Latest BC Healthy Connections Project Features

Catherine, N.L.A., Zheng, Y., Xie, H., Boyle, M., Jack, S., MacMillan, H., & Waddell, C. (Forthcoming). Effectiveness of Nurse-Family Partnership on child outcomes by patterns of program intensity: Secondary evidence from a randomized controlled trial (British Columbia Healthy Connections Project). Child Abuse & Neglect.

Research Overview

This forthcoming paper examines how program intensity influenced child outcomes in the Canadian scientific evaluation of the Nurse-Family Partnership (NFP) program. Led by Nicole Catherine, Associate Director of the Children’s Health Policy Centre, the research team found that when NFP was delivered as intended, with sustained intensity — meaning families received the majority of recommended nurse-home visits consistently throughout the program — children experienced greater benefits in language and mental health-problem behaviour by age two years.

Methodology

• The researchers conducted secondary analysis of data from the British Columbia Healthy Connections Project (BCHCP), a randomized controlled trial evaluation of NFP involving 739 maternal participants and their 737 children in British Columbia.
• Participants in the BCHCP were enrolled in early pregnancy and randomly assigned, like flipping a coin, to two different groups — NFP versus Comparison (the existing services on offer in BC) — to investigate whether NFP provided greater benefits for mothers and children by age two years.
• The BCHCP study team collected data at regular intervals across pregnancy and early childhood (2013 to 2019) including on child injuries, language, cognition and problem behaviour (mental health) at age two years.

Key Findings

• Delivering NFP as intended, with sustained intensity, led to greater benefits regarding maternal-reported child language and mental health-problem behaviour.
• Importantly, the research team also found benefits using a rigorous measure of child language development (Bayley Scales of Infant Development), where children were observed directly in the home. This method is considered less biased than mothers’ self report of their children’s language development.

Implications

• Benefits for kids: Sustaining long-term program engagement with young families experiencing disadvantage can make a difference for children. Improvements in language and mental health — as early as age two years — are associated with longer term benefits across childhood and the school years.
• Longitudinal research: It is important to follow the participating children across adolescence to assess long-term program effects on mental health and academic functioning.
• Funding priorities: Policymakers should fund evidence-informed prevention programs that commence early in pregnancy at adequate levels of intensity to maximize benefits for children in need and for society as a whole.

A report published in BMC Pregnancy and Childbirth has shown that better service reach is both necessary and possible to support urban Indigenous girls and young women who are preparing to parent for the first time.

The report was co-written by Indigenous scholars and community leaders with Nicole Catherine, Associate Director of the Children’s Health Policy Centre. The team studied the experiences of young expectant mothers who were enrolled in the BC Healthy Connections Project (BCHCP). BCHCP enrollment was based on participants’ experiences of socioeconomic disadvantage. Of the 739 participants, a high proportion (200 or 27%) were Indigenous — despite no specialized recruitment pathways.

Crucially, the report acknowledges the strengths of these mothers-to-be in seeking services during pregnancy and consenting to a long-term research study while facing adversities such as unstable housing and very limited income.

This research underscores the need for enhanced interventions that serve pregnant and parenting Indigenous girls and young women, particularly in urban environments. Programs that provide intensive supports throughout pregnancy and childhood can promote healthy life trajectories while also strengthening community.

“In Canada and internationally, tailored Indigenous community-led programs are needed and need to be offered where Indigenous children and their mothers live—to support long-term mental health and well-being,” the researchers conclude. “Alongside this, Indigenous-led research that includes the participants as partners and involves respectful collaborations—and is driven by community priorities—will also help in realizing the collective goal of ensuring healthy development for all Indigenous children.”

To learn more, read the report.

New findings from the Children’s Health Policy Centre’s scientific evaluation of the Nurse-Family Partnership (NFP) program show promising benefits for mothers regarding exposure to intimate partner violence, income, mental health and self-efficacy — warranting follow up of longer-term benefits across childhood.

The scientific team behind the BC Healthy Connections Project, or BCHCP, published these findings in the British Medical Journal Open. According to the study, NFP may help reduce adversities faced by mothers, including intimate partner violence, by the time their children are two years old.

For children, exposure to intimate partner violence is a serious form of maltreatment with long-term mental health consequences. Intimate partner violence is occurring at epidemic proportions, and rates are higher for lone mothers experiencing marginalization. Yet despite known harms to both children and mothers, efforts often focus on aftercare rather than prevention.

“These are important, encouraging findings on how to address early adversities,” said Nicole Catherine, BCHCP co-principal investigator, who holds the Canada Research Chair in Child Health Equity and Policy, Tier II. “We need greater investments in early prevention — well before children are born.”

BCHCP co-principal investigator Charlotte Waddell added that this landmark initiative has been a long-term priority for researchers in British Columbia (BC). It commenced in 2011 as the BC government prioritized early prevention of childhood adversities — leading to the BCHCP (2011-2022). “Our findings contribute further evidence that intervening in early childhood is a powerful policy mechanism to promote healthy child development,” said Waddell.

The Children’s Health Policy Centre (CHPC) at Simon Fraser University led the BCHCP randomized controlled trial, or RCT, in collaboration with McMaster University and other organizations.

A province-wide initiative, the BCHCP intended to address long-term child health inequities beginning before children were born. To do this, the trial was embedded within BC’s universal public health system. Four participating regional health authorities — Fraser, Interior, Island and Vancouver Coastal — were responsible for trial referrals, nursing and program costs. All five health authorities, including Northern Health, participated in a pilot nurse-guiding study and an adjunctive nurse-process evaluation. “BC showed tremendous leadership and foresight in investing in prevention of early childhood adversities,” said Catherine.

The study team was centrally located at the Children’s Health Policy Centre and supported scientific field interviewers across all four regional health authorities. Catherine provided scientific interviewers with intensive training and mentorship to ensure successful reach and sustained engagement with 739 pregnant girls and young women and their 737 children during each family’s 2.5-year participation.

The study included 200 Indigenous (including First Nations, Métis or Inuit) girls and young women. Making up 27% of the total participants, they generously agreed to participate in this long-term trial. Some 237 BCHCP children, or 32%, had an Indigenous mother or father.

“We are grateful to the participants for sharing their experiences with us while preparing to parent for the first time. Many shared how they wanted to make a difference for other children and mothers in similar circumstances,” said Catherine. Previous BCHCP reports have shown the strengths of the participants in seeking prenatal services while coping with cumulative adversities such as unstable housing and living on less than $10,000 per year.

The study was funded by the BC Ministries of Health, and Children and Family Development. The Mowafaghian and Stern Foundations provided additional generous supports.

Nurse-Family Partnership aims to improve the lives of children born to young, first-time mothers. The program focuses on families dealing with socioeconomic inequities. It begins in pregnancy and involves a program of home visits by public health nurses, continuing until children are two years old. NFP was developed in the United States by researcher David Olds and colleagues.

Earlier findings from the BCHCP research team had shown that NFP reduced prenatal substance exposure (nicotine and cannabis) and improved child mental health and language development by age two years. The BCHCP also involved an adjunctive biomarker sub-study.

“There is increasing interest and policy investments in delivering enhanced early prevention programs such as NFP in BC and Canada — all with expectations of sustained benefits. But we have yet to see if these benefits at age two years translate into sustained benefits across childhood and adolescence. This is where we will see the true value of intervening early,” Catherine said. “We are eager to re-engage the BCHCP children to see how they are doing and whether these investments made a difference in children’s lives, and to understand if they were cost-effective.”

Text of the BMJ Open paper is available here.

Media

For more information and contact details, please see the SFU News media release.

Findings from the Children’s Health Policy Centre’s scientific evaluation of the Nurse-Family Partnership program are the subject of a recent podcast recorded with SFU assistant professor Nicole Catherine, co-principal investigator for the randomized-controlled trial.

The podcast was recorded by the Association for Child and Adolescent Mental Health (ACAMH), the organization for the journal that published the main child findings in July 2023.

“I relished the chance to be able to speak about these important findings,” Catherine said. “I’m committed to ensuring that the voices of these young families, as told through their research data, are heard and amplified,” she added.

The podcast recording can be found here.

Charlotte Waddell, Centre Director, joined BC Ministry of Health lead partners for the Sept. 26 Annual Education Meeting held online for approximately 10 public health nurses with BC’s Interior Health Authority.

The focus was Nurse-Family Partnership (NFP) and a review of the main findings from the 10-year randomized controlled trial that the Centre has led. This trial has evaluated NFP in Canada for the first time. Nicole Catherine and Harriet MacMillan are co-leads with Waddell.

The study has shown that NFP reduces prenatal substance exposure and improves child language and mental health by age two years. All three outcomes are crucial for early healthy development.

Waddell also spoke about the high number of Indigenous participants and about ongoing work with Indigenous collaborators to tell the stories of these participants. As well, she noted long-term follow-up plans: “In the US and England, NFP led to enduring benefits in middle school and beyond, so we are also committed to learning how well NFP works to help children longer-term in BC.”