Latest BC Healthy Connections Project Features

Charlotte Waddell believes children are so important that society should ensure their wellbeing even before they are born. So, together with a large team of research and policy collaborators, she is studying the effectiveness of the landmark Nurse-Family Partnership program in Canada for the first time. The study is called the BC Healthy Connections Project (BCHCP).

Nurse-Family Partnership (NFP) is a home visiting program. It involves public health nurses providing intensive supports to disadvantaged young women who are preparing to parent for the first time. Visits start early in pregnancy and continue until children reach their second birthday. The young women develop long-term relationships with the nurses, which is a crucial part of how the program works.

The BCHCP involves a randomized controlled trial of the program’s impact – looking at mothers’ wellbeing, and at children’s health and development from birth through age two. In essence, the research team will compare NFP with BC’s existing maternal and child health and social services.

BC’s participating Health Authorities are seeking 1,000 mothers and children to take part in the BCHCP over the next two years. But beyond this, Waddell hopes that the research team can follow these children and families for 10 years or more. The goal? To look at mental health and development as children progress through early, middle childhood and into their adolescent years.

“We know from US studies that many program benefits actually show up much later – in 10, 15 or 20 years,” Waddell says. “So, in a sense, completing the immediate evaluation of Nurse-Family Partnership is just the first step.”

For example, the team would like to learn whether Nurse-Family Partnership helps prevent kids from developing serious anxiety, depression, behaviour and substance misuse problems. As well, the team is curious about how Nurse-Family Partnership might affect academic achievement – from school entry into the high school years. There are other potential benefits, too, such as reducing the number of children going into foster care – and even reducing mortality for children and mothers.

Beyond these potential benefits for children, it may turn out that Nurse-Family Partnership is a good fiscal investment. In the US, NFP has shown a return on investment of more than $18,000 for every family served. This includes savings across healthcare, income support, youth justice, child protection and other public sectors. “So we’re setting the stage to test cost effectiveness, too.”

But the real reason to care? Says Waddell: “It’s about making sure that all BC children have the chance to flourish and meet their potential.”

Note that NFP is available only through the BC Healthy Connections Project for the duration of recruitment. Practitioners or young pregnant women can click here for details on eligibility for the BCHCP.

As a family doctor who delivers babies in Richmond, BC, Tamara Leung (pictured adjacent) has seen her share of difficult pregnancies. Maybe a woman is new to the community or hasn’t had a doctor involved. Maybe she’s really young and has very few people supporting her. Perhaps she has very little money to cover the everyday costs of living.

But Leung knows her first step: “I try to send everyone to public health” — meaning those community-based health programs that focus, among other things, on promoting health and preventing problems for pregnant women.

Leung particularly likes intensive home visiting programs, such as Nurse-Family Partnership, because they support women throughout the pregnancy and into children’s early years — in their own homes. This allows nurses to understand the real situation that women are living in. “When people are out in public or come into a clinic, you don’t always see the challenges they may face in the home,” Leung says. “They need support and help. The isolation that so many have is heartbreaking.”

However, Leung says that even people who want to help sometimes inadvertently create more problems. As an example, she recalls the time a school wanted to sponsor a family from a transition house. Their intentions were well-meaning. But the organizers made an enormous basket and the woman receiving it ended up having to carry it home on the bus.

As for the women Leung refers to public health, she says she understands that Nurse-Family Partnership is currently being evaluated in comparison with existing health and social services. This evaluation — called the BC Healthy Connections Project — is taking place across BC over the next several years and is looking at children’s mental health and development as well as maternal outcomes. Leung knows that this evaluation, involving a randomized controlled trial, must be rigorous to help us understand how well the program can work in BC. “We need to follow the basic rules of science,” she says.

“And regardless of whether my patients end up receiving NFP or other public health services while this study is going on, I’m happy,” she says. “I just want them better connected with public health. All pregnant women can still benefit from public health support.”

Scientific interviewers who work with the BC Healthy Connections Project (BCHCP) speak to women about some of the most emotionally intense experiences of their young lives. Their first pregnancy. Their relationships. The financial — and other — challenges they face. Their future job prospects. Their education.

Interviewer Vivian Lehman* remembers one mother-to-be especially well. Lehman expressed how much she appreciated the woman taking the time to share her experiences. “She sat there for a minute and looked at me and said, ‘I’m happy I did this and I really hope it can help improve services,’ ” Lehman recalls.

The woman had had experience with foster care and had grown up without much support. But the interview gave her the chance to have her voice heard. She was 18 years old.

“To have [young women] relate these feelings back to you is really powerful,” Lehman says, and she herself remains moved by the potential of her role. Her job is to interview participants in the project, tracking both their successes and the challenges they face.

Lehman believes the BCHCP, which is a scientific study of the Nurse-Family Partnership, will help show if there are benefits to adding new programs to support young first-time mothers facing socio-economic disadvantages compared to what’s currently available.

An intensive child and maternal health program, Nurse-Family Partnership provides disadvantaged young women who are preparing to parent for the first time with one-on-one home visits with public health nurses throughout their pregnancy. The visits continue until children reach their second birthday. The BCHCP is the first Canadian scientific evaluation of this program.

Lehman also believes the study will illustrate the challenge of getting information to the young women who need it. “There are quite a few different services [for young pregnant women],” she says, “but you need the right person or the right link to find your way in to them. It can be really hard when you’re young and find yourself pregnant.”

Having the chance to interview participants in the BCHCP is something Lehman describes as a tremendous experience. “It’s an honour to be able to peek into their lives,” she says. “It’s really a privilege.”

Note that NFP is available only through the BC Healthy Connections Project for the duration of recruitment. Practitioners or young pregnant women can click here for more information.

* Name has been changed to protect privacy

The Public Health Agency of Canada has named Nurse-Family Partnership (NFP) as a “best practice” and has posted it to its Best Practices Portal.

To be included on the portal, an intervention must meet criteria related to:
•    evidence of impact,
•    quality of evidence,
•    adaptability, and
•    credibility of source.

In the case of NFP, the sources were three randomized controlled trials (RCTs) conducted in the US by researcher David Olds.

NFP still needs testing in Canada prior to widespread implementation here — due to differences in our public health, social, and healthcare systems, as well as in our populations, compared with the US.

And for the first time in Canada, NFP’s effectiveness is now being evaluated — through the BC Healthy Connections Project, a large RCT taking place across BC. For this evaluation, the team is recruiting 1,000 young women who are preparing to parent for the first time. Prenatal, child and maternal outcomes will then be assessed in those who receive NFP compared with those receiving usual or existing services. The BC Healthy Connections Project also includes a nursing process evaluation to inform adaptations that may be needed to ensure NFP’s success in BC and Canada.

Note that NFP is available only through the BC Healthy Connections Project (BCHCP) for the duration of recruitment. Practitioners or young pregnant women can click here for details on how to reach public health and determine eligibility for the BCHCP.

For public health nurse Kali Bandi,* the strength of the young women who benefit from Nurse-Family Partnership (NFP) is demonstrated by one of her participants.

An intensive child and maternal health program, NFP gives disadvantaged young women — about to become first-time parents — one-on-one home visits with public health nurses throughout the pregnancy. These visits continue until children reach their second birthday. It is currently being offered in BC as part of an evaluation – the BC Healthy Connections Project – comparing NFP and existing health and social services.

One of Bandi’s 15-year-old participants comes from a family that truly values nursing care. Her own mother had been involved in a home visiting program when she was young. “Trust in nurses is very strong for this family,” Bandi says.

Throughout her interactions with this young mom — whose baby is now four months old — Bandi has been deeply impressed by the young woman’s parenting style. “She has the most amazing way of being with this baby,” Bandi says. “She’s very engaged, asks fabulous questions and has her own view of what she has to do.” At three days postpartum, the mom, who was then living at home, decided her own family situation wasn’t ideal for the baby. So, she moved out, into the home of her boyfriend’s parents.

“She does what she needs to do to take care of that baby in the best way she can,” Bandi says. “She’s a classic example of how age doesn’t equate to parenting ability.  I’ve worked with lots of moms who are older and highly educated and yet they completely flounder in frustration at meeting their baby’s needs.”

Reflecting on her 10 years as a public health nurse, Bandi says that NFP has given her new tools to work with families. But she also credits the families themselves. “Most of the participants have so many fires they’re putting out all the time. But these families have strengths and they can work through a lot.”

Note that NFP is available only through the BC Healthy Connections Project (BCHCP) for the duration of recruitment. Practitioners or young pregnant women can click here for details on how to reach public health and determine eligibility for the BCHCP.

*Name has been changed to protect privacy.