Latest BC Healthy Connections Project Features

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

Here is a progress update on the BC Healthy Connections Project — a scientific evaluation of the Nurse-Family Partnership (NFP).

We closed recruitment in the randomized controlled trial (RCT) last December with 739 families enrolled across four of the five participating regional Health Authorities: 406 from Fraser Health; 84 from Vancouver Coastal Health; 122 from Interior Health; and 127 from Island Health. To date, more than 700 babies have been born to participants, including 11 sets of twins. The BCHCP is continuing with data collection on all women and children until the end of 2019.

Across these four Health Authorities, 215 children and women have now graduated from the study. We’re staying in touch with families after they graduate — to invite them to participate in future follow-up studies, for example, to see how children are doing when they reach kindergarten. Preliminary papers will be released later in 2017 with main study findings to follow after all the families have graduated later in 2020.

NFP is a home visiting program providing intensive supports to young women who are living on low income and preparing to parent for the first time. This innovative public health program is delivered over two-and-a-half years, beginning prenatally and continuing until children reach their second birthday. It aims to improve children’s mental health and development while also improving mothers’ life circumstances.

This evaluation of NFP is the first in Canada and is being led by the Children’s Health Policy Centre at SFU. We are doing this together with scientific collaborators at McMaster University, UBC and the University of Victoria. The project is also being conducted in close collaboration with policy partners in the BC Ministry of Health and the BC Ministry of Children and Family Development — and in Fraser, Vancouver Coastal, Island, Interior and Northern Health Authorities.

As well as the RCT, the BC Healthy Connections Project includes two adjunctive studies, both federally funded. One is a nursing Process Evaluation, which aims to learn how Nurse-Family Partnership can best be adapted for use in BC. It is being conducted in all five participating regional Health Authorities. The other is the Healthy Foundations Study, which is assessing biological markers of stress in children who are receiving NFP, versus those who are not. It is being conducted in Fraser and Vancouver Coastal Health Authorities. Results for Process Evaluation are being released on an ongoing basis, while preliminary Healthy Foundations reports are expected in early 2018.

With study recruitment closed, (and BCHCP data collection ongoing), BC leads the country by being the first province to now be offering Nurse-Family Partnership to all eligible women who are interested. In parallel to the BCHCP, all regional Health Authorities have opened the program to everyone, with no need for randomization to control and intervention groups.

To make or receive a referral to Nurse-Family Partnership 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

BC Healthy Connections recruitment closing as planned

Recruitment into the randomized controlled trial known as the BC Healthy Connections Project (BCHCP) closed on Dec. 16.

This recruitment — which started three years ago, in October 2013 — stood at 739 families at time of closure, a sample size large enough to estimate the effects of the Nurse-Family Partnership (NFP) program in BC. Some 100 of these families have already completed the research study.

With NFP, public health nurses visit young women who are pregnant and preparing to parent for the first time. Aimed at mothers whose circumstances place them at risk for vulnerability, the program provides them with home visits and intensive supports until their child’s second birthday. NFP starts very early in life — prenatally — allowing it to influence child development right from the start.

“We’re very proud to be reaching this study milestone,” says Scientific Director, Nicole Catherine. Her feeling is echoed by another study lead, Charlotte Waddell, who emphasizes the teamwork involved. “This has been an enormous team effort — involving the Ministries of Health and Children and Family Development, and nurses and communities and Health Authorities across this province,” she says.

The Children’s Health Policy Centre (CHPC) at Simon Fraser University is leading this scientific evaluation — with others from across BC and Canada. Collaborators include researchers at McMaster University, the University of BC, the University of Victoria and the Public Health Agency of Canada. (The BC Ministry of Health is funding the project, with support from the BC Ministry of Children and Family Development, as well as from regional Health Authorities.)

The CHPC study team is following each of the 739 families until they all finish a series of interviews. The team has conducted more than 2,500 research interviews with families to date. More than 600 babies have already been born to participating families, including eight sets of twins.

Scientific Director Catherine says that while scientific rigour is at the heart of this project, the CHPC study team has remained strongly committed to the human side of the undertaking. “Our commitment and our frequent contacts have led to some strong connections between the scientific field interviewers and the mothers,” she says. “We’re learning from new mothers and watching the children grow while we are conducting the research interviews.”

The CHPC study team is collecting and analyzing a wide array of child and maternal health information with a special focus on issues relating to child development, as well as mothers’ wellbeing. Young mothers say they enjoy being part of the project because they feel that their voices are being heard — often for the first time.

Following the closure of recruitment, research data collection and participant tracking will continue until all the children in the study reach two years of age. The team is also obtaining consent to remain in contact with all the families — to lay the foundation for longer-term child follow up over the preschool years and beyond.

Beyond evaluating how NFP works in BC, the BC Healthy Connections Project will also provide new information on young mothers who are coping with disadvantages such as living on low income, or struggling to find secure housing. This is a population that has often been underserved. So as a first step to help, the CHPC study team is aiming to provide initial reports by mid-2017. These reports will provide descriptive characteristics on study participants, including information on social determinants of health, as well as service access and use during pregnancy. The results on how well NFP works will follow once data collection closes.

According to BC’s longstanding intentions, regional Health Authorities will begin offering NFP to all eligible women — as a program embedded within other public health services — starting Dec. 17. The regional Health Authorities, together with the BC Ministry of Heath, are responsible for all aspects of planning and implementing the ongoing delivery of NFP as a provincial program from here.

Meanwhile, the BC Healthy Connections Project research team will continue collecting and analyzing data. When all 739 families have completed the study, in just over two-and-a-half-years from now, information on NFP’s effectiveness will be used to further improve BC’s child and maternal public health programs.

More information on the BC Healthy Connections Project is available here. More information on NFP open enrollment, is available here.