Living Well Cross-Site Evaluation Executive Summary: Evaluation Year Two 1

Living Well 2020 

Cross-Site Evaluation

Executive Summary

Evaluation Year Two

Access the full annual report and other evaluation materials here.
Living Well Cross-Site Evaluation Executive Summary: Evaluation Year Two 2

I. Introduction

A. Grant Background

In the last two decades, the number of individuals with intellectual and developmental disabilities (I/DD) living in 

community settings and receiving home and community based services (HCBS) has increased dramatically. While this has 

led to better outcomes, including people with I/DD making more of their own choices and being a part of the community, 

there are great variations in the accessibility of quality HCBS across the country. To address these variations and the 

associated risks, the Administration for Community Living (ACL) awarded eight five-year grants to build and implement 

model approaches focusing on two core components and incorporating eight key features to promote independence, 

integration, and inclusion in community life. Additional information about the Living Well grants is available in Volume I 

of the annual report.

B. Core Components and Key Features

Community 

Monitoring

Community 

Capacity 

Building

Core components for enhancing and 

assuring the independence, integration, 

safety, health, and well-being of individuals 

living in the community

Partnerships

Initiation and coordination 

of partnerships or coalitions 

with local and state-level 

organizations, agencies, and 

other relevant stakeholders, 

including at least one-self 

advocacy organization, in 

the design, implementation, 

and replication of grantee 

activities

Meaningful and 

active engagement 

with self-advocates 

and families

Continuous, meaningful, 

and active engagement of 

self-advocates and family 

members throughout the 

life cycle and in all stages of 

the project

Evidence based 

practices for service 

improvements

Use of evidence based 

and innovative strategies 

to (1) improve access to 

and quality of community 

services, (2) reduce 

and mitigate abuse and 

neglect, and (3) support 

empowerment, selfdetermination, and selfadvocacy

Building capacity 

of DSPs and HCBS 

providers

Prevention-based tools 

and technical assistance 

to address common 

needs, such as changing 

the ‘culture of abuse and 

neglect’ in HCBS settings 

and transferring knowledge 

of positive behavior
Living Well Cross-Site Evaluation Executive Summary: Evaluation Year Two 3

Reducing abuse 

and neglect 

through community 

monitoring

Collection, analysis, and 

dissemination of data to 

develop and implement 

coordinated community 

monitoring that builds 

on existing local or 

state infrastructure and 

partnerships

Addressing health 

and safety with data 

tools

Data tools and evidence 

based practices for 

monitoring high-risk 

individuals and addressing 

reoccurring issues of health 

and safety concerns

Program and 

outcome evaluation

Process and outcome 

evaluation to analyze 

delivery and impact of 

project activities

Sustainability

Assurance of organizational, 

financial, and/or community 

stability to continue and 

refine grantee work

C. Grantees and Introduction to State Summary Profiles 

Cohort 1

University of Georgia 

Institute on Human 

Development

University of New 

Hampshire Institute on 

Disability

Virginia Commonwealth 

University Partnership for 

People with Disabilities

Cohort 2

Alaska Governor’s Council 

on Disabilities and Special 

Education

University of Idaho Center 

on Disabilities and 

Human Development

Indiana Family 

and Social Services 

Administration

University of 

Missouri-Kansas City 

Institute for Human 

Development

Wisconsin Board for 

People with 

Developmental Disabilities
Living Well Cross-Site Evaluation Executive Summary: Evaluation Year Two 4

II. Findings and Analysis

ACL contracted with The Lewin Group (Lewin), as a subcontractor to New Editions Consulting, to conduct a cross-site 

evaluation of Living Well grants. Evaluators collected data through interviews, virtual stakeholder meetings, an online 

reporting tool, and materials review (i.e., semi-annual reports). Findings and analyses from the second year of data 

collection are presented here.

A. Findings

Living Well grantees are tasked with “developing and testing one or more model approaches of a coordinated and 

comprehensive system that includes two interrelated core components for enhancing and assuring the independence, 

integration, safety, health, and well-being of individuals living in the community.”1 The two core components are: (1) 

Community Monitoring and (2) Community Capacity Building. Each grantee is using a detailed work plan to guide 

progress toward specific goals and objectives. As grantees achieve milestones indicated in their work plans, their Living 

Well models are taking shape in varied ways in response to the context in which they are being designed and implemented. 

Additionally, the models are evolving as grantees evaluate their activities and respond to new challenges. 

Several model approaches are emerging, which are not mutually exclusive. One approach is to align with established 

statewide systems change initiatives. Grantees using this approach (e.g., teams in Alaska and Idaho) benefit from existing 

stakeholder groups and a clearly articulated vision or set of goals to which the Living Well grant is aligned. Other grantees 

(e.g., those in Indiana, Virginia, and New Hampshire) are leveraging their Living Well grants to convene partners and 

integrate discrete initiatives to holistically address the core components. Finally, several grant teams (e.g., teams in 

Missouri, Georgia, and Wisconsin) are using a pilot model approach to develop, implement, test, and revise initiatives on a 

local level before planning to scale and finalize their outputs.

A series of profiles summarizing grantee-specific background and experience, relevant state contextual factors, model 

overview, key activities, and analyses comprise Volume II of the annual report.

B. Cross Site Analysis

Evaluators analyzed data by core component and identified emergent themes. The cross-site analysis is presented in 

Volume III of the annual report and summarized here.

Community Monitoring

Community Monitoring refers to the development and implementation of a coordinated system to monitor 

the health and safety of individuals with I/DD living in community settings. In order to develop and support 

comprehensive community monitoring systems in their states, grantees are engaged in the following activities:

• Collaborating with Strategic State Partners: Grantees are developing and utilizing partnerships across state 

systems to improve reporting and data collection and drive systems change. These partnerships inform best 

practices and help to ensure Living Well grant objectives are advanced across the state.

• Collecting and Analyzing Data: Grantees are leveraging data tools such as Therap and the Personal Outcome 

Measure Survey to collect, monitor, analyze, and present data about the health and well-being of individuals 

with I/DD in their communities. Other grantees are working to integrate data from sources such as the National 

Core Indicator survey and the Centers for Disease Control and Prevention and make the data more accessible to 

stakeholders across the system.

• Recognizing the Importance of Policy: To improve statewide community monitoring requirements, grantees 

engaged in policy advocacy and research. State policy change is essential to address many components of effective 

systems of community monitoring and is a critical driver of sustainability.

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

with Developmental Disabilities; HHS-2017-ACL-AOD-DNIQ-0221. https://acl.gov/grants/living-well-model-approaches-enhancing-qualityeffectiveness-and-monitoring-home-and-1
Living Well Cross-Site Evaluation Executive Summary: Evaluation Year Two 5

Community Capacity Building

Community Capacity Building refers to efforts to support, develop and build knowledge among individuals with 

I/DD and the people and systems that support them in the community. In order to build capacity in their 

communities, grantees are engaged in the following activities:

• Building Capacity of Individuals with I/DD: All grantees are engaged in developing and/or implementing 

trainings to build capacity of individuals with I/DD. Training topics range from basic self-advocacy and rights of 

individuals with I/DD to leadership and peer-advocacy. Additionally, many grantees are engaging self-advocates as 

leaders on their grant teams, providing opportunities for individuals with I/DD to grow in leadership and trainer 

roles.

• Building Capacity of HCBS Providers: Grantees are working to build capacity of HCBS providers with a 

particular emphasis on direct support professionals (DSPs). Living Well grantees are developing DSP careers 

through additional training opportunities and support to reduce DSP turnover. Additionally, grantees are both 

utilizing or adapting existing training curricula and also developing new training curricula to meet their unique 

needs.

• Developing and Sustaining Strategic Partnerships: Many grantees are developing partnerships ranging from 

local service providers to state agencies to national organizations. These partnerships build capacity by identifying 

and supporting the implementation of best practices in HCBS.

III. Methodology

A. Evaluation Overview and Purpose

Each grantee designed one or more models integrating 

community monitoring and capacity building with the goal 

of enhancing health, safety, integration, and independence of 

individuals with I/DD living in the community. These models 

work toward:

• Enhancing the health and safety of individuals 

with I/DD;

• Strengthening the direct support 

professional workforce;

• Strengthening the role of self-advocacy in improving 

and assuring the quality of home and community based services; and

• Increasing the coordination and capacity of states to effectively implement comprehensive high quality HCBS.

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

evaluation. These questions and a more detailed discussion of the evaluation methodology are included in Volume IV of 

the annual report. 

Purposes of the 

Cross-Site Evaluation

1. Analyze how the Living Well grants are being 

implemented across grantee sites;

2. Determine whether Living Well grantees are 

meeting the goals of the project; and 

3. Evaluate whether the models implemented across 

the sites impact the quality of life of individuals 

with (I/DD).

1

2

3
Living Well Cross-Site Evaluation Executive Summary: Evaluation Year Two 6

B. Data Collection and Analysis with Timeline

IV. Conclusion

Grantees are completing their second or third years of the five-year Living Well grants and progressing toward the intended 

grant outcomes. Each grantee is impacted by state contextual factors; the factors that exist outside of the Living Well grant 

but affect the activities, outcomes, and progress of the Living Well teams. Some are beginning to finalize and publish 

resources and final toolkits that will be supportive of community monitoring and capacity building activities even after the 

end of the grants. Others are still developing, testing, and refining their resources. These resources are the first step toward 

sustainability as well as scalability. Grantees are addressing both core components of the grant: Community Monitoring 

and Community Capacity Building. Although many of the activities that grantees are developing and implementing to 

address these components are distinct, the activities are pieces of the overall models that grantees are continuing to develop 

to sustainably improve the HCBS system for individuals with I/DD.