Latest BC Healthy Connections Project Features
Interior Health Authority works to see NFP continue
October 11, 2016When Roger Parsonage watched a Kamloops Nurse-Family Partnership (NFP) graduation event for young mothers and their toddlers back in May, he was struck by what the ceremony represented.
Mothers and their children stood at the centre of the room. Nurses stood close by. And, in a semicircle at the back, stood everyone else from Interior Health.
“It struck me it was really representative of how [NFP] works,” said Parsonage, Director of Population Health for Interior Health. “You put the mom and baby at the centre, you have the nurses close by and then you have a larger team supporting them.”
Parsonage is new to child and maternal health, but he’s already a big believer in the NFP program. This landmark intensive home visiting program, which has been operating in the US for almost 40 years, sees public health nurses visiting young women who are pregnant and preparing to parent for the first time. Public health nurses provide the women with home visits and supports until the child’s second birthday.
Although the program is still undergoing its first Canadian scientific evaluation — via a randomized controlled trial, or RCT, through the BC Healthy Connections Project — Parsonage is already making plans for what to do when recruitment for the evaluation closes in December.
In short, he’s determined to see the program continue. “It’s really, really evident that this program leads to a very close bond between the moms and the nurses,” he says. “It opens a door to a level of support that we wouldn’t have otherwise.’’
But for Interior Health, the geographic distances involved remain an enormous challenge. “You really have to drive it to appreciate it, and realize just how far apart these communities are,” Parsonage says. “You go through huge pockets of ‘nothing’ but stunning beauty.” For the nurses, this means lots of driving time. And in turn, this means they have less time to spend with families. Making matters more challenging, socioeconomic status tends to be lower in rural and remote areas so the need for NFP is even higher.
The solution? Parsonage is investigating the possibility of using telehealth technology, meaning that some — but not all — of the visits would be via mobile video conferences. Replacing even a portion of the in-person visits with telehealth would make the system more efficient by reducing driving time for nurses. “We’re consulting with the Ministry about whether we can provide the service in this way without compromising fidelity,” he says. “If we can do that, it will allow us to extend the reach.” BC will consult with NFP’s founder, David Olds, regarding similar work occurring in the US.
Penny Liao-Lusssier, the Maternal Child Health Manager for Interior Health, is equally enthusiastic about NFP. “A highly vulnerable population is welcoming the nurses into their homes,” she says. “The fact that nurses are being invited really demonstrates the trust that is there.”
So far, 700 families have enrolled in the RCT through the BC Healthy Connections Project – with 350 receiving NFP plus existing services, and 350 receiving existing services alone. Sixty families have now completed the study. An additional 300 families have received NFP through the “guiding client” pilot, which involved nurses honing their NFP skills before starting the trial. And a further 150 families are receiving NFP through a Process Evaluation that is running in parallel with the RCT.
The BC Healthy Connections Project is investigating how NFP works in BC – following study participants through into 2019. Meanwhile Health Authorities are beginning to deliver NFP to all qualified families, outside of the study, starting in December. Practitioners or young pregnant women can click here for more information.
Why BC needs to do ‘both/and’ when it comes to health
June 6, 2016When talking about the healthcare system, Jan Tatlock likes to quote Albert Einstein. He defined insanity as, “doing the same thing and expecting a different result.”
For Tatlock, director of public health for BC’s Island Health Authority on Vancouver Island, insanity means spending money only on the sick and otherwise ignoring public health and prevention.
“If we want the madness to stop, we have to make a modest investment,” she says, arguing that at least five cents of every healthcare dollar should go to public health. By way of comparison, she points to the millions of dollars BC invests in surgery every year. She doesn’t call that a bad thing. Instead, she argues that it should be supplemented with more public health interventions as well. “If we don’t do both acute care and public health, we are not going to have the changes that we want. It’s not an ‘either/or’ situation — it’s a ‘both/and.’ ”
For Tatlock Nurse-Family Partnership (NFP) is a good example of a public health approach.
With NFP, public health nurses visit young women who are pregnant and preparing to parent for the first time — providing them with home visits and intensive supports until the child’s second birthday. NFP starts earlier than any other early childhood program, which allows it to influence development right from the start. NFP also has the potential to profoundly alter the trajectory of children’s lives, in part because it focuses on families who are coping with challenges like housing insecurity or low income — reducing the negative impact of any early adversity. In turn, this can contribute to a lifetime of wellbeing and resilience for children.
NFP has been thoroughly tested in the US, and has also been evaluated in the Netherlands and England as they have different health and social services systems. But the BC Healthy Connections Project is the first Canadian evaluation of NFP. Through this project, NFP’s effectiveness is being measured compared to existing services across the province.
In the US, NFP has led to net public savings of $18,000 per family over 10 years. But one of the challenges, Tatlock says, is that these savings take time to accumulate and they frequently occur in systems outside of healthcare, such as justice and foster care. “But that’s how it works,” she says. “Given time, the mum is more likely to be employed and doing well.” And, more importantly, she can provide better care and her child is likely to have a more positive future.
As well, NFP has been good news for nurses delivering the program. The Health Authority is hearing about much more job satisfaction and seeing decreased sick time and decreased attrition. “What we’re finding is that nurses in NFP are loving it,” Tatlock says. “This is the work they’ve always wanted to do and there’s incredible value when they see such meaning in their jobs.”
Tatlock especially likes the way NFP focuses on children and women who, more typically, are last on the public attention list. “We should be making them first,” she says, “because our population is aging. We want them to be as healthy as possible.”
For those who think the BC Healthy Connections’ cohort of young, disadvantaged first-time mums is too small a group to focus on, Tatlock argues that NFP can and should be embedded with overall public health programming — as part of a broader commitment to child and maternal health. So Island Health offers both NFP and other, similar programs that aren’t necessarily limited to young, first-time mothers and their children. “Our approach allows nurses to engage at an intensity determined by the women themselves,” she says. “Some may choose not to engage while others may be open to additional or more intensive services.”
But if it ever comes to the question of acute care versus public health, Tatlock argues passionately that both approaches are necessary. “We’re all pulling on the same lever,” she says. “But we need to do it together.”
Helping children by working “upstream”
March 21, 2016Health policymakers and practitioners often use words like “downstream” or “upstream” to describe the vastly different points at which people may receive care.
Downstream means late in the process, well after the onset of a problem, and often long after a problem has become entrenched. For example, a child who is treated for an anxiety disorder — even if that treatment is successful — is getting help downstream.
But give the child a prevention program, before they have a disorder, and you’ve moved “upstream.” And in doing this, a few things can happen. You can immediately improve the quality of the child’s life — by reducing their distress and removing impediments to their healthy development. You can also alter the trajectory of a young child’s life, by reducing the negative impact of adversity. In turn, this can contribute to a lifetime of well-being and resilience. Upstream interventions can also save healthcare costs, for example, by reducing emergency room visits.
Better yet, you can help the mother as well as the child — before the child is even born. Then you’re moving upstream in way that’s likely to make the most profound difference.
That’s the motivation for Lenora Marcellus, pictured above, an Associate Professor in the School of Nursing at the University of Victoria. A member of the BC Healthy Connections Project scientific team, her original background is in neonatal intensive care. “A lot of the work I’ve done is downstream, when women haven’t been supported when they’ve needed it most, early on,” she says. She notes that much of her work in these hospital settings was with families who were struggling with disadvantages such as not having enough to live on, or not being able to get prevention programs themselves when they needed them.
Marcellus has also volunteered for almost 20 years with a young mothers’ group in her community and has seen first-hand the many challenges faced by young parents. Her experience providing downstream intensive healthcare services is what motivates her to embrace the goals of the BC Healthy Connections Project, which involves an evaluation of the Nurse-Family Partnership (NFP) program.
With NFP, public health nurses visit young women who are in early pregnancy and preparing to parent for the first time — providing them with home visits and intensive supports until the child’s second birthday. The program starts earlier than any other early childhood program, making it a decidedly upstream approach.
For the BC Healthy Connections’ evaluation, NFP is being compared with BC’s existing prenatal and early childhood services. The goal is to learn whether BC can replicate positive results from other countries. These results have shown that NFP can improve prenatal health, parenting, and children’s mental health and development, while also lifting young mothers out of poverty.
According to Marcellus, BC Health Authorities already try to help new moms with highly complex challenges, so they can help their children. But these families need extra supports and it’s often hard for them to get them. That’s why she’s so committed to the BC Health Connections Project.
“With NFP, the public health nurse brings a really unique set of skills,” Marcellus says of the program. “They’re developing a relationship and connecting with the new moms. What’s more, the meeting takes place in the mom’s own home or wherever feels safe for her. That’s very different from a professional setting.”
Although the teen pregnancy rate has declined in BC, young moms continue to be a vulnerable population because these very young women also have other challenges, Marcellus says. They can be invisible, stigmatized or judged. Just as bad, they often fall between the cracks when it comes to getting help. “We know that in society today it’s pretty hard to be an independent adult in our very expensive province,” Marcellus says.
“We could call it a pay now or pay later opportunity,” she says, adding that she would much rather see society pay now. “Investing in programs like NFP is likely to pay huge dividends over generations — for families and communities at large.”
The Nurse-Family Partnership is available only through the BC Healthy Connections Project for the duration of study recruitment. Practitioners or young pregnant women can click here for more information.
Examining the biological mechanisms that influence health
December 14, 2015Nurse-Family Partnership (NFP) is a prevention program that starts far earlier than most other public health interventions. It begins before children are even born — ideally by the 16th week of pregnancy. Its aim? To improve the lives of young mothers and their children. To achieve this, public health nurses make frequent home visits, building a trusting relationship with young first-time mothers and supporting them to nurture and protect their children.
NFP’s early start also presents a unique opportunity to study some of the biological mechanisms influencing health, starting even before birth. This is the subject of the Healthy Foundations Study, funded by the Canadian Institutes for Health Research, being led by Andrea Gonzalez (pictured above), assistant professor with the Offord Centre for Child Studies at McMaster University. The study is being conducted in collaboration with the Children’s Health Policy Centre at Simon Fraser University – and in collaboration with the BC Ministries of Health and Children and Family Development and BC’s Fraser and Vancouver Coastal Health Authorities.
Associated with the BC Healthy Connections Project — BC’s scientific evaluation of NFP, funded by the BC Ministry of Health with support from the BC Ministry of Children and Family Development — the Healthy Foundations Study is examining biological markers of health outcomes for children over the first two years of life. By collecting hair samples, saliva and cheek swabs from infants and consenting mothers, Gonzalez will be able to track changes in stress responses and the way genes work.
We all encounter mild stressors every day — such as unexpected changes in plans, disagreements with friends, family or co‐workers, or losing something. And we all develop different ways to deal with these stressors. Through the Healthy Foundations Study, Gonzalez is hoping to learn how pregnancy and new motherhood may be stressful to the mothers, and how the babies may respond to this stress. The study is also looking at whether NFP may affect the way that moms and babies cope with stress, and how this may influence later infant development. So this study will compare outcomes for children whose mothers receive NFP coupled with existing services to those whose mothers receive existing services only.
“We think that experiences you’re exposed to as an infant may influence a whole host of health outcomes later on,” Andrea Gonzalez says. And NFP aims to improve outcomes for children, and for their families.
The Nurse-Family Partnership is available only through the BC Healthy Connections Project for the duration of study recruitment. Practitioners or young pregnant women can click here for more information.
Will ‘unique program’ succeed in Canada?
September 14, 2015Harriet MacMillan sees the BC Healthy Connections Project (BCHCP) through a unique set of lenses.
One involves her role as the Chedoke Health Chair in Child Psychiatry at the Offord Centre for Child Studies at McMaster University. There, she co-led a Hamilton-based project piloting Nurse Family Partnership several years ago. Looking through that lens, she is eager to see Canadian young mothers-to-be get more help — via Nurse-Family Partnership (NFP). Basically, this program sees public health nurses frequently visiting young, pregnant women — in their own homes — from early in pregnancy until their children turn two years old.
Another lens comes from MacMillan’s position as BCHCP nominated co-principal investigator — along with Charlotte Waddell from Simon Fraser University. Here, MacMillan primarily wants to ensure the rigorous demands of a randomized controlled trial of NFP are met.
“I think it’s such an important study and it’s wonderful we have the opportunity to conduct this trial in BC,” she says. “The collaboration between the scientific team and the BC policy makers is terrific.”
In helping launch the Hamilton pilot project several years ago, MacMillan worked with a team adapting the American NFP materials to meet Canadian needs and standards. For example, in the US, each nurse is responsible for 25 young mothers-to-be. “In Canada, partly due to issues like geographic distance, we determined it should be no more than 20,” she says. As well, even though both countries support breast-feeding, “Canada tends to put a bigger emphasis on it.”
The pilot project also examined the whole referral process. MacMillan recalls: “We asked, are we able to get referrals and are we able to recruit women?” And once women did join the project, the team asked: “Do both the women and the nurses find NFP acceptable?” Indeed, the pilot project showed that NFP referrals were feasible, and that women and nurses both welcomed NFP.
“I think it’s fair to say that these young mothers were a high-risk group, but basically what we found was that once they were on board and engaged, they really seemed to appreciate the program.”
As for whether the program will succeed in Canada the answer remains to be seen. “My hope is that we will see similar benefits associated with NFP here as compared with the US trials,” MacMillan says.
“NFP is such a unique program where nurses develop this special relationship with mothers prenatally, such that mothers become very tuned in to the needs of their child, and so we hope it will improve outcomes for both mothers and their children.”
Note that Nurse-Family Partnership is available only through the BC Healthy Connections Project for the duration of study recruitment. Practitioners or young pregnant women can click here for more information.