Latest BC Healthy Connections Project Features

As a scientific interviewer, Elsa Langdon* now regularly meets with people she wouldn’t otherwise have the privilege of knowing.

Her role, as part of the BC Healthy Connections Project (BCHCP) — a scientific study evaluating the Nurse-Family Partnership program — puts her face to face with young women who’ve dealt with a variety of life experiences. Some have not always had all the supports they needed. Some are living on low income. Some have struggled with finishing school, or with health problems. And now they’re pregnant for the first time.

An intensive child and maternal health program, Nurse-Family Partnership (NFP) gives young women who are preparing to parent for the first time one-on-one home visits with public health nurses throughout their pregnancy. These visits continue until children reach their second birthday. The BCHCP is the first Canadian scientific evaluation of this program.

Says Langdon: “It’s been amazing to me to see how strong these women are. Despite all the challenges they face, they still have so much hope for the future. That’s had a big impact on me.”

Langdon’s job is to speak with all participants in the study (only 50% receive Nurse-Family Partnership; the remainder receive existing health and social services) and track their experiences about being new mothers over two-and-half years.

What has struck Langdon the most is how much she has in common with these women. “A realization that’s been slowly washing over me is this sense of how similar we all are,” she says. “If you read about their lives on a piece of paper you may think, ‘They’re so different from me. We have nothing in common.’ But when I sit down and talk [to them], I realize they have the same worries, the same concerns that I do.”

She has also been surprised by the enthusiasm of the participants. “At the beginning I didn’t expect that,” she says. “We were taking up a lot of time and asking a lot of questions. I thought we’d be more of a burden.” Instead, the women taking part often express their gratitude, saying that being in the study gives them a voice. One young woman, in particular, said it made her “feel she was part of something that was bigger,” Langdon says. “It was great to know she saw it as a positive thing.”

Note that Nurse-Family Partnership is available only through the BC Healthy Connections Project for the duration of recruitment. Practitioners or young pregnant women can click here for details on how to reach public health and determine eligibility for the BCHCP.

When a public health nurse discovered that a young mom in the Nurse-Family Partnership (NFP) program was reading the book Getting Things Done, by productivity expert David Allen, she was surprised.

But that’s exactly what makes the program so unique and valuable, says nursing supervisor Amanda Nazari.*

An intensive child and maternal health program, Nurse-Family Partnership provides selected first-time moms with one-on-one home visits with public health nurses throughout their pregnancy. The visits continue until children reach their second birthday.

“This nurse had shared with me how incredible it was to visit this participant,” Nazari says. A “profoundly contemplative person” who gives her own life tremendous thought, the mom had started to read the book and incorporate some of the principles into her own life. Then she shared what she had learned with her nurse.

“For the nurse, that makes it learning too,” Nazari notes. “In NFP we talk about the parallel process. Sometimes it’s about participants’ lives and their journeys. But at other times they have things to teach us.”

Nazari particularly appreciates what she describes as her own “vicarious experiences” with young moms, through the six nurses she supervises. “The whole basis of NFP is that it’s such a terrific opportunity to support these young women,” Nazari says.

Note that NFP is available only through the BC Healthy Connections Project (BCHCP) for the duration of recruitment. Practitioners or young pregnant women can click here for details on how to reach public health and determine eligibility for the BCHCP.

* Name has been changed to protect privacy.

Charlotte Waddell believes children are so important that society should ensure their wellbeing even before they are born. So, together with a large team of research and policy collaborators, she is studying the effectiveness of the landmark Nurse-Family Partnership program in Canada for the first time. The study is called the BC Healthy Connections Project (BCHCP).

Nurse-Family Partnership (NFP) is a home visiting program. It involves public health nurses providing intensive supports to disadvantaged young women who are preparing to parent for the first time. Visits start early in pregnancy and continue until children reach their second birthday. The young women develop long-term relationships with the nurses, which is a crucial part of how the program works.

The BCHCP involves a randomized controlled trial of the program’s impact – looking at mothers’ wellbeing, and at children’s health and development from birth through age two. In essence, the research team will compare NFP with BC’s existing maternal and child health and social services.

BC’s participating Health Authorities are seeking 1,000 mothers and children to take part in the BCHCP over the next two years. But beyond this, Waddell hopes that the research team can follow these children and families for 10 years or more. The goal? To look at mental health and development as children progress through early, middle childhood and into their adolescent years.

“We know from US studies that many program benefits actually show up much later – in 10, 15 or 20 years,” Waddell says. “So, in a sense, completing the immediate evaluation of Nurse-Family Partnership is just the first step.”

For example, the team would like to learn whether Nurse-Family Partnership helps prevent kids from developing serious anxiety, depression, behaviour and substance misuse problems. As well, the team is curious about how Nurse-Family Partnership might affect academic achievement – from school entry into the high school years. There are other potential benefits, too, such as reducing the number of children going into foster care – and even reducing mortality for children and mothers.

Beyond these potential benefits for children, it may turn out that Nurse-Family Partnership is a good fiscal investment. In the US, NFP has shown a return on investment of more than $18,000 for every family served. This includes savings across healthcare, income support, youth justice, child protection and other public sectors. “So we’re setting the stage to test cost effectiveness, too.”

But the real reason to care? Says Waddell: “It’s about making sure that all BC children have the chance to flourish and meet their potential.”

Note that NFP is available only through the BC Healthy Connections Project for the duration of recruitment. Practitioners or young pregnant women can click here for details on eligibility for the BCHCP.

As a family doctor who delivers babies in Richmond, BC, Tamara Leung (pictured adjacent) has seen her share of difficult pregnancies. Maybe a woman is new to the community or hasn’t had a doctor involved. Maybe she’s really young and has very few people supporting her. Perhaps she has very little money to cover the everyday costs of living.

But Leung knows her first step: “I try to send everyone to public health” — meaning those community-based health programs that focus, among other things, on promoting health and preventing problems for pregnant women.

Leung particularly likes intensive home visiting programs, such as Nurse-Family Partnership, because they support women throughout the pregnancy and into children’s early years — in their own homes. This allows nurses to understand the real situation that women are living in. “When people are out in public or come into a clinic, you don’t always see the challenges they may face in the home,” Leung says. “They need support and help. The isolation that so many have is heartbreaking.”

However, Leung says that even people who want to help sometimes inadvertently create more problems. As an example, she recalls the time a school wanted to sponsor a family from a transition house. Their intentions were well-meaning. But the organizers made an enormous basket and the woman receiving it ended up having to carry it home on the bus.

As for the women Leung refers to public health, she says she understands that Nurse-Family Partnership is currently being evaluated in comparison with existing health and social services. This evaluation — called the BC Healthy Connections Project — is taking place across BC over the next several years and is looking at children’s mental health and development as well as maternal outcomes. Leung knows that this evaluation, involving a randomized controlled trial, must be rigorous to help us understand how well the program can work in BC. “We need to follow the basic rules of science,” she says.

“And regardless of whether my patients end up receiving NFP or other public health services while this study is going on, I’m happy,” she says. “I just want them better connected with public health. All pregnant women can still benefit from public health support.”

Scientific interviewers who work with the BC Healthy Connections Project (BCHCP) speak to women about some of the most emotionally intense experiences of their young lives. Their first pregnancy. Their relationships. The financial — and other — challenges they face. Their future job prospects. Their education.

Interviewer Vivian Lehman* remembers one mother-to-be especially well. Lehman expressed how much she appreciated the woman taking the time to share her experiences. “She sat there for a minute and looked at me and said, ‘I’m happy I did this and I really hope it can help improve services,’ ” Lehman recalls.

The woman had had experience with foster care and had grown up without much support. But the interview gave her the chance to have her voice heard. She was 18 years old.

“To have [young women] relate these feelings back to you is really powerful,” Lehman says, and she herself remains moved by the potential of her role. Her job is to interview participants in the project, tracking both their successes and the challenges they face.

Lehman believes the BCHCP, which is a scientific study of the Nurse-Family Partnership, will help show if there are benefits to adding new programs to support young first-time mothers facing socio-economic disadvantages compared to what’s currently available.

An intensive child and maternal health program, Nurse-Family Partnership provides disadvantaged young women who are preparing to parent for the first time with one-on-one home visits with public health nurses throughout their pregnancy. The visits continue until children reach their second birthday. The BCHCP is the first Canadian scientific evaluation of this program.

Lehman also believes the study will illustrate the challenge of getting information to the young women who need it. “There are quite a few different services [for young pregnant women],” she says, “but you need the right person or the right link to find your way in to them. It can be really hard when you’re young and find yourself pregnant.”

Having the chance to interview participants in the BCHCP is something Lehman describes as a tremendous experience. “It’s an honour to be able to peek into their lives,” she says. “It’s really a privilege.”

Note that NFP is available only through the BC Healthy Connections Project for the duration of recruitment. Practitioners or young pregnant women can click here for more information.

* Name has been changed to protect privacy