Harriet MacMillan sees the BC Healthy Connections Project (BCHCP) through a unique set of lenses.

One involves her role as the Chedoke Health Chair in Child Psychiatry at the Offord Centre for Child Studies at McMaster University. There, she co-led a Hamilton-based project piloting Nurse Family Partnership several years ago. Looking through that lens, she is eager to see Canadian young mothers-to-be get more help — via Nurse-Family Partnership (NFP). Basically, this program sees public health nurses frequently visiting young, pregnant women — in their own homes — from early in pregnancy until their children turn two years old.

Another lens comes from MacMillan’s position as BCHCP nominated co-principal investigator — along with Charlotte Waddell from Simon Fraser University. Here, MacMillan primarily wants to ensure the rigorous demands of a randomized controlled trial of NFP are met.

“I think it’s such an important study and it’s wonderful we have the opportunity to conduct this trial in BC,” she says. “The collaboration between the scientific team and the BC policy makers is terrific.”

In helping launch the Hamilton pilot project several years ago, MacMillan worked with a team adapting the American NFP materials to meet Canadian needs and standards. For example, in the US, each nurse is responsible for 25 young mothers-to-be. “In Canada, partly due to issues like geographic distance, we determined it should be no more than 20,” she says. As well, even though both countries support breast-feeding, “Canada tends to put a bigger emphasis on it.”

The pilot project also examined the whole referral process. MacMillan recalls: “We asked, are we able to get referrals and are we able to recruit women?” And once women did join the project, the team asked: “Do both the women and the nurses find NFP acceptable?” Indeed, the pilot project showed that NFP referrals were feasible, and that women and nurses both welcomed NFP.

“I think it’s fair to say that these young mothers were a high-risk group, but basically what we found was that once they were on board and engaged, they really seemed to appreciate the program.”

As for whether the program will succeed in Canada the answer remains to be seen. “My hope is that we will see similar benefits associated with NFP here as compared with the US trials,” MacMillan says.

“NFP is such a unique program where nurses develop this special relationship with mothers prenatally, such that mothers become very tuned in to the needs of their child, and so we hope it will improve outcomes for both mothers and their children.”

Note that 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.

As a midwife in the Okanagan Valley, Suzanne Lobb sees pregnant women who fit every description – from younger to older, from poor to wealthy, and from many different cultural backgrounds. But regardless of their background, each woman receives the same initial message. “We give everyone a card and encourage them to call public health,” Lobb says. “Once they’re out of our care — six weeks after they deliver — it’s easier for them to stay connected to services in the community if they have a stronger connection to public health.”

In the Okanagan Valley, Lobb works with a number of women who are either “young, transient or single parents.” The key issue she identifies is solo-parenting, sometimes because the women’s partners need to leave the community to find sustainable jobs. “There’s also a large number of very young, very transient women who are single parents,” she says, referring to women who often have to move from place to place because they have no home of their own. “And a lot of dads are in and out of the picture,” she adds. Apart from everything else, this often means that the women don’t have the emotional support they need.

That’s one of the reasons why Lobb is a big believer in the BC Healthy Connections Project. “I support the study because I think it’s important to know whether Nurse-Family Partnership is effective,” she says. In her own practice she’s noticed that young women who sometimes have to miss midwifery appointments can often still attend support groups offered by other community-based organizations. “That kind of support is really valuable to those young women,” she says, adding that one-on-one assistance provided by a nurse might be even more effective.

As a mother of three, herself Lobb delivers almost 50 babies each year. She wants to see all of them grow into healthy, happy adults. “I really want to see the study succeed,” she says.

Note that 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.

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.