In partnership with the Tennessee Department of Health and with coaching from Institute for Child Success, the Tennessee Commission on Children and Youth conducted a feasibility study focused on the possibility of tapping PFS to expand three evidence-based home visiting programs – Parents as Teachers (PAT), Healthy Families America (HFA), and Nurse-Family Partnership (NFP) – to families in need. Through one or more of these home visiting programs, Tennessee hopes to achieve improved maternal and newborn health, increased school readiness, a decrease in domestic violence, and a decrease in child abuse and neglect. The target population for the intervention is families living in poverty with children ages 0-5 in mostly rural areas, and also metropolitan counties such as Davidson, Hamilton, Knox, and Shelby.
The study concluded that Tennessee could feasibly expand home visiting using PFS financing to improve outcomes for low-income mothers and their children. HFA produces at least two PFS-suitable outcomes and could expand in the state via PFS once the program launches a new data system and builds the capacity of local service providers to manage to outcomes. PAT demonstrated strong intermediate outcomes and, with additional data on longer-term “impact outcomes” that can be measured in Tennessee, could consider expansion using PFS in the future. The strongest of the candidates we considered for a PFS project in this context, however, was NFP, which produces at least three outcomes in Tennessee that meet ICS criteria for PFS financing; for example, research indicates that the benefits of investing in NFP significantly exceed the costs. If an outcome payor is secured, Tennessee could use PFS financing to fund the five-year expansion of NFP that would serve nearly 6,000 additional families over five years across six high-need counties, including Shelby County where Le Bonheur Children’s Hospital currently implements the program.