Grant Recipient: Harvard T.H. Chan School of Public Health
Term: 2020 –2023
Principal Investigator: Margaret McConnell, Ph.D., Harvard University and J‑PAL North America at the Massachusetts Institute of Technology
Summary: This project will fund longer-term follow-up of a large-scale randomized controlled trial evaluating the impact of the Nurse-Family Partnership’s expansion in South Carolina. The scientific trial was made possible by a “Pay for Success” program embedded within a 1915(b) Waiver from Medicaid secured by the South Carolina Department of Health and Human Services. NFP is an evidence-based nurse home visitation program for first-time mothers. NFP has been evaluated in three well-conducted RCTs in the United States (in Elmira NY, Memphis TN, and Denver CO). These studies have found a pattern of sizable, sustained effects on important child and maternal outcomes, including reductions in child abuse and neglect and in mothers’ number of subsequent births in their late teens and early twenties.
While these RCTs provide credible evidence of important effects, they were all initiated more than two decades ago when NFP was operating on a relatively modest scale. This new trial will evaluate whether NFP is still effective in a modern policy context and when implemented on a large scale with substantial public funding.
South Carolina is partnering with philanthropic organizations to offer NFP to first-time, Medicaid-eligible mothers through a Medicaid waiver, and to incorporate an RCT evaluation into the state’s NFP expansion. The study’s target sample is 6,000 expectant mothers.
This grant will fund follow-up through their children’s second birthday. The study’s primary outcomes at this follow-up will be (i) a composite measure of adverse birth outcomes or perinatal mortality, (ii) rate of repeat births within 21 months, and (iii) a composite measure indicating health care utilization or mortality associated with major injury or concern for abuse or neglect occurring during the child’s first 24 months of life. The study will measure these and several other (secondary) outcomes using administrative records from multiple state databases.
The study’s original pre-specified analysis plan is linked here, and an addendum is linked here.