Pay for Success would be investment in TN's children (The Tennessean)

By Sumita Keller

A strong and prosperous Tennessee depends on the health and well-being of all children. Science shows brain development begins before birth, with the first three years serving as an especially intense period of brain development. Experiences in this critical early period literally shape the architecture of the brain and establish a sturdy or fragile foundation for all of the development and behavior that follows. Quality early childhood programs like evidence-based home visiting provide families with the support they need for the development of healthy and successful children before their birth and through the early years of their lives.

Pay for Success (PFS) provides an alternative way to fund prevention programs like quality evidence-based home visiting. PFS offers the public sector a new way to pursue proven programs and bring them to scale through an innovative private/public financing structure. As the name suggests, in the PFS model, the private sector makes the upfront investment for a service and is only paid back by the public sector when specific measurable outcomes are successfully met. This model shifts the financial risk away from government, as payment is only made when the targeted outcomes are achieved. Examples of PFS projects include a focus on child welfare, quality early childhood education, homelessness, and recidivism in the adult and juvenile justice systems. A recent PFS project was announced in South Carolina with the aim to support the health and development of first-time mothers and their children through the evidence-based home visiting Nurse-Family Partnership model.

In Tennessee, we serve children and families through three different evidence-based home visiting models: Healthy Families America, Nurse-Family Partnership and Parents as Teachers. Home visiting programs use a two-generation approach to achieve the outcomes of improving maternal and child health. Rigorous research and evaluation shows quality home visiting programs reduce child abuse and neglect and infant mortality.

Quality home visiting programs are among the proven strategies identified to prevent and mitigate Adverse Childhood Experiences (ACEs). Programs provide parents with education and support to better understand the developmental needs of their children, including the negative effects of toxic stress on children. While some stress is inevitable, toxic stress is chronic and severe. In the absence of a safe, supportive and nurturing relationship, toxic stress can hinder the foundation of the developing brain and can lead to lifelong difficulties in learning, memory and self-regulation.

Parents also learn how they help build strong brains in their children by engaging with them beginning at birth and throughout their lives through a process called “serve and return.” A baby may “serve” by babbling and making eye contact and adults “return” by babbling and making facial expressions. The back-and-forth between child and adult is an essential process that helps shape the developing brain and builds a sturdy foundation.

Home visiting programs in Tennessee operate with private and public funding, with a heavy reliance on public funding. Budget constraints limit opportunities to expand programs to new communities. It is important for Tennessee to explore alternative funding strategies like PFS. The Tennessee Commission on Children and Youth, in partnership with the Tennessee Department of Health, was one of four jurisdictions selected by the Institute for Child Success to receive technical assistance coaching on exploring the feasibility of PFS for evidence-based home visiting in Tennessee. This is an exciting opportunity as we know supporting quality home visiting is an investment in the future of Tennessee and a long-term strategy to prevent youth violence.

Sumita Keller is home visiting leadership alliance director for the Tennessee Commission on Children and Youth.