Evidence-based and evidence-informed home visiting is a voluntary early childhood strategy that can enhance parenting and promote the growth and development of young children beginning as early as pregnancy. Home visiting programs are focused, individualized, and culturally competent services for expectant parents, young children, and their families within safe homes and connected communities. These programs are available in the home and help families strengthen attachment and promote optimal development of their children, promote health and safety, and reduce the risk of child maltreatment. Pay for Success is a funding mechanism that has been tested by some state and local governments to scale the reach of critical human service programs when funding and resources are limited.

In the 2018 Appropriation Act, required the Virginia Department of Health (VDH) to lead a workgroup consisting of home visiting and early childhood organizations to evaluate the feasibility of developing a Pay for Success home visiting pilot program. As part of this effort, VDH was directed to report on: 1) a feasibility analysis; 2) availability of federal funding; and 3) the steps necessary to proceed with a pilot program.

In completing this study, VDH built upon prior work completed in the Virginia Home Visitation Pay for Success (PFS) Feasibility Study concluded in 2017. The Virginia Home Visitation PFS Feasibility Study focused on the feasibility of expanding prenatal home visitation for high-risk, low-income mothers through a Pay for Success project. VDH was one of the partner organizations that enabled the manifestation of the prior feasibility study. The scope of the prior study closely aligns with the current 2018 study mandate. To this end, VDH determined that it would be most prudent and fiscally responsible to consider the results of the prior feasibility study and use those lessons learned to make recommendations regarding the feasibility of developing a home visiting PFS pilot program. The 2018 workgroup made recommendations for next steps based on the prior assessment, current Pay for Success opportunities, and future federal funding availability for home visiting Pay for Success projects.