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2020 1st Cycle Direct Effect Quality of Life Grants

​2021 1st Direct Effect Quality of Life Grants

67 Grants totaling $1,305,579

American Therapeutic Riding Center

Sand Springs, OK 74063
$24,530 – Therapeutic Horseback Riding
Outdoor Accessibility and Tactile Stations (OATS) Project
This Direct Effect grant supports the purchase of a portable ramp, lift system, supportive saddles, safety helmets, and an Equicizer, a mechanical horse that simulates riding so riders can build muscle and strength before getting on a horse. Funding will support 18 current participants living with paralysis as well as increase capacity for more individuals to be served throughout the grant year and beyond.

Amyotrophic Lateral Sclerosis (ALS) Association – DC/MD/VA Chapter

Rockville, MD 20850
$9,869 – Assistive Technology
Assistive Technology (AT) for Richmond, VA area Loan Closet and AT Lab
This Direct Effect grant supports the purchase of varied assistive technology and equipment to expand the offerings available at the ALS Association DC/MD/VA Chapter’s AT Loan Closet, located in Richmond Virginia. The addition of this equipment will provide ALS patients the opportunity to test various options and software applications prior to purchasing the expensive equipment for themselves or requesting reimbursement from insurance. This equipment, which includes items such as the PCEye Mini, Windows Control and Communicator 5 software, Microsoft Surface Pro, and ConnectIT tabletop mount, will help ALS patients access and control specialized tablets hands-free, allowing them to maintain a level of independence and communicate with their family members and caregivers. Funding will serve 12 individuals within the grant year.

Assistance Dogs of the West

Santa Fe, NM 87594
$7,397 – Facility Accessibility Modifications
Assistance Dogs of the West Facility Accessibility Modification Automatic Door Installation
This Direct Effect grant supports the installation of automatic door openers for Assistance Dogs of the West’s new training center in Santa Fe, New Mexico, where the client placement process and service dog training occurs. Funding will increase access for over 100 individuals living with paralysis and co-occurring disabilities.

Beaver Brook Association

Hollis, NH 03049
$20,000 – Accessible Trail
Beaver Brook Association Fully Accessible Trail
This Direct Effect grant supports modifications to increase accessibility at Wildflower Trail, an existing, diverse, and popular half-mile nature trail located in Hollis, New Hampshire. By increasing accessibility at Wildflower Trail, wheelchair users will have a new opportunity to join their family and friends outdoors and enjoy everything that the trail has to offer. Following the completion of the trail and in addition to an opening day program, Beaver Brook Association will partner with local organizations and school districts to offer two environmental education program sessions for people living with paralysis to increase awareness and encourage use and nature exploration along the trail. Funding will serve up to 70 people living with paralysis in Hollis and other surrounding communities.

BraveHearts Therapeutic Riding Center

Harvard, IL 60033
$24,750 – Therapeutic Horseback Riding
Equine Services for Veterans with Paralysis
This Direct Effect grant will subsidize the cost of 330 equine therapy hours for 15 military veterans living with paralysis. Each veteran will receive 22 hours of equine therapy at zero cost to themselves. Professional Association for Therapeutic Horsemanship International (PATH) certified instructors will provide lessons, monitor progress, and complete regular evaluations for each participant to ensure individual goals are reached.

Break the Barriers, Inc.

Fresno, CA 93720
$24,943 – Assistive Technology
Adaptive Access
This Direct Effect grant supports the purchase of three specialized wheelchairs that will encourage full participation in outdoor and aquatic programming provided by Break the Barriers (BTB), Inc. The purchase of an Action Track Chair will allow for people with paralysis to access activities on rough terrain, and two Aqua Creek Heavy Duty Pool Chairs will provide the opportunity to take part in water-based athletics and allow BTB to double the number of children assisted through its partner, Valley Children’s Hospital. A minimum of 110 individuals with paralysis/TBI will be served over the course of the grant period.

Bridge II Sports

Durham, NC 27705-8009
$25,000 – Adaptive Sports
Year Round Adapted Sports serving people with SCI
This Direct Effect grant will support a year-round adapted sports program that is designed to cultivate skill, independence, acceptance, community, and giving back. After joining Bridge II Sports program offerings, each athlete is responsible for setting four core goals in alignment with their wants and needs: sport goals, skill goals, independent living goals, and personal growth/educational goals. Program Cultivators work with each participant to implement goal setting and keep accountability, and when the season is over, goals are reviewed to appreciate accomplishments and set new goals for the upcoming season. This program will serve 40 unique people with SCI in 6,600 diverse program hours.

Burleigh County Water Resource District

Bismarck, ND 58502-1255
$25,000 – Accessible Beach/Dock/Pier
McDowell Dam Accessible Kayak/Canoe Launch
This Direct Effect grant supports the installation of an accessible kayak/canoe launch at McDowell Dam, a popular water-based recreational facility in Bismarck, North Dakota. The accessible launch will be the first in the community and will provide access to water recreation for people living with paralysis and co-occurring disabilities. The launch will allow for kayaks, canoes, and paddleboards to enter the water with ease, and includes a transfer station for wheelchair users. Funding is proposed to serve approximately 1,000 community members living with paralysis, their family members, and caregivers.

California Aquatic Therapy & Wellness Center, Inc. (DBA Pools of Hope)

Long Beach, CA 90805-1133
$25,000 – Transportation
Transportation to Wellness Services for Individuals Living with Paralysis
This Direct Effect grant supports the purchase of a full-sized converted van with wheelchair accessibility to allow Pools of Hope to expand access to services by providing transportation from program participants’ homes to the Pools of Hope facility. Pools of Hope serves the under-resourced, medically underserved area of North Long Beach and the surrounding cities of Compton and Paramount, CA. Services include Veteran and youth wellness programs. Funding is proposed to serve a minimum of 75 individuals living with paralysis each year.

Camp Millhouse

South Bend, IN 46614
$13,932 – Facility Accessibility Modifications
Open Table – Empowerment~Independence~Compassion
This Direct Effect grant supports the purchase of 14 accessible picnic tables. Camp Millhouse, which was originally established in 1937 as a camp for children with polio, now serves campers with a variety of paralysis-causing conditions and co-occurring disabilities. The installation of these new accessible picnic tables will remove barriers between campers and encourage inclusion and equality for all. Forty individuals living with paralysis will be served during the grant year.

Catalyst Sports

Atlanta, GA 30325-2021
$25,000 – Adaptive Sports
Get Off the Pavement – Adaptive Mountain Biking Program
This Direct Effect grant supports the Get Off the Pavement Program (GOTP) by providing funding for the purchase of an off-road handcycle and program staff. The GOTP program consists of four components: 1) training on adaptive equipment use, 2) monthly group rides, 3) access to adaptive mountain bikes year around with privately guided tour opportunities and 4) increased awareness of adaptive mountain bikes and the outdoor needs of people living with disabilities in the general community. The addition of an adaptive off-road handcycle will encourage wheelchair users without their own equipment to try off-road handcycling, and the hiring of a Program Director will ensure success of the program’s eight-city adaptive bike tour and year-long schedule of monthly clinics across several southeastern cities. Catalyst anticipates a reach of 350 participants living with paralysis within the first year.

Central Florida Pediatric Therapy Foundation (aka Central Florida Dreamplex)

Clermont, FL 34711-6816
$25,000 – Adaptive Sports
Power Wheelchairs for Power Soccer Program
This Direct Effect grant supports the purchase of three power soccer chairs to allow the Central Florida Dreamplex to provide a top-tier power soccer experience to athletes living with paralysis during practices, scrimmages, and games. With the help of these new power chairs, Dreamplex will be able to continue offering soccer clinics consisting of practices and scrimmages. These clinics, which each serve 15 to 25 individuals from age six and up, afford wheelchair users both familiar and unfamiliar with power soccer the opportunity to learn the game of power soccer, enhance their skills, and have fun with their peers.

City of Elizabeth City

Elizabeth City, NC 27909
$2,119 – Facility Accessibility Modifications
Knobbs Creek Recreation Center Entryway Replacement
This Direct Effect grant provides accessible doors for the City’s only community center, the Knobbs Creek Recreation Center (KCRC). KCRC offers space for fitness classes and other activities for people living with paralysis. It currently serves as a training site for the Special Olympics, and hosts “Chair One” fitness courses, and provides numerous community/activity rooms.

City of Greenville Recreation and Parks

Greenville, NC 27835
$14,525 – Adaptive Sports
Specialized Recreation Access
This Direct Effect grant supports the purchase of an all-terrain wheelchair and adaptive stroller to be used throughout the Greenville Recreation and Parks system. The Greenville Recreation and Parks Department provides a variety of athletic, recreational, and arts and crafts activities for all ages and populations. The funded equipment will be available for community member use for a variety of offerings, including camps, outdoor nature exploration programs, sporting events and community outings. This equipment will promote inclusion and support integration of those living with paralysis and paralysis-causing conditions into the physical, cultural, and spiritual communities in which they live.

City of Warren

Warren, PA 16365-2388
$25,000 – Accessible Playground
Lacy Park Soft Surface Playground
This Direct Effect grant supports a multi-sensory, accessible playground at Lacy Park in the City of Warren, Pennsylvania. Designed for children aged two to twelve, this playground will provide stimulating play opportunities for children of all abilities, with an emphasis on inclusive play for those with disabilities. Funding will support a poured-in-place rubberized safety surface in the play equipment fall zones. The installation of pour-in-place surfacing will enable children and family members living with paralysis and mobility issues to engage in play activities safely and easily and will promote inclusive play among children of all abilities.

Clinic for Special Children

Strasburg, PA 17579-9770
$25,000 – Healthcare
Providing Accessible Healthcare for Plain (Amish/Mennonite) Patients with Paralysis
This Direct Effect grant supports the purchase of three accessible medical examination tables and a gynecological exam table for patients living with paralysis. The Clinic for Special Children serves a unique population – uninsured Plain (Amish and Mennonite) patients living with genetic illnesses in rural Lancaster County, Pennsylvania. Many patients are being treated for medical issues associated with paralysis including spinal muscular atrophy (SMA), cerebral palsy, limb-girdle muscular dystrophy, and other types of muscular dystrophy which are common in Amish communities. It is anticipated that the clinic will treat at least 200 individuals with paralysis in 2021.

Cohesion Dance Project, Inc

Helena, MT 59601
$9,314 – Facility Accessibility Modifications
Cohesion Dance Project’s Facility Accessibility Upgrade Project
This Direct Effect grant supports the purchase and installation of two automatic door openers for an arts center offering education and adaptive dance classes for youth and adults living with disabilities and who have special needs. Seventeen participants living with paralysis who attend or participate in classes, rehearsals, and performances at Cohesion Center will experience increased independence and reduced reliance on caregivers and family members to assist them with accessing the building.

Common Roots Farm

Santa Cruz, CA 95060
$15,175 – Facility Accessibility Modifications
Seed to Salad Project
This Direct Effect grant supports the purchase of six wheelchair accessible picnic tables (two different configurations to add maximum flexibility), four accessible portable outdoor worktables, and a permanent shade structure. During farming season, Common Roots Farm, an urban, organic farm where people with and without disabilities work together to grow healthy food, beautiful flowers, and build relationships that sustain everyone, has a steady schedule of visitors including students on field trips from special education and regular education classes, post-secondary disabled students learning pre-employment skills, adult day program participants, interns who qualify for California’s Blueprint for Employment of People with Disabilities Program, and other nonprofit organizations serving people living with paralysis. The project will serve approximately 70 people living with paralysis.

Craig Hospital Foundation

Englewood, CO 80113-2811
$25,000 – Fitness and Wellness
Therapeutic Recreation for People Living with Spinal Cord Injury
This Direct Effect grant supports an independence and life quality program that integrates multidisciplinary skill development, community reintegration activities, and adventure-based programming. “Adventure outings” range from adaptive bike rides to multi-day adaptive scuba diving trips –and provide opportunities for people with SCI/TBI to experiment with travel, sports, and outdoor exploration. The program aims to serve 350 people living with paralysis along with 500 family members and enables people with paralysis to explore recreation options while still completing their inpatient rehabilitations.

Creston Arts

Creston, IA 50801-3013
$25,000 – Facility Accessibility Modifications
Regional Community Art Center Accessibility and Community Engagement
This Direct Effect grant supports the purchase of a lift, accessible restrooms, and automated door opener for an arts center located in Creston, Iowa. Integrated programming permits individuals living with paralysis to engage with the community, and more beneficially, provides the opportunity for the community to engage with individuals living with paralysis. The project will serve between 50 and 75 individuals with paralysis during the grant year.

Disability Options Network (the CIL)

New Castle, PA 16101-5236
$25,000 – Transition from Institution to Home
Ramp Loan Program
This Direct Effect grant provides, via a loan closet, temporary, modular ramps that will increase independence by allowing for individuals living with paralysis to safely enter and exit their homes. The addition of these ramps will provide the option for those living with spinal cord injuries and paralysis to leave rehabilitative and nursing facilities, live in their own homes, and begin to explore community living. Once the individual returns home, a staff person from the CIL will assist the individual with securing other equipment and services that they might need to live as independently as possible. The project will serve up to 10 individuals in the first year of the program.

Don’t Stop Dreamin’

Butler, PA 16001
$24,000 – Transportation
Drivin’ for Dreams
This Direct Effect grant supports a transportation program for an organization that provides “dreams” to residents living with paralysis who are living in Quality Life Services’ skilled nursing and personal care facilities or in hospice. Funding goes towards the purchase of an accessible van. Don’t Stop Dreamin’ aims to provide transportations services to 100 individuals living with paralysis during the grant year.

Easter Seals Rehabilitation Center

Evansville, IN 47714
$6,607 – Fitness and Wellness
Motorized wheelchair-to-water pool lift
This Direct Effect grant provides funding for a motorized wheelchair-to-water pool lift to enable individuals living with paralysis and cross-disabilities to safely access Easter Seals Rehabilitation Center’s facility pool. Ongoing access to pool exercise will enable people living with paralysis to maintain or improve their fitness levels and overall health status. Enhanced physical and emotional wellness will empower individuals to engage in the life of the community more fully, whatever their interests might be. The project will serve approximately 10 people in the grant year.

Equine Therapy,Inc. dba. Healing Horses Kauai

Lihue, HI 96766-1105
$25,000 – Therapeutic Horseback Riding
Healing Horses Kauai Hoist Mount & Driving Program
This Direct Effect grant supports an equine therapy program that provides riding lessons, youth camps, training workshops and special group programs for people living with paralysis and other co-occurring disabilities. As the only equine therapy center on the Hawaiian island of Kauai, Healing Horses plans to serve over 50 people living with paralysis each month.

Forest County Potawatomi Community

Crandon, WI 54520-8627
$25,000 – Accessible Playground
FCPC Stone Lake Inclusive Playground Project
This Direct Effect grant supports the purchase of a Powerscape Inclusive Ramped Play Unit and ADA Primetime Swing for a fully inclusive and accessible playground in the rural region of Forest County, Wisconsin. Currently, there are no public community centers, swimming pools, or recreational facilities that provide inclusive equipment serving those living with paralysis within 25 miles of the Potawatomi Community. The addition of this fully inclusive playground equipment will provide play, exercise and recreation opportunities to all community members living with disabilities including paralysis.

Forever Parks Foundation of Pearland

Pearland, TX 77584-6047
$25,000 – Accessible Playground
Inclusive Playground
This Direct Effect grant supports the purchase of the We-Go-Swing for an accessible, inclusive playground. The all-inclusive playground will increase independence for people living with paralysis by providing space and equipment that will allow them to develop strength, confidence, self-esteem, and motor skills through play in a safe, but challenging environment. The playground, which will provide 100% accessibility to wheelchair users, will promote inclusion by installing rubberized pour-in-place surfacing and inclusive equipment pieces that will intentionally facilitate play between children of all abilities.

Free Rein Therapeutic Riding

Spokane, WA 99223
$10,000 – Therapeutic Horseback Riding
Sure Hands Lift System for mounting ramp and extension of mounting ramp platform
This Direct Effect grant provides a Sure Hands Lift System equipment and mounting ramp for Free Rein Therapeutic Riding’s Military Horsemanship Program. This program was created through a partnership with the PATH International Equine Services for Heroes program and the Wounded Warrior Project. Injured soldiers returning from a deployment and disabled veterans often struggle with reintegrating into the civilian world and may be in pain from physical injuries or struggling with PTSD. This program focuses on building confidence and self-esteem through relationships formed with horses and is facilitated by the participant grooming and training their equine partner. A Sure Hands Lift System will safely assist participants who are unable to mount the horse without full-body support assistance, and an extension of the mounting ramp platform will better accommodate various sized wheelchairs. The project will serve more than 10 individuals living with paralysis in the grant period.

Glacier National Park Conservancy

Columbia Falls, MT 59912-3843
$25,000 – Accessible Trail
Trail Resurfacing Around Swiftcurrent Lake in Glacier National Park
This Direct Effect grant supports an accessible trail in Glacier National Park. Glacier National Park currently offers a limited number of accessible trails to visitors. Barriers that have long prevented accessibility improvements to this National Park include a lack of trails with appropriate grades in the mountainous park, limited trailheads with adequate parking, and the sustainability of accessible tread for resurfacing. With the goal to create an unmatched experience for visitors living with paralysis and limited mobility, this project overcomes all three of these barriers and adds the additional desirable component of a trail loop. An estimated 18,000-20,000 visitors with limited mobility will benefit from being able to explore the backcountry of one of America’s most treasured and most scenic national parks each year.

Golden String, Inc.

Youngstown, OH 44503
$3,980 – Facility Accessibility Modifications
Restroom Accessibility at Farmer Casey’s Ranch
This Direct Effect grant provides accessible entry switches to two restrooms at Golden String, Inc.’s 30-acre Farmer Casey’s Ranch. The Ranch, which houses a vegetable garden, greenhouse, lake with accessible deck seating, and farm animals, does not currently have accessible restroom entry. This inaccessibility adds independence barriers and causes individuals living with paralysis and limited mobility to rely on others to open the door for them. Six people living with paralysis will be immediately served by the addition of these entry switches, and this increased accessibility is expected to attract numerous visitors with paralysis per year.

Herreid Area Housing Development, Inc.

Herreid, SD 57632
$3,867 – Facility Accessibility Modifications
Fresh Start Market Project
This Direct Effect grant supports the purchase of an ADA compliant door and electronic door openers for the Herreid Area Housing Development’s Fresh Start Market. Located in a remote, rural food desert with the nearest grocery store being 15 miles away, the Fresh Start Market is the only market in the Herreid community. Four people living with paralysis that currently access the Market will immediately be served by this project, and this increased accessibility has the potential to reach even more Herreid community residents that are affected by paralysis and mobility issues.

Idaho Zoological Society, dba Friends of Zoo Boise

Boise, ID 83702
$18,657 – Facility Accessibility Modifications
Improving Access to Mixed Animal Exhibit at Zoo Boise
This Direct Effect grant benefits Zoo Boise visitors living with paralysis, their families, and caregivers by providing a ramp and viewing platform to a popular, large, mixed animal exhibit at the zoo. For more than 100 years, Zoo Boise has become a community treasure that provides wonderful educational and recreational opportunities for more than 340,000 visitors annually – making it one of the largest attractions in the state of Idaho. 168 regular Zoo Boise guests living with paralysis will immediately be served by this project, and Zoo Boise anticipates that the installation of this new viewing platform and ramp will benefit approximately 232 new visitors living with paralysis per year.

Josephine County Parks Department

Grants Pass, OR 97527-5587
$25,000 – Accessible Playground
Tom Pearce Park Rebuild
This Direct Effect grant supports an inclusive and accessible playground at Tom Pearce Park, the most popular Day Use Park in Josephine County. Located on the main Interstate Highway connecting California, Oregon, and Washington, this fully inclusive and accessible playground will be the first in the Josephine County Parks system and will provide an immediate and lasting benefit for the community. Funds will be used to provide rubber tile surfacing for wheelchair access.

Jubilee Association of Maryland

Kensington, MD 20895
$8,028 – Facility Accessibility Modifications
Open Hearts, Open Doors
This Direct Effect grant provides automatic door openers for the Jubilee Association of Maryland’s main administrative building. Jubilee provides opportunities and support for people with intellectual and developmental disabilities (I/DD) to live in and enrich their community while fulfilling their personal, family, social and spiritual needs. Eight people living with paralysis will be served immediately with the potential of 32 people being served during the grant period.

Macungie Memorial Park

Macungie, PA 18062
$15,423 – Facility Accessibility Modifications
Creating an Accessible Park Environment to Serve Multigenerational Families Living with Paralysis
This Direct Effect grant supports a project that will increase independence and inclusion by purchasing a pool lift and accessible restroom accessories such as ADA-compliant grab bars, sinks and toilets for the Macungie Memorial Park in Macungie, Pennsylvania. By providing the pool lift and restroom accessories, park visitors living with paralysis and their families will be able to safely participate in all community activities and recreation. The installation of these accessibility features will have the potential to benefit up to 50 Macungie residents living with paralysis, their family members, and caregivers.

Mesa Verde Foundation

Arvada, CO 80002
$13,139 – Facility Accessibility Modifications
Chapin Mesa Archeological Museum Accessibility Project
This Direct Effect grant provides two wheelchair accessible ramps to the Chapin Mesa Archeological Museum, the only museum in Mesa Verde National Park. Mesa Verde National Park in southwest Colorado is one of the world’s most significant archeological sites, with remarkably well-preserved cliff dwellings that were home to the Puebloan people for more than 700 years starting in 550 A.D. The museum displays dioramas illustrating Ancestral Pueblo life, many exhibits of prehistoric artifacts, and a chronology of Ancestral Pueblo culture. The installation of these two ramps will make the museum fully accessible to wheelchair users.

Miami-Dade County Park and Recreation Department

Miami, FL 33128
$24,207 – Accessible Beach/Dock/Pier
PROS Project Name is Accessibility to Aquatic and Special Events
This Direct Effect grant supports a project that aims to increase accessibility at Miami beaches by purchasing eight new beach wheelchairs, 350 ft. of ADA-compliant pathway, and 480 sq. ft. of portable ADA-compliant decking to accommodate individuals living with paralysis and co-occurring disabilities at beaches and at park special events. Additionally, this project will provide a specialized event, coordinated in collaboration with the Spinal Cord Injury Support Group of Miami. This project will serve approximately 40 people with paralysis living in Miami-Dade County, as well as recently released Spinal Cord Injury (SCI) patients from the SCI rehabilitation units from Jackson Memorial Hospital and the Miami VA Medical Center.

NeuroHope of Indiana

Indianapolis, IN 46236
$17,681 – Fitness and Wellness
“Path to Independence” Wellness Program
This Direct Effect grant supports a wellness program for people living with paralysis that features individualized workout plans, gym assistance from certified personal trainers, daily group cardio, strength training and stretching sessions, and regular participant evaluations. People living with paralysis often have difficulty maintaining cardiovascular health and must continually work to prevent skin-breakdown, muscle contracture, and other complications, and there is currently no place in the Indianapolis metropolitan area that offers an adaptive workout facility, assisted gym access, or personalized fitness plans. The purchase of a NuStep T5-recumbent cross trainer and a SCI-Fit Pros 2 Total Body Exerciser, as well as the support of a wellness coordinator, will provide NeuroHope members with the proper equipment and training to exercise and reach their fitness goals. The project will serve a minimum of 50 people living with paralysis in the first year.

New Mexico Caregivers Coalition

Bernalillo, NM 87004-0297
$25,000 – Caregiving
Stress-Busting for Family Caregivers
This Direct Effect grant supports an evidence-based program of stress reduction techniques for caregivers of people living with paralysis. Stress-Busting Program for Family Caregivers (SBP) is a multi-component program in which facilitators meet with small groups of family caregivers to lead education, support, problem solving and stress management workshops. Program evidence has shown that these workshops not only improve the quality of life of family caregiver participants, but also provide coping tools to help manage stress and day-to-day life.

Each workshop is 90 minutes/week for nine weeks, and topics include (1) stress: effects on mind, body, and spirit; (2) grief, loss, and depression; (3) facing challenges; (4) coping with stress; (5) positive thinking; (6) taking time for yourself; and (7) choosing a path of wellness. Stress management techniques taught include relaxation breathing, meditation, imagery, art, music, journaling, and aromatherapy. The program will serve 200 caregivers.

New York Lawyers for the Public Interest

New York, NY 10001-4017
$25,000 – Advocacy
Fair Housing Advocacy Project
This Direct Effect grant supports a program that aims to prevent the harassment, displacement, and homelessness of at-risk low-income tenants living with paralysis and other co-occurring disabilities in New York City. By educating and empowering tenants and tenant groups, negotiating with landlords, and providing pre-litigation services and full representation to tenants across all f

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $9,447,037 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.