A woman holding a baby in front of bushes.

Leveraging Outcomes-Based Funding to Improve Home Visiting Services in Missouri

Public Sector Solutions, Children & Families


22Providers participating in the statewide rate card


  • Unite and articulate impact by using incentive funding attached to a single set of priority metrics across all of CTF’s contracted home visiting providers
  • Incentivize prenatal enrollment given the low rates of prenatal enrollment at status quo
  • Improve data entry by rewarding providers for collecting more data and reporting it correctly

The Work

Founded in 1983 by the Missouri General Assembly, the Missouri Children’s Trust Fund (CTF) has since allocated nearly $68 million in public funding toward programs and education to prevent child abuse and neglect. One of CTF’s primary funding focuses is on home visiting providers that deliver a range of home visiting models focused on achieving positive outcomes across maternal and child health, child welfare, and child development. Through these grants, CTF served thousands of families and became a hub for data, referrals, and resources to maximize home visiting outcomes.

Previously, CTF’s home visiting service funding was administered on a fee-for-service model in which agencies were paid to carry out services irrespective of the agencies’ performance or impact. In 2020, CTF launched an effort to explore how it might shift away from this traditional fee-for-service funding structure to an outcomes-based funding (OBF) structure—shifting from paying for services to paying for discrete, measurable outcomes.

CTF worked with Social Finance to design an outcomes rate card (ORC), an OBF structure that includes seven high-priority outcome metrics CTF hopes to achieve and an associated payment, or “price,” for each outcome achievement. The ORC provides an opportunity for home visiting providers to earn incremental new incentive funding based on the achievement of specific outcomes.

The work began in 2020 with a pilot focused on Kansas City-area home visiting providers. Based on strong positive responses from providers, CTF allocated American Rescue Plan Act funds to expand the outcomes rate card statewide in July 2023.

The Results

In its first three quarters, the program had a total of 960 parent, caregiver, and guardian (PCG) enrollments as the number of participating providers more than doubled. 391 of those enrollments were prenatal – a key outcome in light of a growing body of evidence showing that home visits for expectant parents is an especially effective way to promote infant and child health and safety.

A bar chart showing the percentage of customer data.
Social Finance has helped the Children’s Trust Fund of Missouri to grow and do things as a funder that we never could have done without them. It is so fulfilling to be innovative and know that families are being served more effectively because of our work.

Emily Van Schenkhof

Executive Director, Children’s Trust Fund

Emily Van Schenkhof headshot

Photo courtesy of the Children’s Trust Fund of Missouri.

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