This is the third of a three-part series that looks at how public agencies can invest resources in programs that work.
Consider a program in which low-income women who are first-time mothers receive regular visits at home from nurses. The nurses work individually with the women, giving them information about nutrition and child development, and serve as trusted resources for women who may otherwise have a difficult time obtaining such advice.
Now consider that this program is also fantastically effective. Rigorous, independent, repeated studies demonstrate that participation in the nurse home-visiting program leads to a 20 to 50 percent reduction in rates of child abuse and neglect—and up to $13,000 in savings from reduced use of Medicare, Temporary Assistance for Needy Families, and the Supplemental Nutrition Assistance Program.
What is described here is a real program, supported by the U.S. Department of Health and Human Services, modeled on what is known as the Nurse-Family Partnership. It is one of a small number of programs supported by the federal government in which there is strong evidence that enrollment in the program leads to better outcomes for participants—and big-picture cost savings for government.
How do we know this? Well, it’s easy to imagine a world in which funding decisions would be made by looking for evidence of what works, but sometimes that’s just not the way Washington works. But in this case it is easy to imagine because that world already exists—in Washington State, rather than in Washington, D.C. There, the Washington State Institute for Public Policy, which was created by the state legislature in 1983, provides a proven model for data-driven legislative decision-making. It’s nothing short of “what works” in action.
The institute’s mission is to conduct “practical, nonpartisan research” as directed by the state legislature “on issues of importance to Washington State.” The institute’s handiwork is evident in its analysis of the Nurse-Family Partnership, but a great deal of the institute’s research revolves instead around reducing crime and recidivism—with remarkable results. “Relative to national rates, juvenile crime has dropped in Washington, adult criminal recidivism has declined, total crime is down, and taxpayer criminal-justice costs are lower than alternative strategies would have required,” reads the Institute’s July 2011 “Return on Investment” update. That update included a cost-effectiveness ranking of a number of juvenile justice programs—revealing, as Wednesday’s column discussed, that the popular Scared Straight program has a negative return on investment.
On a December 2011 episode of “Inside Olympia,” state Sen. James Hargrove drew an even starker picture. After running through a number of evidence-based initiatives undertaken to reduce crime and recidivism, Hargrove said, “All of this now has rolled up to where we have a violent crime rate in this state that is below the national average and we are doing it with less than half as many people in prison per thousand than most states.”
What’s more, Hargrove continues, those efforts are saving Washington taxpayers a little more than $1 billion dollars every two years. Washington state’s experience with evidence-based crime-reduction programs clearly illustrates that a desirable social outcome can be achieved while simultaneously cutting overall costs to the government. The institute’s role in all of this is absolutely critical, and follows four basic steps:
- Identifying “what works” by analyzing high-quality studies of a range of programs, much like the “what works” platforms discussed in yesterday’s column
- Calculating costs and benefits for the state and producing a Consumer Reports-style ranking of options
- Taking uncertainty into account by “testing how bottom lines vary when estimates and assumptions change”—in other words, conducting a risk analysis
- When possible, providing a “portfolio” analysis of how a range of interventions and programs can influence the big picture
A breakdown of this kind of effective analysis is evident in the juvenile-justice programs examined by the Washington State Institute for Public Policy, which ranks public-policy options by clearly showing costs and benefits. These are detailed in the accompanying illustration.
There are multiple benefits to the institute’s approach. Beyond merely identifying “what works,” conducting rigorous cost-benefit analysis provides information vital to policymakers trying to choose the best program for their budget. Calculations of risk and uncertainty provide a range of possible cost-benefit outcomes and provide some measure of insulation from critics. Such a big-picture “portfolio” analysis of how a range of programs interact to improve overall outcomes helps cut across funding streams and program areas that have been historically funneled into isolated “silos.”
In a difficult fiscal environment, congressional appropriators in the nation’s capital should be directing funds toward programs that are proven to deliver positive results, such as the Nurse-Family Partnership, and working to identify more such programs. As the experience of the Washington state legislature and the Washington State Institute for Public Policy shows, you can have evidence-based legislative decision making—as long as you are truly committed to “doing what works.”
Kristina Costa is a Special Assistant with the Doing What Works project.