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Working Together to Empower Community Inclusion: 

Health/Housing/Independent-Living Partnerships

August 22, 2022, | Webinar Transcript

ERICA McFADDEN: Hello everyone. We will get started in a minute; we are just 

waiting for people to fill into the room. 

Good afternoon, everyone. I think we will go ahead and get started as people are 

coming in. Welcome to the Housing and Services Resource Center’s webinar, titled 

“Working Together to Empower Community Inclusion: Health/ Housing/

Independent-Living Partnerships.” You'll be learning a lot from the presenters in a 

short amount of time. We’ve also built in a variety of opportunities for you to be 

active participants too. We really appreciate you joining us today. Next slide. 

My name is Erica McFadden, and I am the Director of the Office of Independent 

Living Programs, at the Administration on Disabilities, which is part of the 

Administration for Community Living. I will be serving as a facilitator for today's 

webinar. It really is a privilege of having so many of you here with us today. When

we saw the registration list, we were really excited. Your active involvement in the 

webinar will be essential, for us to have an engaging, enriching discussion.

There are a few housekeeping items we would like to address. The first is the 

meeting is being recorded. By staying to participate, you are consenting to the 

recording. All of the attendees have been muted for audio quality. One hallmark of 

our webinars is active participation from attendees. So please frequently use the 

chat to make comments, and submit your questions at any time in the Q&A feature 

in the Zoom dashboard. You can also email question or comment to 

HRSC@ACL.HHS.GOV.

We did reserve time to address your questions at the end as well. You can use the 

chat or email if you have a technical issue or comment for other attendees. 

Before we start with the presentations, I would like to tell you about the Housing 

and Services Resource Center, which we call HSRC. It stands for a new partnership 

between the Administration for Community Living, the Department of Health and 

Human Service agencies along with the Department of HUD. Every state and 

community has a number of entities and programs helping people access housing 

and supportive services. But the housing and services system, as we know, is often 

siloed. 
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Stronger collaboration between these systems will help more people with 

disabilities, older adults and people experiencing homelessness to achieve housing 

stability, live with dignity and independence within the community, and avoid 

homelessness and costly institutional care. 

People with disabilities or older adults can stay stably housed, healthy and active in 

their communities. The HSRC provides technical assistance across the federal 

agencies to cultivate cross-sector partnerships that bring together housing, 

homeless services, aging and disability services, and health, including physical, 

behavioral and mental and public health, an effort to address tackling these silos. 

After the webinar, I hope you will look at website. It will be on the slide. At the end, 

we will share email addresses so that you can also be in touch with us to get 

periodic updates of what we are up to. 

The HSRC serves many sectors, each with its own unique terms, policies and 

practices. Within the webinar, we will be approaching community inclusion from the 

ADA or the Americans with Disabilities Act. This far-reaching piece of civil rights 

legislation makes clear that people with all of kinds of disabilities have the same 

right as people who do not have disabilities to live, work and participate in their 

communities. Yet far too many people who can and want to live in a community

remain in institutions because there aren’t many options. That is why a critical 

focus at ACL helping people with disabilities of all ages move out of nursing homes 

and other institutions and avoid entering in the first place. 

So today I ask that we all focus on a single goal, which is community integration. 

We are going to feature partnerships and strategies that have been developed

particularly for people with mental illness but which are broadly applicable to all 

other types of disabilities. 

It is my distinct pleasure to introduce our first presenter. Both are national 

presenters that coming up next, and we will be sending out their bios tomorrow 

after the webinar so you have an idea of their expertise. The first one is Kimberly 

Reynolds, she is a Public Health Advisor and Government Project Officer for the 

Center for Mental Health Services, Substance Abuse and Mental Health Services

Administration. The next is Marti Knisley, with the Technical Assistance 

Collaborative, TAC. Why don't you just kick us off. 

KIMBERLY REYNOLDS: My name is Kim Reynolds, and I work for the Substance 

Abuse and Mental Health Services Administration, or SAMHSA, in the Center for 

Mental Health Services in the division of State and Community Systems 

Development. So SAMHSA is the agency within the U.S. Department of Health and 

Human Services that leads public health efforts to advance the behavioral health of 

the nation and to improve the lives of individuals living with mental and substance 

abuse disorders in their families. It is a privilege to be invited to speak with you 

today about the topic of community inclusion for people with disabilities including 

those with behavioral health conditions. The concept of community living is a 

central tenet of SAMHSA's vision and mission and is inherent in how we define 

recovery from behavioral health conditions. We believe all people can recover from 
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mental illness and substance abuse disorders and their recovery is a process of 

change through which individuals improve their health and wellness, live selfdirected lives, and strive to reach their full potential. 

The four major dimensions of recovery that guide us include health, overcoming 

and managing symptoms, and making informed and healthy choices. Second,

home, having a safe and stable place to live, and I will add that, in the most 

inclusive setting of a person’s choice. Third, purpose, conducting meaningful daily 

activities such as employment, school, other opportunities to participate in society, 

and fourth, community. Having relationships and social networks that provide

support, friendship, love and hope. 

SAMHSA resources support recovery in many ways. I will talk about a couple of 

examples today. First through the Protection and Advocacy for Individuals with 

Mental Illness or PAIMI program, we provide formula grants to protection and 

advocacy programs in all states as well as DC, five territories and the American 

Indian Consortium for Native Americans. PAIMI programs protect and advocate for 

the rights of those with serious mental illness or serious emotional disturbances, 

residing in public and private facilities and community settings at risk for abuse, 

neglect, and rights violations by using administrative, legal, systemic or other 

appropriate remedies on their behalf. 

They also investigate reports of abuse, including the inappropriate use of seclusion 

and restraint. They ensure the enforcement of U.S. Constitution, federal laws and 

regulations as well as state statutes. As you may know, the state of Georgia’s 

PAIMI program was instrumental in bringing the Olmstead vs. L.C. case to the 

Supreme Court. 

So we also provide formula grants to states, territories and tribes that enable them 

the flexibility to meet their unique community-based mental health and substance 

abuse prevention, treatment and recovery needs. We provide funding to behavioral 

health providers for Certified Community Behavioral Health Clinics, or CCBHCs. This 

model is designed to ensure access to comprehensive behavioral health care and is 

assisting individuals not only in navigating and coordinating their behavioral health 

services but also their physical health care, social services and other systems that 

they are involved in. CCBHCs are required to serve anyone who requests care for 

mental health or substance use regardless of their ability to pay. 

Through a variety of mechanisms, we provide funding and other resources to 

support states, territories, tribes, and behavioral health providers to develop 

comprehensive crisis systems designed to support individuals in their homes and 

communities during times they may otherwise end up in more restrictive settings. 

We provide funding, technical assistance and other resources related to housing 

and homelessness including five grant programs. The PATH, Projects for Assistance 

and Transitions Homeless programs; treatment for individuals experiencing 

homelessness; cooperative agreements to benefit homeless individuals; grants for 

the benefit of homeless individuals; and our SSI / SSDI Outreach, Access, and 
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Recovery or SOAR program. We also provide technical assistance and training 

through our national Homeless and Housing Resource Center. 

In addition, within SAMHSA we have an internal housing stability workgroup, which 

focuses on infusing housing stability as a key component and consideration over all 

SAMHSA programs given how foundational housing is to recovery and overall

health. Finally, we partner with a number of federal agencies and national 

nonprofits on related initiatives, including our recent work with the Administration

for Community Living on two new resources to address competitive and integrated 

employment for individuals with disabilities, including those with behavioral health 

conditions. Now I will turn it over to our next speaker, Marti.

MARTI KNISLEY: Thank you, Kim. I am going to briefly reiterate what Kim just 

mentioned about what is community inclusion, and why are we here today. It is 

really the opportunity for a person to live in the community of their choice, as a 

contributing member, being valued for their abilities and uniqueness and at the 

same level as a nondisabled person. We each play a role in helping individuals 

become more included in their community by building partnerships to support a 

person to create their life and be a part of the community and to create housing 

opportunities that make a house a home. 

So why does this matter? As Justice Ginsburg wrote in the Olmstead decision,

"Segregating people with disabilities really severely diminishes [their] everyday life

activities, including family relations, social contacts,” all of which you see here on 

the screen. Educational advancements, cultural enrichment. 

Clearly, institutions segregate people. Without support for those everyday life 

activities, segregation can also continue in the community. We are here today to 

talk about how to prevent that from happening. I believe I am turning it back to 

Erica. 

ERICA McFADDEN: Thank you for the great information. Now we have time to 

turn it over to our powerhouse panel. They will be sharing information about some 

best practices, potential partnerships, things that they are doing to promote 

community integration. First, we will start out by introducing Vicki Smith; she is the 

Executive Director of the Alliance of Disability Advocates, which is a Center for 

Independent Living in North Carolina. We are also going to have Ann Oshel, she's a 

Senior Vice President of Community Health and Well-being for the Alliance Health 

Plan. While both have alliance in their name, just know that they are two totally 

separate distinct organizations, okay? So we all work together in that space. 

Marti is also going to be on our panel; she's been working with both Vicki and Anna. 

We’re going to be speaking to all of them about their approach they are using, their 

funding, partnerships and more. After they are done sharing their wisdom, they will 

turn it over to you all, hearing what your questions are for the panelists. Kim is also 

going to be staying on, you can be sure to post your questions too in the Q&A 

feature. That would be within the Q&A feature. With that being said, we will turn it 

onto the panel discussion, that we will turn it over to Marti first. What is the model 
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of community integration and inclusion that you have been using to guide the 

process of transitioning individuals? 

MARTI KNISLEY: Thank you, Erica. Let me set the context for the model in North 

Carolina first. I’m the independent reviewer advising the state on meeting the 

terms of their Olmstead agreement between the U.S. Department of Justice and

North Carolina. This requires the state to offer and provide services and housing to

individuals with disabilities in the most integrated settings possible. The agreement 

followed the DOJ investigation that found that individuals with serious mental 

illness, and other disabilities and health conditions, were given few if any choices to 

live in the community. 

Instead, individuals were directed to move to and remain in congregate settings,

primarily adult care homes. Over time, this became the de facto placement option 

for thousands of individuals with serious mental illness. The state began 

implementing this agreement with the required transition process providing more 

supportive housing and supported employment and services including tenant 

support. The state knew that the support to help people move and remain in the 

community would not by itself be all the help an individual needed to live a full life 

in the community. We sought opportunities to assist individuals to make 

connections recognizing and pursuing their interest in life. Luckily the NCADA was 

also interested in assisting in the same place and reached out with the idea for a 

community living inclusion project. They knew they would need a partner 

organization, one that could help them make introductions to individuals and adopt 

the model. 

The Alliance for Behavioral Health was responsible locally for transition services, 

supported housing and supports. They also recognized the need for a partnership 

with the NCADA. So the state took the chance by providing seed money for the 

project. But make no mistake. Both the alliances have quite a bit of sweat equity in 

the project. They both knew they would need a partner and it could not come 

through, the supports could not come through, the formal system alone. The [...] of 

their success has [...]. These two partner organizations shaped the model

themselves, again, testing it out one person at a time. It works and now the state 

is wanting to take this approach statewide. 

ERICA McFADDEN: That is a fantastic model, and we appreciate you sharing that 

today. Will turn it over to Ann to share. 

ANN OSHEL: Is nice to be here today. Thank you so much for your visionary work 

and imagining this kind of conversation. I think that this is exactly this kind of 

conversation we need to be having nationally. Even as people were putting their 

names and where they are from in the chat, I saw Oregon, Seattle, LA, Philly. 

Those are all places we have been carefully watching ourselves over the last few 

years, for the innovative work that they have done along the 1115 waivers, 

especially states that have been under a similar settlement as North Carolina. So 

we all learn from each other. I think it is going to be a little weird to hear from two 

alliances that really are separate and apart. For Alliance, as a health plan, we 
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believed before we figured out the operational managed-care logistics that housing 

is health care. 

When you think about the coupling of housing and healthcare, we naively at the 

time, this was more than 10 years ago, thought, we are obligated under managedcare function, so what does it look like to have a benefit package that covers 

community living and community inclusion, supportive services? What does it look 

like to have medical necessities for these services when often their needs of 

tenancy are longer than sometimes their symptoms of whether or not they are in 

the hospital or such. 

So we have spent years to figure from an operational managed care, how do you

pay for it? What does it look like? So finally, the question that we should all get to 

is, is it making a positive difference for people? We could speak the rest of the time 

about the iterations of learning that it took. We are very comfortable in our zone of 

the typical Medicaid services, the services for people who have no insurance. North 

Carolina is not a Medicaid expansion state, where a lot of the work that Vicki, and 

Alliance and others have done together do not want to create a dichotomy of a 

system of those who have Medicaid and those who do not. 

For us it was really the realization several years ago, that said health care doesn't 

just happen within the four walls. Health care happens within the community, and 

health care is not, the outcomes of health are not, necessarily related to what 

service they receive. It is about their satisfaction of life, their inclusion in life. Erica, 

some of the things you described as community inclusion was exactly the impetus, 

of why we have persevered and stayed determined in looking at whole person care

from a managed care perspective. It really is about honoring the life that people 

want for themselves and incumbent upon us to have the money follow that person 

and follow what it looks like in community living to have full and equitable 

participation in their communities. From a health plan perspective, and managed

care perspective really, we are perfectly positioned to make all of that work come 

together in terms of how people perceive services and how people experience 

services. Go ahead; I'm sorry. 

ERICA McFADDEN: That is great. I was going to ask for all the Centers for 

Independent Living participating today, what made your health plan decide to 

partner with the CIL Alliance as an advocate, making that vision a reality?

ANN OSHEL: I can answer that in a single word: Vicki. So for us it really was the 

longest realization, this path, of what does it take? And hearing from the people 

that we have served, especially hearing from the advocates, about what matters 

the most to them. Social connectedness. Having all of the opportunities, doing the 

rights and responsibilities of tenancy in communities of their choosing. Those are 

not just lofty aspirations and theory for us, that is with Vicki's support and always 

sitting in my ear saying we have to do more. We have to get this done. That is 

exactly the kind of advocate that you want to push the system as a payer, push the 

system across all populations to really live our practice of having people not only 

transition out of institutions but living their best lives out of institutions. 
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So it really, Vicki will be way too modest to say, it wasn't me. But it was really Vicki 

and her advocacy and what the Centers for Independent Living represent to health 

plans. So that is really where it came, and it is all for us about empowerment and 

using our best practices, using what we know to create the service system that 

encompasses all of that. Not just having community life be a part of our philosophy 

but a part of our practice, part of our payment structure. 

ERICA McFADDEN: That is great. Sounds like you were saying perseverance pays 

off. Relationships are key. Which is a recurring theme across the panel. So with 

that great introduction, Vicki, is a good segue to you to share some of the 

highlights that your center, what you have done with the center to empower people 

with disabilities and transitioning from institutions, helping them remain in their 

communities. 

VICKI SMITH: I shifted my camera so I couldn’t see my mute button. I think 

Centers for Independent Living are essential to promoting community living. I saw 

as people signed up, lots and lots of folks signed up as a Center for Independent 

Living. So centers really are about moving from an institutional setting into the 

community, so it is a natural fit. This is what we are created to do. I think that this

settlement agreement does create the opportunity for centers to move into an area 

where we do not usually think about as transitioning from a facility given our 

history. What we do mostly, is that we listen to the people who are making the 

moves. 

Literally moving from one place to the other. In North Carolina we call these 

individuals consumers. We do not call them clients, we do not call them patients, 

we call them consumers. They consume our services. So one of the first things we 

do, when we get a referral from Alliance Health and other programs like them, we 

sit down and ask them, the individuals, "What you want to do in the community?" 

The goal is help them to maintain their housing but first we have to turn the house 

into a home. 

We been working with a list of things that people do in the community developed by 

Temple University, the individual named Mark Salzer, some may have heard of him

before. These are about 30-some activities that people do. That you do, I do. We sit 

down, we talk with the individual, then we just work down the list. 

We come to a first item and then we ask them, “Is that important to you? Is going 

to the library important to you?” If they say, no, then we move onto the next one. 

If they say yes, then we ask them, "Are you doing it? And are you doing it 

enough?" If it is something they want to do and not doing enough, that becomes 

our goal. What it does is it creates a connection for those individuals to the 

community. Out of that, they develop a whole list of resources and natural supports 

that make them successful. So when you have that approach, as someone who is 

doing some work on this, Mark Salzer, can say that using this approach, three out 

of four people retain their housing as a result, of finding them, connecting them to 
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the community. If we do not do that, 50% of the people returned to a facility at 

some point in time. 

So this is really, demonstrates that, finding that community, that connection, those 

natural supports, are key to successful community living. 

ERICA McFADDEN: Thank you, Vicki. It sounds like you have the perfect

ingredients for attention by using the Temple model. I know that people on this call 

today are going to be asking about the funding. It is always the big elephant in the 

room, funding. I’m going to turn this question to Ann and Vicki. Ann, I wonder if 

you could just start us out with what are the different sources of funding out there 

that can be used to support this work, especially from your health plan as an 

example?

ANN OSHEL: This is where the rubber hits the road and how do you pay for it. For 

us, for the people we serve, it is a variety of funding streams and funding sources. 

Looking within Medicaid, service definitions for those opportunities, not everybody 

wants to be in a Medicaid network. It changes your business model. How could we 

have flexible funding, for Vicki's group, who says, "Medicaid is great but I do not 

want to hire 10 account specialists each month to reconcile my billing then have 

you all live by what we authorize." 

I think there is opportunity state-by-state to look at block grant funding and 

SAMHSA funding. I think community inclusion, while it has always been a thing, it is 

becoming a thing. So we are always looking for partnerships and funding 

opportunities and those things within Medicaid and where North Carolina has made 

progress on incorporating some of this language in Medicaid service definitions. And 

we still need to take it further because the first thing that you will see in how we 

authorize services is what is their level of functioning, and their symptoms. Not all

of the really important questions that Vicki just talked about. 

We also worked with Mark. He developed a toolkit especially for us and our work on 

transitions of care. Because we haven't figured out how to pay for everything we 

want to pay for, we have hired our own team of community inclusion specialists. So 

that we can test out what are some of the interventions, what are the payments, 

then you just move into the world of Medicaid and everything has a rate. Before we 

do that, we really just wanted to see, how does this model need to evolve to doing 

it according to best practices? How do we back into a payment structure? So we're 

still working on that.

VICKI SMITH: From perspective of any nonprofit organization, we are looking for 

funding sources all the time. So we fund a very similar program for helping people 

with disabilities move out of state prisons. Using an individualized re-entry plan 

based on the activities people want to do in the community. That is funded with DD 

Council money. We also look for a lot of grants; we are constantly looking for 

private foundation funding. As well as the board does fund raising. We are out there 

trying to raise more money to expand our work. 
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ERICA McFADDEN: That is great. I have to tell you, that the people on the chat

are asking for the list of 30 activities from Temple. So we will be sending you all 

that at some point. Hopefully, with the resources after this call. You will have 

access to that, is that available? Vicki? Ann and Marti? 

MARTI KNISLEY: I saw someone put a link in the chat. 

ERICA McFADDEN: Turning it over from funding, I wanted to ask if you have been 

partnering with the Public Housing Authorities in this work? 

ANN OSHEL: Yes. We can spend hours talking about access to housing inventory. I 

think that was another quick learning for us as a health plan. That as much as we 

stood behind community living, housing choice, community choice, you can’t create 

that for people if you do not have access to housing. Even with federal protections, 

the people we serve are often discriminated or marginalized in housing and we are 

not developers, we are not property managers, we’re not landlords, we do not buy 

property. That would never be a business we are in, so we went looking for 

partners where that is what they do. We've done several million dollars in capital 

investments. I think our most impactful work is what we have done with the local 

housing authorities both in terms of creating access to the inventory that we want

as well as educating our housing authorities around the importance of housing for 

people with disabilities. 

For our three major housing authorities in the region that we serve, we all have 

Olmstead agreements with them that outline our partnership agreement in terms of

federal vouchers that they have exclusive to the people we serve. To date through 

the three housing authorities, we have over 170 vouchers exclusive to the people 

that we serve. We can negotiate tenant selection plans, reducing the barriers to 

accessing housing. Since it is a federal voucher, it honors the importance that we 

place on scattered site housing. 

So people choose where they want to live. Yes, the landlord has to accept the 

voucher. We have a whole team that does nothing but landlord outreach and 

engagement, customer service. We didn’t start with that; we started with just 

knocking on the doors of Housing Authority saying, "I know it is kind of an unusual 

relationship, but we would really like to talk to you about how we can be good 

partners." 

So out of this has grown the relationships with housing authorities, and as a result 

of that, the number of specialized vouchers for people with disabilities that have 

come into our communities has over quadrupled. We have housing authorities who 

have never applied for vouchers for people with disabilities because they couldn't 

do the supportive services, and now that is a part of our partnership agreement on 

every round of HUD vouchers that they can for people with disabilities, they are 

partnering with us and applying for that. We went from hardly any, on the same 

waiting list as everyone else, to having these exclusive vouchers in just a few 

years. With the importance of the housing authorities, adopting an Olmstead

preference as a part of their housing voucher plan. 
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So it was that symbolic victory, and it literally created the Willy Wonka Golden 

ticket that we really could give to people who are leaving wherever they are coming 

to and actually get to choose the housing that they want. That is scattered site,

which is really important to us. 

ERICA McFADDEN: Thank you, for detailing how you did that. It was one meeting 

at a time with one Housing Authority at a time to build the relationships and

advocate and educate about the need. So I appreciate you doing that and

increasing at least the access point to affordable accessible housing for our 

community. So that is wonderful. I will turn to the hardest question of the day for 

this panel. Okay? That is, you have to only give one tip to others about how they 

could replicate the work. And if you are going to give them one tip, what would it 

be? Then I will just turn to whoever wants to answer first. 

MARTI KNISLEY: I will start first. Partners have been talking, and really it is about 

trying to find the connections for these partnerships. It is true here in North 

Carolina, the impetus was how do we be successful not just in meeting the terms of 

the settlement agreement, but sustaining long-term. The housing that Ann is 

talking about will be available long after the settlement agreement is over and the

same for Vicki and her work as the state takes this work statewide. For me, I think 

it was finding the two partners, one in the formal system, one who was investing in 

housing, one who was investing in the choice of housing and, by the way, with 

great support for tenancy rights, home health, personal care services, all of that 

package people needed in putting all of that together and finding that missing 

piece. 

As Ann said, I cannot say enough about the CIL and how seriously they have taken 

the step to find that one thing, or more than one thing in some situations. If we 

have time to hear Vicki's stories it would amaze you about what is really happening 

in the community. It is unbelievable. As a reviewer I get a chance to see their work,

and I can tell you, that it is real. 

VICKI SMITH: I would love to take my time to tell one story. 

ERICA McFADDEN: We would love it. Go for it. 

VICKI SMITH: This is first person that I heard about. I retired from Disability 

Rights North Carolina, which is the P&A in North Carolina, and two months later I 

came here to be temporary while they were looking for a new executive director. I 

am still here. The first story I heard from using this connection to community 

inclusion involves a woman named Patty. Patty was at the time in her late 40s, 

early 50s. She had never lived alone before. She had always been in a situation 

where it was an abusive situation, there was a lot of substance abuse. She was in 

and out of facilities. When we first met with Patty, we asked her what she wanted 

to do. She wanted to do is to live in her house alone. But she didn't want to be 

alone. She didn't want to live with any people, but she was terrified to be alone. So 

we started talking with her, and we found out that she also had never had a pet. So 
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she decided she wanted a dog. We helped her go through the process of finding 

work, and she wanted to rescue a dog—that was really important to her. So we 

looked at animal shelters and talked to her about what she would need in order to 

care for a dog, where she would have to walk it, feed it, they would have to get 

permission from her housing provider. 

Long story short, she got a dog. She learned how to take that dog, she got a collar

and a leash, and she started walking the dog. The dog happened to be cute. Which 

was a good thing, and friendly. So she kept running into people who had dogs. 

They were walking their dogs and they would meet up to walk the dogs together. 

They would then go to a park where the dogs can play. Then they started going out 

for coffee afterwards. 

Patty, who had never had a driver's license before, eventually went on to get her 

driver’s license. We helped her practice for the test. We told her how to sign up. 

She is now going to church on a regular basis, connected to the community, and 

she is going out there in the community doing good work. That is Patty's story. She 

wanted to live alone, she had a house, but she didn't know how to make it a home. 

And that is key. 

ERICA McFADDEN: That is a great story, Vicki. It shows the importance of 

actually listening to what the individual or consumer wants as part of that 

transition. Thank you; now we understand, truly inclusion is not just sticking them 

in a house, it is beyond that. Ann, do you want to share your tips before we segue?

ANN OSHEL: That is a hard one to follow, so I had two quick things to say about 

it. That really is about being innovative. Pushing the envelope, pushing the service 

system, pushing the way it always has been done. Really thinking again beyond the 

typical healthcare delivery of what people want for themselves, what they deserve, 

what Olmstead had mandated in setting up your service system, payment system 

for that. 

Just a quick story from a health plan perspective. About eight years ago, when we 

really embarked on this for real, for real. All of that culminated into us deciding as a 

health plan that we will no longer pay for mental health group homes. That we 

created the community living options and the supportive services with the 

community inclusion toolkit, that we wanted to begin giving everyone the 

opportunity to live their lives in the community without saying, you go here and you 

go there. 

We had four gentlemen who had spent their entire adult lives living in the same 

group home. They all said yes, this sounds like a way better life that one we all 

have in the group home. Nothing against group homes, but just to Vicki's point

about asking people, we never asked people is this where you still want to be, 

would you like another life for yourself? We found them four one bedrooms in the 

same apartment complex during COVID. One gentleman, by the time he 

transitioned—for all of them, it was the first time that they signed their own lease in 

their whole lives—and for one gentleman, he was in stage IV kidney failure. His 
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community inclusion process helped him plan his end-of-life. It was powerful to 

watch this group of people, in the community that he had created outside of a 

group home, with the people he chose to accompany him through some difficult 

health decisions that he wanted for himself, which included no longer having 

dialysis, which was not an option for him as long as he was in the group home. He 

eventually passed away. 

His community inclusion team accompanied him through the whole journey. There 

are definitely all of the stories of how people have the opportunity to live their best 

lives. There is a power in community inclusion to give people the opportunity to 

make their own decisions without formal systems, bureaucratic systems forcing a 

different decision upon them. We will never do housing without community 

inclusion. It comes in the same breath. There is a lot more work to be done but for 

us, it really is about finding the great partners of Vicki, the wisdom of Marti, and all 

of our state partners to create a service system that is paid for to do this great 

work. 

ERICA McFADDEN: Thank you. That was definitely a powerhouse panel. Would 

you all agree? We really appreciate your stories and your insight today. Now it is 

your opportunity, as the audience to ask questions of the panelists. I think Kim is 

still here as well. So I'm going to actually tap to my colleague Molly French, who is 

serving as the HSRC director, to field these questions and answers because I 

cannot multitask on technology. Molly, what is our first question? 

MOLLY FRENCH: Thank you Erica. There's been so many great questions. Thank 

you all for putting them in. One of the questions was for Vicki. Ann or Marti, if they 

have also responses they can chime in, or maybe even Kim, you may have an 

additional response. It’s going into the funding question. Vicki, there are a number 

of questions where people are asking if you are still using any Medicaid funding to 

support your community inclusion work? 

VICKI SMITH: We have not to date. We are getting our funding mostly through 

partnerships and grant opportunities. We're trying to avoid a fee-for-service

reimbursement, because that would actually change the dynamic of how we 

approach the work. 

MARTI KNISLEY: I wanted to add, particularly with Kim on the phone here today,

I believe that some of the initial funding for the project did come through the 

mental health block grant. The state has...it is very interesting when you look at the 

success and the outcomes (Audio Issues) the state got the benefit. 

ERICA McFADDEN: Did anyone have any responses for that question? Okay, we 

will turn into the next question. Molly, are there any others in the queue? 

MOLLY FRENCH: There are quite a few. One of the participants asked what can be 

done so states better leverage their existing networks of Centers for Independent 

Living?
13

VICKI SMITH: I will take this one. I'm not sure I know the answer to that. I think 

part of the answer, at least in North Carolina, is early on, Centers for Independent 

Living really operated as an entity unto ourselves. Again, this is history. We didn't 

look to partners like the DD Council. Like the managed care organizations in the 

state.

I think it has to be a blended service. It would be great if we could find one big 

funder or get lots and lots of money to be able to do the work. But in North 

Carolina, we have 100 counties, and our Centers for Independent Living only cover 

half of them. Centers for Independent Living, at least in some states, ours included,

are not covering all of the counties. Until we can get the appropriation from

Congress, that is always going to create gaps. We have to get out there and talk 

about who we are and our successes. 

MARTI KNISLEY: Is it true that the state is asking you to help other centers get 

their projects off the ground? 

VICKI SMITH: Right at the moment, there are I think six or seven LME/MCOs in 

the state. Alliance Health is one. We’re working with another one, East Point, 

directly, but the state is now interested in giving money to the other local 

management entities to expand this. But even when they do that, we still wouldn't 

cover the whole state. So it is a resource. 

ERICA McFADDEN: Thank you, Vicki. So I'm curious; we have a lot of questions. 

Molly, where do you want to go next? 

MOLLY FRENCH: This is a great question we had early on for Kim. Just because 

employment can be a really integral part of that community inclusion, the 

participant was wondering what supports or assistance does SAMHSA make 

available to help people with employment? 

KIMBERLY REYNOLDS: That is a great question. I would say that one of the 

greatest resources that we provide are the mental health block grants to every 

state and territory. States then flexibly decide how they’re going to distribute that 

funding based on the needs within their own state. So supported employment is 

certainly one of those services, one of those key services that are provided using 

block grant funds. 

One of the nice things about mental health block grant funds is that while it is a 

relatively small amount of the total funding of a state on their behavioral health and 

their mental health services, it leverages, it is sort of a key lever to pull down other 

funding. So if you are interested in how supported employment is being funded in 

your state, I would encourage you to talk to your state behavioral health authority. 

ERICA McFADDEN: Thank you, Kim. Next question, Molly. 

MOLLY FRENCH: There were quite a bit in the chat and also some in the Q&A. Just 

relating to community inclusion only works if there is a place for someone to move 
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to that is affordable and accessible. So what have been some effective strategies 

that our panelists have found in terms of finding and securing that housing?

ANN OSHEL: I can start with that. At Alliance, we have over 1,400 people living in 

our supportive housing programs. A thousand of those are persons who are 

participating in the DOJ settlement. It is a struggle. It is a struggle, and there are 

many policy issues that create a hardship. 

So for us, this is where we placed a lot of our sweat equity. We knocked on the 

door of the Housing Authorities with really nothing to offer except a promise that 

we would be good partners. That we would offer supportive services, that we would 

have a point of contact at Alliance, so that if there was a tenancy issue, that they 

would have somebody to call that would always to call them back. We did a 

landlord incentive program. We do have a whole team, and I want to say a whole 

team of people is three people. So a whole team of three. People who really focus 

on our landlord engagement and recruitment. 

It is pretty competitive out there. There are the CoCs that are also looking for 

affordable housing and so for us, several years ago it became apparent to us that 

we would have to develop our own strategies to create access to inventory. And

that is how we make capital investments into acquisition rehab and tax credit

development. We have done that, and it has been a big payoff for us, as well as the 

partnerships with the housing authorities. 

So my advice is, if you're looking to start someplace, start with your housing 

authorities. They are often the largest landlords in your communities. And to 

understand the voucher system, to understand a quid pro quo. It took us a while. 

We knocked on a lot of doors before anyone talked to us, and I think it was because 

we were pesky, but it has more than paid off for us. 

MARTI KNISLEY: To add what Ann was saying, the state of North Carolina has 

also used Home 811, they encourage the application across the state and help with 

applications for mainstream funding. They have been using National Housing Trust 

Fund and setting aside units in tax credit and bond properties for people across 

disabilities. So this is not just for individuals in the settlement, but understanding 

that all people with disabilities need affordable, safe housing, and they work very 

hard on improving tenant selection so people aren’t turned down as often and 

making sure they use reasonable accommodation. They have gone a long way to 

not just say "for settlement we will pay out so much money,” because they

understand that it will end, and what you really need to do is to have a strong 

housing system. The rent issue today is a major (Audio Issues) across the country. 

ERICA McFADDEN: Thank you, Marti. I think with that I think we are going to 

have to segue to conclude the webinar today, but I have to tell you, you all had 

tons of questions and answers. That is why HSRC is here, because after this 

webinar is over, they are still there to provide information and assistance. I want to 

thank the panel. You all have proven that you’re definitely experts. You’ve shared 

some great advice, in a short amount of time, and you stuck to your time
15

allotments, so thank you, as a facilitator. I just... you also showed us what inclusion 

was. The stories are so powerful. It’s not just a house. It is supporting the person 

with a community of people that are there for them. We also heard activities we 

can act on in the couple of weeks. Just wanted to remind you all, in the coming 

days there's going to be a recording of this webinar posted, and the slides are going 

to be located on the HSRC website. I know you are asking about that. Keep using 

the website, which staff provided in the chat. 

We will go ahead and see the upcoming HSRC webinar. We have another fantastic 

webinar coming up. It is next week, it’s going to be on August 29, from 3 to 4 

Eastern Time. It’s called Developing Partnerships between Homelessness Systems

Continuum of Care and the Disability, Aging and Health Sectors. They will be 

offering that and highlighting opportunities for organizations in other service 

networks to collaborate with each other to address homelessness. If you registered

for today's webinar, we will send you the link tomorrow. Or you can use the link 

that staff are putting in the chat. 

We also recommend some other websites that may be useful in your efforts to 

support community integration, community inclusion. Staff will be putting these

web links into the chat as well. We will also email them to you, so do not worry 

about having to remember these. One is the ACL website for Care Transitions

Programs, which features innovation strategies, tools to help to transition 

individuals from institutional settings. For webinar participants who want to learn 

more about Centers for Independent Living, which we hope that you do, we have a

webpage with background and more links on this slide. 

We also recommend our Empowering Advocacy webpage, where you can learn 

about programs and help individuals advocate to make these choices and ask for 

support and services they may need to achieve community living and full 

integration and inclusion. 

One last note, our Independent Living program has background information about 

all of the different types of independent living and wellness programs available, 

even ones in your area, and that is on the slide as well. 

This is the part where we ask you to evaluate us. We will ask you to take some 

time for short feedback. The staff is putting a link in the chat. There are only five 

questions asking you to rate different aspects of the webinar. If you have other 

comments, you can provide them as well. Just know we read all the comments and 

find ways to act on the input, so is not going to be a checkbox. 

Remember, the HSRC is your resource center; it is there for you. You can email us 

at hsrc@acl.hhs.gov. If you need technical assistance or have website suggestions 

or if you want to share stories that you have or examples of great cross-sector

partnerships, we encourage you to do so. 

So finally, I just want to thank Molly and Mission Analytics’ whole team, USAging,

Jasmine, our ASL interpreter, Herman Dell our CART transcriber, for their roles in 
16

producing this webinar. It was a lot of work, but it had a lot of information, so we 

are thankful. We are especially grateful for you all for coming today, asking your

really critical questions and getting involved. We hope you join us again on future 

webinars. Thank you, and have a great afternoon.