When Roger Parsonage watched a Kamloops Nurse-Family Partnership (NFP) graduation event for young mothers and their toddlers back in May, he was struck by what the ceremony represented.

Mothers and their children stood at the centre of the room. Nurses stood close by. And, in a semicircle at the back, stood everyone else from Interior Health.

“It struck me it was really representative of how [NFP] works,” said Parsonage, Director of Population Health for Interior Health. “You put the mom and baby at the centre, you have the nurses close by and then you have a larger team supporting them.”

Parsonage is new to child and maternal health, but he’s already a big believer in the NFP program. This landmark intensive home visiting program, which has been operating in the US for almost 40 years, sees public health nurses visiting young women who are pregnant and preparing to parent for the first time. Public health nurses provide the women with home visits and supports until the child’s second birthday.

Although the program is still undergoing its first Canadian scientific evaluation — via a randomized controlled trial, or RCT, through the BC Healthy Connections Project — Parsonage is already making plans for what to do when recruitment for the evaluation closes in December.

In short, he’s determined to see the program continue. “It’s really, really evident that this program leads to a very close bond between the moms and the nurses,” he says. “It opens a door to a level of support that we wouldn’t have otherwise.’’

But for Interior Health, the geographic distances involved remain an enormous challenge. “You really have to drive it to appreciate it, and realize just how far apart these communities are,” Parsonage says. “You go through huge pockets of ‘nothing’ but stunning beauty.” For the nurses, this means lots of driving time. And in turn, this means they have less time to spend with families. Making matters more challenging, socioeconomic status tends to be lower in rural and remote areas so the need for NFP is even higher.

The solution? Parsonage is investigating the possibility of using telehealth technology, meaning that some — but not all — of the visits would be via mobile video conferences. Replacing even a portion of the in-person visits with telehealth would make the system more efficient by reducing driving time for nurses. “We’re consulting with the Ministry about whether we can provide the service in this way without compromising fidelity,” he says. “If we can do that, it will allow us to extend the reach.” BC will consult with NFP’s founder, David Olds, regarding similar work occurring in the US.

Penny Liao-Lusssier, the Maternal Child Health Manager for Interior Health, is equally enthusiastic about NFP. “A highly vulnerable population is welcoming the nurses into their homes,” she says. “The fact that nurses are being invited really demonstrates the trust that is there.”

So far, 700 families have enrolled in the RCT through the BC Healthy Connections Project – with 350 receiving NFP plus existing services, and 350 receiving existing services alone. Sixty families have now completed the study. An additional 300 families have received NFP through the “guiding client” pilot, which involved nurses honing their NFP skills before starting the trial. And a further 150 families are receiving NFP through a Process Evaluation that is running in parallel with the RCT.

The BC Healthy Connections Project is investigating how NFP works in BC – following study participants through into 2019. Meanwhile Health Authorities are beginning to deliver NFP to all qualified families, outside of the study, starting in December. Practitioners or young pregnant women can click here for more information.

Health policymakers and practitioners often use words like “downstream” or “upstream” to describe the vastly different points at which people may receive care.

Downstream means late in the process, well after the onset of a problem, and often long after a problem has become entrenched. For example, a child who is treated for an anxiety disorder — even if that treatment is successful — is getting help downstream.

But give the child a prevention program, before they have a disorder, and you’ve moved “upstream.” And in doing this, a few things can happen. You can immediately improve the quality of the child’s life — by reducing their distress and removing impediments to their healthy development. You can also alter the trajectory of a young child’s life, by reducing the negative impact of adversity. In turn, this can contribute to a lifetime of well-being and resilience. Upstream interventions can also save healthcare costs, for example, by reducing emergency room visits.

Better yet, you can help the mother as well as the child — before the child is even born. Then you’re moving upstream in way that’s likely to make the most profound difference.

That’s the motivation for Lenora Marcellus, pictured above, an Associate Professor in the School of Nursing at the University of Victoria. A member of the BC Healthy Connections Project scientific team, her original background is in neonatal intensive care. “A lot of the work I’ve done is downstream, when women haven’t been supported when they’ve needed it most, early on,” she says. She notes that much of her work in these hospital settings was with families who were struggling with disadvantages such as not having enough to live on, or not being able to get prevention programs themselves when they needed them.

Marcellus has also volunteered for almost 20 years with a young mothers’ group in her community and has seen first-hand the many challenges faced by young parents. Her experience providing downstream intensive healthcare services is what motivates her to embrace the goals of the BC Healthy Connections Project, which involves an evaluation of the Nurse-Family Partnership (NFP) program.

With NFP, public health nurses visit young women who are in early pregnancy and preparing to parent for the first time — providing them with home visits and intensive supports until the child’s second birthday. The program starts earlier than any other early childhood program, making it a decidedly upstream approach.

For the BC Healthy Connections’ evaluation, NFP is being compared with BC’s existing prenatal and early childhood services. The goal is to learn whether BC can replicate positive results from other countries. These results have shown that NFP can improve prenatal health, parenting, and children’s mental health and development, while also lifting young mothers out of poverty.

According to Marcellus, BC Health Authorities already try to help new moms with highly complex challenges, so they can help their children. But these families need extra supports and it’s often hard for them to get them. That’s why she’s so committed to the BC Health Connections Project.

“With NFP, the public health nurse brings a really unique set of skills,” Marcellus says of the program. “They’re developing a relationship and connecting with the new moms. What’s more, the meeting takes place in the mom’s own home or wherever feels safe for her. That’s very different from a professional setting.”

Although the teen pregnancy rate has declined in BC, young moms continue to be a vulnerable population because these very young women also have other challenges, Marcellus says. They can be invisible, stigmatized or judged. Just as bad, they often fall between the cracks when it comes to getting help. “We know that in society today it’s pretty hard to be an independent adult in our very expensive province,” Marcellus says.

“We could call it a pay now or pay later opportunity,” she says, adding that she would much rather see society pay now. “Investing in programs like NFP is likely to pay huge dividends over generations — for families and communities at large.”
The Nurse-Family Partnership is available only through the BC Healthy Connections Project for the duration of study recruitment. Practitioners or young pregnant women can click here for more information.