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.”

For public health nurse Kali Bandi,* the strength of the young women who benefit from Nurse-Family Partnership (NFP) is demonstrated by one of her participants.

An intensive child and maternal health program, NFP gives disadvantaged young women — about to become first-time parents — one-on-one home visits with public health nurses throughout the pregnancy. These visits continue until children reach their second birthday. It is currently being offered in BC as part of an evaluation – the BC Healthy Connections Project – comparing NFP and existing health and social services.

One of Bandi’s 15-year-old participants comes from a family that truly values nursing care. Her own mother had been involved in a home visiting program when she was young. “Trust in nurses is very strong for this family,” Bandi says.

Throughout her interactions with this young mom — whose baby is now four months old — Bandi has been deeply impressed by the young woman’s parenting style. “She has the most amazing way of being with this baby,” Bandi says. “She’s very engaged, asks fabulous questions and has her own view of what she has to do.” At three days postpartum, the mom, who was then living at home, decided her own family situation wasn’t ideal for the baby. So, she moved out, into the home of her boyfriend’s parents.

“She does what she needs to do to take care of that baby in the best way she can,” Bandi says. “She’s a classic example of how age doesn’t equate to parenting ability.  I’ve worked with lots of moms who are older and highly educated and yet they completely flounder in frustration at meeting their baby’s needs.”

Reflecting on her 10 years as a public health nurse, Bandi says that NFP has given her new tools to work with families. But she also credits the families themselves. “Most of the participants have so many fires they’re putting out all the time. But these families have strengths and they can work through a lot.”

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.

December 2014 marks the first anniversary of the launch of the randomized controlled trial of Nurse-Family Partnership in BC.

Known as the BC Healthy Connections Project, this study evaluates the effectiveness of Nurse-Family Partnership – an intensive home visiting program that aims to improve early childhood mental health and development – in comparison with BC’s existing health and social services.

Nurse-Family Partnership gives disadvantaged 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.

One thousand mothers-to-be are being enrolled across the province. Half will receive Nurse-Family Partnership while the others will receive the services typically provided by their Health Authority. Then, then the two groups will be compared.

Developed in the US more than 30 years ago by David Olds, a Colorado-based researcher, the program is now being adopted and evaluated around the world with his support.

Today, he provides a video message of congratulations to organizers, nurses and participants.

Please click the link above to hear David Old’s message.

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.

On seeing a baby, most people will smile or hold out a finger to be grasped. But all mothers and fathers understand that looking after a baby is one of the most challenging tasks they’ll ever face.

This is particularly true for first-time mothers who are young, or poor, or both.

As Provincial Coordinator for the Nurse-Family Partnership (NFP) program for the BC Health Ministry, Donna Jepsen says her group is working to secure better care for these mothers and their children through the BC Healthy Connections Project (BCHCP).

Developed in the US over 30 years ago by David Olds, NFP is an intensive home-visiting program delivered by public health nurses. It’s specifically designed to help disadvantaged young women who are preparing to parent for the first time. But the program has never been tested in Canada before.

This scientific evaluation of NFP’s effectiveness is being conducted across BC over the next five years. As part of the evaluation (which includes a randomized controlled trial and a process evaluation) 50% of women will receive NFP. The remaining 50% will receive the services typically provided by their Health Authority. Then, then the two groups will be compared.

“The two groups are equally important,” Jepsen notes, because combined, they will help us understand how to improve public health services in BC. As well, all women taking part in the study have the chance to share their experiences with the researchers — a connection that most mothers value.

NFP itself begins early in pregnancy (ideally before 16 weeks) because one of its explicit goals is to improve children’s wellbeing by starting early — before children are even born.

Women enrolled in NFP through the BCHCP receive weekly visits from their public health nurse initially. Visits may then move to biweekly or monthly as the program proceeds.

At the home visits, nurses and the mothers work together on topics such as:
•    Ensuring a healthy pregnancy
•    Preparing for childbirth
•    Understanding early child development
•    Developing healthy parenting skills
•    Future life planning and
•    Accessing community supports and resources for mothers and children.

“This helps women manage the emotional, social and physical challenges they face and gain the confidence to create a better life for their children and themselves,” Jepsen says.

Many positive long-term effects were found when NFP was tested in randomized controlled trials in the US:

•    Improved prenatal health
•    Improved child physical and mental health
•    Improved early child cognitive and language development
•    Fewer adolescent behaviour problems
•    Increased maternal economic self-sufficiency,
•    Reduced healthcare and social service costs, and
•    Decreased overall mortality for both children and mothers.

“These are significant public health outcomes and we’re hopeful that we’ll see these same outcomes here in BC as a result of more intensive and consistent support to these families,” Jepsen says.

Today BC is also going through a change of practice with respect to prenatal care. All primary care providers — doctors, midwives and nurse practitioners — are now being asked to refer pregnant women to public health as early in pregnancy as possible. Formerly, in many BC Health Authorities, this would happen later in pregnancy, post-partum or only in special circumstances.

Note that NFP is available only through the BC Healthy Connections Project for the duration of recruitment. Practitioners or young pregnant women are invited to click here for details on how to reach public health and participate in the BCHCP.

As a scientific interviewer with the BC Healthy Connections Project (BCHCP) in Vancouver, Emilie Watson* is also in the final stages of her Master’s of Public Health degree.

For her, the chance to interview disadvantaged young women who are preparing to parent for the first time is a valuable lesson in real life. “You can read about research in the literature,” she says, “but to experience it in person has been completely different.” As a student whose earlier experience had been solely in labs, she hadn’t had what she calls “that community touch,” before her current job.

Watson says that she not only enjoys the chance to speak one-on-one with the young women but has also been struck by how often they see the value in the study themselves. “They often say to me, ‘I see why you’re doing this research,’” she says. “It’s a privilege they allow me to be part of their lives. It speaks to their hope to help other young mothers and their children and their willingness to contribute.”

Noting that the purpose is to learn more about the effectiveness of the Nurse-Family Partnership Program in BC, Watson adds that although the program was widely tested in the US, it has never before been tested in Canada. “Just because a program works for one country doesn’t mean it ‘s going to work in another,” she says. “That’s the value of doing this study.”

Note that NFP is available only through the BC Healthy Connections Project for the duration of recruitment. Practitioners or young pregnant women are invited to click here for details on how to reach public health and participate in the BCHCP.

*Name has been changed to protect privacy.