Latest BC Healthy Connections Project Features

Nurse-Family Partnership findings featured in podcast

November 16, 2023

Findings from the Children’s Health Policy Centre’s scientific evaluation of the Nurse-Family Partnership program are the subject of a recent podcast recorded with SFU assistant professor Nicole Catherine, co-principal investigator for the randomized-controlled trial.

The podcast was recorded by the Association for Child and Adolescent Mental Health (ACAMH), the organization for the journal that published the main child findings in July 2023.

“I relished the chance to be able to speak about these important findings,” Catherine said. “I’m committed to ensuring that the voices of these young families, as told through their research data, are heard and amplified,” she added.

The podcast recording can be found here.

NFP put on the agenda for Interior Health nurses

October 25, 2023

Charlotte Waddell, Centre Director, joined BC Ministry of Health lead partners for the Sept. 26 Annual Education Meeting held online for approximately 10 public health nurses with BC’s Interior Health Authority.

The focus was Nurse-Family Partnership (NFP) and a review of the main findings from the 10-year randomized controlled trial that the Centre has led. This trial has evaluated NFP in Canada for the first time. Nicole Catherine and Harriet MacMillan are co-leads with Waddell.

The study has shown that NFP reduces prenatal substance exposure and improves child language and mental health by age two years. All three outcomes are crucial for early healthy development.

Waddell also spoke about the high number of Indigenous participants and about ongoing work with Indigenous collaborators to tell the stories of these participants. As well, she noted long-term follow-up plans: “In the US and England, NFP led to enduring benefits in middle school and beyond, so we are also committed to learning how well NFP works to help children longer-term in BC.”

Nurse Family Partnership improves child language and mental health, study shows

July 19, 2023

Findings from the Children’s Health Policy Centre’s scientific evaluation of the program Nurse-Family Partnership have shown that it improved maternal-reported child language and mental health (problem behaviour) at age two years.

Known as the BC Healthy Connections Project, or BCHCP, the study published its findings today in a paper in the Journal of Child Psychology and Psychiatry.

“We are thrilled to have these significant positive findings,” said Nicole Catherine, co-principal investigator for the BCHCP randomized-controlled trial. “We have shown that intervening very early in a child’s life —during pregnancy—can have enduring benefits.”

Co-principal investigator Charlotte Waddell added that the study represents millions of dollars and thousands of hours of work by hundreds of people over 13 years. “Our findings show the power of policy-practice-research collaboration in the service of common goals,” she said. “It’s the ideal way to address tough questions of public health importance.” The Children’s Health Policy Centre (CHPC) at Simon Fraser University led the trial, in collaboration with McMaster University and other organizations.

The study, which started in 2013, enrolled 739 pregnant girls and young women and their 737 children across the four participating regional Health Authorities (Fraser, Interior, Island and Vancouver Coastal Health. Northern Health was involved in an NFP nursing pilot and process evaluation).

Some 200 Indigenous (including First Nations, Métis or Inuit) girls and young women, or 27%,  generously agreed to participate in this long-term trial. Some 237 BCHCP children, or 32%, had an Indigenous mother or father.

The study was funded by the BC Ministry of Health, with support from the BC Ministries of Children and Family Development and Mental Health and Addictions. Participating regional health authorities funded direct nursing costs. The Mowafaghian and Stern Foundations provided addition generous supports.

Nurse-Family Partnership aims to improve the lives of children born to young, first-time mothers. Developed nearly 45 years ago by researcher David Olds and colleagues in the United States, the program starts early — in pregnancy, before children are even born. It involves intensive home visits by public health nurses continuing until children reach their second birthday. The program focuses on those who are coping with socioeconomic inequities.

Public health nurses provide the home visits — up to 64 in total over two-and-a-half years. Nurses delivering the program received extensive education. As well, they received resources to use in the visits, and ongoing supervision and support. “We acknowledge the participating young moms and children who shared their experiences via data collected during 4,000 research interviews,” co-principal investigator Catherine said. “They told us that they wanted to help make a difference for other young families like them.”

An earlier finding, published in the Canadian Medical Association Journal Open, had shown that NFP led to reduced prenatal cannabis use, and in smokers led to modest reductions in cigarette use. Further results will be published in the next year, for example, on NFP’s impact on reducing intimate-partner violence.

“All the findings show that longer term follow-up of our NFP cohort of children is warranted given that further benefits may emerge across childhood and adolescence,” Catherine said adding that the team is identifying new funding to follow the children over 10 years and beyond. “This kind of long-term follow-up is the best way to show the return on public investment in early childhood programs designed to prevent problems from occurring in the first place.”

Full text of the JCPP paper is available here.

BCHCP Methodology Manuals now available for researchers

November 26, 2020

The study team for the BC Healthy Connections Project (BCHCP) has recently released a series of scientific methodology manuals. Their aim is to inform health researchers, research trainees and students conducting similar long-term research, in particular with populations experiencing socioeconomic disadvantage.

This body of work highlights the team’s knowledge and expertise collected over eight years in conducting 4,000 in-person and telephone research interviews with 739 girls and young women and their 737 children who were experiencing socioeconomic disadvantage upon entry into the trial.

The team collected survey and observational data from this cohort at six interview timepoints, starting in early pregnancy and continuing until children reached age two years (2.5. years duration per family). Retention results were encouraging (>83%) given that many participants were experiencing considerable disadvantage including residential instability, low income and intermittent cell phone access.

These methodology manuals highlight key aspects of the Field Interviewer role including:

  • intensive training over four weeks with ongoing support and mentorship over many years
  • rigorous questionnaire administration and data quality
  • participant-centered retention efforts
  • safety awareness and risk mitigation during in-person interviews

The manuals provide resources, practical guidance, and troubleshooting for situations that a Field Interviewer may encounter. The team has  also published its planned, theory-and evidence-based BCHCP retention protocol.

The Nurse-Family Partnership program (NFP) is a primary prevention program involving intensive home visiting by public health nurses starting early in pregnancy and continuing until children reach age two years. It aims to improve child and maternal wellbeing, focusing on young, first-time mothers experiencing socioeconomic disadvantage. While findings from three NFP randomized controlled trials in the United States have shown many short- and long-term benefits for both children and mothers — including the program paying for itself — this trial is the first scientific evaluation of NFP in Canada.

Conducting such a large-scale, public health randomized controlled trial involved intensive resources and rigorous scientific oversight. The manuals represent lessons learned from designing and implementing the trial. The scientific field interviewers were unaware of families’ group assignment (i.e., NFP or comparison) to ensure unbiased data collection, hence this work has implications for all health research studies and not just randomized controlled trials.

“Our goal is to inform health researchers and service providers committed to reaching and sustaining engagement with populations experiencing disadvantage who we describe as “need-to-reach,” rather than “hard-to-reach,” according to study Scientific Director Nicole Catherine.

Recent findings show that NFP reduces cannabis use in all participants and the number of cigarettes used (by smokers) during pregnancy, which is a crucial window for healthy child development. Reports on other outcomes of interest including NFP’s effect on child maltreatment, child cognition, language and mental health, as well as maternal life-course, are expected in 2021 and 2022.

The study manuals may be viewed here (scroll to end of page).

Study shows drop in cannabis and cigarette use during pregnancy for young, first-time mothers

October 27, 2020

Findings from a scientific study by Simon Fraser University give encouraging clues on how to reduce cannabis and cigarette use during pregnancy for young, first-time mothers -to-be.

The BC Healthy Connections Project, which is being led by SFU’s Children’s Health Policy Centre, in collaboration with researchers at McMaster University, is a randomized controlled trial examining an intensive nurse-home visiting program, called Nurse-Family Partnership (NFP). Findings suggest that NFP may help in reducing some types of prenatal substance use in girls and young women experiencing socioeconomic disadvantage.

Findings were recently published in a peer-reviewed academic journal, Canadian Medical Association Journal Open. The paper may be seen here.

Prenatal exposure to alcohol, cigarettes/nicotine, cannabis, and street drugs all place children at risk for poor health outcomes including being born too early, having a low birth weight, and having later learning and behaviour problems.

Girls and young women who received NFP (compared with regular prenatal services) showed a statistically-significant drop in prenatal cannabis use. As well, those who were smokers and received NFP showed a statistically significant drop in daily number of cigarettes smoked — which is important, given that even low-level cigarette smoking is harmful to a fetus.

Prevention is by far the best approach to such issues, according to Children’s Health Policy Centre director Charlotte Waddell. “These findings are good news in that they show we can prevent or reduce substance use during pregnancy,” she says. Study scientific director Nicole Catherine agrees. “It’s exciting to see these positive results during pregnancy, which is a crucial window for promoting children’s health and wellbeing.” 

NFP is a prevention program involving public health nursing home visits starting early in pregnancy and continuing until children reach age two years. It aims to improve child and maternal wellbeing, focusing on young, first-time parents facing socioeconomic disadvantage. While NFP trials in the United States have shown many short- and long-term benefits for both children and mothers—including the program more than paying for itself—NFP has never before been tested in Canada.

For this study, the team is following 739 mothers and 737 children across BC. The BC Ministry of Health is sponsoring the trial, with support from the BC Ministries of Children and Family Development and Mental Health and Addictions—in collaboration with Fraser, Interior, Island and Vancouver Coastal Health Authorities.