Pediatric Neuropsychology Fellowship Program
For over 30 years, our mission has been to train pediatric neuropsychologists to be both practitioners and scientists. As an Association of Postdoctoral Programs in Clinical Neuropsychology member program, we provide training consistent with Houston Conference Guidelines. Our program provides rigorous clinical and didactic experiences to form the basis for neuropsychology boarding and specialty certification. Although the training is predominately clinically-based, it is rooted in strong research and academic foundations. As a National Organization for Rare Disorders (NORD) designated Rare Disease Center of Excellence, pediatric neuropsychology fellows have the unique opportunity to develop expertise in the neuropsychological evaluation of rare medical conditions, including neurodegenerative disorders.
Overview
The Pediatric Neuropsychology section of the Division of Clinical Behavioral Neuroscience provides a diagnostic service for infants, children, adolescents, and young adults with complex medical conditions and associated neurodevelopmental and psychological diagnoses. Patients are referred by medical staff at this hospital as well as by clinics and practitioners in the community. We serve the community, state, five-state area, and for specific disease entities, the entire country and individuals living internationally. We provide services to patients with varying cultural, racial, ethnic, linguistic, religious, and socioeconomic backgrounds and across the gender spectrum. The clinical orientation of the faculty is developmental. Our approach to neuropsychology is to integrate knowledge from neuropsychological testing with data from neurological, imaging, neurophysiological, and laboratory studies to quantify functional deficits in the context of the central nervous system using a developmental framework. Within this context, we are able to offer our postdoctoral fellows rigorous, generalist training that prepares them for pediatric neuropsychology careers in any setting.
Clinical Experience
Evaluation Process
Case Assignments
- Fellows are assigned 3 days per week in clinic (averaging out to 2.5/week), paired each day with one of the supervising neuropsychologists.
- The supervisors then assign cases to the fellows with a goal of making sure fellows get a wide breadth of experience.
Case Preparation
- Prior to the testing day, fellows prepare their case, reviewing available medical and educational records, and completing a brief literature review of unfamiliar diagnoses.
- After the case is prepared, the fellow will staff or present the case to their case supervisor.
Day of Evaluation
- Assessments are typically completed in one day and include caregiver and patient interview, testing, and feedback. Most of the time, testing can be completed in 3-4 hours. Interviews are completed before, during or after the testing. The supervisor is on site throughout the evaluation and available as questions arise. Supervisors may spend some of the evaluation observing in the room or from behind an observation window. When the patient breaks for lunch, the fellow scores the testing and re-staffs the case with the supervisor. The supervisor and fellow jointly conduct feedback in the afternoon after the interviews and testing are completed.
After the Evaluation
- With supervisor consultation and updates, fellows are responsible for case management, including post-evaluation consultation with other providers and educators.
- Fellows complete a written report (generally around 12 pages, including tables), on which the supervisor then provides edits.
Types of Cases
All cases are seen on an outpatient basis at the Masonic Institute for the Developing Brain; some cases, however, are still undergoing active treatment or are in an acute period of recovery. All cases have a medical reason for referral. Many cases have comorbid neurodevelopmental and psychiatric disorders.
Examples of conditions seen:
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Education, Mentorship, & Training
Supervision Types
In Minnesota, fellows are required to have 2 hours of supervision per week. We provide two types of primary clinical case supervision: case-based supervision and group supervision.
Case Based Supervision
- Pre and post testing individual supervision
- Pre case supervision: Each case is assigned to a supervisor, who then assigns the case to the fellow. When possible, an attempt is made to schedule fellows with a variety of supervisors each week. This is meant to provide some breadth of supervisory contact. Most supervisors prefer to staff cases in advance. After the fellow independently prepares the case, they will staff or present the case to their case supervisor. This includes presenting the case background, possible neuropsychological profile for that medical condition, proposed differential diagnoses and tests to administer. The fellow and the supervisor will finalize the plan for the testing day.
Post case supervision: Upon completion of the assessment, fellows and the supervisor meet for immediate supervision to formulate the plan for caregiver feedback and recommendations. Extensive supervision is also provided in report edits for each patient report.
- Pre case supervision: Each case is assigned to a supervisor, who then assigns the case to the fellow. When possible, an attempt is made to schedule fellows with a variety of supervisors each week. This is meant to provide some breadth of supervisory contact. Most supervisors prefer to staff cases in advance. After the fellow independently prepares the case, they will staff or present the case to their case supervisor. This includes presenting the case background, possible neuropsychological profile for that medical condition, proposed differential diagnoses and tests to administer. The fellow and the supervisor will finalize the plan for the testing day.
- Co-clinical care
- Supervision also occurs throughout each case in the form of co-clinical care (i.e. on-the-go check-ins, direct observation of fellow-patient interactions, and modeling of clinical care). Check-ins are made throughout the case to adjust batteries and answer fellow’s questions. Some supervisors observe parts of testing, or join in on, or possibly conduct, some of the interviews. Feedbacks are also entirely co-clinical care as whether the fellow is being observed giving feedback or the supervisor is modeling giving feedback, this is considered direct supervision.
Group Supervision
- Group supervision takes place in Neuropsychology Staffing/Case Conference, occurring 2-3 times monthly. Fellows, interns, and practicum students present some of the week’s cases during this conference. These meetings take the form of a verbal case presentation and collaborative group discussion. A hypothetical – deductive approach to case conceptualization is taught during this time and fellows have many opportunities to practice case presentation, case conceptualization, hypothesis generation, and test selection.
Supervision is also provided to fellows on their supervision of other trainees. Additional supervision is provided as desired or needed by fellows. We are all eager supervisors and want fellows to reach out with questions on cases, professional development topics, report writing and hurdles, or if a fellow is just feeling overwhelmed.
Mentorship
Selection
While we all consider ourselves mentors for every trainee with whom we work, we would like fellows to have a single faculty mentor to be their “go-to” person during their fellowship. This person may be the same person with whom they want to complete a scholarly project or may be different. As fellows start their first year, they will review brief overviews from each available mentor and schedule meetings with mentors they would like to learn more about. The mentor and the fellow will jointly determine goodness of fit. Fellows and mentors are free to change mentoring arrangements at any time during the fellowship. All faculty want fellows to have the best mentor fit possible, and we realize what a fellow wants from mentorship may change across their fellowship.
Meetings
Once a pairing is decided, mentors meet with fellows 1 month after their start to discuss the Self-Assessment and Individual Training Plan/Goals, then at 6-month intervals after the initial start date thereafter. The frequency with which mentors meet with their identified fellows is otherwise decided upon by each mentor/mentee pair and will likely fluctuate throughout the fellowship.
Topics of Mentorship
Other than the required evaluation/outcomes documentation completed at 6-month intervals, the other topics discussed in the mentoring sessions should be decided on by the mentor/mentee pair. Some fellows may want to focus more on achieving specific goals (e.g., identifying a project, EPPP preparation, licensure, job search, preparing themselves for board certification, etc.) and others may desire more of a personal-professional developmental focus (e.g., work-life balance and time management, establishing a professional identity, cultivating interprofessional relationships, etc.)
Training Activities
With a total of 5 fellows, 2 interns, and 1-2 practicum students, we are a well-established training program that provides a wealth of opportunities to learn about brain-behavior relationships from a developmental standpoint. Of the array of educational opportunities listed below, approximately 2 hours per week is required of fellows:
Pediatric Neuropsychology Case Staffing Conference
Some of the week’s cases are staffed during this conference. These meetings take the form of a verbal case presentation and group discussion.
Pediatric Neuropsychology Didactics
The goal of the seminar is to discuss functional neuroanatomy and various disorders that are frequently seen in the clinic, neuroanatomy, special education law, issues of diversity and assessment, etc. Professional development topics are also discussed. Journal articles, recent research advances, and clinical cases are presented as well as didactic training in basic neuroanatomy and neuropsychological theory. The bulk of the presentations are conducted by neuropsychologists and neuropsychology post-doctoral fellows. Neuropsychology didactics will also occasionally include in-person attendance at Masonic Institute for the Developing Brain colloquia when topics are relevant to our practice.
Minnesota Neuropsychology Postdoctoral Consortium
Once a month, APPCN-member programs from across the Twin Cities join for a citywide didactic series, the Minnesota Neuropsychology Postdoctoral Consortium. These didactics cover topics and case presentations relevant for clinical neuropsychologists of all specializations in preparation for board certification. Professional development topics, including fact finding practices, occur regularly. DEI-focused sessions are offered quarterly.
Developmental Behavioral Pediatrics (DBP) and NP Joint Case Conference
This collaborative training opportunity allows one DBP fellow and one NP fellow to each present a case or topic each month for discussion by the group.
Test Conference
Occurring approximately once every few months, a range of tests are discussed by staff and students. The validity, reliability, age range, utility, and any administration/scoring concerns are presented by a trainee and discussed by the members of the group. This information is used to acquaint staff and trainees with the tests available in clinic or to assist in deciding whether to purchase new tests. Some test conferences also cover broader topics such as the process of choosing tests, or the uses and relative comparisons among measures, and differing information provided by the range of instruments (e.g., assessing language) available in the Pediatric Neuropsychology Clinic. Issues of appropriateness of assessment tools in the context of ethnic, cultural, sensory, disability, and diversity are also discussed.
Teaching
Fellows must also create and present 1 didactic per year for our pediatric neuropsychology didactics. In addition to providing learning objectives, as scientifically rigorous presentations, the didactics should use citations of peer-reviewed literature to support assertions. Paired with a second trainee, fellows also present 1 to 2 test conferences during the year.
Fellows, particularly those in their 2nd year, are expected to take on a significant supervisory role in the development of assessment skills in practicum students who are rotating through the clinic. While always working under a tiered-supervision model, fellows:
- Set goals and learning objectives
- Model new skills and test administration
- Teach administration and scoring of new measures
- Teach how to review records and staff cases
- Support student’s efficiency in testing/scoring
- Supervise the student completing caregiver and patient interviews
- Edit student reports
- Provide oral and written feedback to students
Other supervisory experiences may also occur during fellowship training. These experiences include opportunities to train new psychometrists and/or interns starting out the rotation and having medical fellows and residents observe cases in clinic to learn more about neuropsychology. Consultation/peer supervision to share knowledge and expertise with other fellows is also strongly encouraged.
Scholarly Opportunities
Scholarly Opportunities
Fellows are expected to produce a scholarly product during their two years in our program. While a number of fellows choose to participate in research, we also support those that do not have this interest. For these fellows, their projects may focus on areas such as advocacy, community engagement/partnership, or quality improvement. Fellows are also expected to present one didactic per year as part of the Pediatric Neuropsychology Didactic Series and one or two test conferences.
Research Opportunities
Current research in our division is extensive. It includes studies of children with metabolic neurodegenerative diseases, cerebral malaria, autism, attention deficit hyperactivity disorder, diabetes, genetic syndromes, prematurity, weight management, fetal alcohol spectrum disorders, leukemia, brain tumors, and psychosocial considerations (e.g., parental incarceration, foster care), as well as typically-developing populations. Studies in many of these areas include structural and functional neuroimaging as well as specialized approaches such as MR spectroscopy and diffusion tensor imaging. Additional research methods include event related potentials, behavior observation, neuropsychological assessment, and questionnaire development.
Many fellows present abstracts as posters or talks at local, regional, and national conferences. Fellows also may choose to participate in publications. Selected examples include:
- Gimbel BA, Roediger DJ, Ernst AM, Anthony ME, de Water E, Mueller BA, Rockhold MN, Schumacher MJ, Mattson SN, Jones KL, Lim KO. Delayed cortical thinning in children and adolescents with prenatal alcohol exposure. Alcoholism, Clinical and Experimental Research. 2023 May 2.
- Pierpont EI, Isaia AR, McCoy E, Brown SJ, Gupta AO, Eisengart JB. Neurocognitive and mental health impact of adrenoleukodystrophy across the lifespan: Insights for the era of newborn screening. Journal of inherited metabolic disease. 2023 Mar;46(2):174-93.
- Ernst AM, Gimbel BA, de Water E, Eckerle JK, Radke JP, Georgieff MK, Wozniak JR. Prenatal and Postnatal Choline Supplementation in Fetal Alcohol Spectrum Disorder.Foy AM, Hudock RL, Shanley R, Pierpont EI. Social behavior in RASopathies and idiopathic autism. Journal of Neurodevelopmental Disorders. 2022;14:1.’
- Kovac, V., Shapiro, E.G., Rudser, K.D., Mueller, B.A., Eisengart, J.B., Delaney, K.A., Ahmed, A., King, K.E., Yund, B.D., Cowan, M.J. and Raiman, J., 2022. Quantitative brain MRI morphology in severe and attenuated forms of mucopolysaccharidosis type I. Molecular genetics and metabolism, 135(2), pp.122-132.
- Lafavor T, Gimbel B, Olsen A, Travis A, Weber R. Relationship of parent-rated and objectively evaluated executive function to symptoms of posttraumatic stress and attention-deficit/hyperactivity disorder in homeless youth. Child Neuropsychology. 2022 Aug.
- Hampe CS, Yund BD, Orchard PJ, Lund TC, Wesley J, McIvor RS. Differences in MPS I and MPS II disease manifestations. International journal of molecular sciences. 2021 Jul 23;22(15):7888.
- McNeill AM, Hudock RL, Foy AM, Shanley R, Semrud‐Clikeman M, Pierpont ME, Berry SA, Sommer K, Moertel CL, Pierpont EI. Emotional functioning among children with neurofibromatosis type 1 or Noonan syndrome. American Journal of Medical Genetics Part A. 2019 Dec;179(12):2433-46.
Other Professional Activities and Advocacy Opportunities
Our fellows have been invited to present to other programs and family/caregiver support organizations, have participated in policy work, and have partnered with organizations to create guides and resources for families.
Dr. Jasmine Hammer and Dr. Alaa Sakallah were invited to present to pediatric medical residents and fellows at the University of Minnesota M Health Fairview.
Dr. Brianna Yund (right) at the hearings for Newborn Screening for mucopolysaccharidosis, type II.
People
Senior Fellows
Alison Riley-Schmida, PsyD, LADC
riley809@umn.edu
Dr. Riley-Schmida (she/her) received a PsyD in Counseling Psychology from Saint Mary’s University of Minnesota with an emphasis in Pediatric Neuropsychology. She also holds a license in alcohol and drug counseling (LADC). She completed her internship in Pediatric Neuropsychology at the Children’s Hospital of Michigan. Dr. Riley- Schmida's clinical interests include children with adverse childhood experiences, in-utero substance exposure, solid organ transplant, and epilepsy. Research interests include fetal alcohol spectrum disorders, substance use, and underrepresented communities. In her free time, she enjoys spending time with her children and pets, gardening, and exploring restaurants and breweries.
Jennifer Schlak, PhD
schla491@umn.edu
Dr. Jennifer Schlak received her PhD in Clinical Psychology from Southern Illinois University with an emphasis in neuropsychology. She completed her internship at the University of Minnesota. Dr. Schlak's clinical interests include working with individuals with rare genetic diseases, especially following them through pre- and post-treatments (e.g., transplant, gene therapy). Her research interests include understanding the impact of chemotherapy/radiation treatments on cognitive, behavioral, and emotional outcomes in pediatric cancer survivors. In her free time, she enjoys weight training, riding her Harley, and exploring the outdoors.
Junior Fellows
Laisa Forestier-Pérez, PhD
fores072@umn.edu
Dr. Forestier-Pérez (She/Her) is a bilingual, Latina who received her PhD in Clinical Psychology from Ponce Health Sciences University. She completed her internship at Ponce Health Sciences Internship Consortium with an emphasis in clinical neuropsychology and rehabilitation. Dr. Forestier-Pérez’s clinical interests include children and adolescents with neurodevelopmental, neurological, and genetic disorders. Her research interests include understanding the impact of medical conditions (e.g. Type 1 Diabetes, Inflammatory Bowel Disease, etc.) on cognition and emotion regulation in pediatric patients. She is passionate about further developing the inclusivity of care for Spanish speaking patients and underserved populations. In her free time, Dr. Forestier-Pérez enjoys walking with her dog Bella, exploring new restaurants, and visiting the beach in her native Puerto Rico.
Robert Kessler, PsyD, MDiv, NCSP
kessl337@umn.edu
Dr. Kessler received his PsyD in Clinical Psychology from George Fox University with an emphasis in neuropsychology. He has also earned graduate degrees in School Psychology (SSP) and Divinity (MDiv) and is a Nationally Certified School Psychologist (NCSP). He completed his internship at the University of Texas Health Science Center in Houston. Dr. Kessler’s clinical interests include epilepsy, neurosurgical evaluations, congenital heart defects (CHD), neuronal migration disorders (e.g., lissencephaly, polymicrogyria, etc.), and functional neurological symptom disorders (FNSD). His research interests include equity and accessibility to neuropsychological services and tele-neuropsychology. Outside of the clinic, Robert enjoys hiking with his wife, running, reading, archery, ancient languages, teaching, and involvement in his faith community.
Julia Jordan, PsyD
jord0323@umn.edu
Dr. Julia Jordan received her PsyD in Clinical Psychology from The Chicago School of Professional Psychology. She completed her internship in Pediatric Psychology at the University of South Florida and received her Infant Toddler Developmental Specialist certification through the Early Steps program within Florida Department of Health. Dr. Jordan’s clinical interests include working with infants and young children with complex medical conditions and rare genetic disorders, in-utero substance exposure, and organ transplants. Her research interests include autism spectrum disorder, gender identity and expression, factors impacting prenatal development, and advocacy for youth with neurodevelopmental disabilities. In her free time, she enjoys learning about food and wine, doing yoga, and snuggling with her dog, Oakley.
2022-2024
Blake Gimbel, PhD
Dr. Blake Gimbel received his PhD in Clinical Psychology from Pacific University with an emphasis in Pediatric Neuropsychology. He completed internship at the University of Minnesota Medical School. He has specific clinical interests in working with infants through young adults with a history of prenatal alcohol and other teratogen exposures, fetal alcohol spectrum disorders (FASD), prematurity, perinatal encephalopathies, and neurogenetic conditions (e.g., leukodystrophies, lysosomal storage diseases, RASopathies). Dr. Gimbel’s research interests are centered on understanding and supporting brain development in children and adolescents with FASD. He is actively involved in two ongoing NIAAA-funded studies with Dr. Jeffrey Wozniak at the University of Minnesota FASD Research Lab. These studies focus on evaluating the efficacy of novel interventions aiming to better understand and optimize brain development in youth with FASD including nutritional supplementation, neuromodulation, and advanced neuroimaging techniques. As a postdoctoral fellow, Dr. Gimbel received grant funding as a Principal Investigator to study the use of a novel web-based neuropsychological assessment tool in the clinical care of youth with FASD. Outside of his clinical and research endeavors, he enjoys participating in tiered supervision of trainees, medical and community education, and patient advocacy work. In his free time, Dr. Gimbel enjoys mindful walks by the Mississippi River and exploring the food scene in the Twin Cities.
Jasmine Hammer, PhD
Dr. Jasmine Hammer (she/her) received her PhD in School Psychology from Texas Woman's University. She completed her internship at Lewisville Independent School District (Texas). Dr. Hammer's clinical interests include genetic disorders, rare disease, and other neurodevelopmental disorders. She is passionate about policy, such as newborn screening, and educational advocacy for those with complex medical backgrounds. In her free time, Dr. Hammer enjoys spending time outdoors exploring various hiking state parks and attending sporting events.
Alaa Sakallah, PhD
Dr. Sakallah received her PhD in Clinical Psychology with an emphasis in neuropsychology from Palo Alto University. She completed her internship at The Children's Hospital of Philadelphia in the Pediatric Neuropsychology track. Dr. Sakallah's clinical interests include working with non-English speaking patients and families, training other neuropsychologists on how to use interpreters in neuropsychological evaluation, and teaching other disciplines about neuropsychology. In her free time, Dr. Sakallah enjoys hanging out with her cats, taking naps, cooking, and reading. She was born and raised in MN and returned to the state to establish her professional career. Her favorite things about Minnesota are the State Fair (a truly restricted interest!), the seasonal varieties, and the amazing people and diversity!
2021-2023
- Allison Foy, PhD
- Lauren Hindt, PhD
2020-2022
- Ashley Isaia, PhD
- Nadine Ndip, PhD
- Brianna Yund, PhD
After fellowship, our former trainees are employed as clinicians, researchers, and educators in universities, medical centers and health systems, children’s hospitals, specialty clinics/centers, private practices, and industry. Examples include:
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Joining the Fellowship Program
Requirements
- A PhD or PsyD from an APA-approved graduate program, preferably in clinical or school psychology
- Have completed an APA-approved internship with an assessment component
Salary & Benefits
- First year fellow’s salary: $61,008
- All pediatric neuropsychology postdoctoral fellows receive a standard set of benefits which includes:
- Medical and behavioral health and dental insurance
- Life insurance
- Voluntary short and long term disability insurance
- Health and dependent reimbursement accounts
- Optional retirement (403(b) and 457) plans
- 22 days vacation plus University holidays
- Paid sick leave
- Paid parental leave
- Family and medical leave
- Bereavement leave
Diversity, Equity, & Inclusion
The University of Minnesota Medical School is committed to excellence in fulfilling its mission. We uphold that an environment of inclusiveness, equal opportunity, and respect for the similarities and differences in our community fosters excellence, and that institutional diversity fuels the scholarly advancement of knowledge. An atmosphere where differences are valued leads to the training of a culturally competent healthcare workforce qualified to meet the needs of the varied populations we serve.
The Medical School, as part of the University of Minnesota, shall provide equal access to and opportunity in its programs, facilities, and employment without regard to race, color, creed, religion, national origin, gender, age, marital status, disability, public assistance status, veteran status, sexual orientation, gender identity, or gender expression.
The Medical School seeks to attain a diverse learning environment through the recruitment, enrollment, hiring, and retention/graduation of students, faculty, and staff who are underrepresented in medicine and may also be underrepresented in Minnesota.
We strive especially to have our learning community better reflect the demographics of the state by increasing the representation of African-Americans/Blacks, Hispanics/Latinos, Native Americans, Native Hawaiians/Pacific Islanders, Native Alaskans, Hmong, individuals from rural backgrounds, first generation college students, or those from economically disadvantaged backgrounds.
In Pediatric Neuropsychology, we view cultural humility as a lifelong process and integrate these principles throughout all aspects of our training programs, patient care, educational and scholarly activities, supervision and mentorship, advocacy, and personal conduct. Through these activities, we work from individual (e.g., patient, supervision) to macro systems levels (e.g., policy) to promote health equity and reduce disparities. For example, individual patient differences are central considerations throughout all aspects of neuropsychological assessment. Our Pediatric Neuropsychology program engages in various efforts to inform policy (e.g., newborn screening) and advocate for patient populations (e.g., improving access and care for individuals with rare genetic conditions).
Sample Weekly Schedule
How to Apply
Send the following to pedsneuropsych@umn.edu:
- Letter of professional goals
- Current curriculum vitae
- Two de-identified neuropsychological report samples
- Original graduate transcripts
- 3 letters of reference (preferably two clinical supervisors and one academic/research mentor)
Application deadline is Monday December 9, 2024.
We invite interested applicants to virtually meet with our current fellows to learn more about our fellowship program from their perspective. This is entirely voluntary and not required to apply to our program.
- Date: Monday 11/4
- Times: 4-5pm CST or 5:15-6:15pm CST
- Please contact our coordinator at lofgr141@umn.edu for the Zoom link.
As an APPCN-member program, we participate in the Match (Code # 9261). Interviews will be conducted virtually.
Questions?
Contact Dr. King at kingx780@umn.edu
We will also be having a fellow-led open house in November (date/time TBD) to learn more about the program from the fellows’ perspective.
Living in Minnesota
What do you like about living in Minnesota?
- The things to do
- The people
- The cost of living is much lower and commutes are shorter than in other large cities, yet you get similar amenities
- Lots of greenspace within the city limits
- The river/lakes
- The restaurants/food scene
I hear its cold there, and that it snows a lot…
In the winter, yes, the average high in the coldest month (January) is 23ºF. Good boots, gloves/mittens, a hat, and a coat are musts for the winter. However, Minnesota also experiences all 4 beautiful seasons and the average high in July is a lovely 83ºF. Perfect for an afternoon at the lake.- It does snow, with the highest average monthly snowfall (again in January) at 12.1 inches. Minnesota does an excellent job of keeping streets and public walkways clear and salted. For the coldest of days, our downtowns have elevated walkways, and the University has a system of tunnels.
- The people in Minnesota also embrace the outdoors year-round. Spending some time outside every day is not only restorative, but it helps you adjust to the temperature changes throughout the year.
My extended family lives outside the Midwest…
As a fellow, you get 22 vacation days per year, plus University holidays. Our award-winning Minneapolis-Saint Paul Airport, conveniently located to both Minneapolis and Saint Paul, has routinely ranked among North America’s best and most efficient airports and connects millions of passengers to the Twin Cities region each year.