Latest BC Healthy Connections Project Features

New findings from the Children’s Health Policy Centre’s scientific evaluation of the Nurse-Family Partnership (NFP) program show promising benefits for mothers regarding exposure to intimate partner violence, income, mental health and self-efficacy — warranting follow up of longer-term benefits across childhood.

The scientific team behind the BC Healthy Connections Project, or BCHCP, published these findings in the British Medical Journal Open. According to the study, NFP may help reduce adversities faced by mothers, including intimate partner violence, by the time their children are two years old.

For children, exposure to intimate partner violence is a serious form of maltreatment with long-term mental health consequences. Intimate partner violence is occurring at epidemic proportions, and rates are higher for lone mothers experiencing marginalization. Yet despite known harms to both children and mothers, efforts often focus on aftercare rather than prevention.

“These are important, encouraging findings on how to address early adversities,” said Nicole Catherine, BCHCP co-principal investigator, who holds the Canada Research Chair in Child Health Equity and Policy, Tier II. “We need greater investments in early prevention — well before children are born.”

BCHCP co-principal investigator Charlotte Waddell added that this landmark initiative has been a long-term priority for researchers in British Columbia (BC). It commenced in 2011 as the BC government prioritized early prevention of childhood adversities — leading to the BCHCP (2011-2022). “Our findings contribute further evidence that intervening in early childhood is a powerful policy mechanism to promote healthy child development,” said Waddell.

The Children’s Health Policy Centre (CHPC) at Simon Fraser University led the BCHCP randomized controlled trial, or RCT, in collaboration with McMaster University and other organizations.

A province-wide initiative, the BCHCP intended to address long-term child health inequities beginning before children were born. To do this, the trial was embedded within BC’s universal public health system. Four participating regional health authorities — Fraser, Interior, Island and Vancouver Coastal — were responsible for trial referrals, nursing and program costs. All five health authorities, including Northern Health, participated in a pilot nurse-guiding study and an adjunctive nurse-process evaluation. “BC showed tremendous leadership and foresight in investing in prevention of early childhood adversities,” said Catherine.

The study team was centrally located at the Children’s Health Policy Centre and supported scientific field interviewers across all four regional health authorities. Catherine provided scientific interviewers with intensive training and mentorship to ensure successful reach and sustained engagement with 739 pregnant girls and young women and their 737 children during each family’s 2.5-year participation.

The study included 200 Indigenous (including First Nations, Métis or Inuit) girls and young women. Making up 27% of the total participants, they generously agreed to participate in this long-term trial. Some 237 BCHCP children, or 32%, had an Indigenous mother or father.

“We are grateful to the participants for sharing their experiences with us while preparing to parent for the first time. Many shared how they wanted to make a difference for other children and mothers in similar circumstances,” said Catherine. Previous BCHCP reports have shown the strengths of the participants in seeking prenatal services while coping with cumulative adversities such as unstable housing and living on less than $10,000 per year.

The study was funded by the BC Ministries of Health, and Children and Family Development. The Mowafaghian and Stern Foundations provided additional generous supports.

Nurse-Family Partnership aims to improve the lives of children born to young, first-time mothers. The program focuses on families dealing with socioeconomic inequities. It begins in pregnancy and involves a program of home visits by public health nurses, continuing until children are two years old. NFP was developed in the United States by researcher David Olds and colleagues.

Earlier findings from the BCHCP research team had shown that NFP reduced prenatal substance exposure (nicotine and cannabis) and improved child mental health and language development by age two years. The BCHCP also involved an adjunctive biomarker sub-study.

“There is increasing interest and policy investments in delivering enhanced early prevention programs such as NFP in BC and Canada — all with expectations of sustained benefits. But we have yet to see if these benefits at age two years translate into sustained benefits across childhood and adolescence. This is where we will see the true value of intervening early,” Catherine said. “We are eager to re-engage the BCHCP children to see how they are doing and whether these investments made a difference in children’s lives, and to understand if they were cost-effective.”

Text of the BMJ Open paper is available here.

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.

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.”

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.

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).