Nurse-Family Partnership is being tested in Canada

Nurse-Family Partnership aims to improve the lives of young first-time mothers and their children. Developed nearly 40 years ago by David Olds and colleagues in the US, the program starts early — in pregnancy, before children are even born. It involves intensive home visits and continues until children reach their second birthday. The program particularly focuses on young women and their children who are facing disadvantages such as low income.

Public health nurses provide the home visits — up to 65 in total over two-and-a-half years. Nurses delivering the program receive extensive education. As well, they receive resources to use in the visits, and ongoing supervision and support.

Three US randomized controlled trials (RCTs) have been conducted on Nurse-Family Partnership, with follow-up now reported for more than 20 years. The program has shown robust and enduring benefits for children and mothers including:

  • reduced prenatal nicotine use
  • improved parenting
  • reduced child injuries
  • improved child mental health
  • improved child cognitive development
  • improved economic self-sufficiency for mothers.

Two independent research groups have also studied the costs versus benefits of Nurse-Family Partnership in the US. The Rand Corporation estimates a net return of US $2.88 for every dollar invested. And these returns nearly double for the highest-risk families, at US $5.70 for every dollar invested. The Washington State Institute for Public Policy found similar results. They estimate a net return of more than US $18,000 for every family served. Both analyses calculated averted spending across multiple public sectors over 10-15 years following program completion including:

  • healthcare
  • justice system
  • income assistance, and
  • child welfare.

Other groups have now evaluated Nurse-Family Partnership outside the US. An RCT in the Netherlands found it achieved many benefits when compared with existing health and social services. There, Nurse-Family Partnership:

  • reduced prenatal smoking
  • increased breastfeeding
  • improved parenting, and
  • reduced intimate-partner violence.

An RCT in England, meanwhile, found limited benefits compared with existing services for children at two years of age. But there was some evidence that the program improved child language development and mothers’ social supports. This may be the basis for important long-term improvements for children in the future.

Different findings across the American, Dutch and English trials affirm why countries outside the US need to study Nurse-Family Partnership before they use it. Interventions may have very different outcomes in different countries. This may occur because existing services differ from the US, or because RCT outcome indicators differ.

Because of these issues, the program’s developers ask that countries interested in Nurse-Family Partnership go through four distinct steps:

  1. adapt the program to the local context
  2. assess feasibility and acceptability in a small-scale pilot study
  3. test the program in a large-scale RCT, and
  4. put the adapted program in place, if the RCT shows success.

The BC Healthy Connections Project is following these steps.

Nurse-Family Partnership was first adapted to add Canadian content at McMaster University. Starting in 2008, the program was then piloted with 100 families in Hamilton, Ontario. The pilot showed that the program was well received by families, nurses and other healthcare providers, and community agencies — demonstrating acceptability and feasibility.

In 2011, the BC government decided to sponsor a large-scale scientific evaluation of Nurse-Family Partnership. Its goal is to determine how the program can improve the lives of children and mothers here. Called the BC Healthy Connections Project, the evaluation is using RCT methods in a sample of 1,000 families. Program outcomes will be compared with BC’s existing health and social services.

The Children’s Health Policy Centre at Simon Fraser University is leading the scientific evaluation — with collaborators from across BC and Canada. Collaborators include scientists at McMaster University, the University of BC, the University of Victoria and the Public Health Agency of Canada.

The BC Ministry of Health is leading implementation of Nurse-Family Partnership with support from the BC Ministry of Children and Family Development. The implementation is occurring in close collaboration with BC’s five regional Health Authorities:

  • Fraser Health
  • Interior Health
  • Island Health
  • Northern Health
  • Vancouver Coastal Health.

Charlotte Waddell and Harriet MacMillan are the Nominated Co-Principal Investigators for the BC Healthy Connections Project. Nicole Catherine is the Scientific Director and Co-Principal Investigator. Susan Jack and Debbie Sheehan are also Co-Principal Investigators. BC Government policy leads are Warren O’Briain, Ministry of Health, and Rob Lampard, Ministry of Children and Family Development. Donna Jepsen is Provincial Nurse-Family Partnership Coordinator with the Ministry of Health. BC Healthy Connections Project Steering and Advisory Committees provide further guidance for the work.

After nurses received their education and after ethics approvals were obtained, the Children’s Health Policy Centre launched BC’s Nurse-Family Partnership RCT in October 2013. Recruitment closed in December 2016. The BC Healthy Connections Project also includes two associated studies:

  • A Process Evaluation, looking at nurses’ experiences with program implementation across BC. Funded by the Public Health Agency of Canada, this study will help suggest future adaptations for BC and Canadian delivery of Nurse-Family Partnership.
  • The Healthy Foundations Study, looking biological markers of adversity. Funded by the Canadian Institutes of Health Research, this study will measure how Nurse-Family Partnership may reduce the physical effects of adversity for children.

The BC Ministry of Health is funding the BC Healthy Connections Project RCT, with support from the BC Ministry of Children and Family Development, and from the five regional Health Authorities. The Djavad Mowafaghian Foundation, the R. and J. Stern Family Foundation, and the Canada Research Chairs Program are providing additional supports.

For references for the information cited in this article, please contact Charlotte Waddell or Nicole Catherine.

Referral Information

If you would like to be referred to the Nurse-Family Partnership program, please contact:

  • Your family doctor or midwife,
  • Your local Health Authority,
  • Donna Jepsen, Nurse-Family Partnership Provincial Coordinator with the BC Ministry of Health at 604-775-0336.

You can reach the BC Healthy Connections Project by email at: bchcp@nullsfu.ca.

The following links give more information on Nurse-Family Partnership. Note that the program is in different stages of development, evaluation and implementation around the world: