With support from the Social Innovation Fund, Third Sector conducted a feasibility assessment for Washington’s Department of Early Learning (DEL) and Thrive Washington (Thrive). Through the feasibility assessment, stakeholders were brought together from the public, philanthropic and provider spheres in Washington to explore opportunities to drive better outcomes for one of the state’s most vulnerable population, low-income infants and their families.
Sub-Recipient: Washington Department of Early Learning and Thrive Washington
Home visiting is a voluntary, relationship-based intervention that includes regular visits by a trained professional to a family’s home when the parent is expecting and/or after they have given birth. Evidence from home visiting programs shows that when families receive this type of support, children are healthier and better prepared for school, parent-child bonds are stronger, and abuse and neglect are less likely.
In Washington, home visiting services are supported by the DEL and Thrive, together they fund and manage services across the state using a portfolio approach. The portfolio includes eight home visiting models with various areas of expertise (Child-Parent Psychotherapy, Early Head Start Home-Based, Family Spirit, Nurse-Family Partnership, Parents as Teachers, Parent-Child Home Program, Partnering with Families for Early Learning, and Steps to Effective Enjoyable Parenting). This approach allows the state to target services for families’ needs with different home visiting models. Collectively, this home visiting portfolio helps to ensure that children are born healthy and are raised in safe and nurturing environments. For this feasibility assessment four of the eight models were examined; those that are categorized as “evidence-based” or “promising practices” as defined by the Home Visiting Evidence of Effectiveness Review (HomVEE), have a centralized national office or state leadership in Washington, and receive most of their funding in Washington from the DEL.
Motivation for Exploring Pay for Success
While the number of families being served through the home visiting portfolio has increased tremendously in Washington over the last decade, there is still a large unmet need for these services. The DEL and Thrive were interested in PFS to improve, and potentially expand, home visiting services. The organizations recognized the challenges of scarce public resources for social services and the need demonstrate that funds are producing positive outcomes (long and short term).
The PFS feasibility assessment of Washington’s home visiting portfolio was a collaborative effort initiated by the DEL and Thrive. The technical assistance provided for this assessment was led by Third Sector Capital Partners, Inc. with support from the Institute for Child Success and Abt Associates. The assessment included seven work streams that examined: intervention model; target population; data sources; end payer; evaluation design; funder engagement; and appropriations and contracting.
The parties above enlisted experts from across the state to serve on working groups that met regularly to complete the analyses contained in the final report. Additionally, a Steering and Advisory Committee of key stakeholders was convened to review the findings of the working groups and provide strategic guidance.
Findings and Insights
Third Sector synthesized the findings and resulting recommendations from the assessment in an Executive Summary and Final Report. These documents were presented to the Steering and Advisory Committee at a final meeting and sparked a robust conversation about the future of performance-based contracts and funding in Washington. The recommendations may result in one or more of the following: increased data linking, expansion of the home visiting portfolio, expansion of performance-based contracts for social services in Washington.
The Feasibility Assessment enabled the stakeholders involved to:
- Understand the gaps in regularly measuring health and education outcomes for families receiving home visiting services. This was achieved through a rigorous exercise of mapping existing data collection and analysis processes. It was discovered that data on the families receiving home visiting services are stored in service providers’ systems, while data on health and education outcomes are stored in different state agencies’ systems, and there is not a process for linking the data across systems.
- It is recommended that stakeholders establish a shared vision for improved data sharing, and increase data linkages across state agencies and providers. The final report proposed an early childhood “data mart” for better integration of systems. However, the implementation of this type of data repository is not something the DEL and Thrive can do alone, it will involve the owners of the datasets. Third Sector suggested forming a data governance board to establish the vision and to work on the implementation of this type of solution. Many jurisdictions struggle with the issue of data silos as data is usually collected for compliance purposes. Breaking down those silos requires trust, time and financial resources.
- Explore the interest in performance-based contracts, of both home visiting service providers, and of state agencies. Insight in this area was gained through a series of conversations about different approaches for such contracts.
- The national leaders of the four home visiting models examined in this assessment were interested in increasing their organization’s impact in Washington and were supportive of contracts that would hold them accountable for outcomes, in addition to outputs. The local service providers implementing these models could build the capacity needed to implement a performance-based contract.
- Leaders of state agencies consulted for this assessment expressed strong interest in expanding the state’s use of performance-based contracting for social services. Discussions with state legal experts confirmed that multi-year, contingent contracts can be developed. It was recommended that the state create a cross-agency performance-based social services contracts team. Third Sector worked with agency leaders to identify the individuals who could provide expertise in designing this type of contract. It is recommended that this team of experts is assembled to create a template for contracts of this nature, for use by different departments providing social services.
- Create a shared language around outcomes for social services. With consistent meetings throughout the year to discuss the seven work streams, a diverse group of stakeholders investigated this topic, and what it means in Washington, together.
- This work fostered broad-based support for developing proposals for the funding, both public and philanthropic, needed to execute a performance-based contract to expand home visiting. Third Sector proposed a ten-year roadmap that both expanded the number of families served through home visiting, while also moving service provider contracts to be more performance-based, in a phased approach over time. The DEL and Thrive could tailor this roadmap into a proposal for the legislature and for soliciting additional funding from interested philanthropic partners.
- Third Sector Capital Partners, Inc. led the feasibility assessment
- Institute for Child Success (grantee of the Social Innovation Fund) provided technical assistance expertise on the intervention of home visiting, reviewed literature about the efficacy of models employed by the home visiting portfolio and assessed the capacity of local service providers implementing those models.
- Abt Associates provided technical assistance expertise in the areas of data access, target population and evaluation.
- Government Partners: State Office of the Treasurer, State Department of Health, State Senate, State House of Representatives, U.S. Health Resources and Services Administration, State Office of Financial Management, State Department of Social and Health Services, State Health Care Authority
- Home Visiting Portfolio Model Partners: Nurse-Family Partnership, Family Spirit, Parent Child Home Program, Parents as Teachers
- Community Partners: Mission Investors Exchange, Social Venture Partners, Philanthropy Northwest, Fight Crime: Invest in Kids, Giddens Foundation, Foundation for Healthy Generations, Ballmer Family Giving, Partners for our Children, United Way of King County, Ready on Day One, The Boeing Company, The Ounce of Prevention Fund