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Living Well Cross Site Evaluation

Executive Summary: Evaluation Year One

In the last two decades, the number of individuals with intellectual and 

developmental disabilities (I/DD) living in community settings and receiving 

home and community based services (HCBS) increased dramatically. While 

this led to better outcomes, including people with I/DD making more of their 

own choices and being a part of the community, there are great variations 

in the accessibility of quality HCBS across the country. To address these 

variations and the associated risks, the Administration for Community 

Living (ACL) awarded eight five-year Living Well – Model Approaches 

for Enhancing the Quality, Effectiveness and Monitoring of Home and 

Community Based Services (Living Well) grants to build and implement 

model approaches focused on two core components and eight key features to 

promote independence, integration, and inclusion in community life.

Community 

Monitoring

Community 

Capacity 

Building

Core components for enhancing and assuring the 

independence, integration, safety, health, and wellbeing of individuals living in the community

Key Features

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 and active 

engagement with selfadvocates 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, self-determination, 

and self-advocacy

Building capacity of DSPs 

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 health and 

safety with data tools

Data tools and evidence based 

practices for monitoring highrisk 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

Sustainability

Assurance of organizational, 

financial, and/or community 

stability to continue and refine 

grantee work
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Findings

Due to overlap in the grantees’ initiatives to address the key features, the 

evaluation team organized key features into three categories. These categories 

and overall themes from each category include:

Capacity Building 

• Forming new partnerships and expanding of existing partnerships.

These partnerships include various governmental and private

organizations with a wide range of specialties;

• Engaging self-advocates and family members of people with I/DD in

various ways from project leadership to specific initiative development

ensuring that all viewpoints are represented and included; and,

• Developing and implementing a range of trainings for a variety

of audiences. Examples of trainings being developed and/or

implemented include courses in professionalism for direct support

professionals (DSPs) and healthy relationships trainings for people

with I/DD.

Data Collection, Dissemination, and Monitoring 

• Diagnosing problems with current incident reporting and

community monitoring systems to identify gaps in data and barriers

to reporting. Once issues are identified, grantees are collaborating

with partners to develop new practices and systems to address

systemic shortfalls and barriers to reporting and increase the quality

of community monitoring; and,

• Assessing data collection methods and use practices to address

concerns regarding data fatigue and under-utilization of collected

data. Grantees are using the assessments to identify strategies to

efficiently use and share data between partners.

Implementation, Evaluation, and Sustainability 

• Aligning innovative and evidence-based practices with existing

practices and initiatives by building on partnerships. This includes

growing previously developed evidence-based initiatives, both from

their state and from other sources;

• Beginning to develop methods to evaluate the implementation

processes of initiatives developed under the Living Well grant.

Grantees are also beginning to evaluate the progress made toward

goals of the grant by designing evaluation methods and gathering

baseline data; and,

• Integrating grant initiatives into sustainable systems and ensuring the

availability of resources developed by the grant team.

a

Cohort 1

University of Georgia 

Institute on Human 

Development

University of New 

Hampshire Institute on 

Disability

Virginia Commonwealth 

University Partnership for 

People with Disabilities

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

Emerging Practices 

Grantees are developing and 

implementing unique and 

dvanced initiatives to address 

each of the key features of the 

Living Well grant. 
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Methodology

The Lewin Group (Lewin), as a subcontractor to New Editions 

Consulting, initiated the cross site evaluation of the eight grantees 

from cohorts one and two in 2018. Each grantee has designed one 

or more models integrating community monitoring and capacity 

building with the goal of enhancing health, safety, integration, and 

independence of individuals with I/DD living in the community. 

These models work toward:

• Enhancing the health and safety of individuals with 

I/DD;

• Strengthening the direct support professional workforce;

• Strengthening the role of self-advocacy in improving and 

assuring the quality of home and community based services;

• Increasing the coordination and capacity of States to 

effectively implement comprehensive high quality HCBS.

A set of questions focusing on quality and effectiveness, scalability and replicability, and sustainability guide the cross-site evaluation. 

These questions are listed in Exhibit 1 in Volume II of the report. 

Purposes of the 

Cross Site Evaluation

1. Analyze how the Living Well grants are being 

implemented across grantee sites;

2. Determine how Living Well grantees are meeting 

the goals of the project; and 

3. Evaluate whether the models implemented 

across the sites impact the quality of life of 

individuals with intellectual and developmental 

disabilities (I/DD).

1

2

3

Timeline of Year One Evaluation Activities
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Conclusion

The most growth and development of initiatives occurred in the Building Capacity category of key features. All grantees 

are developing and expanding partnerships, working with self-advocates and family members of individuals with 

I/DD, and developing numerous trainings for DSPs and self-advocates. Some complicating factors during the first 

evaluation year include self-reported data, varying project design and state context, and multiple cohorts. The table below 

illustrates high level key themes of activities by grantee during year one of the evaluation. 

Capacity 

Building

Partnerships

Engage new state partners

Engage specialized partners

Engagement with 

self-advocates 

and families

Reach marginalized populations

Improve supports for individuals with dual 

diagnoses and other disability types

Develop and implement trainings for 

self-advocates and families

Building 

competencies of 

DSPs and HCBS

Design and implement DSP trainings

Use technology and social media

Improve DSP recruitment and retention

Solicit DSP and provider feedback

Data Collection, 

Dissemination, 

and Monitoring

Reducing abuse 

and neglect

Use software to collect and analyze data

Monitor, certify, and improve group homes

Addressing health 

and safety Implement Medicaid waivers and statutes

Implementation, 

Evaluation, 

Sustainability

Evidence based 

practices 

for service 

improvements

Improve incident reporting system

Implement frameworks for culture change

Program and 

outcome 

evaluation

Use tools to evaluate project outcomes

Sustainability

Leverage existing grants and initiatives

Secure funding

Key Feature Activity

Cohort 1 Cohort 2 Georgia New Hampshire Virginia Alaska Idaho Indiana

Missouri

Wisconsin

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