South Carolina Nurse-Family Partnership

Last updated Monday, February 13, 2017

Quick Facts

Current Phase
Issue Area
Term of Project
A woman reads to a young child.

In South Carolina, 27 percent of all children are born into poverty, and more than half are born to low-income mothers.  Life in poverty at an early age is linked to severe adverse effects on a child’s cognitive development, health, and overall wellbeing, and mothers who struggle with poverty face a higher likelihood of poor birth outcomes.  Nurse-Family Partnership has developed a proven model to help reduce these risks and support the health and development of low-income mothers and their children.  Currently serving 1,200 families in South Carolina, a new four-year Pay for Success project will help expand NFP’s model to an additional 3,200 families, which will pair nurses with first time mothers to educate them on healthy pregnancies, giving their children the best possible start in life.  Improving early childhood development will lead to stronger communities and improved life outcomes for South Carolina’s residents.

Analysis

  • Market Overview

    • Year Launched
      2016
    • Service Delivery Term (Years)
      6
    • Motivation for Project
      27 percent of children in South Carolina live in poverty, which can be harmful to a child’s cognitive development, health, school performance, and social and emotional well-being.
    • Project Objective(s)
      Support the health and development of first-time mothers and their children; Build a pathway to sustainability for NFP in South Carolina; Evaluate effectiveness of efficiencies in NFP model
    • Individuals Served
      3,200 mothers and their children
    • Geography
      South Carolina
    • Issue Area
      Maternal and Child Health
    • Initial Private Investment ($ millions) [Note 2]
      17
  • Project Partners

    • Service Provider(s) [Note 1]
      Nurse-Family Partnership [Note 13]
    • Payor(s) [Note 2]
      South Carolina Department of Health and Human Services
    • Transaction Coordinator(s) [Note 3]
      Social Finance US
    • Evaluator [Note 4]
      J-PAL North America
    • Validator [Note 5]
      None
    • Project Manager [Note 6]
      Social Finance US [Note 14]
    • External Legal Counsel [Note 7]
      Wilmer Hale; Nelson Mullins; Riley & Scarborough LLP
    • Technical Assistance Provider(s) [Note 8]
      Government Performance Lab
  • Evidence and Program Design

    • Service Intervention(s) Model and/or Type
      Nurse-Family Partnership
    • Evidence base for intervention
      3 RCTs
    • Has effectiveness of the intervention for PFS project target population been evaluated?
      Yes
    • Has the service provider provided this intervention previously?
      Yes
    • Is PFS project: Scaling an existing intervention by replicating at a larger scale? Demonstrating the effect of a new program model or combination of services? Transplanting an existing intervention(s) to a new target population and/or service delivery setting?
      Scaling; Demonstrating
  • Evaluation

    • Evaluation Design Methodology
      RCT
    • Data Source(s) for Evaluation
      Service providers; State of South Carolina
    • Outcomes Tied to Success Payments
      1) Reduction in preterm births; 2) Reduction in childhood hospitalization and emergency department use due to injury; 3) Increase in health spacing between births; 4) Increase in number of first-time moms served in high-poverty ZIP codes
    • Outcomes Tracked, Not Tied to Success Payments
      School readiness; Academic achievement; High school completion; Receipt of government services(e.g., TANF, SNAP); Employment/earnings; Crime
    • Length of Evaluation Period
      5 years
  • Service Provider Characteristics and Service Delivery

    • Single or multiple service providers?
      Multiple
    • Service provider type(s) (nonprofit, government, private)
      Quasi-public, Nonprofit, Public
    • Service provider OR site selection method
      NFP selects local implementing agencies
    • Service Provider Experience with PFS Intervention
      Nine existing implementation sites in South Carolina; many more nationally
    • Referral Method for PFS Target Population
      Voluntary enrollment; referrals made by state Medicaid office; direct marketing to potential participatns
    • Did the project have a ramp-up phase? (Y/N; brief description)
      Yes: 3-month pilot period prior to project launch; paid for with non-PFS funds; participants tracked but not included in evaluation
  • PFS Contracting and Governance

    • Operational Oversight Structure [Note 1]
      Operational committee includes NFP, South Carolina Department of Health and Human Services, Social Finance, and Government Performance Lab
    • Frequency of meetings and/or reports
      Biweekly for first 2 months, monthly during months 3-6, quarterly thereafter
    • Executive Oversight Structure [Note 2]
      Executive committee includes NFP, South Carolina Department of Health and Human Services, and representatives from the three largest funders
    • Frequency of meetings
      Quarterly for first year, annually thereafter
    • Investor role in project governance?
      Three of the largest funders have formal roles in the Executive Committee and can observe Operations Committee meetings
    • Frequency of reporting to investors
      Semi-annually or as requested
    • Non-standard Contract Termination Events [Note 3]
      None
    • Appropriations Risk Mitigation Strategy [Note 4]
      Success payments held in set-aside account by a third party, Children's Trust of South Carolina
  • Investors

    • Senior Investor/ Lender and Total Senior Investment ($MM)
      None
    • Subordinate Investor/ Lender and Total Subordinate Investment ($MM)
      None
    • Deferred Fee Source and Total Deferred Fees ($MM)[Note 1]
      None
    • Recoverable Grant Source and Total Recoverable Grants($MM)[Note 2]
      None
    • Non-recoverable Grant Source and Total Non-recoverable Grants ($MM)[Note 3]
      The Duke Endowment ($8); Consortium of private funders ($4); BlueCross BlueShield of South Carolina Foundation ($3.5); The Boeing Company ($0.8); Greenville, SC First Steps ($0.7); ($17 total)
    • Guarantor and Guarantee ($MM) [Note 4]
      None
  • Basic Repayment Structure

    • Initial Investment ($Millions)
      17
    • Maximum Repayment Funds Committed by Payor ($Millions)
      7.5
    • Full service delivery term (years)
      6
    • Full repayment period (years)
      6
    • Interim outcomes reported? Tied to payments?
      No/Yes
    • Sustainability/ Recycling of Funds
      If outcomes are achieved, philanthropic funders have agreed to reinvest 100% of the State's success payments into NFP delivery in South Carolina
  • Detailed Repayment Terms

    • Interest
      None
    • Trigger for initial repayment of principal [Note 1]
      1) Preterm birth: 13.5% reduction; 2) Healthy birth spacing: 18% reduction; 3) Child injury: 23.4% reduction; 4) Coverage in low-income zip codes: 65% of mothers enrolled
    • Threshold for full repayment of principal
      1) 15% reduction; 2) 20% reduction; 3) 26% reduction; 4) 65% enrolled
    • Threshold for full repayment of principal plus maximum success payments
      Not available
    • Repayment timing
      End of Year 4; End of Year 5
    • Return to Investor [Note 2]
      Not applicable
    • Success Payment to Other Stakeholders? [Note 3]
      Yes: Service provider [Note 8]
  • Project Costs

    • Project Development Costs Not Covered by PFS Capital Raise
      Government Performance Lab fellow; Legal services
    • Funding source(s) for project development costs, if any
      Pro bono legal support; Social Finance (in-kind)
    • Project Implementation Costs not covered by PFS Capital
      $13 million in Medicaid-funded services; Project pilot period
    • Funding sources for implementation costs not covered by PFS capital
      South Carolina Department of Health and Human Services (via a 1915(b) Medicaid waiver); Laura and John Arnold Foundation