Connecting New Moms to Nurse Visits in South Carolina

Impact Highlight: 

The GPL helped South Carolina define a clear target population of mothers they hoped to serve through their Nurse-Family Partnership. The goal was to offer services to improve outcomes for mothers and babies who lived in zip codes with high concentrations of poverty. The structure of the outcomes-based contract required the service providers to engage mothers from this clear target population in their outreach strategies. In order to accomplish this, services providers came up with innovative ways to reach these specific, and previously under-served, mothers.  

Challenge: 

• In 2009, South Carolina began offering nurse home visiting services to try and improve the health outcomes of low-income mothers and their babies. Mothers who enrolled in the Nurse-Family Partnership (NFP) services would receive individualized home visits from trained nurses from early in their pregnancy until their child’s second birthday. 
• South Carolina wanted to reach more mothers who could benefit from these services, but who might not otherwise connect with the state’s programs, especially mothers who lived in zip codes with high concentrations of poverty.  
• In April 2016, South Carolina’s Department of Health and Human Services (SCDHHS) launched the nation’s first “pay for success” contract model to deliver preventive services to first-time mothers in the state’s Medicaid program. The program relied on both government and philanthropic funding. 

Innovation: 

• The GPL set up a three-month pilot program to test new enrollment protocols for the nurse home-visiting program. 
  • The GPL and South Carolina created an outcome metric that was focused on enrolling at least 65% of first-time mothers from specific low-income zip codes in the NFP program. 
  • The pilot also tested adjustments to the consent and information gathering process and data-sharing agreements. 
• Helped South Carolina receive a 1915(b) waiver from the Centers for Medicare and Medicaid Services to allow NFP to bill Medicaid for the nurse visits. This waiver also allowed mothers to have up to 40 nurse visits, instead of just two visits. 
  • The program was funded by Medicaid payments (45%) and philanthropic investor contributions (55%). 
• Helped prepare the NFP for a randomized controlled trial (RCT) and a long-term evaluation by the Abdul Latif Jameel Poverty Action Lab (J-PAL) that would look for evidence of: 
  • Reductions in child injuries, hospitalizations 
  • Reductions in preterm births 
  • An increase in healthy intervals between 1st and 2nd children 
  • An increase in the number of mothers enrolled from low-income zip codes 

Results: 

• The GPL helped South Carolina successfully adjust how mothers were screened for and enrolled in nurse-family partnership home visiting services in South Carolina. 
  • For the randomized controlled trial of the program, the enrolled study population was younger, more likely to have pregnancy-related medical issues, and more socially and medically vulnerable than those who did not enroll. 
• SCDHHS conducted long-term testing through a randomized controlled trial to study the efficacy of the NFP.  
  • The trial showed no differences in the rates of child injuries, birth spacing, and preterm births between mothers enrolled in the study and mothers in the control group. 
• Rigorous evaluations of social services interventions require dedicated resources and political will. South Carolina’s willingness to rigorously evaluate their program demonstrated a commitment to learning and ongoing improvement. Their study added to what is known in the field about what is effective for children and families. Such findings allow leaders in South Carolina and across the country to continue to iterate on programming and seek new, effective ways to serve low-income mothers and babies.  

Additional Documents:

• South Carolina Nurse Family Partnership RFI
• South Carolina Nurse Family Partnership Contract