Catherine N, Barican J, White O, Tang J, Thomson K, & Waddell C (2024). Effective Home Visiting Programs for Children and Mothers Experiencing Adversities. Vancouver, British Columbia: Children’s Health Policy Centre, Faculty of Health Sciences, Simon Fraser University.
Executive Summary
This report aimed to identify research evidence for British Columbia (BC) policymakers on the best options for home visiting with children and mothers experiencing adversity. We first used systematic review methods to identify randomized controlled trial (RCT) evaluations. This approach almost exclusively uncovered intensive nurse home visiting programs similar to or based on Nurse-Family Partnership (NFP). We therefore supplemented our methods by scanning RCT-backed home visiting interventions recommended by the United States (US) Department of Health and Human Services through its Maternal, Infant and Early Childhood Home Visiting (MIECHV) program. The systematic review identified seven NFP-informed programs, some with important variations. The supplemental scan identified six additional programs that varied by provider, intensity and duration. We identified 13 relevant programs in total.
The NFP-based home visiting programs included: Family Nurse Partnership (England); Minding the Baby (US); NFP (US); NFP (BC); and VoorZorg (Netherlands). Two other programs entailed adaptations.
ProKind (Germany) involved delivery solely by midwives and social workers, while right@home (Australia) included multiparous mothers. Minding the Baby and right@home were also delivered by social workers in addition to nurses. All seven programs started in pregnancy and continued until children were age two — approximately 2.5 years duration.
The US MIECHV scan included NFP-based programs as well as other kinds of home visiting including: Child First; Family Check-Up; Healthy Families America; Play and Learning Strategies; Promoting First Relationships; and Video-feedback Intervention to promote Positive Parenting. Providers ranged from community workers to master’s-trained clinicians. Start times also varied — ranging from prenatally to anytime from birth to age seven years. Program duration ranged from only six visits to three to five years.
The seven intensive NFP-related programs led to a comprehensive array of positive outcomes for both children and mothers — including many benefits that emerged later, across childhood and adolescence. The six other programs also led to benefits.
Evaluation is critical to ensure that new and ongoing public investments make a positive difference in the lives of children and mothers — particularly for those who are facing more adversities than others. BC has an opportunity to build on its extensive leadership and experience with delivering NFP and other prevention programs for children — to adapt existing research-informed programs to local needs and to conduct innovative evaluations to ensure effectiveness. The 13 programs we have outlined here all show benefits for children and mothers — some more robust and enduring than others. In choosing among the trade-offs, the main goal must be to ensure the flourishing of all children in this province, and therefore to choose programs that will meet this goal.