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What is
The UNMC Munroe-Meyer Institute (MMI) for
Genetics and Rehabilitation originated in the
late 1950s as a place for children with polio to
receive treatment. Today, Nebraska’s federally
designated University Center of Excellence for
Developmental Disabilities Education, Research
and Service annually provides diagnosis and
treatment to more than 10,000 children and
adults with diverse developmental and physical
disabilities and genetic disorders.
With approximately 230,000 people with disabilities in the state of
Nebraska, the need for specialized programs and support services
to improve their quality of life is vital.
By utilizing professionals who specialize in more than 15 disciplines
and programs, MMI provides an interdisciplinary team approach
that assures a comprehensive diagnostic and treatment program.
Parents, teachers, therapists and community service providers are
involved in the provision of services, which includes the development
of innovative ways to promote inclusion of individuals with disabilities
and their families into the community.
Since becoming a part of the University of Nebraska Medical Center
in 1968, MMI’s research, education, services and statewide technical
assistance training have been a source of hope for patients with
developmental disabilities and their families.
The Munroe-Meyer Institute is committed
to unlocking the potential of children
and adults with developmental disabilities
and genetic disorders through exceptional
patient care, interdisciplinary education
and first-of-its-kind research.
MMI’s mission includes a dedication to basic and applied research
conducted by faculty and staff members in all disciplines and programs.
MMI is committed to training future health care professionals who
will provide care to children and adults with developmental disabilities
and genetic disorders and their families.
Dear Friends of the Munroe-Meyer Institute,
In its 60 years, the mission of the Munroe-Meyer Institute (MMI) has
evolved. From an initial emphasis on services, MMI has since expanded
its interdisciplinary education and leadership programs in order to
meet our state’s needs for trained professionals in disabilities.
The number of students coming from across the country to learn
about developmental disabilities and genetic disorders has dramatically
increased. Most of these students have remained in Nebraska and
now provide services across the state and teach in our colleges
and universities.
Designated a UNMC academic unit in 2009, MMI has since established
master’s, Ph.D., and advanced training opportunities for practitioners
whose goal is to help children and adults with disabilities unlock
their full potential. These degree and post-doctoral programs are
in addition to internship and trainee programs that already exist
at MMI, such as the federally funded Leadership Education in
Neurodevelopmental and Related Disabilities (LEND) program.
While there are few traditional classrooms at MMI, MMI faculty teach
several university courses across all disciplines on the UNMC campus,
at other Nebraska colleges and beyond through telecommunication
technology. From those completing fellowships to the general public
seeking more knowledge on individuals with disabilities, MMI covers it all.
Just this past summer, MMI hosted a symposium in collaboration
with Special Olympics, whose national games were held in Lincoln.
This spring, MMI will host its third interdisciplinary symposium, this
one on cerebral palsy, for every-one from parents to practitioners.
Photographers: David Hussey,
Malone & Co. and Scott Dobry
For additional printed copies,
please contact:
UNMC Public Relations
985230 Nebraska Medical Center
Omaha, NE 68498-5230
Designer: Tom Waples
MMI Annual Report 2010
Editor: Nicole Lindquist
In everything we do, our goal is simple: to improve the quality of life
for each individual with a disability. We couldn’t do it without our
supporters. These include UNMC Chancellor Harold M. Maurer, M.D.,
the Hattie B. Munroe Foundation Board, the MMI Board, the Meyer
Foundation for Disabilities, the MMI Guild, the Enrichment Foundation,
the Scottish Rite Masons, the Autism Action Partnership and the
C. Louis Meyer Family Foundation.
This year’s report features just a few snapshots of the vital work in
education that goes on at MMI. I hope you enjoy the 2010 annual report.
J. Michael Leibowitz, Ph.D., Hattie B. Munroe Professor
Director of UNMC’s Munroe-Meyer Institute
Table of Contents
Mastering Problem Behavior 6
Clinical Geneticists Solve Medical Mysteries 8
Training Shifts into 2nd Gear 10
A Broad Education 12
Department Highlights 14
Facts and Figures 16
This annual report highlights only a few of the programs, activities
and services offered by the UNMC Munroe-Meyer Institute.
For more information, we invite you to visit our facilities on the
UNMC campus, our clinics and other programs across
the state, or our website.
New degree program helps students make their next move
Elizabeth Bullington works with 5-year-old Danny on a
sequencing exercise during an applied behavioral analysis
(ABA) therapy session. Bullington is one of the first graduates
of the ABA master’s program, a partnership between MMI
and the University of Nebraska at Omaha.
Following her graduation from Midland
University (formerly Midland Lutheran College)
in 2008, Elizabeth Bullington came to a
crossroads in her life.
Bullington received her master’s degree in August and soon hopes
to take her turn at the BCBA exam.
“I wouldn’t even be in my field if MMI and UNO didn’t have a joint
program,” she said.
Another draw to the master’s program for Bullington was the people
in charge of the Center for Autism Spectrum Disorders and Pediatric
Feeding Disorders program where she did her practicum. Wayne
Fisher, Ph.D., and Cathleen Piazza, Ph.D., are internationally-renowned
in the ABA world.
Though armed with her bachelor’s degree in psychology, she knew
she needed a master’s degree to work in a clinical setting. But there
were no such local programs with an emphasis in Applied Behavior
Analysis (ABA). Bullington sought to help children with autism, but
wanted to stay in Nebraska. Her family did too.
“Their names would pop up in my textbooks, and I would be like ‘oh my
goodness, I work with them.’”
Luckily for Bullington, the psychology department at the University
of Nebraska Medical Center’s Munroe-Meyer Institute (MMI) and the Their work has inspired students in the master’s program to spread
school psychology program at the University of Nebraska at Omaha their ABA knowledge beyond the walls of MMI. Bullington said her
launched a joint master’s program in ABA just in time.
colleagues talk about opening preschools for children with autism and
During games of Chutes and
Ladders, Danny would swat at
the pieces and echo every word
Bullington said.
Completion of such a program would allow her to sit for a Board
Certified Behavior Analysis (BCBA) exam. Board certification is
important because it is evidence of a service provider’s competence
to provide ABA services. In addition, graduation from the master’s
program also provides the prerequisites for provisional licensure
as a mental health practitioner, a must-have to work in a clinical
psychology setting.
providing parent training programs, all based on the principles of ABA.
The master’s program prepares them for this by providing
opportunities to work with faculty at MMI who practice ABA daily in
outpatient clinics, schools and community and primary care settings.
Bullington personally wants to combine her two loves: faith and
children with autism.
“I want to help children with autism obtain the sacraments and
encourage parents and families to go to church with their kids
with autism,” she said. “They typically don’t because their children
are too noisy and they don’t know the proper ways to handle
problem behavior.”
The need for psychologists with their master’s in ABA is ever-present.
Many parents of children who receive services from the Center for
Autism Spectrum Disorders wait between six to nine months to get in.
In addition, Nebraska has a substantial shortage of behavioral health
clinicians with the expertise to work with children and adolescents
with behavior problems and their families.
Bullington enrolled in the program in the fall of 2008. It consisted
of 30 hours of course work, a 750-hour practicum of supervised
experience and a research thesis. Of two options available, Bullington
chose the autism/severe behavior disorders track over the outpatient
behavioral pediatrics track. She was placed in the early intervention “This is why we started the ABA program,” said Lisa-Kelly Vance, Ph.D.,
professor of psychology at UNO and co-director of the joint master’s
program at MMI. It was there she met Danny, a 5-year-old boy
program along with Mark Shriver, Ph.D., associate professor of
with autism.
psychology at MMI. “We need more professionals trained to work
During games of Chutes and Ladders, Danny would swat at the
with children with behavior problems.”
pieces and echo every word Bullington said. Bullington faithfully used
Bullington is ready to go to work.
applied behavior analysis methods to reduce problem behaviors
and increase desired ones. Fast forward a year later and Danny
counts out the numbers on the board as he moves his game piece
and converses with Bullington during her turn.
Eric Rush, M.D.
It’s nine a.m. on a Monday in November. Eric Rush, M.D., Down the hall, Lois Starr, M.D., sits down with a 14-year-old female
referred for some freckles in an unusual pattern on her back.
pages through his files in the conference room of the
diagnostic building at UNMC’s Munroe-Meyer Institute. In talking with her patient about her past medical history before the
Today he’ll see an 8-year-old girl who was referred for potential
Fetal Alcohol Syndrome. Dr. Rush knows that many of the physical
characteristics the child exhibits are probably due to being born 15
weeks premature.
He enters the exam room and receives a high-five from the little girl
who’s sporting a pink helmet because of behavior problems. He chats
with her foster parent and then measures the distance between her
eyes and her head circumference. The numbers fall in the normal
range for a girl her age.
Dr. Rush explains to the foster mom that the girl’s behavior problems
and delays can’t necessarily be attributed to FAS. He orders a
“microarray” that will test her DNA for genetic disorders that could
be causing her issues. Such a diagnosis would allow for an optimal
treatment plan and a more accurate outlook for her future. Dr. Rush
likens chromosomes that the microarray will test to a book. It looks
for extra pages or pages missing and any abnormal genes it finds are
like spelling errors. This seems to click with the foster mom.
As a clinical geneticist in training, Dr. Rush has done his job.
physical exam, Dr. Starr learns that the girl also has experienced
enuresis, better known as bed wetting, for years. Noting that the
abnormal pattern of skin findings may indicate a disease known
as segmental neurofibromatosis, Dr. Starr recommends an MRI of
the lower spine to look for a potential link between the freckles and
the enuresis.
Also a clinical geneticist in training, Dr. Starr has done her job.
Abigail Haggerty, a cytotechnologist III in the Human Genetics Lab
at MMI, shows Lois Starr, M.D., a clinical geneticist fellow, how to
identify ideal cells for chromosome analysis.
Clinical geneticists solve
medical mysteries
New fellowship program trains geneticists of tomorrow
Clinical geneticists who can consult about lab tests and diagnose
“Some would call genetics the most rapidly expanding field of medicine,”
potential genetic diseases and disorders are in short supply. That’s why he said.
MMI and the UNMC Department of Pediatrics recently launched a
Adds Dr. Starr: “I love putting together the pieces of a patient’s history
fellowship program to train clinical geneticists like Drs. Rush and Starr.
and physical findings and perhaps providing an answer, helping not
Based on the growing need, MMI also will re-launch the clinical
only the patient, but also the patient’s family members.”
cytogeneticist fellowship it discontinued 12 years ago. Cytogeneticists
Following the completion of her clinical genetics fellowship in June
detect chromosome problems early to provide health care professionals
2012, Dr. Starr plans to pursue the clinical cytogenetics fellowship.
with an opportunity to establish the best method for treatment.
“I would like to see patients in the clinic and hospital while also taking
“There are about three open positions in genetics and cytogenetics
an active role in the lab, not just in diagnostics, but also as a part of
for every qualified candidate,” said Warren Sanger, Ph.D., director of
the research essential to advancing the medical care of our patients.”
cytogenetics and interim director of clinical genetics at MMI. “What’s
lacking is the personnel to fill them.”
She is grateful that such programs exist to help her realize her dreams
in the city she calls home. Dr. Starr graduated from medical school
at UNMC in 2007 and also completed her pediatrics residency at
UNMC in 2010.
“Some would call genetics the most
rapidly expanding field of medicine.”
“I feel fortunate to have the opportunity to train for my ideal career
MMI’s geneticists, genetic counselors and lab professionals struggle here,” she said.
to keep up with the growing demand for services in Omaha as well
MMI is happy to provide the opportunity.
as across the state. UNMC provides the majority of genetic services
for Nebraska and portions of several surrounding states, as well as
consultations and lab diagnostic studies nationally and internationally.
Dr. Rush doesn’t understand why more health care professionals don’t
study the science of the future.
Training SHIFTS into
When most people think of physical therapists,
they think of rehabilitation, not “habilitation.”
While rehabilitation reteaches, habilitation
means “to learn for the first time.” For children
with developmental disabilities, it’s essential.
That’s why federal law mandates physical therapists in schools. Even
still, just over 10 percent of physical therapists specialize in pediatrics.
With its new pediatric physical therapy residency, UNMC’s MunroeMeyer Institute (MMI) hopes to produce more specialized practitioners
in the field.
New PT residency to be
one of only six programs
in the country
in the motion analysis lab compares strength training in children with
cerebral palsy, which is standard practice, to “treadmill training
with weight support.”
For Lindsteadt, exposure to the latest research and the chance to work
with well-known physical therapists are among the reasons she chose
to do her PT residency at MMI.
She’s also been impressed by the collaboration at MMI. Because the
residency is offered in conjunction with the Leadership Education in
Neurodevelopmental and Related Disabilities (LEND) program at MMI,
which is based on an interdisciplinary curriculum, she is able to learn
from a multitude of knowledgeable health professionals.
“Because of my education at MMI, I can
help children reach their full potential.”
“Our goal is to provide students with an intensive, well-rounded
learning experience in pediatric physical therapy,” said Wayne Stuberg,
Ph.D., director of the PT department at MMI. “The hope is that upon
completion of the residency, students will take on leadership roles
“Everyone looks at the whole child, not just their motor control or
in pediatric PT.”
cognitive abilities,” she said. “I work with psychologists to understand
Dr. Stuberg strives for MMI to be known as an innovative leader in
behaviors, occupational therapists to understand fine motor skills
pediatric physical therapy. The new residency, to be accredited through and others to better understand the child as a whole person.
the American Physical Therapy Association, is the most advanced
Following her graduation in June of this year, Lindsteadt knows
training program available to physical therapists. Upon accreditation,
someone with her education and skill set will be in high demand.
it will be one of only six such programs in the United States.
Graduates of the PT residency also are eligible for board certification
“We want to offer a unique training opportunity so those who want to
in pediatrics through the American Board of Physical Therapy
receive the highest level of training can do so in the Midwest,” he said. Specialties. And as Neonatal Intensive Care Units save the lives
“It includes clinical practice and problem-solving as well as the chance
of more babies, some of whom grow up with life-long disabilities,
to witness research discoveries and their clinical applications first-hand. pediatric physical therapists will be vital to helping them maintain
a high quality of life.
Jill Lindsteadt is the first resident enrolled in the one-year program.
She spends half her time doing clinical work in homes and local
“Physical therapists are needed everywhere, especially those with
schools. The other half of Lindsteadt’s time is spent with outpatients expertise in working with children with developmental disabilities,”
or in the state-of-the-art motion analysis lab at MMI. The lab analyzes
Lindsteadt said. “Because of my education at MMI, I can help children
abnormal walking patterns pre- and post-surgery. Current research
reach their full potential.”
MMI’s first physical therapy resident
Jill Lindsteadt, coaches her patient,
Guin, as she tests out an adaptive bike.
A Broad Education
New doctoral program first of its kind in Nebraska
In third-world countries, children with severe
behavior disorders are often placed in
orphanages or institutionalized. Rebecca Dogan
wants that to change.
As a Ph.D. student studying Applied Behavior Analysis at UNMC’s
Munroe-Meyer Institute (MMI), Dogan hopes to teach others how to
treat autism and other behavior disorders following her graduation
in 2012.
She recommended they “catch him being good” frequently to keep his
attention gauge high. That way, he’d be less likely to use undesirable
behaviors to gain attention. She also guided the parents on how to
handle unsafe behaviors like running into the street versus behaviors
that parents may find annoying, like wearing the same thing all the time.
In addition to her clinical work at MMI and in behavioral health clinics
around Nebraska, Dogan also conducts research that is published in
journals and presented at conferences. For her dissertation, she plans
to explore why the literature shows that programs like the parent
training don’t always generalize to everyday situations.
“I want to educate those in less developed areas on positive behavioral “They learn the skills, but it doesn’t always transfer to other settings,”
interventions and raise awareness that will hopefully lead to early
Dogan said. “I would like to study what we can do differently to teach
intervention,” she said.
skills that apply more broadly.”
Through the Medical Sciences Interdisciplinary Area at UNMC, MMI
started the three-year Ph.D. program in 2010. It is the first of its
kind in the state of Nebraska and the first one in the nation to be
integrated with a University Center of Excellence on Developmental
Disabilities in a university medical center setting.
The doctoral program focuses on applied behavior analysis for children,
adolescents and families. The training model for the program is
similar to programs used to train basic researchers and scientists.
Principles and concepts introduced in the classroom are immediately
applied in clinical and research settings.
While Dogan chose the “Clinical Behavior Analysis in Pediatrics” track,
Regina Carroll selected the “Intensive Applications of Behavioral
Psychology and Behavior Analysis” track.
Her research interests include decreasing stereotypical behaviors
that often co-occur with autism, such as hand-flapping and repeated
“By integrating courses and hands-on experience, students get practical
use right away which maximizes learning,” said program director,
Wayne Fisher, Ph.D. “They retain more when learning and doing
go hand-in-hand.”
As part of the curriculum at MMI, Dogan is already applying her
education. She conducts a training program for parents of children
with high-functioning autism. Parents bring their real-life problems
to the table and Dogan, supervised by faculty member Terri Mathews,
Ph.D., talks them through the solutions.
One couple struggled to get their son to offer genuine compliments
rather than “I like your giant ear.” Dogan advised them not to attend
to the inappropriate comments, but instead provide high amounts
of praise and attention when he used appropriate compliments.
Ph.D. student Regina Carroll tests the effectiveness of a
computer-based reading program for children with autism.
“We’re finding that it requires a lot of adult intervention,” she
said. “We hope to look for alternatives to make it more
practical for children with autism.”
vocalizations. These behaviors interfere with acquisition of skills.
Carroll also hopes to teach graduate school courses in ABA and
mentor research assistants following her graduation. She may even
go on to do a post-doctoral experience.
“The goal of this new program is to prepare students for prominent
leadership positions in academic, clinical and research arenas,” said
Joe Evans, Ph.D., faculty member in the program and director of the
MMI psychology department.
Ph.D. student Rebecca Dogan and faculty member,
Terri Mathews, Ph.D., go over materials for a parent training
class for those whose children have high-functioning autism.
“The Ph.D. program at MMI is great because you get to network
with the people putting out a significant amount of research
and those whose programs are recognized nationwide
in the field of applied behavior analysis.
So far, mission accomplished.
MMI’s Center for Autism Spectrum Disorders was awarded a
$1.5 million grant from the US Army to study the use of tele-health
and web-based technologies to train para-professionals to provide
services to children with autism in military families. Unfortunately,
most military-dependent children with autism spectrum disorders
do not receive appropriate services, in part because there are not
enough professionals appropriately trained to provide services. This
project will greatly increase the number of well-trained therapists in
areas around many military bases.
MMI hosted the Special Olympics Health Symposium, which
highlighted the health issues faced by people with intellectual
and developmental disabilities. “Improving Health for People with
Intellectual Disabilities - Policy, Practice and Possibility” preceded
the 2010 Special Olympics USA National Games in Lincoln, Neb.
Developmental Medicine
Faculty revised the pediatric resident rotation to provide a more
comprehensive experience in the developmental pediatrics and
behavioral psychology clinics. Now the residency also incorporates
formal training in developmental and autism screening into
the curriculum.
Developmental Neuroscience
MMI created the Department of Developmental Neuroscience in
2010 to conduct research into the causes of autism, cognitive and
motor delays, and language disorders. Three new faculty members
with expertise in brain development and learning processes joined
MMI on July 1 - Anna Dunaevsky, Ph.D., Woo-Yang Kim, Ph.D., and
Jyothi Arikkath, Ph.D. The department’s goal is to find new ways
to diagnose and treat such disorders.
Education and Child Development
The Interdisciplinary Center of Program Evaluation enrolled its first
trainees who will gain skills evaluating community programs such
as the Building Bright Futures Early Childhood Services.
Occupational Therapy
Students from four different states and six colleges and universities
are currently completing their pre-service clinical rotations at MMI.
Physical Therapy
The Physical Therapy department organized a multi-disciplinary
health symposium on Muscular Dystrophy for health care professionals
as well as families to develop new skills and strategies to treat those
with MD. This year’s symposium on April 29th and 30th will focus
on Cerebral Palsy.
Faced with a growing shortage of mental health providers in Nebraska,
the psychology department increased its emphasis on training
behavioral health practitioners. As part of the Nebraska Internship
Consortium in Professional Psychology (NICPP), MMI attracts
doctoral psychology intern applicants from Nebraska and across
the country. In 2010, a record 165 applicants applied for internships
in the NICPP from more than 60 university training programs.
MMI accepted 13 psychology interns in 2010.
Recreation Therapy
A record 478 volunteers provided 15,674 service hours for individuals
with developmental disabilities throughout the year. Almost every
middle school and high school in the Omaha metro area sends
students to MMI for community service hours. For most students
it’s a gateway experience to the world of developmental disabilities.
Many return as repeat volunteers or apply for staff positions.
Speech Language Pathology
The department hosted its annual continuing education conference
about augmentative and alternative communication (AAC) for
speech pathologists, special educators, families and individuals who
use AAC to communicate. The featured speaker, Janice Light, Ph.D.,
inspired the speech language pathology staff at MMI to implement
new methods to teach children who use AAC how to read.
Social Work
The Social Work Department conducted “Safety and ‘Netiquette’
Training in Social Networking” workshops for young adults with
developmental disabilities. The project was made possible by a grant
from the Nebraska Planning Council on Developmental Disabilities.
Andrea Clements conducts an early intervention therapy
session while Lindsey Loutsch records data. Autism spectrum
disorders affect as many as one in 91 children.
Serving the Community
MMI provides technical assistance to other
university departments and programs,
community organizations and governmental
agencies to transfer new knowledge from
the academic setting into the community.
long-term trainees | all other trainees
patient revenues | grants and contracts
This year, 18,208 participants attended
workshops, conferences, teleconferences
and other community education activities.
This chart illustrates the broad spectrum
of issues and services for which MMI
provides evaluation, assistance in program
development or implementation, continuing
and community education and a variety
of other community services.
Funds Leveraged
Interdisciplinary Trainees
Over the past five years, MMI has been successful in maintaining
grants and contracts with existing partners in the community, and
also in identifying new partnerships and funding sources to develop
innovative programs and address emerging issues.
MMI’s education program provided an interdisciplinary training
experience for 167 students, interns, residents and post-doctoral
fellows in 2010 for a total of 99,429 hours. More than half of these
students were long-term trainees, receiving 300 hours or more of
interdisciplinary instruction at MMI.
Fueling our mission
MMI’s complex mission requires that we seek
support from a wide variety of sources. Patient
revenues continue to be the largest part of our
budget with state funds and contracts from
public schools and state agencies providing
a great deal of support. Private donations
continue to be a very important part of our
program as we develop cutting-edge programs
to benefit Nebraskans with disabilities.
10 %
Products developed and disseminated
MMI faculty members publish extensively in professional journals,
monographs, periodicals and books and also disseminate best
practices through reports, manuals and other informational materials.
In 2010, MMI faculty members developed 155 new products and
disseminated 134 different products to professionals, students,
parents, people with disabilities and the general public.
new products developed | all products disseminated
The Munroe-Meyer Institute is committed
to unlocking the potential of people with
disabilities. Every individual with complex
medical and developmental needs deserves
the very best care available. And with
hundreds of thousands of people with
disabilities living in the state of Nebraska,
the need for MMI’s specialized programs
and services is vital.
Today, an unprecedented momentum exists
at UNMC to be the best in health care
for all Nebraskans. Through the University
of Nebraska Foundation’s Campaign for
Nebraska, there’s a tremendous opportunity
to raise the private support needed for MMI
to shape the care available for Nebraskans
with intellectual and developmental
Private support plays a critical role in helping MMI achieve its vision —
to be the premier interdisciplinary center on disabilities in the Midwest.
Specifically, your support will help UNMC:
• Enhance patient services across the state via tele-health
education of families and providers as well as direct services
in numerous communities
• Better understand disorders such as autism in order to improve
diagnosis and treatment options
• Educate providers to better care for individuals with disabilities
• Design, develop, adapt and apply technological solutions to help
children and adults with disabilities reach their full potential
As part of the Campaign for Nebraska, MMI seeks to raise $20 million
to fully realize its key priorities. Since the Campaign began in 2005,
individuals and organizations have generously supported MMI,
helping the Institute reach approximately 25 percent of this goal.
Pulitzer Prize winning journalist, Hodding Carter, said, “There are only
two lasting bequests we can hope to give our children. One is roots;
the other, wings.” Your support offers families hope through research
and innovative treatment programs at MMI. It also provides
important support for faculty and staff needed to reach families
throughout our community and give them opportunities to soar past
perceived boundaries.
For more information about the campaign or to make a donation
contact [email protected] or 402-502-4117.
Melonie S. Welsh
Director of Development MMI
University of Nebraska Foundation
MMI’s mission:
to improve the quality of life
for persons with disabilities
and their families.
UNMC Munroe-Meyer Institute
for Genetics and Rehabilitation
A university center for excellence in developmental
disabilities education, research and service.
985450 Nebraska Medical Center
Omaha, NE 68198-5450
(800)656-3937 ext. 9-6430
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