LIVING WELL CROSS-SITE EVALUATION 2020-2021 1

Strategies for Developing Cultural and 

Linguistic Competency Across Systems

Living Well Grant Background

Grant variations in access to and quality of home and community-based services 

(HCBS) across the country can put the wellbeing of people with intellectual and 

developmental disabilities (I/DD) living in their communities at risk. To address 

these pressing needs, the Administration for Community Living (ACL) issued Living 

Well-Model Approaches for Enhancing the Quality, Effectiveness and Monitoring of 

HCBS for Individuals with I/DD (Living Well) grants, with two key goals: 

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

• Improve the quality of HCBS. 

ACL administers Living Well grants through the Projects of National Significance 

program. ACL awarded eight five-year grants across two cohorts in 2017 and 2018 to 

identify, develop, and evaluate model approaches that address the two goals. Grantees are located in the following states: Alaska, Georgia, Idaho, Indiana, Missouri, New 

Hampshire, Virginia, and Wisconsin. ACL contracted with the Lewin Group, as a subcontractor to 

New Editions Consulting, to conduct a cross-site evaluation of the eight grants.1

Each Living Well grantee is designing and implementing a grant model within the unique 

context of their own state. This brief focuses on how grantees are utilizing cultural and linguistic 

competency strategies in their work with self-advocates and families, DSPs, and state systems. 

Throughout this brief, the recipients of Living Well grants and their respective project teams are 

referred to as “grantees.”

This brief focuses 

on how grantees are 

utilizing cultural and 

linguistic competency 

strategies in their work 

with self-advocates 

and families, direct 

support professionals 

(DSPs), and state 

systems.

Background: The Need for Cultural and Linguistic Competency

Living Well grantees are implementing models that work towards enhanced health and safety 

of individuals with I/DD and increased workforce capacity and stability, while incentivizing 

practices related to supported decision making, person-centered thinking, and other similar 

strategies.2 Cultural competency is critical to reducing health disparities and improving access 

to health care that is respectful of and responsive to diverse needs, including to improve the 

1 For mor e detailed information on the Living Well grant, grantees, and full evaluation findings, evaluation reports can be found here: 

https://acl.gov/programs/program-evaluations-and-reports

2 Living W ell-Model Approaches for Enhancing the Quality, Effectiveness and Monitoring of Home and Community Based Services for 

Individuals with Developmental Disabilities; HHS-2017-ACL-AOD-DNIQ-0221. https://acl.gov/grants/living-well-model-approachesenhancing-quality-effectiveness-and-monitoring-home-and-1
LIVING WELL CROSS-SITE EVALUATION 2020-2021 2

health and well-being of individuals with I/DD. In 2013, the U.S. Department of Health and 

Human Services (HHS) released National Standards for Culturally and Linguistically Appropriate 

Services (CLAS) in Health and Health Care, which states that its principal standard is “to 

provide effective, equitable, understandable, and respectful quality care and services that 

are responsive to diverse cultural health beliefs and practices, preferred languages, health 

literacy, and other communication needs.” Application of this standard requires changes in 

values, policy structures, and practices and by responding effectively to the growing cultural 

and linguistic diversity among individuals living with I/DD and their families. This could mean, 

for example, collecting demographic data that could inform service delivery, producing durable 

products using plain language, or providing professional language interpretation services during 

learning events at no cost to participants.

Cultural and Linguistic Competency 

Grantees are engaged in efforts to increase cultural accessibility in the DSP workforce, increase 

engagement of individuals with I/DD and their families, and implement strategies to build 

cultural competency into their service systems. This brief features examples from Living Well 

grantees using innovative practices to advance cultural and linguistic competency.

Individuals with I/DD and their Families

Overview

Grantees emphasized their practices to increase the accessibility of materials and events for 

individuals with I/DD and their families. Highlighting a commitment to the use of plain language,3

grantees worked with self-advocates to produce communication, including durable products, that 

are clear, straightforward, and use only words that are necessary. Some grantees additionally 

worked to ensure that these materials were made available in several languages.

Example 1: Virginia

The Virginia Living Well team commits to language accessibility in their 

communications, including through reporting research results to people with 

I/DD and families in Facebook Live events and to cultural agility in its direct 

support of people with I/DD and families. For example, a Living Well partner, 

the Virginia Board for People with Disabilities/Developmental Disabilities 

(DD) Council, consulted with Partnership for People with Disabilities staff to 

develop and publish plain language versions of their State Disability Services 

Trend Reports. One-to-one support was provided to 240 families (40% 

identified as culturally or linguistically diverse) and 65 DSPs through the 

Virginia Living Well family support capacity building project. Additionally, two 

Spanish language support groups met monthly and virtually based out of 

Virginia Beach and Richmond.

3 The Plain Writing Act of 2010 defines plain language as: “writing that is clear, concise, well-organized, and follows other best practices appropriate to the subject or field and intended audience. More information can be found here: https://www.plainlanguage.gov/about/definitions/
LIVING WELL CROSS-SITE EVALUATION 2020-2021 3

Example 2: Alaska

In alignment with the Alaska Developmental Disabilities Shared Vision, 

which includes “supported families, professional staff and services available 

throughout the state now and into the future”, the Alaska Living Well team 

sought means to sustainably expand accessibility to its resources and 

events.4 For example, to better advertise their advocacy events, the Alaska 

Living Well team developed plain language flyers for promoting Empower 

Hour (i.e., self-advocate meetings) events to go alongside messages shared 

via the email listserv and on social media. Additionally, the Alaska Living Well 

team recorded stakeholder meetings and incorporated graphically-oriented 

notes to expand the accessibility of meeting materials for individuals who 

learn best through visual representation. Graphic recording can easily be 

pulled into reports and other shared materials for distribution.

Example 3: Wisconsin

The COVID-19 pandemic raised concerns surrounding the health, safety,

and social connectedness of individuals with I/DD. The Wisconsin Living

Well team created the COVID-19 Toolkit to provide guidance on COVID-19

and strategies for staying connected. The toolkit also includes a number

of products targeted at increasing awareness of individuals’ rights and

how to report abuse since the COVID-19 pandemic changed how many

people with I/DD live and work. All resources are written in plain language

and developed by self-advocates. The materials were then reviewed by

People First Wisconsin, a statewide self-advocacy organization. The team

developed four training sessions based on the toolkit, and the training was

piloted by more than 150 individuals including self-advocates, provider

agencies, and managed care organizations. The pilot included an evaluation

component, which was used to compile detailed recommendations to

improve the toolkit and prepare it to be expanded into a broader toolkit 

addressing ways to stay healthy, safe, and connected.

Example 4: Idaho

The Idaho Living Well team hired a staff member focused on producing 

materials in plain language, Spanish-language, and which are 508-compliant 

(i.e., accessible to individuals using a screen-reader).

4 The Shar ed Vision for Developmental Disabilities can be found on the Alaska Association on Developmental Disabilities website here: 

http://www.aaddalaska.org/
LIVING WELL CROSS-SITE EVALUATION 2020-2021 4

Example 5: Wisconsin

Wisconsin Living Well has additionally developed COVID-19 vaccine 

resources in collaboration with the Wisconsin Department of Health 

Services. These resources were translated into Hmong, Spanish, and 

Somali, which they identified to be the three predominant languages after 

English in Wisconsin’s underserved communities. These documents include 

resources to support individuals and their supporters on who could receive 

a vaccination, where they could access a vaccination, and answer questions 

about the safety of the vaccine.

Intended Outcomes

The efforts to offer events and materials in plain language and expand service offerings in 

languages other than English effected by Living Well grantees showcase a commitment to 

engaging self-advocates and families in grant activities in an active and meaningful way. The 

accessibility of the language used in trainings, communications, and durable products support 

the goal of building knowledge and advocacy skills among individuals with I/DD and their 

families and allows for a means to receive meaningful feedback from these individuals in all 

aspects of grant work.

DSP Workforce

Overview

Grantees can embed cultural and linguistic competency into their governance, leadership, 

and workforce by recruiting, promoting, and supporting a culturally and linguistically diverse 

workforce responsive to the population in the service area and providing education and training 

on policies and practices on an ongoing basis. One means to reduce the barriers to accessible 

training is to collect data on the workforce’s first languages and provide professionally 

translated training materials.
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Example: New Hampshire

Early in their grant design, the New Hampshire Living Well team, in 

collaboration with the state DD agency, identified medication administration as 

an important factor for promoting health and safety among people with I/DD 

using HCBS. The original training was only provided in English and had not 

been updated in over a decade. This attention to medication administration 

came as the team learned that individuals that do not speak English as their 

first language are more likely to make medication errors that result in the 

revocation of medication administration privileges, resulting in DSPs and other 

support staff struggling to meet foundational requirements for their job and 

often being terminated from their positions. The team worked with a retired 

nurse to update the state’s medication administration training, reduce the 

amount of technical and clinical language, and then translate it into Spanish 

and Nepalese, the two most spoken languages within the workforce following 

English.

When the COVID-19 pandemic prompted closures and physical distancing 

requirements, the state DD agency sought help converting the training to 

a virtual format. Within four days, the New Hampshire Living Well team 

responded to the request and produced the training virtually, including a 

series of videos created by self-advocates, a state developmental disability 

nurse, and home provider. The New Hampshire Living Well team intends to 

share the training with other states. 

Intended Outcomes

The goal of the new training is to facilitate community capacity building by improving the 

accessibility of required training materials. The New Hampshire Living Well team believes this 

effort will help attract and retain providers in the DSP workforce, which sees an increasing 

demand for labor.

Service Systems

Overview

Two grantees, the Idaho and Indiana Living Well teams, have worked to build cultural and linguistic competency across their service systems by embedding these principles in their models.
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Example 1: Idaho

The Idaho Living Well team worked with Community Now! (CNOW!) to review, 

modify, and approve recommendations moved forward from each of the 

Idaho Living Well workgroups associated with their grant objectives.5 This 

partnership expanded to include the Culturally Responsive Advisory Group 

(CRAG), which includes five parent advocates and five self-advocates with 

Latinx background. The CRAG engages meaningfully in grant activities to:

• Shape policy recommendations that are culturally and linguistically 

relevant to the Latinx population;

• Provide feedback on material introduced during CNOW! meetings, on 

the Quality Assurance workgroup’s scope of work related to abuse 

and neglect reporting and monitoring, proposed research studies, and 

DSP competencies, including on what DSPs need to know to be more 

culturally competent;

• Join with the Quality Assurance subcommittees to provide feedback on 

trainings, and;

• Work with a new Spanish-speaking project coordinator hired by the 

Idaho Council on Developmental Disabilities (ICDD) in March on future 

recommendations.

Example 2: Idaho

The Idaho Living Well team also contracted with Vivian Jackson from the 

National Center for Cultural Competence at Georgetown University to adapt 

a one-day cultural competency training into a five-part webinar series. The 

webinar series aims to create a greater understanding of cultural differences 

within the current service system. Participants included individuals from 

the ICDD, Idaho Center on Disabilities and Human Development, DisAbility 

Rights Idaho, Vocational Rehabilitation, State Independent Living Council, 

service provider agencies, self-advocates, and family member advocates. 

Attendees were asked to complete post-event surveys after each webinar, 

with satisfaction rates ranging from 95% to 100%.

5 More information about Community Now! can be found here: https://healthandwelfare.idaho.gov/services-programs/community-now
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Example 3: Indiana

The Indiana Living Well team is engaged in a system-wide effort with 

stakeholders towards a common vision. They continued efforts to align 

their work in the Community of Practice (CoP) for Cultural and Linguistic 

Competency in Developmental Disabilities with the Charting the Life Course 

framework and the Living Well grant work to ensure adequate consideration 

of people’s backgrounds and cultures. The premise of the CoP is that 

collaboration is required for integration, a culture shift requires partnerships 

across siloes that are communicative, and monitoring is vital to understand 

how efforts could impact other partners. To achieve this, they are integrating 

their Living Well grant with other state initiatives, such as their HCBS waiver 

redesign, supported decision making, Culture of Quality, and communities of 

practice for supporting families and cultural and linguistic competency. The 

Indiana Living Well team recognizes that cultural and linguistic competency is 

foundational to their vision that “all people are empowered to live, love, work, 

learn, plan, and pursue their dreams.”

Intended Outcomes

The Idaho and Indiana Living Well teams both designed interventions meant to reach across their 

service systems. The Idaho Living Well team structured their grant operations around meaningful 

partnerships with self-advocates and their families, including by creating purposeful leadership 

positions in the CRAG for Latinx individuals with I/DD and their families. Because of their advisory 

capacity, the CRAG is able to influence grant activities across both core components. The Indiana 

Living Well team is engaging stakeholders towards a shared vision of system transformation.

Conclusion

Living Well grantees show a commitment to cultural and linguistic competency in many of their 

grant activities, including in their efforts to:

• Remove barriers to required trainings for DSPs and HCBS providers;

• Engage self-advocates and family members in grant activities through the use of plain 

language and professional translation services, and;

• Create leadership positions for self-advocates and family advocates, ensuring that the 

advisory groups are representative of the community at-large (including consideration by 

race, ethnicity, language, gender, sexuality, religion, education, and income level).

This attention to cultural and linguistic competency within the system of services, supports, and 

assistance recognizes the capacity of individuals, removes barriers, and thus maximizes the 

ability of providers, self-advocates, and family members to participate more effectively.