Living Well 

Cross-Site Evaluation

Access the full annual report and other evaluation materials here.
LIVING WELL CROSS-SITE EVALUATION: INTRODUCTION 2

Volume I: Introduction

Grant Context and Purpose

Between 1998 and 2017, the number of people with intellectual and developmental disabilities 

(I/DD) living in facility settings decreased 43 percent, while the number of people in small group 

settings of four to six people increased 78 percent. During the same period, the number of 

people with I/DD living in their own home increased 144 percent, and the number of people 

living in a host or foster home increased by 148 percent.1 People with I/DD who live in home 

and community-based service (HCBS) settings are more likely than people with I/DD living in 

institutional settings to make their own choices, have friends who are not paid staff, and have 

a paid job in the community.2 Despite these positive outcomes, variations in access to and 

quality of HCBS across the country can put the well-being of people with I/DD living in their 

communities at risk. A recent series of Office of Inspector General (OIG) reports identified 

significant gaps in the reporting of and response to critical incidents in group homes.3

To address these pressing needs, the Administration for Community Living 

(ACL)4 issued Living Well-Model Approaches for Enhancing the Quality, 

Effectiveness and Monitoring of HCBS for Individuals with I/DD (Living Well) 

grants, with two key goals:

• Increase community integration and independence of individuals with I/DD; and,

• Improve the quality of HCBS.

ACL awarded eight five-year grants across two cohorts to identify, develop, and 

evaluate model approaches which address two interrelated core components 

by incorporating eight key features. ACL administers Living Well grants through 

the Projects of National Significance (PNS) program. Funded under Subtitle E 

in the Developmental Disabilities Assistance and Bill of Rights Act (DD Act), PNS create and 

enhance opportunities for people with developmental disabilities (DD) to contribute fully in all 

aspects of community life. Further, PNS support the development of national and state policies 

that promote independence, integration, and inclusion in community life.

Variations in access 

to and quality of

HCBS across the

country can put

the well-being 

of people with

I/DD living in their 

communities at risk. 

1 Larson, S.A., Eschenbacher, H.J., Anderson, L.L., Taylor, B., Pettingell, S., Hewitt, A., Sowers, M., & Bourne, M.L. (2018). In-home and 

residential long-term supports and services for persons with intellectual or developmental disabilities: Status and trends through 2016. 

Minneapolis: University of Minnesota, Research and Training Center on Community Living, Institute on Community Integration.

2 Human Services Research Institute (HSRI) and National Association of State Directors of Developmental Disabilities Services 

(NASDDDS). (2019). National Core Indicators In-Person Survey: 2017-2018 Final Report.

3 Office of Inspector General, Department of Health and Human Services. (2016). Massachusetts did not comply with federal and state 

requirements for critical incidents involving developmentally disabled Medicaid beneficiaries.

4 The Administration on Intellectual and Developmental Disabilities (AIDD) oversaw the Living Well grants when they were awarded in 2017 

and 2018. The Administration on Disabilities (AoD) now provides oversight to the grants within ACL.
LIVING WELL CROSS-SITE EVALUATION: INTRODUCTION 3

Beginning in early 2020, the COVID-19 pandemic exacerbated challenges associated with 

community living for individuals with I/DD, such as concerns about health and safety, abuse 

and neglect, and social isolation. While the COVID-19 pandemic was not anticipated when 

ACL awarded Living Well grants, the public health crisis magnified gaps in effective systems 

of community monitoring for individuals with I/DD and provided opportunities for grantees 

to rapidly respond to local and state needs. As a result of the pandemic, grantees faced 

unprecedented decision making related to their priorities, methods of engagement (e.g., inperson, virtual), and long-term sustainability plans for their grants. The increase in information 

about and access to COVID-19 vaccinations beginning in late 2020 further shifted the context in 

which grantees implemented their model approaches.

Two Core Components

Grantees address two core components through their Living Well model(s).

Community 

Monitoring

Community 

Capacity

Building

Community Monitoring:

Community Monitoring includes the

development and implementation of a

coordinated system utilizing multiple

community and state level partners for

monitoring the safety, health, and wellbeing of individuals with intellectual and

developmental disabilities living in a variety 

of community settings. The purpose of this 

component is to identify and eliminate the 

risk factors for tracking, redressing, and

preventing abuse, neglect and exploitation in 

community settings.

Community Capacity Building:

Community Capacity Building addresses 

the application of evidence based practices 

and innovative strategies focusing on 

improving services that support people with 

DD living in the community or those moving 

to the community from a more restrictive 

setting; improving access to and quality 

of community services through capacity 

building and scaling of evidence based and 

other promising practices; reducing and 

mitigating the incidence of and risk factors 

for abuse and neglect; and supporting 

empowerment, self-determination, selfadvocacy, and an individual’s independence, 

autonomy and right to live alongside their nondisabled neighbors.5

5 Living Well-Model Approaches for Enhancing the Quality, Effectiveness and Monitoring of Home and Community Based Services for 

Individuals with Developmental Disabilities; HHS-2017-ACL-AOD-DNIQ-0221. https://acl.gov/grants/living-well-model-approachesenhancing-quality-effectiveness-and-monitoring-home-and
LIVING WELL CROSS-SITE EVALUATION: INTRODUCTION 4

Eight Key Features

Grantees incorporate eight Key Features into their Living Well models.

Partnerships

Initiation and coordination of partnerships 

or coalitions with local and state-level 

organizations, agencies, and other 

relevant stakeholders, including at least 

one self-advocacy organization in the 

design, implementation, and replication 

of grantee activities;

Meaningful & active engagement 

with self-advocates and families

Continuous, meaningful, and active 

engagement of self-advocates and family 

members throughout the life cycle and in 

all stages of the project; 

Evidence based practices 

for service improvements

Use of evidence based and innovative 

strategies to: (1) improve access to and 

quality of community services, (2) reduce 

and mitigate abuse and neglect, and (3) 

support empowerment, selfdetermination, and self-advocacy; 

Building capacity of direct support 

professionals (DSP) and HCBS providers: 

Prevention-based tools and technical 

assistance to address common needs, 

such as changing the ‘culture of abuse 

and neglect’ in HCBS settings and 

transferring knowledge of positive 

behavior;

Reducing abuse and neglect through 

community monitoring: 

Collection, analysis, and dissemination 

of data to develop and implement 

coordinated community monitoring 

that builds on existing local or state 

infrastructure and partnerships;

Addressing healthy and safety 

with data tools:

Data tools and evidence based practices 

for monitoring high-risk individuals and 

addressing reoccurring issues of health 

and safety concerns;

Program and outcome evaluation:

Process and outcome evaluation to 

analyze delivery and impact of project 

activities; and,

Sustainability

Assurance of organizational, financial, 

and/or community stability to continue and 

refine grantee work.
LIVING WELL CROSS-SITE EVALUATION: INTRODUCTION 5

Grantees and Partnerships

ACL awarded grants in two cohorts, with the first cohort of three grantees beginning in September 

2017. The second cohort of five grantees began their five-year grants in September 2018.

2017: COHORT 1

University of Georgia Institute on 

Human Development

University of New Hampshire 

Institute on Disability

Virginia Commonwealth University 

Partnership for People with 

Disabilities

2018: COHORT 2

Alaska Governor’s Council on 

Disabilities and Special Education

University of Idaho Center 

on Disabilities and Human 

Development

Indiana Family and Social Services 

Administration

University of Missouri-Kansas City 

Institute for Human Development

Wisconsin Board for People with 

Developmental Disabilities

The grant requires partnerships among, at minimum:

• One Protection and Advocacy System, State Developmental Disabilities Council, or 

University Center for Excellence in Developmental Disabilities; and,

• At least one state agency (state I/DD agency, state Medicaid agency, self-advocacy 

organization, consumer-controlled organizations, or family-led organizations). Additional 

partnerships are strongly encouraged.

About this Report

Four volumes comprise this report: (I) Introduction, (II) Grantee Profiles, (III) Cross-Site Analysis 

and Conclusion, and (IV) Methodology. Volume II reports grantee-specific data, including 

grantee background, state context data, and evaluation findings and analysis. Volume III 

provides cross-site analysis and discussion, comparing and contrasting grantee models by 

core components and Key Features.

The evaluation reports from prior grant years, 2018-2020, are publicly available on the 

Administration for Community Living’s website: https://acl.gov/programs/program-evaluationsand-reports.