During the last two decades, the number of individuals with intellectual and developmental disabilities (ID/DD) living in community settings and receiving home- and community-based services (HCBS) increased dramatically. While this led to better outcomes, including people with ID/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.
In 2017 and 2018 ACL awarded Living Well grants to help develop and test model approaches for enhancing the quality, effectiveness, and monitoring HCBS for people with developmental disabilities. These Model Approaches for Living Well grants, awarded as Projects of National Significance by ACL’s Administration on Disabilities, are focused on building the capacity of HCBS systems and enhancing community monitoring to prevent abuse, neglect, and exploitation.
In 2018, ACL funded a cross-site evaluation of all eight grantees from cohorts one and two. Each grantee has designed one or more models integrating community monitoring and capacity building with the goal of enhancing health, safety, integration, and independence of individuals with ID/DD living in the community. The cross-site evaluation of the Living Well grants focused on eight key features.
Grantees are completing their third or fourth years of the five-year Living Well grants and progressing toward the intended grant outcomes. Each grantee is impacted by state contextual factors that exist outside of the Living Well grant, yet 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. 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 ID/DD.
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.
As part of the ongoing evaluation, ACL has released a new report in five parts and three briefs:
The three briefs:
- Strategies for Building Capacity of the Direct Support Workforce
- Strategies for Using Data Tools for Monitoring and Decision-Making
- Strategies for Developing Cultural and Linguistic Competency Across Systems
Learn more about the Living Well grants evaluation and see previous reports. Contact Ophelia McLain with questions.