Karen Armstrong

Karen Anderson
Pay for Success Coordinator
Department of Children and Family Services
Cuyahoga County, Ohio


Families that consumed many resources across multiple county health and human service systems (eg, child welfare, homeless shelters, mental health) often had poorer outcomes than families that were involved in fewer systems. The county wanted to consolidate programs and in the process both improve services and save money.


First, the county partnered with Case Western Reserve University’s Center on Urban Poverty, which used its database of public sector information to cross-match clients using those services. It then partnered with local non-profit FrontLine Service and its own housing authority to provide intensive services and housing to families with children in foster care.

Second, Cuyahoga is the first county in the U.S. to try a unique financing model called Pay for Success, or performance-based contracting, which pays for outcomes rather than reimbursing providers for services rendered. So it’s using an intermediary, Enterprise Community Partners, to pay FrontLine for services. At the end of a 5-year contract, if the nonprofit and county are successful, investors will be repaid with interest.

There’s already evidence the plan is working in terms of family reunifications.

Karen’s Background

Grew up in blue-collar community in Painesville, Ohio, 30 miles east of Cleveland, where she skated at the roller rink, hit golf balls, and played in the band. Got degree in social work from Eastern Nazarene College in Quincy, MA (’82) then master’s from Boston University (’85). Has spent her career in child welfare and homeless services. Came to Cuyahoga to lead Pay for Success.

Startling Fact

Plays trombone in several community bands

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