Through this commitment, NFP will implement a Pay for Success (PFS) project (also known as a Social Impact Bond or SIB), in partnership with New York State and Social Finance. This transaction will also include private investment, philanthropic capital and a third-party outcomes evaluator. This transaction will be the first maternal and child health PFS project in the nation. During the commitment, NFP will seek to serve 2,200 low-income moms and babies (1,100 moms and 1,100 babies enrolled in first two years) in New York State. Additionally, it will provide over 41,000 health visits to the moms and babies by trained nurses directly in the home and create approximately 37 jobs, the majority of which will be filled by women.
This commitment scales existing NFP infrastructure in New York to serve more low-income, first-time moms in areas of high need. It will replicate the NFP program model with fidelity. Through ongoing home visits from registered nurses, low-income, first-time moms receive the care and support they need to have a healthy pregnancy, provide responsible and competent care for their children, and become more economically self-sufficient. From pregnancy until the child turns two years old, Nurse-Family Partnership nurse home visitors form a much needed, trusting relationship with the first-time moms, instilling confidence and empowering them to achieve a better life for their children and themselves.
Through this commitment and NFPs proven model, nurses will seek to provide moms with an average of 25-30 nurse visits. In each home visit, nurses cover material from five health domains: personal health, environmental health, life course development, maternal role, and friends and family. The curriculum is based on nearly 40 years of research and backed by five randomized control trials.
This commitment expands the capacity of the NFP program in NYS and will replicate similar positive results. Subject to final contracts, the PFS initiative will measure reductions in preterm births, closely spaced births, and child injury-related emergency department visits and hospitalizations through age two.
NFPs PFS initiative with New York State is an innovative method to scale this evidence-backed program. Through PFS, funds raised from private investors are used to deliver a service that will benefit society. The New York State government is only required to pay back investors if and when the provider meets agreed-upon outcome metrics. Currently, in this PFS, there is no philanthropic subsidy or junior capital; private investors will only recoup funds if target results are met. Philanthropic dollars cover upfront, one-time PFS-related costs, while the private investors cover the programmatic costs, up-front costs, and other expenses throughout the project. This PFS is a contract between NFP, Social Finance and the State of New York.
Social Finance, a social impact financing non-profit, is assisting in identifying funders. Social Finance contracts with NFP, who in turn is working with implementing agencies in three greater New York City regions to deliver the NFP program. NFP will ensure the program is implemented with fidelity to the evidence-based model and will conduct data tracking throughout the PFS project. NFPs impact in this PFS will be evaluated through a randomized control trial. The philanthropic funding covers one-time startup costs, while the private capital will pay for program delivery and the randomized controlled trial.
During the first seven months of the commitment, June 2015 through December 2015, NFP will finalize the contracts and financing for the PFS project, in partnership with Social Finance and New York State.
- NFP, New York State and Social Finance will finalize all contracts.
- NFP will begin process to secure commitments of $4.25 million in philanthropic funding to support project start-up costs, ramp-up and evaluation-related outreach costs
September 2015 to December 2015
- Social Finance will secure approximately $22 million in private capital to finance project costs.
- The deal is anticipated to close in December 2015, with philanthropic support secured.
January 2016 through December 2017
During the next two years of the commitment, NFP will provide the NFP service model to 1,100 moms in New York. The moms will be referred to NFP by targeted referral sources including community health clinics. Moms will either be placed in the control group or the NFP program based on a randomized process. Subject to final contracts, success of this initiative is anticipated to be measured by three outcome metrics in the randomized controlled trial: Reductions in preterm births, closely spaced births, and child injury-related emergency department visits and hospitalizations through age two.
-Program service delivery will launch; the first wave of NFP nurse home visitors and nurse supervisors will be hired, and will attend the required Nurse-Family Partnership education.
-Enrollment of families will begin. In enrollment, the nurse will meet with the mom and begin to establish rapport, make sure the mom understands the program purpose and structure, set expectations with the mom, begin assessment of moms health status in relation to pregnancy, and introduce information about how to have a healthy pregnancy. The nurse will then begin regular home visits.
-The second set of nurse home visitors and one additional nurse supervisor will be hired.
Q4 2016 through Q4 2017
-Service delivery will continue as the NFP program is conducted with enrolled families.
-By December 2017, NFP will be serving a total of 2,200 individuals, 1,100 moms and 1,100 babies.
Although this is a two-year commitment, enrollment will span a total of four years with service delivery spanning 6 years.
Nurse-Family Partnership (NFP) is an evidence-based nurse home visitation program that serves first-time, low-income moms and their babies. The commitment addresses two challenges: creating duel-generation change that shifts cycles of poverty in America and the difficulty of scaling high-impact programs due to traditional non-profit financing models.
First-time, low-income mothers face significant barriers to achieving economic self-sufficiency. In New York State at intake, the median age of NFP participating women is 20; 85% are unmarried and only 52% have completed high school; 71.5% receive benefits from Medicaid, 19.4% receive food stamps, and 8.8% receive TANF assistance. The median household income is $9,000. These women have typically been socially isolated or abused and often lack the education, skills and support systems necessary to provide a safe, stable and nurturing home environment for their children.
It is a challenge to change the life trajectory of these vulnerable women and children and improve their health, education, and economic outcomes. Successful interventions are needed to break the cycle of poverty in America.
NFP is a proven model that changes individuals lives and the communities around them. Based on a review of evidence from multiple NFP evaluation studies, including five randomized controlled trials, quasi- experimental studies and large-scale replication data, NFP has been shown to achieve a:
29% reduction in smoking during pregnancy
18% reduction in first preterm births (<37 weeks)
72% reduction in infant mortality (4.1 fewer infant deaths per 1,000 families served)
38% reduction in closely-spaced second births (within 2 years postpartum)
46% reduction in emergency department use related to childhood injuries (ages 0-2)
38% reduction in child maltreatment (through age 15)
56% reduction in youth crimes and arrests (ages 11-17)
64% reduction in alcohol, tobacco & marijuana use (ages 12-15)
9% reduction in TANF payments (through 9 years postpartum)
11% reduction in Food Stamp payments (through 10 years postpartum)
Current resources that fund NFP in New York do not meet population demand. There are more than 28,000 eligible moms in New York City. In 2014, NFP served only 11% of eligible mothers. To scale this proven program, NFP must identify new funding models.
The Nurse-Family Partnership National Service Office is seeking philanthropic financial support. In the first two years of the PFS project, NFP requires philanthropic funding to support start-up, capacity building, performance management, and evaluation-related client outreach. These funds will ensure a robust launch of operational and evaluation implementations and active performance management during the critical initial phases of the project.
The philanthropic funding covers one-time startup costs. The private capital will pay for program delivery and the randomized controlled trial.
Philanthropic partners can include: foundations, individuals, corporations, corporate foundations. Sufficient philanthropic funding must be committed prior to launch in December 2015.
NFP will tailor each philanthropic partnership to give the organization the best support and information to fit its needs. Possible services could include, but are not limited to: regular project reports, sharing of best practices, subject matter expertise in designing future PFS projects, press release and media notification of financial gift.
When implemented, this New York State PFS project will be the first maternal and child health PFS project in the entire country and will provide important and transferable lessons for the Pay for Success and early childhood development fields.