South Carolina Nurse-Family Partnership Project

The Problem

More than 280,000 children in South Carolina (27 percent) live in poverty, and more than half of babies in South Carolina are born to low-income mothers who qualify for Medicaid. Mothers experiencing poverty are at higher risk for poor birth outcomes, including delivering premature or underweight babies. 

The Basics

Location: 29 of 46 counties in South Carolina

Policy area: Maternal and child health

Population served: 3,200 first-time, low-income mothers

Service provider: Nurse-Family Partnership

Size of investment: $30 million

Maximum success payments possible: $7.5 million

Investors: BlueCross BlueShield of South Carolina Foundation ($3.5 million), The Duke Endowment ($8 million), The Boeing Company ($800,000), Greenville First Steps ($700,000), Laura and John Arnold Foundation ($491,000), a consortium of private funders ($4 million), Medicaid via a 1915(b) Medicaid Waiver awarded to the South Carolina Department of Health and Human Services ($13 million)

Intermediary: Social Finance

Other partners: The Children’s Trust Fund of South Carolina (fiscal agent), Harvard Kennedy School Government Performance Lab (technical assistance), WilmerHale (legal support), Nelson Mullins Riley & Scarborough LLP (legal support)

Evaluator: J-PAL North America

Evaluation methodology: Randomized control trial

Outcome payor: The State of South Carolina

Outcomes that yield payments: (1) Reduction in preterm births, (2) reduction in child hospitalization and emergency department usage, (3) increase in healthy spacing between births, (4) increase in the number of first-time moms served in predetermined zip codes with high concentrations of poverty

Timeframe: 4 year service delivery term; 5 year repayment term; 7 year evaluation period

Date announced: February 2016

Photo via Shutterstock.

The Intervention

Intervention: Nurse-Family Partnership (NFP) partners first-time moms with nurse home visitors, who provide knowledge and support throughout pregnancy and until children reach the age of 2. NFP currently serves 1,200 families in South Carolina. 

Evidence base behind the intervention: NFP has been extensively evaluated and is considered effective by multiple evidence-based program clearinghouses. The intervention has undergone multiple rigorous domestic randomized control trials over the last several decades, including three considered well-conducted by the Coalition for Evidence-Based Policy, in different geographic regions. Because the studies tracked a wide range of outcomes over a long time horizon, the program has been able to build a strong evidence base for the approach. The three high-quality RCTs show sizable, sustained effects on important child and maternal outcomes. Meta-analysis shows positive outcomes in crime, child abuse and neglect, disruptive behavior disorder symptoms, and internalizing symptoms. At least three benefit-cost analyses show NFP is cost beneficial.

The effectiveness of this intervention for the target population had been evaluated, and the service provider had provided this intervention previously.