Emerging Trends and Issues in Incorporating Pay for Success/Social Impact Bonds to Increase Collective Impact of Prevention Programming

Over the last 25 years, sophisticated designs have been developed to identify evidence-based programs which target one or more risk factors for risky and unhealthy behaviors. These have allowed for drawing inferences regarding which programs work for whom and under what conditions.

Despite these advances in prevention science, it takes around 17 years for these research findings to reach clinical and behavioral health practice. Furthermore, the life cycle of these programs most often ends at the implementation and evaluation stage and does not move towards dissemination and scale-up; consequently, their collective impact is minimized. 

The current research literature has reasoned that in addition to funding issues, influential factors for this translational gap can be found in three domains, including aspects of project design and characteristics (e.g., involvement of local stakeholders as champions), organizational setting (e.g., organizational capacity), and broader community environment (e.g., support from external community stakeholders). These domains do not exert their influence in isolation, but tend to create a complicated configuration of favorable and unfavorable influences.

It is in this context that Pay for Success/Social Impact Bond (PFS/SIB) models garner their relevance. Originally developed in the UK, the first PFS/SIB project was launched in the U.S. in 2012, focusing on recidivism among adolescent inmates on Riker’s Island.

PFS/SIB is an innovative, multi-stakeholder partnership funding mechanism in which government and philanthropic organizations provide upfront funding for program implementation under the umbrella of pay-for-performance principles. There are currently 17 PFS/SIB programs active in the U.S. and more than 40 being considered for inception in Europe and the U.S., and in other countries. This funding approach tries to address three main issues: inconsistent funding for providers; fiscal constraints, which hamper the support for prevention programs; and a lack of systematic government involvement required for scale-up.

This presentation from the 2017 European Society for Prevention Research Conference expands on the current implementation gap literature by critically reviewing how the PFS/SIB project structure has the potential to increase the collective impact of prevention programming by addressing above described translational challenges.