Why Should Delaware Care?
New Castle County is testing a new way to fund social programs where the government only pays if results are evident. The county first tried this model in 2022 to support first-time mothers. With early outcomes showing promise, it could support more pay-for-success initiatives in the county and across the state.
When Taiwo Gariba learned she was pregnant and would become a first-time mother, she was both excited and nervous.
“Of course, there were fears,” she said. “I’ve heard so many stories of things going wrong.”
But eventually the anxiety calmed, Gariba said, particularly after her health insurance told her she qualified for a program that would pair her with a nurse for guidance and support throughout the pregnancy and after it.
Part of a relatively new initiative in New Castle County, the program aims to serve 120 Medicaid-eligible first-time mothers. Over 90 mothers are currently enrolled.
It is also the latest to test a new way to pay for social programs by first raising private dollars, then paying them back with government money if positive results come in.
The initiative launched in 2022 through a collaboration between New Castle County and Children & Families First, a local nonprofit. Nurses in the program work one-on-one with mothers through regular home visits. They check blood pressure and weight, help mothers build birth plans, and walk them through safe sleep practices and developmental milestones.
They also serve as a reliable point of contact for mothers when worries arise.
Gariba laughed as she recalled one time she texted her nurse a picture of her newborn baby’s stool to make sure it was normal.
“The resources were still there,” she said.
Big donor underpin program
Rather than traditional funding, the county has turned to a pay-for-success approach for the program where federal money is released to the county only if and when the program meets its goals.
It follows the model of an evidence-based program, called Nurse-Family Partnership, that pairs mothers with specialized registered nurses who offer home-based care to support healthy pregnancies and improve childhood health.
That program marked the county’s first use of a pay-for-success model, and recently, county officials have been testing whether the approach can scale. Last month, New Castle announced the Family HOPE Project, an $11-million initiative aimed at helping homeless families. The county has secured access to federal funding, but it must first raise private investment as proof of concept.
For the Nurse-Family Partnership project, New Castle County and Children & Families First secured $3 million from the du Pont family nonprofit, the Longwood Foundation.
New Castle County agreed to reimburse Longwood up to the full amount with American Rescue Plan Act funds based on the outcomes achieved through the program, which is set to end in the winter of 2026.
“[The county is] not actually on the hook to pay until they have evidence that outcomes are achieved,” said Matthew La Rocque, associate director at Social Finance, which manages project finances and evaluates program outcomes on behalf of New Castle County.
‘I gave birth safely’
Children & Families First has been using the Nurse-Family Partnership, a nationally-recognized model, statewide since 2010. The nonprofit currently receives funding from the Delaware Division of Public Health.
Kirsten Olson, CEO of Children & Families First, noted that Delaware sees roughly 5,000 Medicaid births each year. Even if only a fraction are first-time pregnancies, the program’s current capacity of 200 clients reaches only a small share of those who qualify, she said.
The new project, she said, “gave us an opportunity to expand services to more eligible folks and really expand the programmatic footprint.”
La Rocque said they are measuring different aspects that are aligned with strong health outcomes, like breastfeeding initiation, mental health screenings, immunizations, and whether moms remain in the program.
So far, he said those metrics have shown progress. More than 75% of mothers are staying enrolled through childbirth. More than 90% have initiated breastfeeding, completed mental-health screenings, and received referrals when needed. Immunization completion in year one is also above 75%.
To date, the county has been charged about $1.7 million on the project costs.
La Rocque said the goal of the project is sustainability. Longwood has committed to reinvesting 40% of whatever it recoups back into Children & Families First for additional programming.
“The hope is that a blend of funding from state, federal, and private sources can continue the expansion team in some way,” he said.
Gariba has been in the program since last winter. During that time, her nurse offered consistent support, she said, providing helpful information about childbirth and regularly bringing items like teething toys, a breastfeeding pillow, and even a crib.
Nurse visits have shifted from every two weeks to once a month since the baby is now 5 months old. Gariba still feels the program remains a steady and accessible resource for her.
“I gave birth safely. I gave birth with knowledge. I gave birth knowing that there were supporters around me, and it wasn’t just my family. It was the state,” she said.
Funder Notice
The Longwood Foundation has supported Spotlight Delaware with a multi-year grant. The funding bears no impact on Spotlight’s editorial decision-making per our Editorial Independence Policy.