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Increasing Collaboration to Address Substance Abuse, Women & Their Children: Strategies and Approaches Beth Glover Reed, PhD Kathleen Branson Hillegas,

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Presentation on theme: "Increasing Collaboration to Address Substance Abuse, Women & Their Children: Strategies and Approaches Beth Glover Reed, PhD Kathleen Branson Hillegas,"— Presentation transcript:

1 Increasing Collaboration to Address Substance Abuse, Women & Their Children: Strategies and Approaches Beth Glover Reed, PhD Kathleen Branson Hillegas, RN, PhD candidate Suzie Antonow, MSW, CSW, CACI Julie D. Cushman, MSW, CAC-1 Ruth Gordon Shabazz, MSW, ACSW, CSW

2 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 2 Outline/organization of Workshop 1. Overview 2. Desired outcomes & principles 3. Strategies  Conferences & Trainings  Educational case conferences, Problem-solving & Priority setting  Generating/using knowledge  Institutionalizing change  Services coordination 4. Components to increase collaboration & create change p 2 handout

3 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 3 Overall Goal - present ways to collaborate to increase and coordinate resources for substance abusing women and their children Specific Goals Strategies to increase & coordinate resources for substance abusing women and their children Strategies to increase & coordinate resources for substance abusing women and their children Ways to Link strategies targeting policy makers Ways to Link strategies targeting policy makers Horizontally across systems Horizontally across systems Vertically throughout systems Vertically throughout systems Use of Task Forces & Coalitions to catalyze change by Use of Task Forces & Coalitions to catalyze change by Raising awareness Raising awareness Creating new culturally competent knowledge & tools Creating new culturally competent knowledge & tools Planning change to address issues Planning change to address issues

4 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 4 Specific Goals - continued Link a variety of initiatives to identify gaps and barriers Link a variety of initiatives to identify gaps and barriers Training/education Training/education Coordinated case conferences and forums Coordinated case conferences and forums Conferences to catalyze common views of needs and generate ideas across boundaries to address gaps Conferences to catalyze common views of needs and generate ideas across boundaries to address gaps Strategies to link services & programs Strategies to link services & programs

5 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 5 Context Washtenaw County, MI Population 300,000 Population 300,000 2 cities, 2 cities, Ann Arbor & Ann Arbor & Ypsilanti Ypsilanti Towns, Villages, townships & rural areas Towns, Villages, townships & rural areas 2 Universities, 2 Universities, U of Michigan & U of Michigan & Eastern Michigan U Eastern Michigan U Median age 31.3 Median age 31.3 Median income $51,990 Median income $51,990 Affluent areas Affluent areas Pockets of very low income Pockets of very low income Problems with homelessness Problems with homelessness 3 major health care systems 3 major health care systems p 3 handout

6 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 6 Gender Breakdown of Those Receiving AOD & MH Services in 2002 Total Revenue and Expenditures for Substance Abuse and Mental Health in 2002 $4,275, 736 WomenMen Substance Abuse %64.90% Mental Health49%51%

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9 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 9 Background Washtenaw County MI 1980’s Few sources of women-centered substance abuse treatment Few sources of women-centered substance abuse treatment High levels of infant mortality High levels of infant mortality Crisis intervention & violence against women services had little knowledge of AOD Crisis intervention & violence against women services had little knowledge of AOD Segmented service systems Segmented service systems Trouble communicating across boundaries between agencies/systems Trouble communicating across boundaries between agencies/systems Concern about crack cocaine Concern about crack cocaine AOD services beginning to consider family members AOD services beginning to consider family members p 4 handout

10 7/15/04 Reed, Antonow, Cushman, Hillegas & Shabazz 10 p 5 handout

11 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 11 Desired Outcomes Make existing resources more women-friendly Make existing resources more women-friendly Add elements to address gaps Add elements to address gaps Transformation - change existing practices Transformation - change existing practices p 6 handout

12 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 12 General Principles Long term vision AND short-term activities/successes Long term vision AND short-term activities/successes Theoretical/conceptual AND Practical/applied Theoretical/conceptual AND Practical/applied Work simultaneously at Multiple Levels AND in multiple systems Work simultaneously at Multiple Levels AND in multiple systems Continuous assessment Continuous assessment Small committed leadership team Small committed leadership team Widespread communication & involvement Widespread communication & involvement

13 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 13 Triangle of Collaboration

14 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 14 Strategies Conferences & Trainings Conferences & Trainings Educational Case Conferences Educational Case Conferences Action Research Action Research Institutionalizing Change Institutionalizing Change Services Coordination Services Coordination

15 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 15 General Strategy - Conferences & Trainings Objectives Objectives Build knowledge & skills Build knowledge & skills Create neutral space Create neutral space Mobilize people across systems Mobilize people across systems Generate common vision & language Generate common vision & language Build relationships at different levels Build relationships at different levels p 7 handout

16 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 16 Conferences & Trainings, cont. Key Elements/Principles Key Elements/Principles Identify topics of interest Identify topics of interest Plan with representatives of different systems Plan with representatives of different systems Incorporate consumers Incorporate consumers Include teams from each organization Include teams from each organization Make language and assumptions explicit Make language and assumptions explicit Include variety of approaches Include variety of approaches Create linkages across systems Create linkages across systems Recruit new people Recruit new people Identify & develop advocates/leaders among participants Identify & develop advocates/leaders among participants Participants plan next steps & prioritize Participants plan next steps & prioritize

17 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 17 Conferences & Trainings, cont. Examples Coordinating Project on Women Coordinating Project on Women Conferences/training on AOD, DV, HIV/AIDS, drugs and women, pregnancy & AOD Conferences/training on AOD, DV, HIV/AIDS, drugs and women, pregnancy & AOD Assault Crisis Center & Council for Children Assault Crisis Center & Council for Children Child sexual abuse/trauma & AOD Child sexual abuse/trauma & AOD SAFE ANCHOR SAFE ANCHOR Cross agency simulation Cross agency simulation CTTI CTTI FAS/FAE conferences FAS/FAE conferences

18 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 18 General Strategy - Problem Identification, Solving & Priority-setting Objectives Objectives Improve coordination of services between agencies Improve coordination of services between agencies Explore how clients move through each system Explore how clients move through each system Consider how to enhance working relationships Consider how to enhance working relationships Key elements/Principles Key elements/Principles Ground rules for interactions Ground rules for interactions Client confidentiality Client confidentiality Focus on clarification, identification of issues Focus on clarification, identification of issues Preparation of presenters Preparation of presenters Use of nominal group process Use of nominal group process Priority setting Priority setting p 8 handout

19 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 19 Problem Identification, Solving & Priority-setting, cont. Examples Examples Educational case conference, case autopsy (Infant Survival Initiative) Educational case conference, case autopsy (Infant Survival Initiative) Nominal group process & priority setting Nominal group process & priority setting Interagency simulation (SAFE ANCHOR) Interagency simulation (SAFE ANCHOR) Forums (SAFE ANCHOR) Forums (SAFE ANCHOR) pp handout

20 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 20 General Strategy - Action Research Goals Goals Generate knowledge to guide planning Generate knowledge to guide planning Generate knowledge from actions Generate knowledge from actions Involve participants in the process Involve participants in the process Principles Principles Action Research Model Action Research Model p 12 handout

21 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 21 ACTION RESEARCH CYCLE p 13 handout

22 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 22 Action Research, cont. Examples: Formal Needs Assessments Formal Needs Assessments 25 focus groups of women various stages of change 25 focus groups of women various stages of change SWOT (Strengths, Weaknesses, Opportunities & Threats) analyses SWOT (Strengths, Weaknesses, Opportunities & Threats) analyses Organizational Assessments Organizational Assessments Components Components Perceptions Perceptions

23 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 23 Action Research, cont. STEPS Forum STEPS Forum Assessment of expectations Assessment of expectations Data about attendees, organizations & clientele Data about attendees, organizations & clientele Data about concerns, priorities Data about concerns, priorities Evaluate event Evaluate event Share information with leadership & participants Share information with leadership & participants

24 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 24 General Strategy - Institutionalizing Change Goals Goals Critical assessment of existing practices Critical assessment of existing practices Creation of alternatives Creation of alternatives Identify changes in policy, budget and administrative procedures to institutionalize change Identify changes in policy, budget and administrative procedures to institutionalize change p 14 handout

25 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 25 Institutionalizing Change, cont. Principles Principles Work across and within systems Work across and within systems Generate new or redeploy resources to fill gaps Generate new or redeploy resources to fill gaps Provide on-going support, education & supervision past initial change Provide on-going support, education & supervision past initial change

26 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 26 Institutionalizing Change Examples Critical Pathways, St. Joseph Mercy Health System Critical Pathways, St. Joseph Mercy Health System Community Team Training Institute Community Team Training Institute SAFE ANCHOR Executive leadership sessions SAFE ANCHOR Executive leadership sessions Resources for ongoing work Resources for ongoing work

27 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 27 Examples of Service Coordination Ruth Gordon Shabazz, MSW, ACSW, CSW Director Programs & Services Shelter Association of Washtenaw County Ann Arbor, MI p 15 handout

28 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 28 General Strategy - Increasing Services Coordination Objectives Objectives Coordinating & advocating for services/resources Coordinating & advocating for services/resources Address multiple and overlapping areas Address multiple and overlapping areas Principles Principles State of readiness and stages of change as framework State of readiness and stages of change as framework Comprehensive assessment Comprehensive assessment Must be client centered Must be client centered Care coordination Care coordination Within the larger community Within the larger community

29 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 29 Increasing Services Coordination, cont. Steps/Tasks Steps/Tasks Network with those of like-mind Network with those of like-mind Work with individuals from different perspectives Work with individuals from different perspectives Boundary crossing Boundary crossing Don’t burn any bridges Don’t burn any bridges Consider alternate ways to deliver services Consider alternate ways to deliver services Provided informal education and consultation Provided informal education and consultation

30 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 30 Shelter Association of Washtenaw County Community Kitchen Community Kitchen Food Gatherers Food Gatherers 50 bed shelter for adults 50 bed shelter for adults 20 bed rotating shelter (winter) 20 bed rotating shelter (winter) 50 chair warming center (winter) 50 chair warming center (winter) Medical clinic Medical clinic Case management Case management Focus on income/savings/housing Focus on income/savings/housing

31 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 31 Services Sheltering Sheltering Assessment Assessment Physical Physical Psychological Psychological Mental health Mental health Family Family Trauma Trauma Chemical Dependency Chemical Dependency Other Barriers Other Barriers Literacy Literacy Lack of income Lack of income Legal issues Legal issues

32 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 32 On-site Services Groups Groups Gender specific trauma groups Gender specific trauma groups Women’s group on “toxic relationships” Women’s group on “toxic relationships” Dual recovery education series Dual recovery education series Life skills - practical Life skills - practical Eight 12-step groups Eight 12-step groups Literacy Literacy Fiber arts Fiber arts Alumni group Alumni group

33 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 33 On-site Services, cont. Case management Case management Medical case workers Medical case workers Obtaining entitlements (SSI, VA, FIA, insurance) Obtaining entitlements (SSI, VA, FIA, insurance) Employment Employment Soft skills Soft skills Resumes Resumes Job search Job search Housing search Housing search Community Kitchen Community Kitchen

34 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 34 Networking with agencies (on-site representatives) Dawn Farm (substance abuse) Dawn Farm (substance abuse) VA VA Food Gatherers Food Gatherers Community Supports & Treatment Services (mental health) Community Supports & Treatment Services (mental health) PORT - outreach mental health PORT - outreach mental health Michigan Rehabilitation Services Michigan Rehabilitation Services Health Services Access - county Health Services Access - county Michigan Works - county Michigan Works - county Family Independence Agency - DSS Family Independence Agency - DSS Washtenaw Literacy Washtenaw Literacy Area hospitals Area hospitals Student volunteer groups Student volunteer groups Michigan Ability Partners/Homeless Response Team Michigan Ability Partners/Homeless Response Team HIV/AIDS Resource Center HIV/AIDS Resource Center Volunteer lawyer Volunteer lawyer

35 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 35 Examples of Service Coordination Suzie Antonow, MSW, CSW, CACI Mental Health & Chemical Dependency Therapist St. Joseph Mercy Health Systems, Ann Arbor, MI

36 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 36 ST.JOSEPH MERCY HEALTH SYSTEM ACADEMIC OB/GYN CLINIC ACADEMIC OB/GYN CLINIC OUR PROGRAM PROVIDES MEDICAL CARE FOR PREGNANT WOMEN AND WOMEN WITH GYNECOLOGIC CONCERNS. OUR PROGRAM PROVIDES MEDICAL CARE FOR PREGNANT WOMEN AND WOMEN WITH GYNECOLOGIC CONCERNS. ST. JOSEPH MERCY HEALTH SYSTEM IS A TEACHING HOSPITAL. ST. JOSEPH MERCY HEALTH SYSTEM IS A TEACHING HOSPITAL.

37 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 37 SERVICES PROVIDED IN THE ACADEMIC OB/GYN CLINIC HIGH RISK OBSTETRICS HIGH RISK OBSTETRICS TEEN PREGNANCY TEEN PREGNANCY CD COUNSELING SERVICES CD COUNSELING SERVICES SOCIAL WORK SOCIAL WORK FINANCIAL COUNSELING FINANCIAL COUNSELING MATERNAL SUPPORT SERVICES MATERNAL SUPPORT SERVICES

38 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 38 C.D. THERAPIST ROLE EDUCATION, TRAINING EDUCATION, TRAINING LINKAGES WITH OTHER PARTS OF THE HOSPITAL LINKAGES WITH OTHER PARTS OF THE HOSPITAL LINKAGES IN THE COMMUNITY LINKAGES IN THE COMMUNITY

39 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 39 HOW PATIENTS ARE SCREENED, REFERRED ALL PATIENTS SEEN AT THEIR NURSE VISIT ARE INFORMED OF DRUG URINE SCREENS. ALL PATIENTS SEEN AT THEIR NURSE VISIT ARE INFORMED OF DRUG URINE SCREENS. IF A PATIENT TEST POSITIVE AND/OR REPORT A HISTORY OF DRUG USE IF A PATIENT TEST POSITIVE AND/OR REPORT A HISTORY OF DRUG USE NO PRENATAL CARE NO PRENATAL CARE

40 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 40 INITIAL CONTACT/TRIAGE RESULTS OF THE URINE TOX SCREEN RESULTS OF THE URINE TOX SCREEN BRIEF COMPREHENSIVE ASSESSMENT BRIEF COMPREHENSIVE ASSESSMENT REVIEW RISK OF ATOD ON THE FETUS REVIEW RISK OF ATOD ON THE FETUS RECOMMENDATION/ABSTINENCE RECOMMENDATION/ABSTINENCE

41 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 41 WHAT IS NEEDED SYSTEMICALLY FOR THE INTERVENTION TO WORK ANYONE WHO WORKS WITH THIS POPULATION NEEDS TRAINING ANYONE WHO WORKS WITH THIS POPULATION NEEDS TRAINING COLLABORATIONS WITHIN THE HOSPITAL(NURSES, SW,PHYSICANS) COLLABORATIONS WITHIN THE HOSPITAL(NURSES, SW,PHYSICANS) MUST BE INDIVIDUALIZED MUST BE INDIVIDUALIZED

42 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 42 REFERRALS/LINKS LINKS WITH OTHER GATEKEEPERS (HEALTH CARE ACCESS,ANN ARBOR SHELTER ASSOCIATION,HOME OF NEW VISION, ETC…) (HEALTH CARE ACCESS,ANN ARBOR SHELTER ASSOCIATION,HOME OF NEW VISION, ETC…) LINKS WITH FETAL ALCOHOL INITIATIVE. COMMUNITY GRANTS PROCESS TREATMENT PROGRAMS

43 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 43 DATA ON THE EFFECTIVENESS OF THE PROGRAM NUMBER OF WOMEN REFERRED TO TREATMENT NUMBER OF WOMEN REFERRED TO TREATMENT NUMBER OF BABIES BORN WITH NEGATIVE SCREENS AT THE TIME OF DELIVERY NUMBER OF BABIES BORN WITH NEGATIVE SCREENS AT THE TIME OF DELIVERY WHAT PRECENTAGE OF TOTAL POPULATION BEING SERVED TESTED OR REPORTED A HISTORY WHAT PRECENTAGE OF TOTAL POPULATION BEING SERVED TESTED OR REPORTED A HISTORY

44 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 44 SUMMARY REMEMBER TO EDUCATE REMEMBER TO EDUCATE HELP COORDINATE SERVICES /SUPPORT FOR HIGH WOMEN HELP COORDINATE SERVICES /SUPPORT FOR HIGH WOMEN KEEP WOMEN AND CHILDREN ON THE AGENDA KEEP WOMEN AND CHILDREN ON THE AGENDA

45 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 45 Examples of Service Coordination Julie Cushman, MSW, CAC-1 Clinical Director, Home of New Vision, Home of New Vision, Ann Arbor, MI

46 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 46 Women-Specific Services - Home of New Visions, 12/96 Structured safe environment for women recovering from chemical dependency - Includes: transitional housing (4 homes, up to 30 women, up to 10 children) outpatient services, individualized and gender- specific, through individual and group activities (about 120/year) outreach activities of various kinds dual program (for women with mental health issues) transportation and childcare

47 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 47 New Horizons,1995 component of the Family Support Network (a coalition of agencies with the mission of ending homelessness for families) Address an identified gap (the absence of women-specific treatment sensitive to homelessness and violence issues advisory group from the multi-agency network of programs concerned with homelessness, violence, and housing.

48 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 48 New Horizons, cont. Provides education, consultation, outreach, screening, assessment, brief interventions and intensive outpatient therapeutic daycare for children from 0 – 6, with after school services as well for older children transportation

49 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 49 Key Organizational Principles Team approach, non-hierarchical Former consumers co-facilitators of groups, and as liaisons with New Horizons consumers Treatment addresses more than drugs—also understanding selves, and changing lives Self-esteem, gender roles, and shame must be addressed Skill development focus

50 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 50 Women-specific treatment issues Parenting Mental health issues Other familial issues Communication issues and skills Relationships Adapting “street” skills for other situations Health and dental problems Sexual, physical, emotional & spiritual abuse Boundary Issues Financial issues (income, management) Eating disorders Employment Legal problems Housing

51 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 51 Services Coordination Issues Outreach — Recognize signs of problems with AOD (housing alliance, health care, criminal justice, mental health, consumers) Staff go where women are, make repeated contacts Respond quickly to initial contacts Women need to be “loved” into treatment (low self- esteem and shame are major barriers) Start where the woman is—comprehensive assessment, address need areas of most concern to her

52 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 52 Services Coordination Issues, cont. Resource coordination and advocacy (some internal and some external) Bring people in to provide groups (AOD training provided for their staff) When external resources don’t include AOD, we develop them internally Work with external resources to become gender and AOD sensitive

53 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 53 Issues Different philosophies Different philosophies With other AOD programs With other AOD programs With other services for women, homeless advocates With other services for women, homeless advocates Lack of knowledge Lack of knowledge About women’s needs About women’s needs AOD AOD Huge variability in response Huge variability in response Standard reimbursement criteria/procedures do not fit what women need Standard reimbursement criteria/procedures do not fit what women need

54 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 54 How to Address: Two-way street - education and exchanging occur both directions Two-way street - education and exchanging occur both directions Gather data - document what is not working to support advocacy Gather data - document what is not working to support advocacy Reframe issues to help understand impact of addiction & trauma Reframe issues to help understand impact of addiction & trauma Develop more flexible procedures Develop more flexible procedures Improvise - advocacy & support for women to maintain contact & provide services Improvise - advocacy & support for women to maintain contact & provide services

55 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 55 Tasks to Collaborate to Change Systems Planning, visioning, theorizing Planning, visioning, theorizing Creating opportunities for change Creating opportunities for change Developing & sustain resources Developing & sustain resources Creating knowledge, skills, options Creating knowledge, skills, options Facilitating & support application of knowledge & skills Facilitating & support application of knowledge & skills p 16 handout

56 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 56 Tasks to Collaborate to Change Systems, cont. Work on relationships & linkages Work on relationships & linkages Across systems Across systems Within systems Within systems Develop leadership & infrastructure for change Develop leadership & infrastructure for change Create plans and structures for change Create plans and structures for change Develop/generate & build on knowledge Develop/generate & build on knowledge p 17 handout

57 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 57 Challenges Loss of institutional memory & commitment Loss of institutional memory & commitment Staying the course Staying the course Creating long-term linkages with child welfare Creating long-term linkages with child welfare p 18 handout

58 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 58 Major Lessons Small group of line & mid-level people can make a difference Small group of line & mid-level people can make a difference Work closely with consumers to drive priorities Work closely with consumers to drive priorities Collaboration across service systems, academia and client advocates brings together different perspectives Collaboration across service systems, academia and client advocates brings together different perspectives p 18 handout

59 7/15/04Reed, Antonow, Cushman, Hillegas & Shabazz 59 OPEN FOR QUESTIONS


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