Title VI and Title III Grantee Collaboration Study Final Report

Prepared for: Administration for Community Living 

Office for Performance and Evaluation

Submitted by: New Editions

The Lewin Group

September 28, 2020
1

Contents

Title VI and Title III Grantee Collaboration Study Final Report.................................................................................. 1

Executive Summary......................................................................................................................................................2

BACKGROUND AND STUDY OVERVIEW .................................................................................................................2

FINDINGS.................................................................................................................................................................4

CONCLUSIONS AND RECOMMENDATIONS.......................................................................................................7

Introduction..................................................................................................................................................................8

Chapter I: Overall Findings.........................................................................................................................................10

TYPES OF COLLABORATION ACTIVITIES................................................................................................................10

CULTURAL COMPETENCY AND TRIBAL SOVEREIGNTY ........................................................................................12

FACILITATORS OF COLLABORATION.....................................................................................................................13

BARRIERS TO COLLABORATION............................................................................................................................13

ORGANIZATIONAL CHALLENGES AND OPPORTUNITIES FOR GROWTH..............................................................15

ROLE OF ACL’S REGIONAL ADMINISTRATORS IN FACILITATING COLLABORATION............................................15

RECOMMENDATIONS FOR SUCCESSFUL COLLABORATION ................................................................................15

Chapter II: Case Studies..............................................................................................................................................17

CASE STUDY: Kodiak Area Native Association (KANA) and Senior Citizens of Kodiak, Inc. (SCOK) ....................18

CASE STUDY: Alu Like, Inc. and the Hawai‘i County Office of Aging (HCOA) ......................................................19

CASE STUDY: Standing Rock Sioux Tribe and North Dakota Aging Services Division (ASD) ...............................20

CASE STUDY: Wyandotte Nation and Grand Gateway Area Agency on Aging (AAA)........................................21

CASE STUDY: Nooksack Tribe and Northwest Regional Council (NWRC)............................................................22

Chapter III: Impact of COVID-19 ................................................................................................................................23

CHALLENGES .........................................................................................................................................................23

RESPONSES TO COVID-19 .....................................................................................................................................24

Conclusion and Recommendations...........................................................................................................................25

HOW DO TITLE VI AND TITLE III GRANTEES COLLABORATE?...............................................................................25

WHAT ARE BEST PRACTICES RELATED TO TITLE VI AND TITLE III GRANTEE COLLABORATION?........................26

WHAT ARE FACILITATORS AND BARRIERS RELATED TO TITLE VI AND TITLE III GRANTEE COLLABORATION?..26

Appendices.................................................................................................................................................................28

APPENDIX A: METHODOLOGY..............................................................................................................................28

APPENDIX B: SME PROTOCOL ..............................................................................................................................31

APPENDIX C: DATA COLLECTION INTERVIEWEE LISTS.........................................................................................33

APPENDIX D: PRE-VIRTUAL SITE VISIT SURVEY....................................................................................................35

APPENDIX E: TITLE VI GRANTEE INTERVIEW PROTOCOL.....................................................................................36

APPENDIX F: AAA/SERVICE INTERVIEW PROTOCOL ............................................................................................41

APPENDIX G: SUA INTERVIEW PROTOCOL...........................................................................................................46

APPENDIX H: REGIONAL ADMINISTRATOR SURVEY TEXT...................................................................................49
2

Executive Summary

BACKGROUND AND STUDY OVERVIEW

The Older Americans Act (OAA) provides funding for state aging programs in 56 states and territories, as well as more 

than 400 tribes represented by 281 tribal organizations and one Native Hawaiian organization.1 Within the OAA, there is 

language that requires coordination between Title VI grantees and AAAs/service providers with support from State Units 

on Aging (SUAs).2,3In 2018, Administration for Community Living’s (ACL) Administrator and Assistant Secretary for Aging, 

Lance Robertson, reiterated this requirement and advised SUA directors to support collaboration to meet the needs of 

tribal elders.4

While the OAA requires grantee coordination, it does not specify how grantees should work together and collaborate. As 

a result, ACL contracted with New Editions Consulting and their subcontractor, The Lewin Group (Lewin), to identify 

examples and best practices of Title VI and Title III grantee collaboration. The study addressed the following questions:

¡ How do Title VI and Title III grantees collaborate?

¡ What are best practices related to Title VI and Title III grantee collaboration?

¡ What are facilitators and barriers related to Title VI and Title III grantee collaboration?

Title VI grantees must represent federally recognized Native American tribes, Alaska Villages, or Native Hawaiian Organizations. Title VI 

grantees provide home- and community-based services such as nutrition, supportive, and caregiver services to eligible Native elders.5

Title III grantees are state and community programs on aging, such as area agencies on aging (AAAs), State Units on Aging (SUAs), and 

service providers, that provide similar services to all persons aged 60 and older.

SUAs are designated agencies located in each state that have planning and policy responsibilities and lead OAA activities.6

1 Older Americans Act. (2020, July 21). Retrieved August 13, 2020, from: https://acl.gov/about-acl/authorizing-statutes/older-americans-act

2 Compilation of Older Americans Act of 1965, as amended through P.L 116-131. (2020, July 21). Retrieved August 13, 2020 from: https://bit.ly/33LkvHz

3 Three sections relevant to grantee collaboration are: Sec. 306(a)(11) for Title III area plans, Sec. 614(a)(11) for Title VI applications, and Sec. 

307(a)(21)(A) for state plans on aging.

4 As referenced in a letter sent by Lance Robertson on March 30, 2018 to the directors of SUAs.

5 Services for Native Americans (OAA Title VI). (2020, August 12). Retrieved August 13, 2020, from http://bit.ly/30Pc11W

6 Colello, K., & Napili, A. (2020, April 22). Older Americans Act Overview and Funding. Retrieved August 13, 2020, from: 

https://crsreports.congress.gov/product/pdf/R/R43414
3

Lewin took a multi-faceted approach to 

understand the nature of Title VI and Title III 

grantee collaboration. Steps included: collecting 

background materials; conducting an 

environmental scan; creating a collaboration 

framework; conducting subject matter expert 

(SME) phone interviews; reviewing Title VI 

grantee applications; fielding a regional 

administrator (RA) online survey; holding virtual 

site visits, which included phone interviews with 

representatives from Title VI grantees and Area 

Agency on Aging (AAA)/service provider 

organizations and SUAs; and analyzing and 

summarizing common themes. A timeline of 

study activities is shown in Exhibit ES-1.

Exhibit ES-1.

STUDY TIMELINE

Based on recommendations from SME interviews

and background research, the evaluation team 

chose five case studies representative of various 

Aging Service Network contexts (e.g., singleplanning and service area [PSA] versus multiplePSA) and regions. The virtual site visit sample is 

outlined in Exhibit ES-2 below. Additional 

information on the study methodology can be 

found in Appendix A: Methodology.
4

Exhibit ES-2.

VIRTUAL SITE VISIT SAMPLE

FINDINGS

The evaluation team identified common themes across case studies and drew the majority of information from virtual 

site visits. This executive summary provides a high-level overview of the study findings. For more details on the overall 

findings, please go to Chapter I: Overall Findings of the full report.
5

TYPES OF COLLABORATION ACTIVITIES

The evaluation team adapted Kagan’s (1991)7collaboration framework to guide analysis and reporting of results. In 

general, the four levels build on each other from cooperation to service integration (from least complex and involved to 

most complex and involved); however, organizations may engage in activities in any order. This framework, along with 

examples of collaboration activities from site visit interviews is shown in Exhibit ES-3. An expanded version of the 

collaboration framework with examples of activities is found in the Types of Collaboration Activities section.

Exhibit ES-3.

SUMMARY OF COLLABORATION ACTIVITIES

7 Kagan, S. L. (1991). United We Stand: Collaboration for Child Care and Early Education Services. Teachers College Press.
6

CULTURAL COMPETENCY AND TRIBAL SOVEREIGNTY

A cornerstone issue for collaboration among Title VI grantees, AAAs/service providers, and SUAs is the presence of trust. 

Due to historical and current strains on relationships among Native groups and federal or state governments, the 

evaluation team found it important to explore trust within the context of cultural competency and tribal sovereignty 

during the initial SME interviews and subsequent conversations with case study organizations. Cultural competency 

refers to a set of practices that acknowledge and meet individuals’ cultural, social, and linguistic needs.8Tribal 

sovereignty is the inherent right of American Indians and Alaska Natives to self-govern. Many, but not all, Title VI 

grantees are federally recognized sovereign nations. In this study, three out of five of the Title VI grantees interviewed 

represented federally recognized tribal nations.9Interviewees shared the following recommendations for 

acknowledging, integrating, and respecting Native values and practices in collaborative relationships:

¡ Having an equitable approach to collaboration;

¡ Utilizing tribal liaisons;

¡ Incorporating cultural competency into organizations including practices such as holding regular staff trainings on 

cultural competency, hiring Native employees, or making an effort to learn about Native values, practices, and 

histories;

¡ Accepting feedback from the Title VI grantees and acknowledging their contributions; and,

¡ Visiting the Title VI grantee in person.

Additional details can be found in the Cultural Competency and Tribal Sovereignty section.

8 National Center for Cultural Competence, Georgetown University Center for Child and Human Development. (n.d.). NCCC: Curricula Enhancement 

Module Series. Retrieved August 11, 2020, from: https://nccc.georgetown.edu/curricula/culturalcompetence.html

9 The Wyandotte Nation, Standing Rock Sioux Tribe, and Nooksack Tribe are the three Title VI grantees in this study that are sovereign, federally 

recognized tribal nations. There are no federally recognized tribal nations in Hawai‘i; as a result, Alu Like, Inc. does not represent a sovereign nation. 

KANA serves Alaska Native beneficiaries and represents federally recognized tribes, but the organization itself is not a sovereign nation.

FACILITATORS AND BARRIERS TO COLLABORATION

Interviewees mentioned the following themes related to facilitators (i.e., activities that made collaboration easier) and 

barriers to collaboration shown in Exhibit ES-4.

Exhibit ES-4.

FACILITATORS AND BARRIERS TO COLLABORATION
7

Additional information can be found in the Facilitators of Collaboration and Barriers to Collaboration sections.

SNAPSHOT OF COVID-19 IMPACT

Interviewees noted a number of challenges in response to the pandemic, such as shortages of food and necessary 

supplies, relationship building over virtual platforms, cancelation of events, lack of social opportunities for elders served, 

and adaptations to service delivery due to safety protocols. All interviewees mentioned service changes in response to 

COVID-19, such as regular in-person meetings shifting to virtual settings and the temporary closure of congregate 

services. Other changes included more frequent meetings between organizations, implementation of drive-through 

meals, increased home-delivered meals, and provision of supplies outside of meals (e.g., shelf-stable food, hygiene 

items, and other supplies) to reduce out-of-home shopping trips.

Organizations reported using innovative strategies to support service recipients, especially with regards to social 

isolation. For example, the Wyandotte Nation held a series of drive-through Car Bingo events in a local parking lot. 

Seniors were encouraged to “dress up their cars” as part of a contest, and the Bingo game was held over a megaphone.

CONCLUSIONS AND RECOMMENDATIONS

This study was small in scale and provided initial insights into collaboration between Title VI and Title III grantees. 

Overall, the key takeaways of the study included the importance of trust in fostering relationships, and vice versa; the 

absence of trust serving as a barrier to relationships; recognition of tribal sovereignty (if applicable to the Title VI 

grantee) and Native cultures; and consideration of time needed to build lasting and collaborative relationships.

Future studies on Title VI and Title III grantee collaboration could include an expanded sample of grantees and use inperson site visits for greater rapport and opportunities for observation of grantee collaboration. Lewin anticipates that 

future case study research with larger samples of grantees across and within multiple states as well as in-person data 

collection approaches may build upon the findings of this study.
8

Introduction

Originally passed in 1965, the Older Americans Act (OAA) creates funding provisions for state support of aging adults 

through health promotion activities, senior centers, legal assistance, caregiver support, transportation, and other 

programs. Since 1965, Congress has passed multiple amendments and reauthorizations, many of which outline 

assurances for state agencies to support older adults with the greatest economic and social needs. The OAA provides 

funding for state aging programs in 56 states and territories, as well as more than 400 tribes represented by 281 tribal 

organizations and one Native Hawaiian organization.10

The original OAA language established Title III grants for state and community programs on aging, such as area agencies 

on aging (AAAs), State Units on Aging (SUAs), and service providers, that provide home- and community-based services 

such as nutrition, supportive, and caregiver services to all persons aged 60 and older. SUAs are designated agencies 

located in each state that have planning and policy responsibilities and lead OAA activities.11 In 1978, the OAA was 

amended to include Title VI grants for organizations that represent federally recognized Native American tribes, Alaska 

Villages, or Native Hawaiian Organizations. Title VI grantees provide similar nutrition, supportive, and caregiver services 

to eligible Native elders.

Funding allocations for both the Title VI and Title III grants are based upon the population aged 60 and older in their 

respective service areas; in the case of Title VI grants, this only includes American Indian, Alaska Native, and Native 

Hawaiian populations.

12,13 While funding allocations are based on the population aged 60 or older, Title VI grantees 

determine their program’s age of service eligibility and may establish age requirements below 60 years of age.14

Conversely, AAAs/service providers receiving Title III grants are restricted to an age requirement of 60 years and older.15

Within the OAA, there is language that requires coordination between Title VI and AAA/service providers with support 

from SUAs.16,17 In 2018, the Administration for Community Living’s (ACL) Administrator and Assistant Secretary for Aging, 

Lance Robertson, reiterated this requirement and advised SUA directors to support collaboration to meet the needs of 

tribal elders.18 While the OAA requires grantee coordination, it does not specify how grantees should work together and 

collaborate. As a result, ACL contracted with New Editions Consulting and their subcontractor, The Lewin Group (Lewin), 

to identify examples and best practices of Title VI and Title III grantee collaboration. The study addressed the following 

questions:

¡ How do Title VI and Title III grantees collaborate?

¡ What are best practices related to Title VI and Title III grantee collaboration?

¡ What are facilitators and barriers related to Title VI and Title III grantee collaboration?

10 Older Americans Act. (2020, July 21). Retrieved August 13, 2020, from: https://acl.gov/about-acl/authorizing-statutes/older-americans-act

11 Colello, K., & Napili, A. (2020, April 22). Older Americans Act Overview and Funding. Retrieved August 13, 2020, from: 

https://crsreports.congress.gov/product/pdf/R/R43414

12 Compilation of Older Americans Act of 1965, as amended through P.L 116-131. (2020, July 21). Retrieved August 13, 2020 from: 

https://bit.ly/33LkvHz

13 Services for Native Americans (OAA Title VI). (2020, August 12). Retrieved August 13, 2020, from: http://bit.ly/30Pc11W

14 Ibid.

15 Colello, K., & Napili, A. (2020, April 22). Older Americans Act Overview and Funding. Retrieved August 13, 2020, from: 

https://crsreports.congress.gov/product/pdf/R/R43414

16 Compilation of Older Americans Act of 1965, as amended through P.L 116-131. (2020, July 21). Retrieved August 13, 2020 from: 

https://bit.ly/33LkvHz

17 Three sections relevant to grantee collaboration are: Sec. 306(a)(11) for Title III area plans, Sec. 614(a)(11) for Title VI applications, and Sec. 

307(a)(21)(A) for state plans on aging.

18 As referenced in a letter sent by Lance Robertson on March 30, 2018 to the directors of SUAs.
9

Lewin took a multi-faceted approach to understand the nature of Title VI and Title III grantee collaboration. Steps 

included: collecting background materials; conducting an environmental scan; creating a collaboration framework; 

conducting subject matter expert (SME) phone interviews; reviewing Title VI grantee applications; fielding a regional 

administrator (RA) online survey; holding virtual site visits, which included phone interviews with representatives from 

Title VI grantees, AAAs/service providers, and SUAs; and analyzing and summarizing the common themes. Based on 

recommendations from SME interviews and background research, the evaluation team chose five case studies 

representative of various Aging Service Network contexts (e.g., single-planning and service area [PSA] versus multiplePSA) and regions (e.g., Pacific Northwest, Midwest, and non-U.S.-mainland). The virtual site visit sample is outlined in 

Exhibit 1 below.

Exhibit 1.

VIRTUAL SITE VISIT SAMPLE

Please see Chapter I for a summary of themes, the collaboration framework, and recommendations for successful 

collaboration. Summaries of the virtual site visits can be found in Chapter II. The impacts of the COVID-19 pandemic are 

discussed in Chapter III. The study methodology, the protocols, interview lists, and the text of the RA survey can be 

found in the Appendices.
10

Chapter I: Overall Findings

This chapter summarizes the overall findings of the study. Most results are derived from the virtual site visits, which 

covered topics such as: background information, including organizational challenges and opportunities for growth; 

different types of collaboration activities; facilitators and barriers to collaboration; cultural competency and tribal 

sovereignty; and recommendations for collaboration. Additionally, this section includes results from the RA survey on 

the nature of Title VI and Title III grantee collaboration in their regions, how they support collaboration, and their 

perceptions and tips related to successful collaboration. The evaluation team systematically reviewed notes from 

interviews and survey responses to determine major themes for discussion in this report.

TYPES OF COLLABORATION ACTIVITIES

The evaluation team adapted a collaboration framework established by Kagan (1991)19 with four levels:

¡ COOPERATION: Personal, informal relationships among organization staff members

¡ COORDINATION: Joint coordination of services, such as one-time programming

¡ PARTNERSHIP:

20 Formalization of organizational relationships through sharing of resources

¡ SERVICE INTEGRATION: Creation of new shared services using resources from multiple organizations

At the beginning of the evaluation, Lewin identified examples for each category drawn from peer-reviewed and gray 

literature on organizational collaboration. Lewin reflected on the framework when developing the virtual site visit 

interview protocols. During data analysis, Lewin adapted the framework to reflect activities discussed during interviews. 

The revised framework is shown in Exhibit 2. In general, the four levels build on each other from cooperation to service 

integration (from least complex and involved to most complex and involved); however, organizations may engage in 

activities in any order.

19 Kagan, S. L. (1991). United We Stand: Collaboration for Child Care and Early Education Services. Teachers College Press.

20 Kagan calls this level “collaboration,” but for the purposes of this study, we will call this level “partnership.”
11

Exhibit 2.

STUDY COLLABORATION FRAMEWORK

COOPERATION

 Referrals of clients between organizations

 Information sharing

Example activity: Alu Like, Inc. and the Hawai’i County Office of Aging (HCOA) refer clients 

to each other based on the needs of caregivers and elders as well as the services offered 

by the other organization.

COORDINATION

 One-time or occasional joint events

 Regular joint meetings

Example activities:

• Northwest Regional Council

(NWRC) hosts a booth with 

information on their services 

at Nooksack tribal functions.

• Kodiak Area Native Association (KANA) and Senior

Citizens of Kodiak (SCOK) are both part of the

Human Services Coaltion that meets quarterly to

discuss social services on Kodiak island.

PARTNERSHIP

 Shared funding

Consistent or many 

joint events

 Shared resources

 Regular advising

Example activities:

• KANA receives

supplemental Title III

funding from SCOK to

support congregate

meals and in-home

meal delivery.

• The Standing Rock Sioux Tribe and North

Dakota ASD both advise each other on a

number of topics. For instance, the director

of the Standing Rock Sioux Tribe provides

advice on Native cultural norms, while

North Dakota ASD staff provide advice on

OAA services and reporting requirements.

SERVICE

INTEGRATION

Continuous 

communication

Multiple layers of 

collaboration at the 

leadership & staff level

Development of new 

programs or services 

together

Example activities:

• The directors of the Wyandotte Nation

and Grand Gateway AAA regularly 

communicate to communicate any 

issues that arise. The director of Grand 

Gateway AAA has encouraged all of 

her staff, regardless of their level, to 

be involved in collaboration efforts. 

• Alu Like, Inc. and HCOA

worked with the state’s 

two other AAAs, the SUA, 

and the Self-Management 

Resource Center to 

develop the Healthy Aging

Partnership.
12

CULTURAL COMPETENCY AND TRIBAL SOVEREIGNTY

A cornerstone issue for collaboration among Title VI grantees, AAAs/service providers, and SUAs is the presence of trust. 

Due to historical and current strains on relationships among Native groups and federal or state governments, the 

evaluation team found it important to explore trust within the context of cultural competency and tribal sovereignty 

during the initial SME interviews and subsequent conversations with case study organizations.

Cultural competency refers to a set of practices that acknowledge and meet the cultural, social, and linguistic needs of 

service recipients.21 Tribal sovereignty is the inherent right of American Indians and Alaska Natives to self-govern. 

Sovereign nations exercise this right by developing their own forms of government, determining citizenship, establishing 

civil and criminal laws,22 taxing, licensing, and regulating, among other governing activities.23 Many, but not all, Title VI 

grantees are federally recognized sovereign nations. In this study, three out of five of the Title VI grantees interviewed 

represented federally recognized tribal nations.

In the context of Title VI and Title III grantee collaboration, it is imperative that relationships between Title VI grantees 

and state institutions, such as SUAs, reflect government-to-government relationships, when applicable, and consider the 

needs and experiences of Native elders and caregivers.

Interviewees said that they valued culturally competent practices and found it important to recognize tribal sovereignty 

(when applicable) in planning and service delivery. Interviewees shared the following recommendations for 

acknowledging, integrating, and respecting Native values and practices in collaborative relationships:

¡ Having an equitable approach to collaboration leads to genuine partnership and support of elders and tribal 

communities. A Title VI grantee shared that their relationship with their state previously felt like “oversight of the 

tribe.” The Title VI grantee addressed this issue by reiterating that the contract between their organizations states 

that the two organizations should work in collaboration, and that the relationship has since been successful.

¡ Utilizing tribal liaisonsto connect Title VI grantees with AAAs/service providers and SUAs can be beneficial to 

begin collaborations with a foundation of trust.

¡ Incorporating cultural competency practices into organizations,such as holding regular staff trainings on cultural 

competency, hiring Native employees, or making an effort to learn about Native values, practices, and histories. 

Title VI grantees shared that the responsibility to educate on cultural norms and practices is often placed on their 

organizations.

¡ Accepting feedback from the Title VI grantees and acknowledging their contributions are important. For 

example, the SUA of a single-PSA state made it a practice to ask Title VI grantees what they needed, rather than 

providing them designated funds without first understanding their needs. Additionally, a Title VI grantee shared 

that they are consistently acknowledged by their AAA partner because the organization repeatedly uses language 

stating, “The AAA and the tribe...”

¡ Visiting the Title VI grantee in person to form face-to-face relationships is beneficial. One Title VI grantee shared 

an experience of being required to travel hours away on short notice to attend a meeting at the request of a state 

agency. The interviewee said that, per their tribal practices, the party making the request should be the one 

responsible for traveling.

“We continue building trust by being there for each other, continuing with the same idea [referring to shared events], 

listening to each other, and knowing that not one person has the only right answer.”

21 National Center for Cultural Competence, Georgetown University Center for Child and Human Development. (n.d.). NCCC: Curricula Enhancement 

Module Series. Retrieved August 11, 2020, from: https://nccc.georgetown.edu/curricula/culturalcompetence.html

22 The extent of this varies by area due to state and federal legislation that may restrict criminal jurisdiction over non-Native individuals.

23 National Congress of American Indians. (2020). Tribal Nations and the United States: An Introduction. Retrieved August 1, 2020 from: 

http://www.ncai.org/tribalnations/introduction/Indian_Country_101_Updated_February_2019.pdf
13

FACILITATORS OF COLLABORATION

Interviewees mentioned the following themes related to facilitators of collaboration (i.e., activities that made 

collaboration easier).

¡ Consistent and open communication was a recurring theme and regular practice of grantees that collaborated 

successfully together. Many grantees have regular weekly, biweekly, or monthly standing meetings. Some 

grantees with long-standing relationships described continuous, open communication. Meetings between 

grantees occur over the phone and in person, and grantees indicated the importance of having face-to-face 

discussions at least annually. Meetings serve as an opportunity to discuss updates and successes, as well as 

brainstorm solutions for current challenges.

¡ Shared visions, aligned goals, and flexibility were reported as important by grantees.

¡ A “champion” or liaison that serves a consistent point of contact creates deeper trust and streamlines the process 

of answering questions. 

¡ Cultural respect and awareness was important to all grantees. Beneficial practices included: providing cultural 

competency trainings to employees, asking for feedback from the Title VI grantee related to cultural competency, 

taking time to listen to different perspectives and needs, having tribal liaison positions through the AAA, service 

provider, and/or SUA, and including language about tribal sovereignty in state and organizational policies.

¡ Inclusion of a representative from the Title VI grantee organization on governing or advisory boards of the 

AAA/provider agency and/or SUA was reported as being particularly important. Not only was this described as 

providing an opportunity for Native concerns to be heard, but it also aids trust building and allows for more 

frequent communication.

¡ Support from the SUA is integral to Title VI grantee and AAA/provider agency collaboration success. This support 

can look different from state to state. Generally speaking, grantees reported that SUAs share lists of grantees, 

make introductions, host regular meetings, and help resolve conflicts among grantees.

¡ Pre-existing relationships can contribute to successful, long-term collaborations. Many interviewees noted that 

collaboration existed before they started their positions. In these cases, collaboration tend to occur naturally and 

without intentional effort due to routine communication practices and a strong foundation of trust between 

organizations.

“Everyone wants the same thing; [elders] living well and independently in their communities as long as possible.”

BARRIERS TO COLLABORATION

¡ Staff turnover and limited staffing was cited as a barrier to collaboration. Staff turnover exacerbates obstacles in 

relationship building. With new staff, roles and processes must be re-explained and changing relationship 

dynamics can hinder successful collaboration. Additionally, grantees noted that staff are often very busy and 

organizations may not have a designated employee who focuses on collaboration and communication efforts.

¡ Misaligned visions contributed to collaboration struggles. Grantees stressed the importance of Title VI grantees, 

AAAs/service providers, and SUAs having similar visions and adequate transparency when communicating and 

planning. 
14

¡ Varying reporting requirements across Title VI and Title III programs posed challenges for grantees. One Title VI 

grantee shared that reporting differences for supplemental meal funding (e.g., more frequent required reporting) 

requires substantial additional administrative responsibilities with inadequate funding and staff support. An 

additional reporting difference mentioned was age discrepancies for service eligibility between Title VI and Title III 

programs.24 Lastly, a Title VI grantee shared an experience of being required to report certain data to their Title III 

organization, but only one staff member having access to the database, making the process tedious and 

challenging.

¡ Miscommunication or lack of communication can be detrimental to collaboration efforts. Grantees said that 

consistent and clear communication is integral to success.

¡ Lack of information increased challenges to successful collaboration. One Title VI grantee shared an experience of 

being newer in their role and not knowing the local AAA/service provider, the services and activities available, or 

policies related to Title III funding. Another grantee shared an experience of onboarding to their position but not 

receiving invites to meetings between organizations, which accidentally prevented collaboration from occurring.

¡ Rural geography contributes to increased challenges for some grantees. In rural locations, grantees reported that 

services are not as readily available, there are unique challenges specific to that location, and in-person meetings 

may not be accessible. A grantee shared that there may not be as much contact with or knowledge of formal 

services in rural areas.

¡ Pre-existing relationships that were not successful can become a hindrance to current and future relationships of 

grantees. Previous negative interactions can slow down the process of rebuilding relationships.

The evaluation team asked RAs about barriers to collaboration faced by Title VI and Title III grantees. Their responses 

were in alignment with the barriers reported from the interviews with Title VI grantees, AAAs/provider agencies, and 

SUAs. In summary, barriers reported including the following:

¡ Lack of understanding of the OAA collaboration requirement and activities that may encompass collaboration; 

¡ Resource limitations, such as insufficient time for staff to devote to collaboration efforts and limited funding; and 

¡ Lack of trust and cultural competency.

“It’s takes time and showing up and continued efforts. If something isn’t successful, don’t give up and say it didn’t work.”

 

24 While the age requirement for Title III services is set at 60, Title VI grantees can set the age of service eligibility. Many grantees have established age 

requirements to be between 50 and 60 years of age.
15

ORGANIZATIONAL CHALLENGES AND OPPORTUNITIES FOR GROWTH

To better understand the context of interviewee organizations, the evaluation team also asked questions related to 

perceived organizational challenges and opportunities for growth. Common organizational challenges mirrored the 

perceived challenges to collaboration with other grantees and included:

· Funding shortages that hinder meeting the full needs of all elders and caregivers;

· Rural landscape of grantees’ service area associated with challenges in transportation, access to essential items, lack of 

broadband access, and high costs of living;

· OAA grant reporting requirements and administrative burden, particularly with requirements associated with the 

Title III program;

· Turnover leading to a lack of service continuity; and 

· The necessity for cultural sensitivity to meet the diverse needs and backgrounds of elders and an understanding that 

elders may not have experience with or trust of governmental services.

In response to opportunities for growth, many interviewees discussed ways to better support their service clients. Examples 

included expansion of phone or virtual platforms to administer activities,25 increased tribal housing and long-term care 

supports, and increased socialization opportunities.

25 This is related to, but not exclusive to, programming changes as a result of COVID-19.

ROLE OF ACL’S REGIONAL ADMINISTRATORS IN FACILITATING COLLABORATION 

All of the RAs reported directly supporting grantee collaboration in their region, but only five of the seven RAs reported 

knowing of successful Title VI and Title III collaboration occurring in their region. The following were the most common 

ways RAs reported facilitating collaboration for grantees in their region:

¡ Providing technical assistance (TA) and supporting development of state plans on aging, area plans, and Title VI 

grant applications;

¡ Supporting new Title VI grantee, AAA/service provider, and SUA staff, such as introducing new staff members 

and offering personalized orientation sessions to incoming directors to thoroughly explain the relationships and 

expectations of the role;

¡ Promoting state and tribal initiatives to inform grantees about services and events; and

¡ Supporting SUA staff in awareness of collaboration requirements and of concerns and needs of Title VI grantees.

RECOMMENDATIONS FOR SUCCESSFUL COLLABORATION

Interviewees offered the following recommendations for Title VI grantees, AAAs/service providers, and SUAs, to create 

and maintain successful collaborations (Exhibit 3).

 
16

FIND LOCAL GRANTEES FOR COLLABORATION

See the Older Indians 

website for a list of Title 

VI Directors or the Aging, 

Independence, and Disability 

(AGID) map for information 

on grantee organizations.

State Units on Aging (SUAs) 

can consider distributing 

lists of grantees.

Introduce yourself and get 

to know the grantees.

TITLE VI

GRANTEE

AAA/

SERVICE

PROVIDER

SUA

UNDERSTAND THE POLICIES AND 

REQUIREMENTS AROUND COLLABORATION

Check out the Older Americans Act or 

state-specific information.

TITLE VI

GRANTEE

AAA/

SERVICE

PROVIDER

SUA

INCORPORATE CULTURAL COMPETENCY PRACTICES 

INTO ORGANIZATIONS

 Practice cultural competency.

 Recognize tribal sovereignty.

 Practice diverse hiring.

AAA/

SERVICE

PROVIDER

SUA

HAVE A CONSISTENT POINT OF CONTACT 

TO STREAMLINE COMMUNICATION

TITLE VI

GRANTEE

AAA/

SERVICE

PROVIDER

SUA

HAVE STANDING CHECK-IN MEETINGS

Meetings can be helpful to brainstorm 

solutions or work on events together.

TITLE VI

GRANTEE

AAA/

SERVICE

PROVIDER

INCLUDE TITLE VI GRANTEE STAFF 

REPRESENTATIVES AND/OR TITLE VI 

SERVICE RECIPIENTS ON POLICY AND 

ADVISORY BOARDS

AAA/

SERVICE

PROVIDER

SUA

REGULARLY SHARE ORGANIZATIONAL

GOALS AND PLANS WITH EACH OTHER

TITLE VI

GRANTEE

AAA/

SERVICE

PROVIDER

REACH OUT FOR HELP

SUAs, Regional Administrators, and grantees 

can all support collaboration.

TITLE VI

GRANTEE

AAA/

SERVICE

PROVIDER

SUA

DON’T GIVE UP! 

Remember that collaboration can take time.

TITLE VI

GRANTEE

AAA/

SERVICE

PROVIDER

SUA

Exhibit 3.

RECOMMENDATIONS FOR SUCCESSFUL COLLABORATION
17

Chapter II: Case Studies

This chapter summarizes each of the five case studies and includes background and contact information, collaboration 

details, successes, challenges, and recommendations.
 

	 	 	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	 	

 

  

  

Administration for Community Living (ACL) Title VI and Title III Grantee Collaboration Study

CASE STUDY: Kodiak Area Native Association (KANA) and 

Senior Citizens of Kodiak, Inc. (SCOK)

BACKGROUND OF COLLABORATION

KANA and SCOK first established a formal contract in 2003.

Before the contract started, SCOK collaborated with KANA

through providing referrals and ensuring services for Native

elders when they were in the city of Kodiak, Alaska.

The Older Americans Act (OAA) provides 

funding provisions for state support of 

aging adults, and requires collaboration 

between Title VI and Title III grantees. 

This ACL study aims to summarize best 

practices among five case studies.

FUNDING

One of the primary ways that KANA collaborates with SCOK is through a formal contract

for supplemental meal funding. SCOK provides Title III funding for KANA’s congregate and

home-delivered meal services to outlying villages year round.

MEETINGS

KANA and SCOK participate in quarterly Human Services Coalition meetings, which have been very

meaningful and helpful in sharing information and updates, brainstorming solutions, and reducing

service duplication. KANA started coordinating quarterly Human Services Coalition meetings over 10

years ago due to a grant. The organizations primarily communicate through the coalition meetings,

but there are ad hoc communications on grant writing, contract renewal, referrals, and questions.

EVENTS

KANA and SCOK invite each other to attend health fairs and trainings that they host.

SUCCESSES, CHALLENGES, AND RECOMMENDATIONS

KANA faces a number of challenges related to the 

supplemental meal funding collaboration because of 

reporting differences for Title VI and Title III funding. 

This results in additional administrative responsibilities 

for KANA in distributing annual applications to elders, 

sending reminders for application completion, 

identifying Title VI and Title III eligibility, and tracking 

meals based on elder funding eligibility. 

Staff turnover and miscommunication can be 

obstacles to relationship building.

For successful collaboration, the Title VI, AAA/service 

provider, and State Unit on Aging (SUA) administrators 

need to be on the same page with their objectives, 

outcomes, and strategies. Consistent and open 

communication is also very important.

“I would advise [to AAAs, service providers, and SUAs] that it is more of a two-way street and [the

organizations] own the collaboration and communication of services equally.”

Title VI Grantee: KANA

Contact: Greg Zadina, Director

of Community Services

greg.zadina@kodiakhealthcare.org

907-486-9820

Service Provider: SCOK

Contact: Pat Branson, Executive Director

scokinc@ak.net

907-486-6181

SUA:

AK Senior and Disability Services (SDS)

18
 

	 	 	 	 	 	 	 	 	 	 	 	

 

  

 

Administration for Community Living (ACL) Title VI and Title III Grantee Collaboration Study

CASE STUDY: Alu Like, Inc. and the Hawai‘i 

County Office of Aging (HCOA)

BACKGROUND OF COLLABORATION

Alu 

enhancing the lives of Native Hawaiians. Alu Like, Inc. and HCOA

have had a longstanding and successful relationship for over 10

years. A centerpiece of their collaborative efforts is the Healthy Aging

Partnership, which is a series of evidence-based disease prevention

programs for elders in Hawai‘i.

Like, Inc. is a non-profit social service agency that focuses on

The Older Americans Act (OAA) 

provides funding provisions for 

state support of aging adults, 

and requires collaboration 

between Title VI and Title III 

grantees. This ACL study aims 

to summarize best practices 

among five case studies.

MEETINGS

Alu Like, Inc. and HCOA have meetings over the phone every two to four weeks to discuss

updates, short- and long-term plans, and organizational visions. Additionally, despite being on

different islands, they try to meet in person at least once annually.

EVENTS AND SERVICE DELIVERY

The two organizations routinely attend each other’s events and host workshops on various topics

together, such as health promotion. For the Healthy Aging Partnership, Alu Like, Inc. provides the

trainers and curriculum, and HCOA provides the training materials and meeting space as well as

occasionally covers travel for Alu Like, Inc. trainers.

REFERRALS

Alu Like, Inc. and HCOA regularly refer elders to each other and work together to ensure that

elders receive the services needed. 

SUCCESSES, CHALLENGES, AND RECOMMENDATIONS

Representatives from both organizations reported 

that their collaborative relationship comes naturally 

and is built on a history of trust. Mutual respect 

helps the organizations solve problems together.

The Aging Program planner for HCOA recommended 

being open and willing to share knowledge, 

and providing everyone a fair platform to express 

their needs in order to have a successful and 

collaborative relationship.

“The collaboration is something I believe in so much that I’m willing to go above and beyond to ensure

collaboration continues even if funding is limited. I will do the extra work to keep the flame burning

and providing services to people who so desperately need it.”

Title VI Grantee:

Alu Like, Inc.

Contact: Leslie Tanoue, Title VI Director

letanoue@alulike.org

808-535-6725

Area Agency on Aging (AAA):

Hawai‘i County Office of Aging

Contact: Keola Kenoi-Okajima,

Aging Program Planner

mary.hcoa@hawaiiantel.net | 808-961-8340

State Unit on Aging (SUA):

HI Executive Office on Aging (EOA)

19
 

  

 

Administration for Community Living (ACL) Title VI and Title III Grantee Collaboration Study

CASE STUDY: Standing Rock Sioux Tribe and 

North Dakota Aging Services Division (ASD)

BACKGROUND OF COLLABORATION

The Standing Rock Sioux Tribe spans both North Dakota and South

Dakota. North Dakota does not have any Area Agencies on Aging (AAAs).

The North Dakota ASD is the designated State Unit on Aging (SUA).

Standing Rock Sioux Tribe and the North Dakota ASD have a formal

contract and routinely share data and information regarding information,

trainings, and lists of elders and caregivers who receive Title III services.

The two organizations have been working together for over 20 years.

The Older Americans Act (OAA) 

provides funding provisions for 

state support of aging adults, 

and requires collaboration 

between Title VI and Title III 

grantees. This ACL study aims 

to summarize best practices 

among five case studies.

ADVISING AND SUPPORTING

Through North Dakota ASD’s assessment related to Title III funding, the Standing Rock Sioux Tribe

learned that they faced challenges in keeping delivered foods in the temperature “safe zones” due

to limited delivery staff and a large delivery area. The North Dakota ASD purchased temperaturecontrolled delivery containers and sent them directly to the tribe to help them meet this need.

FUNDING

Standing Rock Sioux Tribe receives Title III funding from the North Dakota ASD and from the

South Dakota SUA.

MEETINGS

Standing Rock Sioux Tribe and North Dakota ASD have standing weekly virtual check-in meetings

to discuss areas that are going well and areas where they could use support. Additionally, North

Dakota ASD is willing to travel to the reservation for meetings with Standing Rock Sioux Tribe.

SUCCESSES, CHALLENGES, AND RECOMMENDATIONS

Standing Rock Sioux Tribe successfully uses 

collaboration with the North Dakota ASD as an 

opportunity to build in quality assurance and 

quality improvement. Through their collaboration, 

the organizations identify new needs. For Standing 

Rock Sioux Tribe, working with the Title III program 

provides added accountability. 

North Dakota ASD has been receptive to prioritizing and 

learning about the cultural norms of Standing Rock Sioux 

Tribe, which improves their cultural competency and 

allows their collaboration to be more successful. An elder 

from Standing Rock Sioux Tribes sits on North Dakota 

ASD’s Committee on Aging. This inclusion also helps 

ensure tribal needs are addressed at the state level.

“The Title VI and Title III [AAA/service provider/SUA] administrators need to be on the same page with

their objectives, outcomes, and strategies. Consistent and open communication is also very important.”

Title VI Grantee: Standing Rock Sioux Tribe

Contact: Petra Harmon One Hawk,

Title VI Director

pharmononehawk@standingrock.org

701-854-3846

SUA: ND ASD

Contact: Nancy Nikolas-Maier,

Aging Services Director

nmaier@nd.gov

701-328-4607 20
 

 

 

  

Administration for Community Living (ACL) Title VI and Title III Grantee Collaboration Study

CASE STUDY: Wyandotte Nation and Grand Gateway 

Area Agency on Aging (AAA)

BACKGROUND OF COLLABORATION

The Wyandotte Nation and Grand Gateway AAA have

collaborated for over 30 years. The collaboration started

before either of the current directors were in their roles.

Currently, the two organizations do not have a formal contract.

The Older Americans Act (OAA) provides 

funding provisions for state support of 

aging adults, and requires collaboration 

between Title VI and Title III grantees. 

This ACL study aims to summarize best 

practices among five case studies.

MEETINGS

Both organizations are members of the Caregiver Coalition that formed in 2000. Other members include

additional tribes in the Northeast Oklahoma region and various area social service agencies. Through

the Caregiver Coalition, the two organizations plan two annual health fairs and a picnic where elders,

caregivers, and community members can socialize and learn about available services.

TRANSIT SERVICES

Since 2011, Wyandotte Nation, Grand Gateway AAA, and other tribes have coordinated tribal transit

through the Pelivan, which is a local bus service that provides free transit to all tribal citizens with a

Certificate of Degree of Indian Blood.

REGULAR COMMUNICATION

The director and staff of the two organizations communicate regularly through e-mail, coalition

meetings (previously in-person and now over Zoom), phone calls, text messages, and Facebook.

ADVISORY COUNCIL PARTICIPATION REFERRALS

The current Title VI Director has been a The Wyandotte Nation and Grand Gateway member of the Grand Gateway AAA Advisory AAA regularly refer clients to each other. 

Council on Aging since 1992.

SUCCESSES, CHALLENGES, AND RECOMMENDATIONS

It was noted that Grand Gateway AAA 

has a strong understanding of tribal 

sovereignty through their consistent 

acknowledgment and consideration of 

the tribes while making decisions. 

The long-standing and supportive relationships between the two 

directors and the organizations contributes to a high level of trust 

underpinning collaboration activities. For example, all Grand Gateway 

AAA staff members are encouraged to be active in collaboration 

efforts with Title VI grantees, regardless of their staff level.

“When I’m doing a PowerPoint at the national level, such as the National Title VI training, I tell them

‘Don’t wait for the AAA to call you. You call them! They can help you and you can help them. It works

great.’ They don’t know what they’re missing if they’re not coordinating with their local AAA.”

Title VI Grantee:

Wyandotte Nation

Contact: Brenda House, Title VI Director

bhouse@wyandotte-nation.org

918-678-6327

Area Agency on Aging (AAA):

Grand Gateway AAA

Contact: Staci Pierce, AAA Director

spierce@grandgateway.org

800-482-4594

State Unit on Aging (SUA):

OK Aging Services Division (ASD)

21
 

 

  

Administration for Community Living (ACL) Title VI and Title III Grantee Collaboration Study

CASE STUDY: Nooksack Tribe and Northwest Regional Council (NWRC)

BACKGROUND OF COLLABORATION

Since 1994, Nooksack Tribe has been one of six tribes that partner

with NWRC’s Tribal Outreach & Assistance Program. Currently, the two

organizations do not have a formal contract. In the state of Washington,

the 1989 Centennial Accord requires all state programs develop a

government-to-government relationship with tribes. This includes the

7.01 Policy and Plan that requires each AAA to develop and collaborate

on an annual plan with individual tribes.

The Older Americans Act (OAA) 

provides funding provisions for 

state support of aging adults, 

and requires collaboration 

between Title VI and Title III 

grantees. This ACL study aims 

to summarize best practices 

among five case studies.

MEETINGS

The Nooksack Tribe and NWRC participate in monthly Task Force meetings to discuss approaches

to supporting elders outside of medical services. Participants include Nooksack Tribe social services

staff (which encompasses Title VI services), NWRC, health professionals, and other area social service

agencies. In addition to the monthly Task Force meetings, NWRC recently invited the Title VI Director

to a meeting with other tribal leaders and the local hospital to discuss tribal norms in medical settings.

EVENTS

Prior to COVID-19, NWRC hosted booths at Nooksack functions, such as health and housing fairs.

REGULAR COMMUNICATION REFERRALS

The Title VI Director and NWRC staff

communicate regularly when questions or

issues arise. The Title VI Director noted that

NWRC staff were very helpful in supporting

her transition into the director role. 

The Nooksack Tribe and NWRC

refer elders and caregivers to 

each other if their organization

is not able to meet that

individual’s needs.

SUCCESSES, CHALLENGES, AND RECOMMENDATIONS

The two organizations have built trust together as a result of monthly Task Force meeting discussions of sensitive 

and pressing issues. For example, during one of the Task Force meetings, the group discussed a Nooksack elder 

who was reluctant to pay for services provided by NWRC. The Title VI director noticed his unfamiliarity with NWRC 

and recommended that a Nooksack tribal staff member explain the process to him. The elder trusted this individual 

and eventually understood the need and expense for services. This anecdote highlighted the importance of cultural 

competency through openness and receptiveness from non-Native staff and organizations towards issues that concern 

Native service recipients. “It’s important to let us lead sometimes and then they follow. As long as we can open the 

door, the tribal member is more willing to let someone in,” stated the Title VI director.

“It’s good for programs to reach out to each other. Find out what is successful at other programs. From

my experience, programs are always willing to share what they’re doing, what’s working, and what’s

not working. This has been helpful for not only Title VI, but also my other programs.”

Title VI Grantee:

Nooksack Tribe

Contact: Heidi Davis, Title VI Director

hdavis@nooksack-nsn.gov

360-592-5176 ext. 3423

Area Agency on Aging (AAA):

Northwest Regional Council (NWRC)

State Unit on Aging (SUA):

WA Aging and Long-Term Support

Administration (ALTSA)

22
23

Chapter III: Impact of COVID-19

Both older adults and individuals of Native heritage are high-risk groups for COVID-19, based on preliminary studies.26,27

Particularly for the latter group, increased risk of COVID-19 is associated with underlying disparities in health, social, and 

economic factors. This may be exacerbated by a lack of access to health insurance, medical care, and broadband 

internet for those living in tribal areas. Due to interest at ACL, the evaluation team asked additional questions during 

interviews about organizational responses to COVID-19 and potential impact on Title VI and Title III grantee 

collaboration. This chapter describes themes identified.

CHALLENGES

Interviewees noted challenges in responding to COVID-19, including but not limited to:

¡ Supply line shortages for food and necessary supplies were obstacles particularly at the onset of COVID-19. For 

example, Standing Rock Sioux Tribe described challenges in local supply chains, payment policies, and tribal 

purchase approval that hindered the Title VI program’s access to food for meals as well as personal protective 

equipment for employees.

¡ Relationship building on virtual platforms presented challenges when relationships had been historically inperson. For example, North Dakota ASD reported difficulties in supporting local service providers, as relationships 

have been very dependent on in-person interactions.

¡ Event cancelation occurred to meet social distancing requirements and maintain safety. The Wyandotte Nation 

and Grand Gateway AAA cancelled annual informational and social events for elders and caregivers. Alu Like, Inc. 

cancelled their Healthy Aging T-trainer series (T-trainers are certified trainers of trainers) where they had 

anticipated sharing skills with the state’s four AAAs, SUA, and other social services leaders around the state.

¡ A lack of social opportunities for elders has led to social isolation. Multiple interviewees noted that many elders 

are facing social isolation due to public health guidelines.

¡ Service delivery adaptations to ensure safety and compliance with public health guidance results, at times, in 

challenges. For example, interviewees reported being short-staffed due to employees being from high-risk groups. 

Additionally, due to safety guidance, grantees had to shut down congregate service settings.

26 Older Adults and COVID-19. (2020, July 30). Retrieved August 13, 2020, from: https://www.cdc.gov/coronavirus/2019-ncov/need-extraprecautions/older-adults.html

27 Artiga, S., & Orgera, K. (2020, May 14). COVID-19 Presents Significant Risks for American Indian and Alaska Native People. Retrieved August 13, 2020, 

from: https://www.kff.org/coronavirus-covid-19/issue-brief/covid-19-presents-significant-risks-for-american-indian-and-alaska-native-people/
24

RESPONSES TO COVID-19

All interviewees mentioned service changes in response to COVID-19, such as:

¡ Increased frequency of meetings to discuss program needs, such weekly meetings between the North Dakota

ASD and Standing Rock Sioux Tribe, weekly meetings between the Hawai‘i EOA and state AAAs, and weekly or 

biweekly meetings between Oklahoma ASD and state AAAs.

¡ Changes to meal provision through the use of home delivery or drive-through meals.

¡ Streamlined service provision including shelf-stable food, hygiene items, and other supplies so that elders did not 

have to leave their homes.

¡ Increased demand for services, such as in the case of the Wyandotte Nation that noticed an uptick in demand for 

meals from about 120 meals distributed per day prior to COVID-19 to about 200 meals, or in the case of Alu Like 

Inc., where they are now serving and engaging with additional younger elders who previously did not believe they 

needed services.

¡ Innovative strategies in addressing social isolation, such as:

· The Wyandotte Nation held a series of drive-through Car Bingo events in a local parking lot. Seniors were 

encouraged to “dress up their cars” as part of a contest, and the Bingo game was held over a megaphone.

· Grand Gateway AAA provides a weekly newsletter to seniors as they picked up their meals that 

summarized the latest social updates and news from the community.

· ALTSA reported that many tribes are supporting grandparents who are primary caretakers of their 

grandchildren and responsible for assisting with distance learning.

· Oklahoma ASD shared that they are hosting remote caregiver support groups, which have attracted 

additional participants compared to past in-person meetings.

¡ Increased Title VI grantee and AAA/service provider collaboration, such as in the case of Nooksack Tribe Title VI 

staff relaying messages related to the clinic or medication refills between NWRC and elders during daily meal drop 

offs, and in the case of HCOA offering ready-to-eat meals to Alu Like, Inc.’s elders.
25

Conclusion and Recommendations

This study was small in scale and provided initial insights into collaboration practices, facilitators and barriers to

collaboration, cultural competency and tribal sovereignty, and recommendations for collaboration. Interviews with Title 

VI grantees, AAAs/service providers, and SUAs across the five case studies provided context into the landscape of Aging 

Network Services and the nature of Title VI and Title III grantee collaboration. The research questions and a summary of 

the main findings are included below.

HOW DO TITLE VI AND TITLE III GRANTEES COLLABORATE? 

Lewin found that Title VI grantees, AAAs/service providers, and SUAs collaborated in a variety of ways across the five 

case studies (Exhibit 4). All grantees described participating in less complex and involved “cooperation” or 

“coordination” activities, such as providing referrals, sharing information or data, and participating in occasional joint 

events or regular meetings together. A couple of grantees noted deeper “partnership” activities, such as sharing Title III 

grant funds or resources, advising, and hosting recurring events. Additionally, a couple of the grantees described 

activities that could be described as “service integration.” These grantees described being in continuous communication 

with each other, involving staff at all levels in collaborative efforts, and partnering on delivering services together. Each 

case study reflected different collaboration activities based on the needs of elders and caregivers, historical 

relationships, and other local factors. This reinforces the contextual nature of collaboration. Additionally, grantees 

wishing to start or renew a collaborative relationship may want to begin with simply reaching out, as all of the case 

study relationships were built on a foundation of open communication and connection. 

Exhibit 4. 

SUMMARY OF COLLABORATION ACTIVITIES 

COLLABORATION LEVEL EXAMPLES OF ACTIVITIES

COOPERATION § Referrals of clients between organizations

§ Information sharing

COORDINATION § One-time or occasional joint events

§ Regular joint meetings

PARTNERSHIP

§ Shared funding

§ Shared resources

§ Regular advising

§ Consistent or many joint events

SERVICE INTEGRATION

§ Continuous communication

§ Multiple layers of collaboration at the leadership and staff level

§ Development of new programs or services together
26

WHAT ARE BEST PRACTICES RELATED TO TITLE VI AND TITLE III GRANTEE COLLABORATION?

Throughout the study, interviewees reflected on practical steps that grantees could take to create and maintain 

successful collaborations. Major recommendations included:

¡ Understanding relevant policies and requirements and knowing potential grantees in the area with which to 

collaborate.

¡ Incorporating cultural competency practices into organizations and including Title VI representatives on policy and 

advisory boards of AAAs/service providers and SUAs.

¡ Establishing standing check-in meetings and having one person serve as a consistent point of contact.

¡ Regularly sharing organizational goals and plans with each other.

¡ Reaching out for help and acknowledging that collaboration can take time.

WHAT ARE FACILITATORS AND BARRIERS RELATED TO TITLE VI AND TITLE III GRANTEE 

COLLABORATION?

Interviewees also shared what they perceived as key factors that made collaboration easier or more difficult. Some 

factors are within grantees’ control, such as open communication or a shared vision or goals. Other factors are 

contextual or beyond the immediate control of grantees, such as previous relationships, geography, or differing 

reporting requirements. Findings are summarized in Exhibit 5.

Exhibit 5.

FACILITATORS AND BARRIERS TO COLLABORATION
27

The COVID-19 pandemic was described as both a barrier and a facilitator to collaboration. The public health emergency 

is forcing grantees to change the way that they connect with each other by shifting from in-person to only virtual 

meetings. Additionally, some planned joint events were cancelled during this time. However, the crisis also has

strengthened collaborations by requiring grantees to communicate more often and, at times, it led to innovative

solutions and new ways to partner.

Overall, the key takeaways of the study included the importance of trust in fostering relationships, and vice versa; the 

absence of trust serving as a barrier to relationships; recognition of tribal sovereignty (if applicable to the Title VI 

grantee) and Native cultures; and consideration of time needed to build lasting and collaborative relationships. 

In addition to this full report, the evaluation team developed an abbreviated report and other materials to support Title 

VI grantees, AAAs/service providers, SUAs, and other stakeholders in fostering Title VI and Title III grantee collaboration. 

Please see this webpage for more details. Lewin recommends that ACL consider additional dissemination strategies, 

such as webinars or training sessions that incorporate these materials. After the release of the reports, 

recommendations, and collaboration framework, ACL can also consider conducting outreach to grantees to identify 

questions and recommendations. 

There were some limitations to this study. Firstly, the COVID-19 pandemic altered the study design. The evaluation team 

originally planned for in-person, half-day visits with longer interviews and the potential for attending collaborative

events or meetings. Due to the pandemic, Lewin shifted to a virtual site visit design with phone interviews. Conducting 

only virtual site visits may have limited the richness of data obtained. Additionally, despite using multiple sources of 

data, the team experienced some difficulty in selecting an appropriate sample of case studies. Lewin found that the 

usefulness and accuracy of written materials such as state plans or Title VI grantee applications varied. At times, the 

written descriptions of collaboration practices were outdated. 

Future studies with the goal to identify best practices could implement additional sampling strategies, such as an open 

solicitation for grantees that feel like they have strong collaboration, or further investigation into the full list of grantees 

recommended in RA survey responses. In particular, dual Title VI/AAA grantees and Title VI grantees with consortia 

structure present an additional area of research, as they were not represented in this study’s sample. Additionally, the 

evaluation team recommends in-person approaches to data collection, if feasible, to build rapport and observe

collaboration meetings or events. Lewin anticipates that future case study research with larger samples of grantees 

across and within multiple states as well as in-person data collection approaches may build upon the findings of this 

study. 
28

Appendices

APPENDIX A: METHODOLOGY

This chapter describes the evaluation team’s 

evaluation activities between January 2020 to 

September 2020 as indicated in Exhibit A-1. The 

exhibit divides activities into three overarching 

sections: evaluation design, data tool development 

and data collection, and data analysis and 

reporting. The timeline of project activities 

included:
29

EVALUATION DESIGN

During the evaluation design phase of the study, the evaluation team identified existing research on general 

organizational collaboration, background information about Title VI grantees, AAAs, service providers, and SUAs, and 

resources on grantee collaboration. The evaluation design included the following components:

¡ An environmental scan on organizational collaboration identified best practices of collaboration among 

organizations, as well as tools for measuring collaboration. This environmental scan informed the creation of a 

collaboration framework detailed in Chapter I: Overall Findings.

¡ A materials review that included the National Association of Area Agencies on Aging’s (n4a) biannual Title VI and 

Title III survey reports28,29 and survey instrument, as well as publicly available online materials on collaboration, 

provided background information. Examples include presentations on Title VI and Title III grantee collaboration in 

from Shelly Zylstra30 and Leonard Geshick.31

¡ Phone interviews with SMEs informed the evaluation strategy. The evaluation team conducted ten telephone 

interviews with SMEs, such as ACL RAs, directors of Title VI grantees (who were also members of n4a Title VI 

advisory board), and SUA staff. The evaluation team used snowball sampling to identify additional SMEs to 

interview. Interviewees discussed recommendations for case study sites, their past experience working with Title 

VI and Title III grantees, and their current involvement in Title VI and Title III grantee collaboration. The interview 

protocol is located in Appendix B and interviewee lists are located in Appendix C.

¡ A review of select Title VI grantee applications provided additional context to Title VI and Title III grantee 

collaboration. To narrow down the proposed grantees, the evaluation team reviewed and coded select Title VI 

2020-2023 grant applications by type of collaboration. Lewin focused on case study sites with strong descriptions 

of collaboration.

After these activities, the evaluation team identified five primary case studies for further data collection. Due to 

difficulties contacting the Minnesota Chippewa Tribe/Minnesota Indian AAA (MCT/MIAAA), Lewin and ACL replaced the 

case study with Alu Like, Inc. and HCOA. The final list is as follows:

¡ KANA and SCOK

¡ Alu Like, Inc. and HCOA

¡ Standing Rock Sioux Tribe and North Dakota ASD

¡ Wyandotte Nation and Grand Gateway AAA

¡ Nooksack Indian Tribe and NWRC

 

28 National Association of Area Agencies on Aging (n4a) & Scripps Gerontology Center at Miami University. (2017). National Title VI Program Survey: 

Serving Tribal Elders Across the United States. Retrieved August 13, 2020, from: https://www.n4a.org/Files/

Title%20VI%20Survey/Title%20VI%20Program%20Survey_508.pdf

29 National Association of Area Agencies on Aging (n4a) & Scripps Gerontology Center at Miami University. (2017). National Survey of Area Agencies on 

Aging 2017 Report: Serving America’s Older Adults. Retrieved August 13, 2020, from: https://www.n4a.org/

Files/2017%20AAA%20Survey%20Report/AAANationalSurvey_web.pdf

30 Zylstra, S. (2017). Working with Tribal Communities: Title III and Title VI Coordination. Retrieved August 13, 2020, from: 

https://www.oregon.gov/dhs/SENIORS-DISABILITIES/SUA/AAABusinessTraining/Title-III-Title-VI-Coordination.pdf

31 Geshick, L., & Hammer, S. (2019). OAA Services in Indian Country. Retrieved August 13, 2020, from: https://bit.ly/2PIDKuG

DATA TOOL DEVELOPMENT AND DATA COLLECTION

The evaluation team used two main forms of data collection: virtual site visits and a survey administered to RAs.
30

VIRTUAL SITE VISITS

The evaluation team originally planned to conduct in-person site visits to five case study sites. However, due to COVID19, the evaluation team shifted to virtual site visits. Each case study site visit consisted of interviews with the Title VI 

grantee, AAA/service provider, and SUA (if not the main Title III collaborating organization). If possible, the evaluation 

team requested to observe any planned collaboration meetings.32

32 Due to the timing of the interview request and COVID-19, all interviewees reported that they did not have a virtual collaboration meeting within the 

window of June to July.

To prepare for these interviews, Lewin collected relevant information about each case study from the respective state 

plan(s) on aging, Title VI 2020-2023 grant application, and online public information. Additionally, Lewin sent a survey in 

advance (Appendix D) to identify ongoing types of collaboration to ask about during the interview. Background 

information and survey responses supported the evaluation team in adapting protocol questions and tailoring each 

interview to the respondent, allowing for compliance with Paperwork Reduction Act regulations. Interview protocols are 

located in Appendices E (Title VI grantee), F (AAA/service provider), and G (SUA). Within two weeks of conducting each 

interview, Lewin developed a one- to two-page summary document to send to the interviewee for suggestions and 

confirmation.

RA SURVEY

Lewin developed a 13-question survey to better understand the role of RAs in supporting Title VI grantees and 

facilitating collaboration with Title III grantees. This survey contained a mixture of open- and close-ended questions, 

such as yes/no, matrix, short answer, and long answer questions. Topics included types of collaboration present in the 

RA’s region, their thoughts on facilitators and barriers to collaboration, and areas for better support. ACL assisted with 

survey dissemination to the seven out of nine RAs who are directly involved with Title VI grantees in their region. All 

seven RAs provided feedback. The full RA survey text is located in Appendix H.

DATA ANALYSIS AND REPORTING

The evaluation team used a number of techniques to analyze data collected from the virtual site visits and RA survey.

DATA COLLECTION TOOL ANALYSIS TECHNIQUE

VIRTUAL SITE VISITS

The evaluation team used an “informal thematic analysis” technique to analyze site visit findings, 

which included iterative review of interview notes, development of interview summaries, and 

discussions of themes across interviews and summaries.

RA SURVEY The evaluation team used descriptive quantitative analysis of close-ended survey questions and 

informal thematic analysis of open-ended survey questions.

The evaluation team used themes identified across data collection tools to inform the writing of the final reports and 

other project deliverables (e.g., checklist of recommendations for Title VI and Title III grantee collaboration, 

collaboration framework, and slide deck).

 
31

APPENDIX B: SME PROTOCOL

Exhibit B-1.

OUTREACH TEXT

SUBJ: Subject Matter Expertise Requested Re: ACL Project

Dear [SME name],

We are from The Lewin Group, and are currently working with ACL on a project related to areas of collaboration between 

Title III and Title VI grantees. As part of our study, we are conducting several interviews with ACL regional administrators and 

members of the n4a Title VI board. Members of ACL (Cynthia LaCounte, Krissy Hudgins, and Leslie Green) identified you as 

an expert who could provide valuable information on this topic.

If you are available and interested, we would like to schedule a 30-minute call to explain more about the project and learn 

from your experience. Below are some time blocks (Central Time) when we are available—could you send back a few 

preferred and alternate times?

· Thursday, February 27: 8am – 10am, 12pm – 1pm (CT)

· Monday, March 2: 8am – 12pm, 12:30pm – 4pm (CT)

· Wednesday, March 4: 12pm – 4pm (CT)

· Thursday, March 5: 11am – 1pm (CT)

Please reach out to sarah.bergman@lewin.com and rebecca.chang@lewin.com with any questions and thank you in advance 

for your time!

Best,

Sarah Bergman and Rebecca Chang

INTERVIEW SCRIPT

Bolded questions within the interview guide indicate high-priority questions. Other questions should be asked if 

appropriate and if time allows.

PROJECT BACKGROUND AND PRIVACY

Thank you for taking the time to meet with us today. The Administration for Community Living (ACL) has contracted the 

Lewin Group to conduct a study on Title III and Title VI grantee collaboration. Within the Older Americans Act (OAA), 

there is language that requires this collaboration: specifically, each Title VI funding application should contain examples 

of service coordination with Title III grantees33 of the same geographical area, and each State Unit on Aging (SUA) should 

include program coordination with Title VI grantees in their state plan.

However, there are no specific guidelines on collaboration within the OAA, and ACL is interested in exploring best

practices among Title III and Title VI grantees.

 

33 Within the protocols, Lewin used the general term “Title III grantees” to refer to AAAs/service providers.
32

As part of our study to better understand these collaboration areas, we are conducting several interviews with subject 

matter experts to inform the study’s design and sample of grantees. You were identified as an expert who could provide 

valuable information on this topic.

This interview will take about 30 minutes. Thank you in advance for taking the time to speak with us. Your participation 

is voluntary and you do not have to answer any questions you don’t want to answer.

If it is OK with you, we are interested in recording this interview to supplement our notes. The recordings will be deleted

after the notes are finalized.

[If yes: Hit record and proceed]

[If no: That is fine; we can proceed without recording.]

INTRODUCTION

1. What is your role at your organization?

2. Can you tell us a bit about your experience working with Title III and Title VI grantees?

3. What are some common challenges or opportunities for Title III and Title VI grantees? If they have different 

challenges, please describe.

COLLABORATION

1. In which ways have you seen Title III and Title VI grantees collaborate? 

a. If not brought up by interviewee, probe using examples such as working together on one-time or 

occasional events, Title VI programs receiving Title III funding, or developing new programs or services 

together.

2. What does successful collaboration among Title III and Title VI grantees look like?

3. What are some facilitators of collaboration (or factors that lead to collaboration) among Title III and Title VI 

grantees?

4. What are some barriers to collaboration among Title III and Title VI grantees?

5. We are going to be conducting a limited number of site visits to Title III and Title VI grantee organizations that are 

successfully collaborating. Which organizations would you suggest for us to visit? Why would you choose these 

grantees?

6. When the study is done, we hope to share a document with best practices. What do you think would be the best 

format for stakeholders?

a. If not brought up by interviewee, probe on infographic or visuals, short report, example case studies, or 

checklist.

CLOSING

1. [If seeking additional SMEs to interview]: Do you have any recommendations for other individuals with 

knowledge on Title III and Title VI grantee collaboration who we should consider contacting?

2. Is there anything else about this topic that you would like to share?

Thank you so much for your time today! We appreciate being able to learn from your expertise. If you think of anything 

else that you wish you had brought up during our conversation, please feel free to e-mail or call us.
33

APPENDIX C: DATA COLLECTION INTERVIEWEE LISTS

Exhibit C-1.

SME INTERVIEWEE LIST

NAME ROLE

Amy Wiatr-Rodriguez ACL Regional Administrator (Region V)

Brenda House Title VI Director of Wyandotte Nation and member of n4a Title VI Board

Glen (Manny) Carlo Title VI Director, Denakkanaaga, Inc. and member of n4a Title VI Board

Lacey Boven ACL Regional Administrator (Region VII)

Laurai Atcitty AAA Director of Inter-Tribal Council of AZ

Leonard Geshick Indian Elders Coordinator, Minnesota Board on Aging

Percy DeVine ACL Regional Administrator (Region VIII, IX)

Rhonda Weaver Title VI & Caregiver Director of Quapaw Nation Elders Center and member of n4a Title VI Board

Shelly Zylstra ACL Regional Administrator (Region X)

Wendell Holt Aging & Disability Program Lead of Great Lakes Inter-Tribal Council

Exhibit C-2.

VIRTUAL SITE VISIT INTERVIEWEE LIST

STATE ORGANIZATION NAME ORGANIZATION TYPE INTERVIEWEE(S)

Alaska

Senior Citizens of Kodiak, Inc. (SCOK) AAA/Service Provider Patricia (Pat) Branson

Kodiak Area Native Association (KANA) Title VI Greg Zadina

Alaska Senior and Disabilities Services 

(SDS) SUA Lisa Morley

Hawai‘i

Hawai‘i County Office of Aging (HCOA) AAA/Service Provider Keola Kenoi-Okajima

Alu Like, Inc. Title VI Leslie Tanoue

Hawai‘i Executive Office on Aging

(EOA) SUA Caroline Cadirao

North Dakota

North Dakota Aging Services Division

(ASD) SUA Petra Harmon One Hawk

Standing Rock Sioux Tribe Title VI Nancy Maier

Oklahoma

Grand Gateway Area Agency on Aging

(AAA) AAA/Service Provider Staci Pierce, Mary Satterwhite

Wyandotte Nation Title VI Brenda House

Oklahoma Aging Services Division

Aging Services Division (ASD) SUA Rebecca Snellen

Washington

Nooksack Tribe Title VI Heidi Davis

Washington Aging and Long-Term 

Support Administration (ALTSA) SUA Marietta Bobba, Rosemary Biggins, Ann Dahl
34

Exhibit C-3.

RA SURVEY RECIPIENTS

NAME REGION

Jennifer Throwe Region I

Rhonda Schwartz Region III

Amy Wiatr-Rodriguez Region V

Derek Lee Region VI

Lacey Boven Region VII

Percy Devine Regions VIII & IX

Shelly Zylstra Region X
35

APPENDIX D: PRE-VIRTUAL SITE VISIT SURVEY

The following questions were sent to Title VI and Title III grantees before virtual site visit interviews, to guide interview 

questions.

1. Over the course of your collaboration with the [other grantee organization name], which of the following activities 

have your organizations done in the past or do currently with each other? (Marked by X’s in the table columns)

COLLABORATION ACTIVITY YES NO

Communicate regularly (e.g., e-mail, phone, in-person interactions)

Attend meetings together

Serve as members on your advisory boards

Share data or reports (e.g., related to elders, caregivers, or community 

members)

Have a liaison or “champion” working on collaboration

Provide and/or attend trainings

Provide advice

Host events together

Support programs or services

Develop new programs or services together

Receive funding and/or provide funding to each other

Refer elders or caregivers to each other

2. Are there any ways you collaborate with the other organization that were not included in the earlier question?

3. Which form(s) of collaboration are most valuable for your organization?

4. Does your organization collaborate with other [Title VI or Title III] grantees? If so, please list the names of the 

organizations.

5. Do you have any additional comments or questions to add?
36

APPENDIX E: TITLE VI GRANTEE INTERVIEW PROTOCOL

PROJECT BACKGROUND AND PRIVACY

Thank you for taking the time to meet with us today. The Administration for Community Living (ACL) has contracted the 

Lewin Group to conduct a study on Title III and Title VI grantee collaboration. Within the Older Americans Act (OAA), 

there is language that requires this collaboration: specifically, each Title VI funding application should contain examples 

of service coordination with Title III grantees of the same geographical area, and each State Unit on Aging (SUA) should 

include program coordination with Title VI grantees in their state plan.

However, there are no specific guidelines on collaboration within the OAA, and ACL is interested in exploring best 

practices among Title III and Title VI grantees. The results and best practices will be publically shared when the study is 

completed. We will also write a one to two-page summary of today’s interview and you will have an opportunity to 

provide feedback on the summary.

To better understand these collaboration areas, we selected five case studies of collaboration and are conducting 

several [virtual] site visits. [Include information on how this specific case study was chosen, if relevant and necessary]

This interview will take about an hour and a half. Thank you in advance for taking the time to speak with us. Your 

participation is voluntary, and you do not have to answer any questions you don’t want to answer.

If it is OK with you, we are interested in recording this interview to supplement our notes. The recordings will be deleted

after the notes are finalized.

[If yes: Hit record and proceed]

[If no: That is fine; we can proceed without recording.]

SECTION I: INTRODUCTION

We want to start first with learning about your organization and the services that you provide.

1. Please describe your organization and your role.

2. Please describe the community that your organization serves (e.g., geographic, historical, demographic context).

3. What about your organization makes you most proud?

a. Probe:34 Some examples include community members served, notable programs or services, and 

relationships created.

4. What are a few of the biggest opportunities for growth for your organization?

5. What are a few of the biggest challenges for your organization?

a. Probe: How does this compare to challenges faced by Title VI grantees in other areas?

6. Which other organizations do you most frequently collaborate with (e.g., Tribal organizations/governmental 

bodies, other Title VI grantees, SUA, Title III grantees, nursing homes, Indian Health Services)?

 

34 Lewin included various probes throughout the interview guide to ensure that specific details are answered. It is likely that the interviewee will answer 

some or all of the probes, but in the event that they do not, the interviewers will follow up.
37

SECTION II: Collaboration Types

Now we want to spend some time learning about your relationship with [Title III organization name].

1. Why did your organization start collaborating with [Title III organization name]? What key events led to 

collaboration?

2. How formal is your relationship with [Title III organization name]? Do you have a Memorandum of 

Understanding, a different written agreement, or a verbal agreement?

3. When did you start working together? Do you recall or know who reached out to whom?

4. Has the relationship changed over time? If yes, how so?

a. Probe: Have both organizations been flexible and adaptive to change?

If the grantee has filled out the questionnaire beforehand, Lewin will focus the conversation on those collaboration 

types, but still reserve time to confirm that the other collaboration types are not practiced and/or understand why they 

are not practiced.

¡ If questionnaire was answered: We’ll now ask a series of questions about how you collaborate with [Title III 

organization name] based on the answers you provided on the questionnaire.

¡ If questionnaire was not answered: We’ll now ask a series of questions about how you collaborate with [Title III 

organization name]. We are interested in different kinds of collaboration, such as communication, data and 

reporting, meetings, staffing, trainings, events, funding, and service development.

COMMUNICATION AND INFORMATION SHARING

1. Do you share any information with [Title III organization name]?

a. What kinds of information do you share with [Title III organization name]? 

2. How do you share information with [Title III organization name]?

a. Probes:

i. Is information shared through emails, listservs/newsletters, phone calls, face-to-face, or multiple 

ways?

ii. How often do you share information with [Title III organization name]? Would you say it is 

continuous communication, weekly, monthly, or less frequent?

3. What do you think about [Title III organization name]’s communication style? How well does it align with your 

organization’s communication style?

DATA AND REPORTING

1. What data or reports do you share with [Title III organization name] (e.g., data on number of community 

members served)?

2. Is [Title III organization name] tracking some of the same metrics that your organization tracks? If yes, which 

metrics are similar?

3. Have either of your organizations worked together on needs assessments or area plans before?

REFERRALS/CONNECTING ELDERS TO SERVICES

1. Do you refer elders to each other? If yes, please describe.

2. Does [Title III organization name] provide services to the elders in your community? If yes, which services?

MEETINGS

1. Do you attend meetings together? If yes, what are your meetings like?
38

a. Probes:

i. Who holds the meetings?

ii. How often do you meet?

iii. How do you meet (e.g., face-to-face, over the phone)?

iv. Where do you meet?

v. Who attends your meetings? What roles do they have (e.g., social services, health care 

providers)?

2. Do you serve on any of [Title III organization name]’s advisory councils or boards? Are they on your advisory 

councils or boards?

STAFFING

1. At what levels of the organization does collaboration occur? Does it include staff and members of leadership?

2. Is there a person who serves as a liaison or as a “champion” from each organization? Does this person or others 

work for both organizations?

3. What is the level of engagement of collaborators? What are the responsibilities of each organization?

4. Are any [Title III organization name] staff of Native American heritage? Do any [Title III organization name] staff 

have extensive experience working with tribal communities? How does this impact your collaboration?

TRAININGS

1. Do you provide training/education to [Title III organization name]? Do they provide training to your organization?

a. Probes:

i. How often?

ii. What are the topics of these trainings? 

iii. How were the topics determined and who chose the topics?

ADVISING

1. Do you advise the other organization? 

a. [If yes] On which topics do you provide support (e.g., policies, grant writing, assessment, service 

delivery)?

b. [If no] On which topics does [Title III organization name] need support?

2. Does the other organization advise you?

a. [If yes] On which topics do they provide support?

b. [If no] On which topics would your organization need support?

EVENTS

1. Do you ever host events with [Title III organization name]? If yes, please describe.

a. Probe: How often does this happen?

DEVELOPING PROGRAMS OR SERVICES TOGETHER

1. Have you worked with [Title III organization name] to develop any new programs or services together? If yes, 

please describe.

a. Probes: Why was the program or service created? Who does the program or service serve? What 

responsibilities does each grantee have?
39

2. Do you or [Title III organization name] use any Native-specific or adapted models or programs? If yes, please

describe.

FUNDING

1. Do you receive any funding from [Title III organization name]? If yes, please describe.

2. Have you ever collaborated with [Title III organization name] on grants? If yes, please describe.

3. [If not currently a Title III grantee]: Have you ever considered applying to be a Title III grantee? Why or what 

not? 

[If currently a Title III grantee]: Why was the decision was made to become a Title III grantee? How does your

organization use Title III funds? Are they used in a different way than Title VI funds? What are the challenges 

and advantages to being a Title III grantee? 

SECTION III: CULTURAL COMPETENCY, SOVEREIGNTY, AND TRUST

Thank you for explaining the specific forms of collaboration between your organization and [Title III organization name]. 

Now we would like to ask some questions about the overall collaboration. First, we want to learn more about the role 

that cultural competency, sovereignty, and trust play in your relationship.

1. How do your organization and [Title III organization name] build trust with each other?

2. How are your organizational goals and vision aligned with [Title III organization name]’s goals and vision? How are

they different?

3. Does [Title III organization name] understand and work with the cultural needs of the elders you serve?

a. [If yes]: How do they demonstrate their understanding?

b. [If no]: What could they do to strengthen and demonstrate their understanding?

4. [If a sovereign nation]: Do you feel like [Title III organization name] does a good job of recognizing tribal

sovereignty?

a. [If yes]: How do they demonstrate their recognition?

b. [If no]: What could they do to demonstrate their recognition?

5. Some states have statutes related to tribal sovereignty and practices for collaborating with tribes. We’ve heard

that these laws may help facilitate or shape collaboration. Do you know of any laws in your state that may impact

your collaboration with other organizations?

6. An important concern we have heard from many Native groups is a lack of trust due to historical and current

relationships among Native tribes, federal, and state governments. How does [Title III organization name] take

this into account while collaborating with your organization?

SECTION IV: OVERALL THOUGHTS ON COLLABORATION

Now we would like to ask some questions about collaboration more broadly.

1. How has your collaboration with [Title III organization name] been successful?

2. What factors made collaboration easier with [Title III organization name] (e.g., sufficient resources or capacity,

mutual trust, clearly defined partnership roles, shared goals, or champions)?

3. Do you have any recommendations for other Title VI and Title III grantees on how they can make and keep

collaborative relationships?

4. What are the challenges related to your collaboration with [Title III organization name], if any?

5. Do you think any factors made it more difficult to collaborate with [Title III organization name]?

6. Is there anything you wish was different about your collaboration with [Title III organization] (e.g., more, less, or

different communication, support, trainings, meetings, or programs)?
40

7. [If answered yes to the survey question, “Does your organization collaborate with other Title III grantees”]: How 

do you collaborate with [other Title III grantee organization name]? How is your collaboration with [other Title III 

grantee organization name] different to that with [Title III grantee organization name] (e.g., is one more 

prominent, or do you collaborate with both in complimentary ways)?

In response to COVID-19, organizations supporting aging individuals and their caregivers have had to make changes 

related to their operations and strategy.

1. How has your organization been responding to COVID-19?

2. Have you met with or discussed needs related to COVID-19 with [Title III organization]?

[If yes] How has collaboration with [Title III organization] supported your organization’s response?

SECTION V: ROLE OF THE STATE UNIT ON AGING (IF APPLICABLE)

Interviewers will skip this section for case studies where the SUA serves as the main Title III collaborator of focus for the 

study, since similar questions will be covered in Section II: Collaboration Types section.

1. Do you communicate or work with staff from [SUA name]?

2. Are there staff members at [SUA] who liaison with Native/tribal organizations?

a. [If yes] How does this support your Title VI work?

3. Was your organization involved with creating your state plan? Was anyone from [SUA name] involved in helping 

you assess the needs of your elders for the Title VI grant?

4. Does [SUA name] support your collaboration with [Title III organization] or other organizations in any way? If yes, 

please explain.

SECTION VI: CLOSING

1. When we finish this study, we hope to share a document with best practices. What do you think would be the 

best format for you and other stakeholders (e.g., infographic or visuals, short report, example case studies, or 

checklist)?

2. If we share a description of your collaboration, would you be willing to have you or your organization’s contact 

information listed on the best practices document?

3. Is there anything else about this topic that you would like to share?

Thank you so much for your time today! We appreciate being able to learn from your expertise. If you think of anything 

else that you wish you had brought up during our conversation, please feel free to e-mail or call us. In the next couple of 

weeks, we will send you a one to two-page summary of today’s interview and you will have an opportunity to provide 

feedback on the summary.
41

APPENDIX F: AAA/SERVICE INTERVIEW PROTOCOL

PROJECT BACKGROUND AND PRIVACY

Thank you for taking the time to meet with us today. The Administration for Community Living (ACL) has contracted the 

Lewin Group to conduct a study on Title III and Title VI grantee collaboration. Within the Older Americans Act (OAA), 

there is language that requires this collaboration: specifically, each Title VI funding application should contain examples 

of service coordination with Title III grantees of the same geographical area, and each State Unit on Aging (SUA) should 

include program coordination with Title VI grantees in their state plan.

However, there are no specific guidelines on collaboration within the OAA, and ACL is interested in exploring best 

practices among Title III and Title VI grantees. The results and best practices will be publically shared when the study is 

completed. We will also write a one to two-page summary of today’s interview and you will have an opportunity to 

provide feedback on the summary.

To better understand these collaboration areas, we selected five case studies of collaboration and are conducting 

several [virtual] site visits. [Include information on how this specific case study was chosen, if relevant and necessary]

This interview will take about an hour and a half. Thank you in advance for taking the time to speak with us. Your 

participation is voluntary and you do not have to answer any questions you don’t want to answer.

If it is OK with you, we are interested in recording this interview to supplement our notes. The recordings will be deleted 

after the notes are finalized.

[If yes: Hit record and proceed]

[If no: That is fine; we can proceed without recording.]

SECTION I: Introduction

We want to start first with learning about your organization and the services that you provide.

1. Please describe your organization and your role.

2. Please describe the community that your organization serves (e.g., geographic, historical, demographic context).

3. What about your organization makes you most proud?

a. Probe: Some examples include community members served, notable programs or services, and 

relationships created.

4. What are a few of the biggest opportunities for growth for your organization?

5. What are a few of the biggest challengesfor your organization?

a. Probe: How does this compare to challenges faced by Title III grantees in other areas?

6. Which other organizations do you most frequently collaborate with (e.g., health care providers, other Title III 

grantees, SUA, Title VI grantees, nursing homes)?

SECTION II: COLLABORATION TYPES

Now we want to spend some time learning about your relationship with [Title VI organization name].

1. Why did your organization start collaborating with [Title VI organization name]? What key events led to 

collaboration?

2. How formal is your relationship with [Title VI organization name]? Do you have a Memorandum of 

Understanding, a different written agreement, or a verbal agreement? 
42

3. When did you start working together? Do you recall or know who reached out to whom?

4. Has the relationship changed over time? If yes, how so?

a. Probe: Have both organizations been flexible and adaptive to change?

If the grantee has filled out the questionnaire beforehand, Lewin will focus the conversation on those collaboration 

types, but still reserve time to confirm that the other collaboration types are not practiced and/or understand why they 

are not practiced.

¡ If questionnaire was answered: We’ll now ask a series of questions about how you collaborate with [Title VI 

organization name] based on the answers you provided on the questionnaire.

¡ If questionnaire was not answered: We’ll now ask a series of questions about how you collaborate with [Title VI 

organization name]. We are interested in different kinds of collaboration, such as communication, data and 

reporting, meetings, staffing, trainings, events, funding, and service development.

COMMUNICATION AND INFORMATION SHARING

1. Do you share any information with [Title VI organization name]? 

a. What kinds of information do you share with [Title VI organization name]? 

2. How do you share information with [Title VI organization name]?

a. Probes:

i. Is information shared through emails, listservs/newsletters, phone calls, face-to-face, or multiple 

ways?

ii. How often do you share information with [Title VI organization name]? Would you say it is 

continuous communication, weekly, monthly, or less frequent?

3. What do you think about [Title VI organization name]’s communication style? How well does it align with your 

organization’s communication style?

DATA AND REPORTING

1. What data or reports do you share with [Title VI organization name] (e.g., data on number of community 

members served)?

2. Is [Title VI organization name] tracking some of the same metrics that your organization tracks? If yes, which 

metrics are similar?

3. Have either of your organizations worked together on needs assessments or area plans before? Do you consult 

with tribes or elders when developing or updating your area plan?

REFERRALS/CONNECTING ELDERS TO SERVICES

1. Do you refer elders to each other? If yes, please describe.

MEETINGS

1. Do you attend meetings together? If yes, what are your meetings like? 

a. Probes:

i. Who holds the meetings?

ii. How often do you meet?

iii. How do you meet (e.g., face-to-face, over the phone)?

iv. Where do you meet?

v. Who attends your meetings? What roles do they have (e.g., social services, health care 

providers)?
43

2. Do you serve on any of [Title VI organization name]’s advisory councils or boards? Are they on your advisory 

councils or boards?

STAFFING

1. At what levels of the organization does collaboration occur? Does it include staff and members of leadership?

2. Is there a person who serves as a liaison or as a “champion” from each organization? Does this person or others 

work for both organizations? 

3. What is the level of engagement of collaborators? What are the responsibilities of each organization? 

4. Are any of your organization staff of Native American heritage? Do any staff have extensive experience working 

with tribal communities? How does this impact your collaboration?

TRAININGS

1. Do you provide training/education to [Title VI organization name]? Do they provide training to your organization? 

a. Probes:

i. How often?

ii. What are the topics of these trainings?

iii. How were the topics determined and who chose the topics?

ADVISING

1. Do you advise the other organization? 

a. [If yes] On which topics do you provide support (e.g., policies, grant writing, assessment, service 

delivery)?

b. [If no] On which topics does [Title VI organization name] need support?

2. Does the other organization advise you?

a. [If yes] On which topics do they provide support?

b. [If no] On which topics would your organization need support?

EVENTS

1. Do you ever host events with [Title VI organization name]? If yes, please describe. 

a. Probe: How often does this happen? 

DEVELOPING PROGRAMS OR SERVICES TOGETHER

1. Have you worked with [Title VI organization name] to develop any new programs or services together? If yes, 

please describe. 

a. Probes: Why was the program or service created? Who does the program or service serve? What 

responsibilities does each grantee have?

2. Do you or [Title VI organization name] use any Native-specific or adapted models or programs? If yes, please 

describe.

a. [If yes] How were these models or programs developed? How does [model or program] ensure that 

services are culturally congruent?

FUNDING

1. Do you provide any funding for [Title VI organization name]? If yes, please describe.
44

a. Probes: How is the funding calculated? If there are more than one Title VI organizations in your area, 

how is it determined which receive funding?

2. Have you ever collaborated with [Title VI organization name] on grants? If yes, please describe.

SECTION III: CULTURAL COMPETENCY, SOVEREIGNTY, AND TRUST

Thank you for explaining the specific forms of collaboration between your organization and [Title III organization name]. 

Now we would like to ask some questions about the overall collaboration. First, we want to learn more about the role 

that cultural competency, sovereignty, and trust play in your relationship.

1. How do your organization and [Title VI organization name] build trust with each other?

2. How are your organizational goals and vision aligned with [Title VI organization name]’s goals and vision? How 

are they different?

3. How do you understand and work with the cultural needs of Native elders?

a. Probe: What, if anything, could your organization do better to strengthen and demonstrate 

understanding of cultural needs?

4. [If Title VI grantee is a sovereign nation] How does your organization acknowledge, recognize, and work with 

tribal sovereignty in collaboration with [Title VI organization name]?

5. Some states have statutes related to tribal sovereignty and practices for collaborating with tribes. We’ve heard 

that these laws may help facilitate or shape collaboration. Do you know of any laws in your state that may impact 

your collaboration with other organizations? 

6. An important concern that we have heard from some Native groups is a lack of trust due to historical and current 

relationships among Native tribes, federal, and state governments. How does your organization take this into

account while collaborating with [Title VI organization name]? 

SECTION IV: OVERALL THOUGHTS ON COLLABORATION

Now we would like to ask some questions about collaboration more broadly.

1. How has your collaboration with [Title VI organization name] been successful?

2. What factors made collaboration easier with [Title VI organization name] (e.g., sufficient resources or capacity, 

mutual trust, clearly defined partnership roles, shared goals, or champions)?

3. Do you have any recommendations for other Title III and Title VI grantees on how they can make and keep 

collaborative relationships?

4. What are the challenges related to your collaboration with [Title VI organization name], if any?

5. Do you think any factors made it more difficult to collaborate with [Title VI organization name]?

6. Is there anything you wish was different about your collaboration with [Title VI organization] (e.g., more, less, or 

different communication, support, trainings, meetings, or programs)?

7. [If answered yes to the survey question, “Does your organization collaborate with other Title VI grantees”]: How 

do you collaborate with [other Title VI grantee organization name]? How is your collaboration with [other Title VI 

grantee organization name] different to that with [Title VI grantee organization name] (e.g., is one more 

prominent, or do you collaborate with both in complimentary ways)?

In response to COVID-19, organizations supporting aging individuals and their caregivers have had to make changes 

related to their operations and strategy.

1. How has your organization been responding to COVID-19?

2. Have you met with or discussed needs related to COVID-19 with [Title VI organization]? 
45

a. [If yes] How has collaboration with [Title VI organization] supported your organization’s response to 

meet the needs of Native elders?

b. [If no] Are there reasons why you have not met to discuss COVID-19? How could collaboration around 

COVID-19 response assist your organization’s response to meet the needs of Native elders?

SECTION V: ROLE OF THE STATE UNIT ON AGING (IF APPLICABLE)

Interviewers will skip this section for case studies where the SUA serves as the main Title III collaborator of focus for the

study, since similar questions will be covered in Section II: Collaboration Types section.

1. Do you communicate or work with staff from [SUA name]?

2. Are there staff members at [SUA] who specialize providing support for Title III/Title VI collaboration?

a. [If yes] How does this support your collaboration work?

3. Was your organization involved with creating your state plan? Was anyone from [SUA name] involved in helping 

you assess the needs of your elders for the Title III grant?

4. Does [SUA name] support your collaboration with [Title VI organization] or other organizations in any way? If yes, 

please explain.

SECTION VI: CLOSING

1. When we finish this study, we hope to share a document with best practices. What do you think would be the 

best format for you and other stakeholders (e.g., infographic or visuals, short report, example case studies, or 

checklist)?

2. If we share a description of your collaboration, would you be willing to have you or your organization’s contact 

information listed on the best practices document?

3. Is there anything else about this topic that you would like to share? 

Thank you so much for your time today! We appreciate being able to learn from your expertise. If you think of anything 

else that you wish you had brought up during our conversation, please feel free to e-mail or call us. In the next couple of 

weeks, we will send you a one to two-page summary of today’s interview and you will have an opportunity to provide 

feedback on the summary.
46

APPENDIX G: SUA INTERVIEW PROTOCOL

PROJECT BACKGROUND AND PRIVACY

Thank you for taking the time to meet with us today. The Administration for Community Living (ACL) has contracted the

Lewin Group to conduct a study on Title III and Title VI grantee collaboration. Within the Older Americans Act (OAA), 

there is language that requires this collaboration: specifically, each Title VI funding application should contain examples 

of service coordination with Title III grantees of the same geographical area, and each State Unit on Aging (SUA) should 

include program coordination with Title VI grantees in their state plan.

However, there are no specific guidelines on collaboration within the OAA, and ACL is interested in exploring best 

practices among Title III and Title VI grantees. The results and best practices will be publically shared when the study is 

completed. We will also write a one to two-page summary of today’s interview and you will have an opportunity to 

provide feedback on the summary.

To better understand these collaboration areas, we selected five case studies of collaboration and are conducting 

several [virtual] site visits. [Include information on how this specific case study was chosen, if relevant and necessary.]

This interview will take less than an hour. Thank you in advance for taking the time to speak with us. Your participation is 

voluntary and you do not have to answer any questions you don’t want to answer.

If it is OK with you, we are interested in recording this interview to supplement our notes. The recordings will be deleted

after the notes are finalized.

[If yes: Hit record and proceed]

[If no: That is fine; we can proceed without recording.]

SECTION I: INTRODUCTION TO INTERVIEWEE AND SUA

First we want to learn about [SUA name] and your role more generally.

1. Could you introduce us to your organization, [SUA name]? 

2. Within [SUA], what is your role and what responsibilities does it entail? 

3. We know that one of the overarching responsibilities of SUAs is to write and administer the state plans on aging.

a. How does [SUA name] account for tribal needs in the state plan? Do you consult with tribes or elders 

when developing or updating the state plan?

b. How do tribal needs factor into funding applications and allocations (such as in the event of Title III 

grantees sharing funding with Title VI grantees)?

c. How do you learn of new collaboration initiatives that are included in the state plan? 

SECTION II: SUA OUTREACH TO TITLE III GRANTEES

Thank you for the broad overview of [SUA name]. Now we’re interested in delving into a few specific topics, such as 

support and outreach to grantees. We’ll start first with Title III grantees.

1. How does [SUA] conduct outreach and support Title III grantees (e.g., regular communication, regular meetings, 

technical assistance)?

2. What common challenges or opportunities for growth do you hear most from Title III grantees?

SECTION III: SUA OUTREACH TO TITLE VI GRANTEES
47

Now we’ll ask some questions about SUA outreach to Title VI grantees in your state.

1. How does [SUA] conduct outreach to Title VI grantees (e.g., regular communication, regular meetings, technical

assistance)?

2. Does [SUA] have a tribal liaison or office?

a. [If yes] When and why was it created? What specific duties fall under this role or office?

b. [If no] Is there interest in creating a liaison position or office? What barriers are there to creating the

position or program?

3. Does [SUA] have an advisory board that includes Native and/or Title VI leaders?

a. [If yes] What issues are discussed during advisory boards? What issues are brought up or commented on

by Native or Title VI leaders during advisory board meetings?

b. [If no] Is there interest in [creating the advisory board or inviting leaders to the advisory board]? What

barriers are there?

4. Some states have statutes related to tribal sovereignty and practices for collaborating with tribes. We’ve heard

that these laws may help facilitate or shape collaboration. Do you know of any laws in [state name] that may

impact collaboration? Are there any policies that may impact collaboration? Please describe.

5. [Only ask questions not covered in background research] Do you provide any Title III funding for Title VI

organizations? If yes, please describe.

a. Probes: How is the funding calculated? If not all Title VI organizations receive funding, how is it 

determined which receive funding?

6. What common challenges or opportunities for growth do you hear most from Title VI grantees?

SECTION IV: Collaboration Among Title III/Title VI State Grantees

We’d like to focus on your understanding of collaboration among Title III and Title VI grantees in the state, and the role 

your SUA may play in fostering this collaboration.

1. For this study, we are focusing on [case study sites] in [state]. What is your understanding of collaboration

between [grantees]?

2. What support does [SUA name] provide to encourage or support collaboration among grantees?

a. Probe: For instance, does the [SUA] provide opportunities to Title III and Title VI grantees to meet each

other or trainings related to collaboration?

3. What does successful collaboration among Title III and Title VI grantees look like?

4. What are some facilitators of collaboration (or factors that lead to collaboration) among Title III and Title VI

grantees?

5. What are some barriers to collaboration among Title III and Title VI grantees?

6. What opportunities do non-Native SUA and Title III staff have for cultural competency training to better

understand the context and needs of Native populations in [state]?

a. [If yes] Could you provide more details about these opportunities and trainings? How have they led to

increased understanding in non-Native staff?

b. [If no] Is there interest in training opportunities? What barriers are there to establishing them?

7. An important concern we have heard from some Native groups is a lack of trust due to historical and current

relationships among Native tribes, federal, and state governments. How does [SUA] take this into account while

facilitating collaboration among Title III and Title VI organizations?

In response to COVID-19, organizations supporting aging individuals and their caregivers have had to make changes 

related to their operations and strategy.

1. How has your organization been responding to COVID-19?
48

2. Have you met with or discussed needs related to COVID-19 with Title III or Title VI grantees?

3. How do you think COVID-19 has impacted collaboration among Title III and Title VI grantees? 

CLOSING

1. To wrap up, we’re interested in shifting our focus from collaboration specifically with Title VI grantees to the 

larger Native population in [state name]. In many states, not all registered tribes are Title VI grantees, and there 

may also be Native individuals living away from their reservation, such as in urban areas. How do Title III 

programs in [state name] work to ensure the needs of elders in all tribal entities and urban Native populations 

are met?

2. When we finish this study, we hope to share a document with best practices. What do you think would be the 

best format for you and other stakeholders? (e.g., infographic or visuals, short report, example case studies, or 

checklist)

3. Is there anything else about this topic that you would like to share?

Thank you so much for your time today! We appreciate being able to learn from your expertise. If you think of anything 

else that you wish you had brought up during our conversation, please feel free to e-mail or call us. In the next couple of 

weeks, we will send you a one to two-page summary of today’s interview and you will have an opportunity to provide 

feedback on the summary.
49

APPENDIX H: REGIONAL ADMINISTRATOR SURVEY TEXT

1. Name:

2. Are you aware of Title III and Title VI grantees in your region collaborating together on the following activities?

ACTIVITY YES NO

Attending meetings together

Serving as members on each other’s advisory boards

Sharing data or reports (e.g., related to elders, caregivers, community members)

Having a liaison or “champion” working on collaboration

Providing and/or attending trainings

Providing advice

Hosting events together

Supporting programs or services

Developing new programs or services together

Providing funding to each other

Referring elders or caregivers to each other

3. Do you have any comments related to Title III and Title VI grantee collaboration activities in your region that you 

would like to share?

4. Are you directly engaged in supporting Title III and Title VI grantee collaboration in your position (e.g., 

communicating the requirements to collaborate, connecting grantees, sharing best practices)?

Yes

No

If yes, please describe how you support Title III and Title VI grantee collaboration.

5. What could central office do to make it easier for you to support Title III and Title VI grantee collaboration?
50

6. What does successful collaboration among Title III and Title VI grantees look like?

7. Do you know of any successful Title III/Title VI grantee collaborations in your region?

Yes

No

If yes, please list the names of some of the Title III/Title VI grantees that are successfully collaborating and a brief 

description of how they are collaborating.

8. Do you have any recommendations for Title III and Title VI grantees on how they can make and keep 

collaborative relationships?

9. What are some facilitators or factors that lead to collaboration among Title III and Title VI grantees?

10. What are some barriers to collaboration among Title III and Title VI grantees?

11. Do you have any collaboration tools or presentations that you would be willing to share? If yes, Lewin staff will 

reach out to you via email.

Yes

No

12. How do you think COVID-19 has impacted collaboration among Title III and Title VI grantees?

13. Do you have any other information or questions that you would like to discuss further via email or phone call? If 

yes, Lewin staff will reach out to you via email.

Yes

No