“We Can Do Better Together” Encouraging Health, Housing, Transportation,

and Social Service Partnerships: Successful Strategies to Expand

Chronic Disease Self-Management Education Programs September 20, 2016

Department of Health & Human Services, Administration for Community Living,

Health Resources and Services Administration, Department of Housing and Urban Development ,

and Federal Transit Administration Lori Simon-Rusinowitz, MPH, PhD

University of Maryland, School of Public Health

Project partially funded by the Administration for Community Living (ACL). The Health and Aging Policy Fellows program supported the first phase of this project.

Views expressed do not necessarily represent the views of ACL.

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Lori Simon-Rusinowitz

Program Developer and Moderator Associate Professor at the University of Maryland,

School of Public Health

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Agency Leaders and Planning Team Members

• Carol Crecy, Elena Fazio, Kristie Kulinski, and Lan Marshall, HHS ACL

• Suma Nair, Kent Forde, and Joan Weiss, HHS, HRSA • Jennifer Ho, Leah Lozier, Leigh van Rij, and Ron Ashford, HUD • Marianne Stock and Danielle Nelson, FTA • Cora Plass and Kathleen (Cain) Zuke, National Council on

Aging • Lori Simon-Rusinowitz, University of Maryland, School of

Public Health

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• Kristie Kulinski, Aging Services Program Specialist, Office of Nutrition and

Health Promotion Programs, HHS ACL • Anand Parekh, Chief Medical Advisor, Bipartisan Policy Center • Molly Dugan, Director, and Amy Perez, Statewide Support Coordinator,

Support And Services at Home (SASH), Vermont

• Brenda Goldstein, Psychosocial Services Director, LifeLong Medical Care, California

Presenters

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Webinar Agenda

• Webinar Overview and Introductions • We Want to Learn About You: Audience Polling Questions • What Does Research Tell Us About Evidence-Based Chronic

Disease Self-Management Education (CDSME) Programs? • We Want to Learn From You: Audience Polling Questions • Recommendations from the Bipartisan Policy Center Senior

Health and Housing Task Force • Learning from CDSME Partnerships in Vermont and California • We Want to Learn From You: Audience Polling Questions • Audience Discussion

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Carol Crecy Senior Advisor

to the Principal Deputy Assistant Secretary for Aging HHS ACL

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About the Administration for Community Living (ACL)

• Mission – maximize the independence, well-being, and health of older adults, people with disabilities across the lifespan, and their families and caregivers

• Commitment to one fundamental principle – people with

disabilities and older adults should be able to live where they choose, with the people they choose, and participate fully in their communities

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ACL Chronic Disease Self-Management Education (CDSME) Funding History • Evidence-based Prevention Program (2006-2007)

27 grantees (3 funded by Atlantic Philanthropies) • ARRA Communities Putting Prevention to Work (2010)

47 grantees • Prevention and Public Health Fund CDSME (2012)

22 grantees • Prevention and Public Health Fund CDSME (2015)

8 grantees • Prevention and Public Health Fund CDSME (2016)

12 grantees (including 5 Tribes)

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Individuals Served to Date

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Suma Nair Director of the Office of Quality Improvement

Health Resources and Services Administration’s Bureau of Primary Health Care

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National Impact of Health Center Program

Source: Uniform Data System, 2008-2015. National Data: U.S. Census Bureau, 2015 Population Estimates

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Jennifer Ho Senior Advisor on Housing and Services

U.S. Department of Housing and Urban Development

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Marianne Stock Division Chief

Rural and Targeted Programs Federal Transit Administration

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We Want to Learn About You: Audience Polling Questions

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Kristie Kulinski Aging Services Program Specialist

Office of Nutrition and Health Promotion Programs HHS ACL

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Overview of Self-Management Education

Kristie Kulinski, MSW September 20, 2016

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Chronic Disease: The Facts

• In the US, ~80% of older adults have 1 chronic condition (e.g. arthritis, hypertension, diabetes) and ~70% of Medicare beneficiaries have two or more

• Adults with disabilities experience health disparities compared with general population (high blood pressure, overweight/obese, less physically active)

• Profound impact on health care costs: 95% of health care costs for older Americans can be attributed to chronic diseases

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Once a chronic disease is present, one cannot NOT

manage, the only question is “how.”

Chronic Disease Self-Management

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• “Involves [the person with the chronic disease] engaging in activities that protect and promote health, monitoring and managing of symptoms and signs of illness, managing the impacts of illness on functioning, emotions, and interpersonal relationships, and adhering to treatment regimes.”

Self-Management Definition

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Patient Education vs. Self-Management Education

Patient Education Self-Management Education

Assumes that knowledge creates behavior change

Skills to solve patient-identified problems

Usually disease-specific Skills are generalizable across chronic conditions

Goal is compliance Stresses self-efficacy and goal setting

Teachers are health care professionals

Teachers are facilitators, often with chronic conditions

Didactic Interactive

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Managing Chronic Conditions through Proven Community Programs • Chronic Disease Self-Management Education (CDSME)

Programs: build multiple health behaviors and generalizable skills such as goal setting, decision making, problem solving, and self-monitoring

• Self-Management Support Programs: increase 1 or more skills or behaviors relevant to chronic disease self-management such as physical activity and medication management

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Evidence-Based CDSME and Self-Management Support Programs* • Stanford University CDSME suite • EnhanceFitness • EnhanceWellness • Fit and Strong! • Healthy IDEAS (Identifying Depression, Empowering Activities for

Seniors) • HomeMeds • Program to Encourage Active, Rewarding Lives for Seniors

(PEARLS) *Not an exhaustive list

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CDSME Programs

• Notable programs developed by Stanford University: – Chronic Disease Self-Management

• English and Spanish – Diabetes Self-Management

• English and Spanish – Chronic Pain Self-Management – Cancer: Thriving and Surviving – Positive Self-Management Program for HIV – Better Choices, Better Health® Online Programs

• Chronic Disease, Diabetes, Arthritis, Caregivers, and Cancer

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Stanford CDSME Program Overview

• 6 weekly workshop sessions • Each session 2 ½ hours, highly interactive • Co-facilitated by 2 trained leaders (at least one with an

ongoing health condition) • Detailed script for leaders • Highly participative:

– Activities that build self-efficacy (belief in one’s ability to succeed)

– Goal setting, action planning, and brainstorming

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Stanford CDSME Program Overview (cont.)

• Core content similar across programs: – Techniques to deal with frustration, fatigue, pain, isolation – Appropriate exercise for maintaining/improving strength,

flexibility, endurance – Appropriate use of medications – Effective communication with family, friends, and health

professionals – Nutrition – Decision making – Evaluating new treatments

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• Basics of a successful action plan: – Something YOU want to do – Reasonable – Behavior within your control – Answers the questions:

• What, how much, when, how often? – How confident are you? (0=not confident, 10=totally

confident) • Goal of 7 or higher

Action Planning

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Self-management goals

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Research Findings

• Improved self-rated health • Increased self-efficacy • Less reported disability • Increased energy/less fatigue • Increased healthy behaviors • Reduced health distress and depression • Less pain • Reduced health care utilization (Emergency Room (ER)

visits and hospitalizations)

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CDSMP National Study

• Better Care – Communication with health care team – Medication compliance – Health literacy

• Better Health – Self-assessed health – Depression – Quality of life – Unhealthy physical/mental days

• Lower Costs – ER visits – Hospitalizations

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CDSMP – Estimated Cost Savings • $364 cost savings per person after considering cost of the

program • Reaching just 10% of Americans with one or more chronic

conditions could save $4.2 billion

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What Participants Are Saying

• “I feel more like the engine that could…it is easier to do things that for years I had just given up on trying.”

• “I’ve lost 25 pounds…after losing weight along with exercise, I have been able to get off my blood pressure medicine…I feel great and have a lot more energy.”

• “I enjoyed the workshop so much I was trained as a leader so I could help other people as much as it helped me.”

• “My wife signed up to attend…I figured I could earn some brownie points and show her some support. I intended to attend only the first class…proved to be so interesting and educational that I resolved to attend all classes with her.”

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Learn More

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We Want to Learn From You: Audience Polling Questions

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Anand Parekh Chief Medical Advisor

Bipartisan Policy Center

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Healthy Aging Begins at Home

ANAND K. PAREKH, M.D., M.P.H. CHIEF MEDICAL ADVISOR

BIPARTISAN POLICY CENTER

35 HTTP : / / B I PA R T I SA NP O L IC Y .O RG / L I BR AR Y / RE C O M ME NDA T I O NS - FO R -HEA LT HY -A G ING /

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THE NATIONAL CHALLENGE

• The U.S. older adult population is growing. As a country we face: – Higher Demand for LTSS:

• Spending on LTSS is expected to increase from 1.3 percent of GDP in 2010 to 3 percent of GDP in 2050.

– Increased Spending on Chronic Conditions: • 93 percent of Medicare spending is for seniors with multiple chronic conditions.

– Inadequate Personal Savings: • Nearly 40 percent of individuals over the age of 62 are projected to have

financial assets of $25,000 or less.

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Priority Areas:

SENIOR HEALTH AND HOUSING TASK FORCE

Co-Chairs:

Vin Weber Former U.S. Representative

Henry Cisneros Former Secretary, HUD

Mel Martinez Former Secretary, HUD; Former U.S. Senator

Allyson Y. Schwartz Former U.S. Representative

Lack of a Home Impacts Health

Problem: Many seniors are priced out of the housing market or tenuously able to afford their rent. - Understand the need deficit. - Evaluate efforts to expand affordable housing. - Identify opportunities to expand access to more seniors.

A Home Impacts Health

Problem: Housing stock does not accommodate the physical and cognitive difficulties that come with aging. - Identify most critical home & community-based modifications. - Understand current barriers to implementation. - Identify policy solutions to accelerate these modifications.

Home as a Place for Health Services

Problem: Seniors could substantially benefit from in-person or in-home health services. - Identify integrated models of care. - Estimate cost savings implications of these models. - Propose plans to scale them nationally.

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HEALTH BEGINS AT HOME: THE OVERRIDING NEED FOR MORE AFFORDABLE SUPPLY We recommend: • Preventing and ending homelessness among older adults; • Increasing federal support for the Low Income Housing Tax Credit;

and • Adequately funding the Section 202 Supportive Housing for the

Elderly program and also creating and funding a new program for senior-supportive housing.

Supply-Demand Imbalance in Available and Affordable Rental Homes

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AGING WITH OPTIONS: TRANSFORMING OUR HOMES AND COMMUNITIES

The aspiration should be to help seniors not just to age in place but to age with options.

We recommend: • Authorizing a new Modification Assistance Initiative to coordinate

federal resources for home modifications on an interagency basis; and

• Establishing and expanding programs to assist low-income seniors with home modifications through property tax credits, grants, forgivable loans, and targeted tax relief.

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INTEGRATING HEALTH CARE AND SUPPORTIVE SERVICES WITH HOUSING

We recommend: • An initiative that coordinates health care and LTSS for Medicare beneficiaries

living in publicly-assisted housing; • An expansion of the Independence at Home Demonstration program into a

permanent, nationwide program; • Greater support of falls prevention by Medicare and other federal programs; • Housing-related questions in health risk assessments used by Medicare

providers and Medicare Advantage plans; • An extension of the Money Follows the Person (MFP) program to support

state efforts to rebalance their Medicaid long-term care systems; • Data collection of state Medicaid coverage of housing-related activities and

services and their associated impacts on outcomes and costs; • Hospitals incorporating housing questions as part of their discharge

planning, and for non-profits, as part of their IRS-required community health needs assessment;

• Greater reimbursement of telehealth and other technologies with the potential to support successful aging, improve health outcomes, and reduce costs.

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INTEGRATING HEALTH CARE AND SUPPORTIVE SERVICES WITH HOUSING

Recommendation: CMS should launch an initiative that coordinates health care and LTSS for Medicare beneficiaries living in publicly assisted housing to test the potential of improving health outcomes of a vulnerable population and reducing health care costs. • 1.3 million older adult renters live in publicly assisted housing, the

vast majority of whom are dually eligible for the Medicaid and Medicare programs.

• CMS should solicit proposals from health care entities (ACOs, managed care plans, etc.) willing to be accountable for quality, health outcomes, and costs of care for these individuals.

• Eligible applicants would ensure the delivery and coordination of health care, LTSS, and preventive services and wellness programs within a congregate housing setting, using service coordinators and evidence-based models or programs (e.g., CDSMP) with a record of health care utilization reduction.

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INTEGRATING HEALTH CARE AND SUPPORTIVE SERVICES WITH HOUSING

Recommendation: The administration should ensure Medicare and other federal programs and policies support substantially reducing the number of older adult falls and their associated financial impact. • The nation should strive, at the very least, toward a 10 percent

reduction in the rate of emergency department visits due to falls among older adults. (Healthy People 2020 objective)

• There are several efforts that could further orient federal programs toward falls prevention, for example:

• CMS should ensure that quality measures related to falls prevention are embedded in all of its quality-measurement and alternative payment model programs.

• ACL should coordinate an executive branch-wide Modification Assistance Initiative to assist seniors households with home modifications necessary for aging in place.

• CDC should work with states to target clinical falls prevention resources to regions with high fall rates.

• States, through Medicaid state amendment plans, could make sure evidence-based falls prevention programs are provided and reimbursed.

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INTEGRATING HEALTH CARE AND SUPPORTIVE SERVICES WITH HOUSING

Recommendation: Congress and the administration should work together to extend the MFP program to support state efforts to rebalance their Medicaid long-term care systems. • MFP has helped states safely transition nearly 52,000

institutionalized Medicaid beneficiaries to community settings in over 45 states since December 2014. • 37 percent have been older adults.

• This is the last year states can request MFP funding. • The program should be extended and funds appropriated at a level

similar to previous years. • To better accommodate older adults transitioning into community

settings, states should think creatively about how to expand affordable housing options (e.g. Iowa rental subsidy program), and about how to provide enhanced case management and evidence-based programs.

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CONCLUDING THOUGHTS

• The best the way to increase value in healthcare is through clinical-community linkages.

• The “game-changers” for better health and lower costs will come from inside and outside the clinical setting.

• Integration of health & human services will be paramount to reducing health care costs.

Molly Dugan Director

and Amy Perez

Statewide Support Coordinator Support And Services at Home

(SASH), Vermont

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SASH – Using Housing as a Platform To Expand CDSME Programs

September 20, 2016 46

The Intersection of Health & Housing

• 65 partner agencies part of SASH Collaboratives

• SASH Available through non-profit housing across the state

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Connecting the Medical Home to Home

Housing Based SASH Team

Housing - Mental Health – VNA - AAA

Community Health Team

Medical Home

Vermonter

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Blueprint Health Service Areas

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SASH

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The Picture of Housing and Health

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The SASH Model Focuses on Three Components of Care Management

• Coordinates with discharge staff, family and neighbors • Personal visit to review discharge instructions • Helps ensure a safe home transition

Care Coordination

• Develops healthy living plan • Coaches SASH participants • Provides reminders and in-person check-ins • Organizes/presents evidence based programs

Self Management

• Conducts wellness assessment • Convenes SASH team • Understands participants’ needs and preferences • Coordinates individual/community healthy living plans

Transitional Care

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Data Collection and Use: Key to Integrating Coordinated Care

• Uniform Assessment

• Minimum Annual • Includes

Medications, Allergies, Chronic Conditions and more…

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CDSMP Structure in Vermont

• Blueprint leads the charge. • Greater Burlington YMCA manages logistics and

coordination. • SASH provides space, marketing, staff leaders and

referral network. • All those coordinating programming, including

SASH Administrators, are trained leaders. • Quarterly all day meetings with all coordinators

to work on constant program improvement.

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CDSMP and SASH

Class Name Number of leaders

Number or classes provided Number of completers

All Healthy Living Workshops listed below 48 21

158

CDSMP 31 11 87

Chronic Pain 7 4 32

Diabetes 10 6 39

Tai Chi 19 49 288

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Transportation Solutions

• Medicaid rides • Meal site rides • Ride sharing • Bus vouchers • Gas cards at end of series • Work with local public transportation

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Program Improvements in the Coming Year

• Classes have doubled to a minimum of 20 per Hospital Service Areas (HSA), 12 tobacco, 3 Diabetes Prevention Programs, remainder are based on community needs and outcomes of the Learning Collaborative.

• Learning Collaborative starting up to fully invest in local partnerships.

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Lessons Learned

• There is a higher completer rate when classes hosted at housing sites. • It takes time. Once there are one or two successful workshops, the

word gets out and more people come. • Lots of preparation time, BUT the value of time with participants

during class pays off ten fold. • Some provide food vouchers at the hospital, have a potluck,

coordinate with a meal site. • Partnering with staff in a systematic approach can help.

– Work with participants on the issues that will engage and retain them. – Outreach to a targeted audience.

• Call early and often. • Coordinate with popular events. • Physicians referring is very successful.

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Successes

• Grant for partnership with Cathedral Square and Greater Burlington YMCA to do blood pressure

self-monitoring and an educational curriculum for four months.

• At a SASH site, the food bank demonstrated fresh, healthy cooking at a Diabetes Prevention Program led by the Greater Burlington YMCA.

• Held workshops at Senior Centers to engage a wider variety of participants.

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Contact Information

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Brenda Goldstein Psychosocial Services Director

LifeLong Medical Care, California

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Brenda Goldstein, MPH LifeLong Medical Care bgoldstein@lifelongmedical.org 62

Federally Qualified Health Center (FQHC) providing services in Oakland, Berkeley, West Contra Costa County and Marin County

50,000 patients served annually 13 Primary Care Clinics, 32 sites including Supportive Housing Dental Urgent Care Adult Day Health School-Based Clinics

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Elderly

Permanent Supportive Housing Residents Single Room Occupancy (SROs) – Project Based Scattered Site: Shelter Plus Care, Veterans Affairs

Supportive Housing (VASH)

Currently homeless

Frequent Users of Emergency Department (ED)

High cost disabled 64

Hypertension control with Supportive Housing Residents

Tobacco Cessation for Homeless Adults with Mental Illness

Behavioral Health Services for seniors and Supportive Housing Residents

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Population Formerly homeless adults with physical and/or

behavioral disabilities

Setting Congregate living in supportive housing

Partners Housing owners/operators: space, funding FQHC Clinic: case management, groups, clinic Hospital: data management and evaluation Urban Farming Agency: garden, food, programming

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Program

Weekly blood pressure monitoring in building lobbies

Self-Management Education: monitoring, medications, lifestyle

Support to access health care

Incentives for tracking blood pressure and participating in groups/activities (walking, stress management, etc.)

Access to healthy foods from the garden

Peer support groups

For FQHC patients – medication monitoring/management 67

Population Formerly homeless adults with serious mental illness

Setting Scattered site subsidized housing Office based Assertive Community Treatment team

Partners Mental health agency: space, mental health support California Smokers’ Helpline: education/counseling FQHC: case manager/medical support, prescribing

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Program Identify smokers wanting to quit or cut down

Set up phone appointment with CA Helpline

Case manager co-facilitates the phone call

Helps consumer set realistic goals in context of their recovery, housing, behaviors, activation level

Provide medical support – nicotine patch, monitoring

Support and track success over time

Peer run cessation groups

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Population Very low income seniors, formerly homeless

Setting Primary care clinic Senior service agency Home

Partners Senior center: screening, referral, home visits FQHC: screening, community-based

organization referral, treatment, data

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Program

Depression screening at both clinic and senior center Consumers diagnosed with depression offered: Clinic based treatment with Primary Care Provider (PCP)/Licensed

Clinical Social Worker (LCSW)/Psychiatrist Social connection through Friendly Visitor program Support for addressing social determinant/resource needs Community based activities

Use of Patient Health Questionnaire (PHQ9) to track recovery/response to depression treatment

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Funding

Data collection/evaluation

Use of Electronic Health Records that are useful for patients and staff

Launching new initiatives when providers are stretched

Maintaining momentum when new initiatives are launched

Resource limitations in community (housing)

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Recognition of impact of social determinants of

health (especially housing)

Medicaid eligibility expansion

Improved coverage of mental health services

Integration of primary/behavioral health care

Focus on care management for high risk/high cost consumers

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We Want to Learn From You: Audience Polling Questions

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Discussion

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Webinar Speaker Biographies: Carol Crecy is the Senior Advisor to the Principal Deputy Assistant Secretary for Aging, Administration for Community Living (ACL), Administration on Aging (AoA) in the U.S. Department of Health & Human Services. AoA is the one federal agency dedicated exclusively to policy development, planning, and the delivery of supportive home and community-based services to our nation’s diverse population of older Americans and their caregivers. She also serves as the Acting Director, Office of Nutrition and Health Promotion Programs. Since July of 1979, she has served in several management positions within AoA and ACL, starting out as a Special Assistant for Minority Affairs and serving as the Director for the offices of Management and Budget, Policy and Planning, and State and Community Programs and ACL Office of External Affairs. A native of Baltimore, Maryland, Ms. Crecy received a B.A. degree in Psychology from the University of Maryland and an M.B.A. degree from Trinity College in Washington, D.C. Molly Dugan is the SASH (Support And Services at Home) Director and over the past six years has been responsible for overseeing the pilot program design and statewide expansion which currently includes 138 SASH program locations in every county and Health Service Area in Vermont. Prior to joining Cathedral Square Corporation, she was Deputy and then Acting Commissioner of the Department of Housing & Community Affairs for the State of Vermont. She is the staff lead on the SASH evaluations. Ms. Dugan received her Master’s Degree in Public Administration from the University of Vermont.

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Webinar Speaker Biographies (continued): Brenda Goldstein is the Psychosocial Services Director at LifeLong Medical Care, a community health center serving Berkeley, Oakland and West Contra Costa County, California. Ms. Goldstein is a vocal advocate for increased access to care for the underserved and has fostered numerous partnerships between public and community agencies to create medical, mental health and social services systems of care for those experiencing homelessness, mental illness and lack of access to health services. Ms. Goldstein has developed LifeLong’s Supportive Housing Program into a nationally recognized model of care serving dually diagnosed homeless adults and is recognized as a leader in developing policies and programs to promote integrated primary care and behavioral health services. Ms. Goldstein received her Master’s in Public Health from University of California Berkeley in 1984. Kristie Kulinski is an Aging Services Program Specialist at the Administration for Community Living/Administration on Aging (ACL/AoA) within the U.S. Department of Health & Human Services. Ms. Kulinski serves as the team lead for ACL/AoA’s chronic disease self-management education (CDSME) initiative. Prior to joining ACL/AoA, she held positions with the National Council on Aging (Washington, D.C.) and Partners in Care Foundation (Los Angeles, California). Her experience has focused on providing expertise, guidance, technical assistance, and other support to state and community-level aging services and public health organizations on the topics of CDSME and other evidence-based health promotion programs. Ms. Kulinski is passionate about advancing the availability and sustainability of evidence-based health promotion programs for older adults. She has a B.S. in Human Development and Family Studies from Penn State University and an M.S.W. from California State University, Northridge.

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Webinar Speaker Biographies (continued): Anand Parekh is Bipartisan Policy Center’s (BPC) Chief Medical Advisor providing clinical and public health expertise across the organization, particularly in the areas of aging, prevention, and global health. Prior to joining BPC, he completed a decade of service at the Department of Health & Human Services (HHS). As deputy assistant secretary for health from 2008 to 2015, he developed and implemented national initiatives focused on prevention, wellness, and care management. Briefly in 2007, he was delegated the authorities of the assistant secretary for health overseeing ten health program offices and the U.S. Public Health Service Commissioned Corps. Earlier in his HHS career, he played key roles in public health emergency preparedness efforts as special assistant to the science advisor to the secretary. Dr. Parekh is a board-certified internal medicine physician, a fellow of the American College of Physicians, and an adjunct assistant professor of medicine at Johns Hopkins University, where he previously completed his residency training in the Osler Medical Program of the Department of Medicine. He provided volunteer clinical services for many years at the Holy Cross Hospital Health Center, a clinic for the uninsured in Silver Spring, Maryland. Dr. Parekh is an adjunct professor of health management and policy at the University of Michigan School of Public Health. He currently serves on the dean’s advisory board of the University of Michigan School of Public Health, the Presidential Scholars Foundation board of directors, and the board of directors of WaterAid America. He has spoken widely and written extensively on a variety of health topics such as chronic care management, population health, value in health care, and the need for health and human services integration. A native of Michigan, Dr. Parekh received a B.A. in political science, an M.D., and an M.P.H. in health management and policy from the University of Michigan. He was selected as a U.S. Presidential Scholar in 1994. Amy Perez is the SASH (Support And Services at Home) Statewide Support Coordinator and has worked with vulnerable populations for the past 15 years, with a focus on housing needs the last nine years. Her housing retention work has included supporting homeless prevention to prison reentry to family support and is now with the innovative SASH model as a Statewide Support Coordinator. In this role, Ms. Perez supports interagency staff teams working with elders and adults living with disabilities to stay healthy and happy in the place they call home. She has been supporting and training SASH staff for the last two years. One of her focus areas is coordinating Chronic Disease Self-Management Program (CDSMP) programming statewide for SASH staff. She sees firsthand the valuable work SASH staff and partners are involved with enhancing the quality of life of participants.

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Webinar Speaker Biographies (continued): Lori Simon-Rusinowitz is an Associate Professor at the University of Maryland, School of Public Health, in Health Services Administration. She was a 2014-15 Atlantic Philanthropies Health and Aging Policy Fellow. Her research has addressed aging and disability policy issues for over 20 years. Dr. Simon-Rusinowitz served as Research Director for the three-state Cash & Counseling Demonstration and Evaluation, the twelve-state Next Steps replication project, and the National Resource Center on Participant-Directed Services. These national programs involved designing, implementing, and evaluating a participant-directed approach to personal care services for people of all ages with disabilities. This approach emphasizes independence and choice for people who need help with personal care activities such as bathing, dressing, and eating. Dr. Simon-Rusinowitz has published and presented extensively on this topic. Her Health and Aging Policy Fellowship project addressed health, housing, and social support partnerships in livable communities. She was based at the Department of Health & Human Services, Administration for Community Living, and worked in partnership with the Health Resources and Services Administration and Department of Housing and Urban Development. Since completing her Fellowship, she has continued working with these federal agencies in addition to the Federal Transit Administration. In collaboration with these agencies, she developed a webinar encouraging health, housing, transportation, and social service partnerships to provide educational programs for people with chronic diseases. Marianne Stock is currently Division Chief, Rural and Targeted Programs for the Federal Transit Administration (FTA). She is responsible for the administration of FTA formula and discretionary grant programs for rural areas, tribes, and the enhanced mobility of seniors and individuals with disabilities. This includes the management of three technical assistance centers and overseeing FTA’s leadership of the Coordinating Council on Access and Mobility. She came to FTA in 2015 after 32 years with New Jersey Transit, most recently as Program Director, Community Mobility. In that role, she oversaw administration of New Jersey Transit's pass-through grant program for sub-recipients, including providing grant support, technical assistance, and compliance oversight to county, municipal, and private non-profit transit services funded through a variety of state and federal grant programs. She also oversaw planning functions related to data collection and analysis. She previously directed New Jersey Transit's strategic planning and policy development efforts. Ms. Stock has a B.A. from the University of Virginia and an M.B.A. from New York University, Stern School of Business Administration. 79