Latest BC Healthy Connections Project Features

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).

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.

Life has been challenging for many of the girls and young women participating in BC’s randomized controlled trial that is evaluating the Nurse-Family Partnership (NFP) program for the first time in Canada.

The first data report on participants’ profiles when they entered the trial in early pregnancy has just been released. This report reveals a group of 739 girls and young women who were pregnant and preparing to parent for the first time and selected based on socioeconomic disadvantage. They were age 24 or younger and experiencing low income, low education and/or being single.

The data show that some 83% of these girls and young women were earning less than $20,000 annually, while 53% of them had not completed high school. Most were also single. As well, almost half had experienced homelessness in their lifetime and a third had recently experienced housing insecurity (having to move more than three times within the past year).

Most participants — some 74% — also reported having coped with serious long-term mental and physical health conditions. Nearly half reported coping with severe anxiety or depression and 22% reported they had diagnosed mental disorders.

More than half reported having experienced moderate-to-severe child maltreatment when they were younger. Half also report experiencing intimate partner violence more recently.

While 77% had recently visited primary healthcare providers for physical health concerns, only 28% had received prenatal classes. Perhaps most surprising, only 29% had recently received important BC benefits for people living on low income such as Income and Disability Assistance.

Overall, 89% of these girls and young women were experiencing three or more forms of disadvantage, with 77% experiencing four or more and 56% experiencing five or more.

“Our data show there are unacceptable pockets of deep socioeconomic disadvantage for BC girls and young women who are preparing to parent for the first time,” said lead principal investigator Charlotte Waddell. “This finding has important policy implications,” she added.

An intensive home-visiting program provided by public health nurses, NFP starts early in pregnancy and continues until children reach their second birthday. First developed more than 40 years ago in the United States, NFP has shown many benefits in that country including:

• reducing prenatal substance use
• reducing childhood injuries
• improving children’s mental health and cognitive development, and
• helping lift young mothers out of poverty

Through the BC trial, we may discover similar benefits for young mothers and their children here. Trial recruitment began in October 2013 and closed in December 2016. The study team is now following the 739 families, who are participating in research interviews until children reach their second birthday (the duration of the NFP program). Study results will be available later in 2020.

Participating regional Health Authorities are also offering NFP to all eligible girls and young women and their children as an enhanced public health service. Trial results will help strengthen the program across BC.

Based in the Faculty of Health Sciences at SFU, the trial is funded by the BC Ministry of Health with support from the BC Ministry of Children and Family Development and from four Health Authorities (Fraser Health, Interior Health, Island Health and Vancouver Coastal Health). Funding is also being provided by the Mowafaghian and R. and J. Stern Family Foundations.

Charlotte Waddell and Harriet MacMillan are the Nominated Co-Principal Investigators. Nicole Catherine is the Scientific Director and Co-Principal Investigator. Susan Jack and Debbie Sheehan are also Co-Principal Investigators. A larger Scientific Team provides guidance, including from collaborators at McMaster University, UBC, the University of Victoria and the Public Health Agency of Canada.

Anyone in BC who wishes to be referred to the Nurse-Family Partnership program should contact their primary care practitioner or their local Health Authority. For more information about Nurse-Family Partnership, see here. The BC Healthy Connections Project Study Team can be reached by email at: bchcp@nullsfu.ca.

Consider this an unusually weighty birth announcement.

All the babies have now been born to the young mothers enrolled in the BC Healthy Connections Project (BCHCP). There are 744 young ones, including 11 sets of twins.

“People are usually happy to hear birth announcements, but this one is particularly exciting,” says Charlotte Waddell, one of the project leads. “We believe this project will give these mothers and these children a stronger voice.”

The BCHCP is the first Canadian scientific evaluation of the Nurse-Family Partnership (NFP) program. NFP aims to help young first-time mothers and their children by providing intensive visits by specially-trained public health nurses. The goals are to improve children’s health and development, while also improving the mothers’ lives.

The success of the program has been widely documented in the US, most recently in a study released July 24/17 by James Heckman, a Nobel laureate economist at the University of Chicago. By ages six and 12, children whose mothers received the home visits were healthier and had better cognitive and social and emotional skills, he found. And mothers had better mental health and parenting skills, he added. A US National Public Radio interview with Heckman spells out why he believes NFP has been so successful in the US.

The BC evaluation is using randomized controlled trial methods to investigate how NFP compares with the province’s existing health and social services. Preliminary profiles of the participants will be released later in 2017 with main study results to follow after all the families have graduated in late 2020. An outline of the project may be seen here, along with a journal article on the study protocol.

There are also two adjunctive studies associated with the BCHCP. The first is a Process Evaluation, determining how well the intervention is being implemented and what factors may be influencing its outcomes. The second is the Healthy Foundations Study, examining biological markers of health outcomes for children over the first two years of life.

BC leads the country by being the first province to now offer Nurse-Family Partnership to all eligible women who are interested. Five regional Health Authorities — Fraser, Interior, Island, Northern Health and Vancouver Coastal Health — have opened the program with no need for randomization to control and intervention groups.

To enquire about Nurse-Family Partnership or to enroll in the program, please contact:

1. Your nurse practitioner, family doctor or midwife, or
2. Your local Health Authority:

• Fraser Health — Best Beginnings Program
• Vancouver Coastal Health — Public Health Prenatal Program Toll-free: 1-855-550-2229
• Island Health — Right From the Start Program
• Interior Health — Healthy From the Start Program Toll-free: 1-855-868-7710
• Northern Health — Heathy Start Program