It was a proud day for ICS when South Carolina Governor Nikki Haley announced the Nurse–Family Partnership Pay for Success Project back in February. ICS had been a key proponent of this project from its early days, conducting the feasibility study that explored using Pay for Success (PFS) financing to expand this evidence-based home-visiting model – plus, as an organization that calls South Carolina home, we were thrilled to see the largest yet PFS project launch here, with a focus specifically on children and families who can most benefit. (Details on the project can be found here).
But what happens after the press conferences, when the rubber meets the road in implementation? Our colleagues at Social Finance, the intermediary in this project, have published a paper co-authored by a number of project partners exploring the pilot period of the South Carolina project.
The partners shared several lessons learned, which not only help us reflect on the process in South Carolina but can inform other developing projects in the field:
- Building program capacity prior to project launch is essential, including allowing enough time for scaling efforts and strengthening the pipeline of referrals.
- Integrating and transferring data is an iterative process, so it is important to allow significant time for establishing data sharing agreements among partners and establish a process for combining data securely across partners.
- Pilot periods allow the PFS project partners to build crucial working relationships and communications channels that will set the stage for success, encouraging direct communication and feedback among partners and developing a unified message for difficult questions. The partners note that the randomized nature of the evaluation meant home visitors faced difficult conversations when families were placed in the control group – enhanced training around messaging reduced some of the stress around this conversation.
- It is critical to build ample time into project plan to test, refine, and finalize the integration of a randomized controlled trial with a PFS project. The partners noted three specific challenging areas – adhering to the enrollment protocol, especially for home visitors who were new to this process; monitoring randomization of participants, which is key to the evaluation; and adhering to protection protocols for human subjects, including the often lengthy Institutional Review Board process.
The authors of the South Carolina report conclude:
“PFS projects are intense collaborations between diverse stakeholders to achieve a common goal. Pilot periods ease the transition into a complex project by affording stakeholders time to pilot, test, and refine key operational, project management, and evaluation functions prior to launch, while also providing space for the partners to build strong working relationships.”
These lessons learned align with what we heard from project partners on a panel at our June conference, as well as a recent session on the challenges of evaluating home-visiting programs at the Home Visiting Summit held in November. In the still-young field of Pay for Success, knowledge sharing is essential to improving the project pipeline. We hope this new report on South Carolina draws attention to the exciting work being done in the Palmetto State and helps those developing new PFS projects.