Many policies and programs in the United States target either children or their parents. Few keep the whole family in focus, and even fewer have mastered the complex task of measuring outcomes for families. This month, the state of Connecticut took a big step forward when its Office of Early Childhood announced a new way to measure when positive outcomes are achieved for families enrolled in voluntary home visitation services, and how to provide additional financial incentives for the service provider. This groundbreaking pilot initiative – the first in the nation of its kind – will reward positive outcomes for evidence-based home visitation services, from reduced child welfare involvement to increased parental employment.
Home visitation services are provided by specially trained nurses, social workers or peer educators who work with families in their homes and focus on child and parent well-being, including preparing for a healthy delivery, brain development, child milestones and attachment, and parental return to work and or school. Services are provided through programs such as Healthy Families America, Parents as Teachers, and Nurse-Family Partnership. Programs provide parents with support to enhance the child-parent relationship, build parenting skills, and support social and emotional development. These programs have met the highest-quality standards for outcomes when families are provided services in their homes and have proven highly effective at increasing child well-being and helping parents return to school and work.
Following recommendations from Ascend at the Aspen Institute for measuring outcomes for children and parents, the Office of Early Childhood designed a set of whole-family, or two-generational (also known as 2Gen) outcomes measures representing key family goals that also generate value for Connecticut. Specific outcomes measures include:
- Healthy birth: Avoidance of pre-term birth which presents both immediate long-term risks for children and costs for government;
- Safe children: Avoidance of emergency room visits as well as substantiated child-maltreatment which drive childhood trauma, negative health impacts, and child welfare system involvement;
- Family stability: For highest risk families, the achievement of key, measurable stability goals including attaining child care, health care (such as treatment for maternal depression), and housing for homeless or unstably housed families; and
- Caregiver employment: Achievement of attaining and maintaining a job or enrolling in and completing proven education or training programs, thereby advancing family economic stability and success while reducing dependence on safety net programs.
Referred to as a rate card, this effort allows government to define a menu of outcomes it wishes to “purchase” and the amount it is willing to pay each time a given outcome is achieved. In Connecticut, the outcomes rate card encourages providers to take a family-centric approach that tailors services to the needs of individual parents and their children. The provider receives a payment for each positive outcome achieved per family. Outcomes rate cards are common in the United Kingdom where data systems facilitate the tracking of outcomes for individual families. Traditional Pay for Success and Pay for Performance projects in the US have been based on population-served outcomes (e.g., 90 percent of the families delivered a baby on time, 50 percent of parents are working or in school).
The pilot is an early result of renewed 2Gen legislation in Connecticut, the Two-Generation Initiative, which established the framework for achieving 2Gen outcomes and promotes systemic change to support early childhood education, education, health and workforce readiness and self-sufficiency in Connecticut. This legislation also charges the Office of Early Childhood to advance 2Gen solutions – recognizing that child well-being depends on parental stability and success. It allows Connecticut to more efficiently deploy taxpayer resources by better focusing on whole-family results rather than delivering fragmented care within agency siloes. This model was developed with input from families and programs, informing the specific goals and principles the Office of Early Childhood developed to guide the work:
- Continuing progress towards performance orientation in early childhood services;
- Building out the value proposition for continued investment in home-visiting services; and
- A focus on outcomes.
Supported by Social Finance through a Federal Social Innovation Fund award, and approved by the Health Resources and Services Administration within the Department of Health and Services which administers the federal home visitation funding, the CT program is also supported by the evidence-based home visiting programs which are serving families in Connecticut. The rate card has potential to make outcome contracting a simpler process for small home visiting providers.
Rate cards such as the one developed by the Connecticut Office of Early Childhood clearly and deliberately focus on evidence and outcomes for children and parents, support the scaling of high quality services based on measurable results, and provide the opportunity for optimizing the use of government resources to break the cycle of intergenerational cycle of poverty for children and their caregivers.
David Wilkinson is Commissioner of the Connecticut Office of Early Childhood. Roxane White is the Morgridge Family Innovator in Residence at Ascend at the Aspen Institute.