your own biases and beliefs so as not to impose those on families or people with disabilities,
• Look beyond individuals’ diagnosis to life at home and in the community.

Due to various unfortunate circumstances, including the departure of Ms. Fuller from PRO, we are in the process of working with PRO, Family Practice and Pediatrics to revamp this rotation. Home visits are suspended, until such time as the redesign is complete. Key stakeholders are meeting 8/29/01 to continue work on this.

• As in previous years, on December 13, 2000, Jennifer Thorne-Lehman presented a half-day seminar to family nurse practitioner students that covered topics listed below. (In addition a representative from Parents Reaching Out presented on the elements of family-centered care.)
• An overview of the DD service system.
• Eligibility criteria for early intervention, how to refer, the benefits of early intervention services, importance of developmental screening and early referral.
• Transition issues for adolescents and importance of applying for the DD Waiver as soon as the child starts high school if not earlier.
• Role of various members of the Interdisciplinary team, especially as it relates to interaction with healthcare providers
• Technical assistance resources available to healthcare providers regarding the DD population including Continuum of Care Project, TEASC, CDD programs, UNM genetics and dysmorphology, etc.

• Dr. Aceves served as attending physician (supervising residents) for pediatric ward July 5-11, 2000 and in the newborn nursery July 17, 18, 29, & 30.
• Dr. Aceves tutored medical students twice per week from September 5 to October 27, 2000.
• Dr. Reeve presents to Phase II medical students on conducting mental status assessments with patients who are non-verbal, along with some key issues in psychiatric care for patients with DD. This occurs every other month.

Activity #2: The CONTRACTOR shall present on developmental disability topics during at least one "Grand Rounds" session at UNM/HSC.

• Grand Rounds for Indian Health Service regarding services available through Continuum of Care Project on August 17, 2000.
• Grand Rounds at Los Alamos Medical Center on Down Syndrome August 23, 2000.
• Grand Rounds for Ben Archer Clinics (SW part of the state) October 25, 2000.
• Dr. Vickers presented a noon lecture for the Department of Pediatrics on "Coma and Brain Death" on 8/30/00.
• Presented on the medical home concept at Pediatric Grand Rounds on 2/8/01.
• Dr. Bouquin, NW Regional Medical Consultant, presented "Overview of DD in New Mexico" at grand rounds in Los Alamos on 5/22/01.
• Dr. Bouquin presented at grand rounds in Tucumcari and Santa Rosa, in collaboration with Early Childhood Evaluation Program on DD related issues on March 27, 2001.

Activity #3: The CONTRACTOR shall participate in the LEND Project. This project is dedicated to the training of graduate students from ten different disciplines on issues pertaining to developmental disabilities. The project also provides supervision of social work students.

• Alejandro Moralez participates as LEND faculty representing social work; supervising & mentoring graduate level social work student, facilitating Problem Based Learning cases, presented on Facilitating for Results and Cultural Diversity during the fall semester, conducted PATHs for LEND students & faculty and community agencies involved with LEND.

Activity #4: The CONTRACTOR shall provide opportunities to medical and nursing students to participate in specialty clinics through this project.

• LEND fellows observe the SAFE clinic once per month, and most SAFE clinics also have at least one community therapist attending to receive professional guidance/consultation regarding feeding issues.
• Two Physicians’ Assistant students rotated through all of our specialty clinics.
• One Neurology student rotated with Dr. Vickers this fall as an elective.
• Neurology residents rotate periodically with Dr. Vickers as well as Drs. Phillips and Morrison at Carrie Tingley.
• One medical student elected to attend an Adult Special Needs Clinic.

Activity #5: The CONTRACTOR shall encourage and assist students/residents to participate in research related to individuals with developmental disabilities, as part of their course of study, in collaboration with Continuum of Care faculty.

• I am not aware of any research during fall semester, but will poll our physicians and update this item in the next report.

Activity #6: The CONTRACTOR shall provide coordination to expand these activities to other UNM/HSC departments, including allied health professions, other nursing schools, and/or emergency services personnel (EMTs).

• Dr. Burke delivered a lecture on "Politics of Women’s Healthcare" at NMSU on 11/28/00.
• Dr. Vickers presented a lecture for PT and OT students on management of chronic headaches.

Activity #7: The CONTRACTOR shall continue to support the development and delivery of learning experiences, related to services for individuals with developmental disabilities, for residents assigned to clinics throughout New Mexico.

• Multidisciplinary team tutoring via consultation clinic at La Familia family practice residency program November 30, 2000. Dr. Aceves, Dr. Vickers, and Carla Fedor RN from our office participated along with the NW regional medical consultant Erin Bouquin MD.
• Delivered CCM seminars at Family Practice Residency Program in Roswell July 12^th and October 4^th, 2000 and April 25, 2001.
• Dr. Witemeyer presented to Psychiatry Residents at UNM on the Autism Clinics (child and adult).
• Neurology residents rotate periodically through Dr. Vickers adult and pediatric clinics as well as other clinics at Carrie Tingley.
• Delivered CCM seminar in at Las Cruces Family Practice Residency on 2/14/01, with special emphasis on patients with autism.
• Dr. Reeve serves as attending physician for psychiatry residents.
• Conducted Problem Based Learning POL session with residents at La Familia clinic on 4/11/01 on the topic of health decisions. POL sessions always include a brief presentation followed by relevant case discussion.

Activity #8: In collaboration with the DEPARTMENT, the CONTRACTOR shall identify opportunities to provide meaningful work and fair payment for individuals with developmental disabilities. Self-advocates who provide training to physicians and Interdisciplinary teams, via contract, will be reimburse at a rate of $l0.00 per hour; if travel and/or purchase of special materials is required the hourly reimbursement rate will be $l5.00 per hour.

• We have a contract in place with RCI to pay a consumer to serve as greeter for the Adult Special Needs Clinic twice per month.
• We have a contract in place with a consumer to provide us with assistance in developing materials for patients with DD and provide input on consumer perspective in delivery of healthcare.

Activity #l: The CONTRACTOR shall continue to offer and deliver between three and six, "Chronic Conditions Management Training" sessions in clinics statewide. The CONTRACTOR agrees to provide Continuing Medical Education credits for these sessions. The DEPARTMENT agrees to meet with the CONTRACTOR twice annually to identify sites.

• CCM delivered at Family Practice Residency program in Roswell on July 12, 2000 and again on October 4, 2000. Dr. John Phillips from Carrie Tingley Hospital, Elizabeth Ceysens RD, and Lourie Smith SLP participated in these sessions (Continuum of Care paid for their travel to present). A third CCM was delivered in Roswell on 1/17/01 where Alejandro Moralez presented on transition considerations, Dr. Reeve presented on Self-Injurious Behavior and Traumatic Brain Injury, one patient case was discussed in conjunction with these topics.
• CCM delivered at San Juan Pediatrics in Farmington July 21, 2000. Drs. Aceves and Vickers presented along with Judy Liesveld CNP (regional medical consultant for NW region) and Jennifer Thorne-Lehman
• We have received a request to conduct a CCM this spring for the clinic in Embudo, NM which serves several patients who live at Santa Maria El Mirador. Scheduling arrangements are in process. Our regional medical consultant for the NW region, Erin Bouquin MD had made them aware of this opportunity. To date, we have not been able to schedule with them.
• February 14, 2001 we conducted CCM at Las Cruces Family Practice Residency Program, with special emphasis on patients with autism.

Activity #2: The CONTRACTOR shall collaborate with the Transdisciplinary Evaluation and Support Clinic (TEASC) in the publication of a bi-annual newsletter for physicians throughout New Mexico that will also be available on the continuum of Care web site.

• Winter 2000 issue covered Women’s Health, SAFE Clinic and overview of all clinics available through TEASC and Continuum of Care.
• The second issue was begun, but not finished in time to send out prior to end of the fiscal year. We expect publication this summer.

Activity #3: The CONTRACTOR shall respond to requests for information/consultation on an ongoing basis, utilizing Regional Consultants whenever possible.

• In order to increase the capacity and utilization of Regional Medical Consultants we began having regular meetings so that the consultants can network and plan. Dr. Witemeyer has taken the lead in coordinating the activities of the Regional Medical Consultants including arrangements for the quarterly meetings and collecting data for monthly reports. Meetings occurred June 9, 2000, November 10, 2000, February 2, 2001 and March 30, 2001.

• Dr. Aceves was interviewed on a talk show for a Spanish radio station on August 24, 2000.
• Dr. Aceves conducted a patient consultation on August 30, 2000.
• Dr. Aceves consulted with Dr. Ciudad regarding medical home issues on October 25, 2000.
• As Regional Consultant for Metro, Dr. Witemeyer arranged and presented with Dr. Reeve on medical conditions in adults with DD at the First Choice Clinic in Albuquerque’s south valley.
• Dr. Burke provided consultation regarding 4 patients to a pediatrician in Las Cruces, and consultation to three other pediatricians in the SW. Provided consultation at the Las Cruces homeless clinic regarding DD patient there.
• As Regional Consultant for Metro, Dr. Witemeyer consulted with seven different physicians regarding ten different patients with developmental disabilities between July 1, 2000 and January 29, 2001 and with nine different physicians between February 1 – June 30, 2001.
• As Regional Medical Consultant for the NW, Dr. Bouquin provided consultation to three physicians regarding four different patients with DD. Dr. Bouquin made arrangements for PCP to refer two of these patients to Adult Special Needs Clinic for evaluation. She also made arrangements for Debra Hall MD to provide technical assistance to the clinic in Embudo. Consulted with Dr. Burke regarding a patient who will be moving from Alamogordo to Espanola upon her graduation from the NMSVI spring 2001.

Activity #4: The CONTRACTOR shall develop curriculum on specific topics, as indicated by trends in requests for information/consultation and/or at the request of the DEPARTMENT.

• Dr. Aceves presented on "Life Span Issues in DD" at the annual DDNA conference on November 17, 2000. Jennifer Thorne-Lehman presented on Health Decisions and Advance Directives at this same conference. Carla Fedor and Analissa Watkins coordinated planning and arrangements for this years DDNA conference.
• In collaboration with TEASC, developed workshops on mental health issues in DD population. The first workshop was held in Roswell on 4/27/01 and was attended by 11 persons, including 3 counselors. Most persons in attendance were case managers and community program supervisors. Topics covered include 1) distinguishing between medical and psychiatric causes of challenging behavior, 2) supporting people with DD through the grief process, 3) helping people with DD manage stress, 4) Trauma Spectrum Disorders, 5) how to access mental health services in New Mexico. This workshop is scheduled to be presented in Farmington on 7/27/01, except that Anxiety Disorders will be covered instead of Trauma Spectrum. The Trauma Spectrum Disorders presentation was video taped, as will be the session on Anxiety Disorders.

Activity #5: The CONTRACTOR shall make curriculum and job tools available on the Continuum of Care Project web site, as appropriate.

• All power point presentations made by Continuum of Care are placed on our website.

Activity #6: The CONTRACTOR shall continue to participate in specialty clinics as a source of consultation and as training sites as follows:

• Adult Special Needs Clinic was held in collaboration with TEASC on the 2^nd and 4^th Thursday morning of each month. Continuum of Care staff that regularly participate are Sharon Witemeyer MD, Jennifer Vickers MD, Alejandro Moralez LISW, Analissa Watkins LPN, and Jennifer Thorne-Lehman MA.

• Under Dr. Witemeyer's leadership, on July 27, October 26 of 2000, January 25, 2001 and April 26, 2001 Adult Special Needs clinics were devoted to adults with, or suspected of having Autism. We intend to continue these Adult Autism focused special needs clinics on a quarterly basis. On Autism dates, Alison Reeve MD also participates along with several staff from the SW Autism Network and Jim Jensen MD from the Department of Psychiatry. (Note: via funding from CDD, Dr. Witemeyer also provided physician services to the Children’s’ Autism Clinic every Tuesday July – December.) It should be noted that Dr. Witemeyer conducted multiple meetings and phone calls to plan and implement this specialty clinic. In March, Dr. Witemeyer developed a specific intake form and patient handouts for the Autism clinic. She also prepared and disseminated a "press release" advertising the availability of this clinic.

• Dr. Witemeyer has participated in 13 SAFE clinics between July 1, 2000 and January 30, 2001. Two of these were conducted via Telemedicine. Also in conjunction with SAFE clinic preparation and follow up, Dr. Witemeyer conducted phone consultations on 3 SAFE patients. Dr. Witemeyer participated in 11 SAFE clinics between February 1 – June 30, 2001. Judy Liesveld CNP, our Regional Medical Consultant for NW Region, assisted with a telemedicine SAFE evaluation on 2/16/01 in Gallup.

• In collaboration with TEASC, we have supported Dr. Rick Madden in providing a monthly special needs clinic to patients of Presbyterian Family Practice in Belen. Continuum of Care staff that have regularly participated include Carla Fedor RN, who coordinates the clinic, Sharon Witemeyer MD, and Jennifer Vickers MD; also via contract Mary Swift RD. Staff who has occasionally participated, depending upon patient identified needs include Alison Reeve MD and Jennifer Thorne-Lehman.

• Carla Fedor RN coordinates Dr. Vicker’s weekly pediatric neurology clinics, including the Ketogenic Diet clinic held one Tuesday of each month. This is the only Ketogenic Diet clinic in the state of New Mexico and is much in demand.

• We had lost our space in Roswell for conducting Dr. Vicker’s Neurology outreach clinics, but Analissa Watkins LPN was able to make temporary arrangements to hold one on 10/27/00. Beginning January 2001 we are contracting with the Family Practice residency program in Roswell for space to hold this clinic every other month and thus additionally give the family practice residents there an opportunity to participate and learn more about seizure management.

• Dr. Vickers conducted Neurology outreach clinic in Clovis on 8/3/00 and 10/14/00.

• Dr. Vickers and Mary Swift continue to participate in UNM Westside special needs clinic on a quarterly basis.

• Dr. Witemeyer represented Continuum of Care at a meeting with representatives from CDD and UNM/HSC Neuro-Psych Department regarding how to best share resources for clinics.

Activity #7: The CONTRACTOR shall collaborate with TEASC, Salud! Providers and BHOs, the DEPARTMENT and other UNM Health Science Center Departments to enhance availability and quality of statewide psychiatric care for individuals with developmental disabilities. This shall include technical assistance and consultation to BHO network providers.

• Training for BHO providers was offered, but they did not choose to take advantage of this opportunity during Fall 2000, probably because of proposed return to fee for services system this spring. Continuum of Care has discussed with LTSD and HSD/MAD our need for assistance in recruiting an audience for this training.
• MI/DD clinic is fully operational on a weekly basis at UNM/MHC. Drs. Reeve and Williams deliver psychiatric services through the clinic and UNM/MHC hired a nurse coordinator which was trained by Analissa Watkins LPN, Continuum of Care’s clinical coordinator, during the early fall. Patients access this clinic via intake through UNM/MHC General Clinic.
• Dr. Reeve met with Jeff Gonzales M.D. and his staff on 4/9/01 at his private psychiatric practice in Taos. Dr. Gonzales also works and the Community Mental Health Center in Taos. The purpose of the session was to familiarize them with supports available through Continuum of Care Project and with key considerations of serving the DD population.
• On 6/29/01, Dr. Reeve, Jennifer Thorne-Lehman, and Helene Silverblat from TEASC, met with representatives of BHSD to inform them of supports available through our projects and to begin discussions of how to improve access to quality mental health services for the DD population. BHSD agreed to generate a report from their data base to determine how many patients with DD are seen through State funding at Community Mental Health Centers. They also agreed that their Regional Care Coordinators need to be informed of supports available through our project and through DD Waiver. Paul Schwalje was in attendance representing LTSD.

Activity #8: The CONTRACTOR shall inform community medical practitioners of multidisciplinary resources and availability of technical assistance and training opportunities on a quarterly basis. The CONTRACTOR shall provide scholarships for training opportunities so that medical professional scan enhance their knowledge and skills related to patients with developmental disabilities. The CONTRACTOR shall also advertise availability of training, technical assistance and scholarships, on the Continuum of Care and Long Term Services Division web sites.

• Continuum of Care provided scholarships for the following health professionals to attend continuing education related to individuals with disabilities:
• Jane Pitts MD – "Developmental Disabilities - A Primer for Primary Care Providers" in San Diego, July 26-29, 2000.
• Catherine McClain MD – "IASSID World Congress" in Seattle, July 31 to August 3, 2000.
• Judy Ledman MD – "IASSID World Congress" in Seattle, July 31 to August 3, 2000.
• Pamela Arenella MD "The Many Faces of Autism: Meeting the Challenge Through Teamwork" in Albuquerque November 3&4, 2000.
• Pennye Thompson RN – "Psychotropic Medications" in Albuquerque 11/29/00.
• Kathline Burke MD – "Developmental Disabilities – A Primer for Primary Care Providers" in San Diego, July 26-29, 2000.
• Erin Bouquin MD – "AACPDM" in Toronto September 20-23, 2000.
• Rosemary Gallegos and Amy Osborne (counselors) – Play Therapy Conference – Westminster, Colorado – March 8 – 10, 2001.
• Patricia Lilley (SLP at SAFE clinic) – Spectrum of DD XXIII – March 26 – 28.
• Pennye Thompson, Yvonne Marquez, Arabella Gallegos – DDNA Conference March 5 – 8, 2001.
• Paulette Whalen (couselor) – Sand Tray Training Institute – Corrales, NM – May 10 & 11, 2001.
• An annual subscription to "Mental Health Aspects of DD" was provided to George Baca MD, a psychiatrist in Valencia county, beginning March 2001.

Activity #9: The CONTRACTOR shall participate on the Center for Development and Disability Library Committee to assure collection meets the needs of medical practitioners and Interdisciplinary team members regarding medical issues of individuals receiving long-term services, throughout the life span.

• Project Coordinator, attended all meetings, gathering input from Continuum of Care staff and reporting back to the CDD Library Committee as needed.

Activity #10: The CONTRACTOR shall continue to assure that the expertise and skills of the staff of the Continuum of Care Project remain on the cutting edge, by arranging for ongoing staff development and by assuring ongoing service delivery to patients via specialty clinics.

• Dr. Aceves participated in the following activities for this purpose: Attended Society of Developmental and Behavioral Pediatrics conference in Providence Rhode Island September 23-25, 2000; attended NM Pediatric Society meeting in Taos on October 20, 2000; attended and presented at NADD conference in San Francisco on November 2-5, 2000; attended PALS training at UNM/HSC on November 10, 2000; attended pediatrics clinic on November 11, 2000; attended local chapter of AAMR on November 15, 2000. Attended National AAMR convention in Denver May 30 – June 1, 2001. Attended a symposium on Social Engagement on 4/23/01.
• Dr. Witemeyer – Regional Medical Consultant for Metro, participated in the following activities for this purpose: meeting with Dr. Andy Hsi regarding MPH July 28, 2000; on-line OSHA training August 25, 2000; "Doctor I Just Don’t Feel Well!" Managing Migraine and IBS September 16, 2000; AACPDM annual conference in Toronto September 20-24, 2000; "End of Life Care: Cultural Diversity in NM" November 13, 2000; Attended and presented "A Report of Outpatient Psychiatric Care for Persons with Dual Diagnosis (MI/MR)" at NADD in San Francisco November 2-5, 2000; AAUAP Children’s SSI Project conference in Chicago November 15-17, 2000; Ethics Law & Medicine grand rounds January 19, 2001; attended local chapter of AAMR meetings on July 11, September 12 and November 14, 2000, March 13 and June 12, 2001; UNM General Faculty Meeting August 24, 2000. 2/28/01 attended CDD Day on Cultural Competence, 4/29/01 – 5/6/01 attended YAI in New York, where our Regional Medical Consultants presented on their role here in New Mexico (Dr. Bouquin, Dr. Benton and Judy Liesveld also attended), 6/1/01 attended "The Many Faces of Grief", and on 6/22/01 attended "Medications, Sensory Issues, and Jobs for People with Autism", by Temple Grandin in Albuquerque.
• Dr. Burke – Regional Medical Consultant for the SW and SE regions participated in the following professional development activities: Readings: "Primary Care of the Child with Chronic Conditions", recent articles on Tourette’s Syndrome, materials on cultural diversity working with families who have members with DD; CME: Neurology update, Autism conference, PTSD update; Clinical Neuro-Sciences conference in October 2000; Networking meetings: CMS medical advisory committee, P&A advocate regarding intervention in DPS, meeting with other regional medical consultants at regularly scheduled meetings (July, November and Feb). Attended Temple Grandin talk on Autism 6/22/01.
• Carla Fedor RN has begun working toward becoming a Certified Developmental Disabilities Nurse. She is studying materials in preparation for the test in May 2001. Ms. Fedor attended the National DDNA convention in Florida May 3-8, 2001, where she passed the test, and is now a Certified Developmental Disabilities Nurse! She attended as well as presenting with Drs. Witemeyer and Reeve at the NADD conference in San Francisco in November 2000. She also attended the Clinical Neuro-Sciences conference in Albuquerque October 5-7, 2000.
• Analissa Watkins is taking college pre-requisites in order to apply for the Physician Assistants program which she hopes to begin in spring 2002. She also attended the NADD conference in November and the Clinical Neuro-Sciences Conference in October, 2000. Ms. Watkins also attended the National DDNA convention in Florida, and the Temple Grandin talk on Autism in Albuquerque.
• , Program Coordinator attended quarterly AAMR chapter meetings; the NADD Conference in San Francisco in November 2000; and the End of Life Care: Cultural Diversity in New Mexico conference on 11/13/00, National AAMR convention 5/29/01 – 6/1/01.
• Valerie Ford attended the SPIDR international conference in Albuquerque in September 2000; attended 2 Marshall Rosenberg Non-Violent Communication Model Workshops; read several books and articles on mediation, conflict resolution and ethics; Began module 1 of the UNM/HSC Bio-medical ethics certificate program on 1/27/01.
• Dr. Reeve & Dr. Vickers attended the National AAMR convention in Denver May 29 – June 1, 2001.
• Dr. Vickers studied for and passed her boards, and is now a board certified Nuerologist.
• Alejandro Moralez attended the NM NASW conference for social workers 2/21 – 23/01. Attended workshop on sexual victimization on 3/9/01 and Temple Grandin talk on autism 6/22/01.
• Jennifer Thorne-Lehman attended the SPIDR international conference in Albuquerque in September 2000; the Clinical Neuro-Sciences conference in Albuquerque October 5-7, 2000; Pediatric Grand Rounds on Medical Care for Patients who are Deaf or have Hearing Impairments 2/15/01; Ethics, Law & Medicine Grand Rounds on 2/16/01; Begin the UNM/HSC Bio-Medical Ethics Certificate Program on 1/27/01 – module one will go weekly through March 31^st, with module two in the fall of 2001. Attended National AAMR convention May 29, 2001 – June 1, 2001; attended Temple Grandin talk on Autism 6/29/01.
• Continuum of Care has instituted in-service topics periodically at staff meetings (to which we invite TEASC staff). Jennifer presented on Instructional System Design on July 19, 2000; Dr. Witemeyer and Dr. Reeve presented on Autism on August 23, 2000; Jennifer gave an overview of the DD service system September 20, 2000. Dr. Reeve presented on the proposed AAMR definition of mental retardation October 18, 2000. 4/4/01 and 4/18/01 Valerie Ford presented on conflict resolution strategies.

Activity #1: In collaboration with TEASC, the CONTRACTOR shall develop and disseminate reference manuals related to the management of medical and mental health issues in persons with developmental disabilities. The materials will be made available through the web site with hard copies available to each regional office. The purpose of the manual is to support community program supervisors in providing on the job training of direct care staff in accordance with Addendum B of the Individual Service Plan. Table of contents will be negotiated with the LTSD Training Unit. Priority content will be on the web site by l2/2000. Phase II content by 6/2001. A Trainer Certification Session, in the use of the web based reference manual, will occur 2/2001. The CONTRACTOR will coordinate with the LTSD Training Unit for review and approval of content prior to dissemination of materials.

• Priority topics of asthma, aspiration pneumonia, COPD, GERD, osteoporosis, hypoglycemia, hypo and hyper thyroidism, diabetes, inflammatory bowel disease, dementia, psoriasis, acne, depression, eczema, are completed and went "live" in both the training and resource section of our web page (http://www.unmcoc.org/coc). Additional topics added since February include fungal skin disorders, inborn errors of metabolism, aspiration pneumonia, grief, depression, congenial rubella syndrome, down syndrome, autism, spina bifida, sturge weber syndrome, and tourette syndrome.
• In collaboration with LTSD Training Unit and TEASC a train-the-trainer session for individuals responsible for implementing Addendum B training was conducted in Roswell on 10, 2001 on how to use this site. A second session is scheduled in METRO for 7/10/01.

Activity #2: The CONTRACTOR shall provide support to teams responding to findings of the community quality system review, upon request of the LTSD Regional offices and/or individual interdisciplinary teams. The CONTRACTOR shall utilize Regional Consultants for this activity, whenever possible.

• In response to concerns about compliance with regulations for Crisis Prevention Plans, Carla Fedor RN, with assistance from Analissa Watkins LPN and Jennifer Thorne-Lehman developed training for nurses on how to develop effective Crisis Prevention Plans. This workshop was delivered to Santa Maria El Mirador nurses on September 8, 2000, Nurses from the SE region (sponsored by the Door of Opportunity in Artesia) on December 15, 2000, and at ResCare on January 19, 2001 – with several participants from other agencies in Albuquerque.

Activity #3: The CONTRACTOR, in collaboration with LTSD Training Unit Staff, shall deliver two trainer certification sessions for each pre-service/orientation and level l in-service health module for community programs. A total of 4 sessions will be provided.

• Alejandro Moralez and Jennifer Thorne-Lehman delivered train-the-trainer session for the SW and SE regions in Las Cruces on October 11-13. This session covered the merged version of Basic and Orientation Health modules, plus cross-waiver version of Level 1 Health. SWAT was certified as course mentor for these modules and Continuum of Care has contracted with SWAT for additional train the trainer sessions for southern NM.
• Alejandro Moralez, Judy Stevens, Carla Fedor and Jennifer Thorne-Lehman conducted a train the trainer for the cross-waiver version of Level 1 Health for the 3 northern regions in Albuquerque on November 29 & 30, 2000.
• A second train-the-trainer for Level 1 Health was held in Santa Fe/Espanola on April 5 & 6, 2001. Three trainers were certified, one more began the process and as a side benefit, 16 staff of Las Cumbres met the competencies for the course.
• A trainer was certified at Mentor, and another at Las Cumbres for both (Pre-Service) Basic and Orientation Level Health modules. Certification of the Mentor trainer required multiple mentoring sessions, including a session with Valerie Ford on positive approach to providing feedback.

Activity #4: The CONTRACTOR shall continue to disseminate CHUMS upon request of agencies or interdisciplinary teams.

• 845 CHUMS have been disseminated from 7/1/00 – 12/31/00. January 1, 1001 – June 30, 2001 510 Chums were distributed statewide.
• A supply of CHUMS provided to nurse case managers of the Medically Fragile Program at their annual meeting 4/4/01.

Activity #5: The CONTRACTOR shall respond to requests for information, training and/or consultation on an ongoing basis, utilizing Regional Consultants for these activities whenever appropriate.

• Dr. Aceves participated on the SEAD project advisory group December 14, 2000 and the MCH Collaborative on September 27, 2000.
• Dr. Burke provided consultation in the southern regions as follows: parental training for child with tourette’s, assisted parent of child with sever LD to prepare for IEP meeting, helped family prepare for transition from high school to adult services, advice to team with guardianship issues for an adult with schizophrenia, provided information about DNR orders for mother of adult with DD and significant health issues, training for a family regarding an adult with ADHD, consulted with a team regarding baclofen pumps and referred to appropriate specialist, conducted a training for the school in Columbus NM, assisted with 13 ECEP evaluations, consulted with CMS regarding teen with newly recognized deafness, consulted with LTSD SW Regional Office regarding doctor – team communication issues in Alamogordo, consulted with Tresco regarding expected death client with terminal condition, consulted with Tresco regarding medication renewal and annual exams needed for 2 clients, follow up with a family of child diagnosed with autism, family with 5 year old with severe speech delays, consulted with IDTs on 12 different individuals between 2/15/01 – 6/30/01, consulted with guardian regarding 2 individuals about health decisions and staffing needs.
• Dr. Burke presented at NM Highlands University to social work students on cultural sensitivity in dealing with families of those who have disabilities.
• Dr. Bouquin consulted with three families from the NE region.
• Judy Liesveld CNP consulted with one family and also presented a workshop on prevention of aspiration pneumonia for a home operated in Gallup by Tohatchi. On 2/1/01 she met with Barbara Bragg and Charlene Cain-Tholund at the NW Regional office.
• Alejandro Moralez, Analissa Watkins and Jennifer Thorne-Lehman presented a ½ day workshop on Health Decisions for Santa Maria El Mirador on 1/31/01.
• Alejandro Moralez is scheduled to mentor Ron Olguin RN of Residential Resorts in delivery of the Pre-Service Health module.
• Dr. Aceves & Jennifer Thorne-Lehman provided training for nurse case managers of the Medically Fragile Program on 4/4/01 on the topics of Advance Directives and DNR orders, guardianship, seizure disorders, and considerations when serving adults on the MF Waiver.
• Dr. Witemeyer provided consultation to 9 teams and 4 families.
• Dr. Benton provided consultation to 2 teams in the METRO region.
• Alejandro Moralez delivered the Pre-Service Health module at Residential Resorts on 2/20/01.

Activity #6: The CONTRACTOR shall provide facilitation and/or mediation for interdisciplinary teams in distress, upon request, and agreement to participate, by the entire team. Requests and intervention plans will be coordinated with the LTSD Training Unit and the DRP unit to ensure that the Division’s resources are accessed when appropriate.

• Two meetings were held with IAA/DRP unit to clarify roles related to team mediation. IAA/DRP shared their brochure with Continuum of Care – and Continuum of Care has begun to develop a brochure about our services. We agreed that in general IAA/DRP will deliver team facilitation when conflict is limited to a single IDT, but that in situations where conflict is multi-agency and affecting multiple teams that Continuum of Care would mediate. However Continuum of Care received a referral regarding a single IDT which was referred to us because of extreme distrust of the state on the part of the family guardian. We negotiated a protocol for such instances. (See attached document).
• Held several sessions with Alta Mira respite staff assisting them to develop effective ways to resolve conflict and work together effectively. This led to consultation with the executive director regarding internal communication issues which in turn lead to Constructive Feedback and Empathic Listening training for the entire staff (4 full day sessions to allow all to participate).
• Planned and held a two-day team building event with staff of the SW Regional Office. Feedback immediately after the event was quite positive. However, Valerie later provided additional consultation to LTSD staff regarding continuing conflict in that office.
• Facilitated a one and one-half day "Open space" planning sessions with the staff and board of NM Arc.
• Conducted follow up calls to Farmington mediation participants – who do not wish to pursue further mediation at this time.
• Conducted a 5 hour Vision Workshop with CDD managers to kick off their strategic planning process. Facilitated multiple strategic planning sessions for CDD as a follow up.
• Facilitated several meetings with Carrie Tingley Hospital and Salud MCOs to develop protocols for discharge planning for children with TBI.
• Conducted first mediation session with IDT in the Espanola area at Visions Case Management on 2/1/01. Second session 2/15/01.
• Provided consultation to director of ECEP regarding internal staff conflict issues on that multidisciplinary team.
• Conducted multi-party mediation session with Otero County Arc and Sun Country Case Management May 8 & 9, 2001.
• Conducted strategic planning meeting for EASI on 6/19/01.

Activity #7: The CONTRACTOR shall coordinate and facilitate the Health Decisions Resource Team, which provides assistance to interdisciplinary teams faced with complex and/or ethically charged health decisions. The CONTRACTOR shall coordinate with the DEPARTMENT to clarify the role of Continuum of Care in the coordination and provision of training to Interdisciplinary teams regarding health decision related issues.

• Dr. Aceves presented on bio-ethics at the "refresher" training for members of the HDR team held August 9^th, 2000. Tara Ford presented on the UHDA statute and related legal issues. The group practiced with case examples.
• Dr. Witemeyer provided bio-medical ethics consults on 7/6/00, 7/20/00, 8/2/00, and 8/14/00. She carried the UNM ethics pager from July 31 – August 7, 2000. She attended UNM ethics committee meetings on 7/24/00, 8/14/00, 8/28/00, 9/11/00, 9/25/00, 10/23, 1/22, 3/26, 6/25.. She attended St. Joseph Hospital ethics committee meetings on 7/7/00, 8/4/00, 10/6/00, 12/1/00, 1/5/01, 2/2, 4/6. Valerie Ford also participated in the ethics committee for St. Joseph Hospital. Ms. Ford also provided consultation to the President of this committee regarding meeting format issues.
• HDR meeting was held January 24, 2001 to review amendment proposed to the UHDA in the 2001 Legislative session as advocated by Protection & Advocacy. Additional HDR meetings held 4/18/01 and 6/30/01.
• Jennifer Thorne-Lehman and Valerie Ford had two meetings with staff of the IAA/DRP Unit of LTSD, (in addition to email correspondence) to clarify roles related to health decision support to teams and related training. Ingrid Nelson of the IAA/DRP now participates regularly in HDR activities, but Continuum of Care is still taking the lead on training while the IAA/DRP continue to enhance their knowledge and skills in this area.
• Valerie Ford and Dr. Aceves met with the chair of the ethics committee for Presbyterian Hospital to explain supports available from HDR. This led to a presentation delivered by Valerie Ford and Jennifer Thorne-Lehman to the entire committee on 11/21/00.

Activity #1: The CONTRACTOR shall arrange and/or deliver approved competency based training to case managers, upon request of case management agencies and/or the LTSD Training Coordinator. The CONTRACTOR may provide services directly and/or through subcontracts to outside trainers, upon approval of the LTSD Training Coordinator. The applicable curriculums are as follows:

• Rights and Advocacy, Challenging Behavior, Effective Advocacy Strategies for IDTs & Communication – none requested by LTSD

• Facilitating for Results: Alejandro Moralez delivered this two day workshop August 7&8 in Roswell, October 11 & 12 in Las Cruces. The session scheduled in Roswell for February has been postponed by LTSD. Delivered this workshop in Las Cruces March 22 & 23, 2001 and again 5/30 & 31, 2001. Mr. Moralez went to Roswell to present this workshop on 4/25 & 26/01, but only one participant showed up so the workshop was cancelled.

• Alejandro Moralez has completed Level 1 Health curriculum for case managers related to competency A. He is waiting for Carla Fedor RN to complete competency B section for submission of total package to CAST for review. She is working on the competency achievement questions, which is the last item for that section. This module is being paginated and copied for CAST review and should be submitted not later than 2^nd week in July, 2001.

Activity #2: In collaboration with the LTSD training unit, the CONTRACTOR shall provide coordination and fiscal intermediary services to ensure that the DEPARTMENT has access to trainers of level one in-service modules for case managers and service coordinators. It will be the responsibility of the DEPARTMENT to identify a cadre of trainers and to determine regional training needs on a quarterly basis. In collaboration with the LTSD training unit, the CONTRACTOR shall identify and coordinate with trainers from the list of eligible trainers and to provide payment for services. Payment will be made in the amount of $500.00 per course day. Funds in the amount of $76,800 are allocated, and shall be reserved for, completion of this activity. $69,l20.00 will be utilized for reimbursement to trainers; $7,680.00 will be applied to the l0% indirect.

• We have contracted with SWAT at Tresco for $13,750 to arrange or conduct train the trainer session for "Team Advocacy", "Traumatic Brian Injury", and cross Waiver versions of all three health modules. In addition they will arrange and deliver three one day sessions of "Positive Team Approach" and "Team Advocacy" and contract for mediation in their region as needed.
• We have contracted with Adelante for $19,930 to arrange or conduct five train the trainer sessions (one per region) for "Positive Team Approach", three train the trainer sessions (one per northern region) of "Team Advocacy" and "Traumatic Brain Injury". In addition they will deliver three Participatory Communication workshops (one per northern region). So far they have completed the "Team Advocacy" trainer session in Grants, Santa Fe and Albuquerque and the "TBI" trainer session in Albuquerque and Grants.
• We contracted with Kerry de Palma for $3200, for two days of case manager training per quarter. So far she has only conducted one two day session of Facilitating for Results held in October 2000.

Activity #3: In collaboration with the LTSD training unit, the CONTRACTOR shall provide coordination and fiscal intermediary services to ensure that the DEPARTMENT has access to an authorized trainer of the level one in-service module for case managers and service coordinators, pertaining to sexuality issues for individuals with developmental disabilities. It will be the responsibility of the DEPARTMENT to identify the trainer and to determine regional training needs on a quarterly basis. It will be the responsibility of the CONTRACTOR to provide payment for services. Payment will be made in the amount of $600.00 per course day. The subcontractor shall develop an annual schedule of training to provide l training per quarter in each of the five regions of the Long Term Services Division. Funds in the amount of $13,200.00 are utilized for reimbursement to the trainer; $12,000.00 will be applied to the 10% indirect.

• We contracted with Barbara Ludwig for $3,176.25 for five workshops on sexuality by 6/30/01. So far she has conducted one of these workshops in Taos on 1/9/01.
• We contracted with Jill Ryan for $3,176.25 to conduct five workshops on sexuality by 6/30/01. She has not billed us for any training to date.

Activity #4: The CONTRACTOR shall participate, at the request of the DEPARTMENT on a workgroup to review/revise the Level 2 in-service training requirements for case managers.

• No workgroup meetings held to our knowledge.

Activity #5: The CONTRACTOR respond to requests for health related information/consultation, utilizing Regional Consultants as appropriate.

• Several of the consultations described above in Outcome 3, Activity 5 were referred by case managers.
• We are scheduled to give an overview of supports available through Continuum of Care at the next staff meeting of Quality Case Management on 2/20/01.

Activity #6: In collaboration with TEASC, the CONTRACTOR shall develop and disseminate reference manuals related to management of medical and mental health issues of persons with developmental disabilities. The materials will be made available through the web site, with hard copies available to each regional office. The purpose of the manual is to provide case managers with information on congenital and/or chronic health conditions experienced by the individuals they serve. Table of contents will be negotiated with the LTSD Training Unit. Phase II content by 6/2001. A trainer certificate session for supervisors, in use of the web based reference manual, to occur 2/2001. The CONTRACTOR will coordinate with the LTSD Training Unit for review and approval of content prior to dissemination of materials.

• See Outcome 3, Activity 1 above.

Activity #7: The CONTRACTOR shall provide technical assistance to relevant LTSD staff and/or contractors regarding:

• Valerie Ford has provided confidential consultation to various LTSD staff regarding internal personnel conflicts.

• Jennifer Thorne-Lehman presented on the role of case managers in Crisis Prevention Plans at the Metro quarterly meeting October 27, 2000.

Activity #1: The CONTRACTOR shall assemble of team of University faculty and senior residents from family practice, pediatrics, internal medicine or other related disciplines to conduct the review of deaths.

Part A: The CONTRACTOR shall conduct a review of death for individuals referred by the DEPARTMENT. The review of events surrounding each death shall include:

Part B: The CONTRACTOR shall prepare a written report that addresses the following:

Part C: The CONTRACTOR will advise and consult with DEPARTMENT staff designated for that purpose by the Director of the Long Tern Services Division, and upon the specific requests of the DEPARMENT, submit a written report regarding:

Part D: The CONTRACTOR shall provide its written report on each death to the DEPARTMENT’S Division of Health Improvement, Quality Assurance Bureau within sixty (60) days of receipt of records on each death. The sixty-day requirement may be extended and a time mutually agreed upon, when multiple deaths are presented for review.

• Dr. Vogel has provided four written reports to DHI of the eight reviews given to him so far this year. It is our understanding that an invoice is being prepared regarding those reviews already completed.
• Four more were completed during the second half of the year; all eight have now been billed through our contract.

Activity #2: The CONTRACTOR shall provide training and/or consultation to enhance the awareness and knowledge of medical care issues of DEPARTMENT staff participating in the Community System Quality Review.

• No activity to date

Activity #3: The CONTRACTOR shall maintain regular communication regarding Continuum of Care activities with relevant Division staff. The CONTRACTOR shall also provide training, materials and/or consultation to the Division, regarding medical issues, upon request, including sharing of relevant existing materials with program managers for D&E, Medically Fragile Waiver, and TBI.

• has represented Continuum of Care on the Disability and Health Advisory Committee of DOH.
• Continuum of Care staff presented all aspects of our project to Regional Office managers on 9/21/00.
• Met with the new DOH Medical Director, Dr. Pintz, and LTSD Director, Ramona Flores-Lopez to update them on activities of this project on 6/20/01.
• Dr. Burke participated in LTSD regional meetings for nurses on 2/20 & 3/15.

Activity #4: The CONTRACTOR shall participate on the Medicaid Long Term Managed Care Advisory Committee.

• Jennifer Thorne-Lehman sits on this committee – however the scheduled meetings are often in conflict with other Continuum of Care commitments and so she was only able to attend 2 of the monthly meetings since July 2000. She would like to discuss with LTSD whether this continues to be a priority. Given LTSD preference that she continue to participate, Jennifer attended meetings of this group February 22, March 22, April 26, and May 24, 2001.