Did You Know?

The COVID-19 pandemic has killed more than two million people worldwide, put extraordinary pressure on mental health (especially that of children), and affected the financial wellbeing of frontline workers — cleaners, grocery store clerks and other essential services.

But it also has an impact on other areas, including that of researchers. The BC Healthy Connections Project (BCHCP) — a scientific evaluation of the Nurse-Family Partnership program (NFP) — has been fortunate that the pandemic has resulted in only minimal effects.

“We are lucky that all of our in-person work was finished before the first lockdown, says BCHCP Scientific Director Dr. Nicole Catherine, referring to the order by Dr. Bonnie Henry in March 2020. “If this pandemic had occurred before we’d been able to complete our in-person research interviews with children, our data would have been seriously affected.”

While some of the visits to study participants could have been conducted by phone, observing the cognitive skills of children would have been close to impossible.

The study — a randomized controlled trial — was launched in October 2013. The study team followed 739 families until all 737 children had reached their second birthday, by November 2019.

The aim of the study is to determine how NFP, an intense nurse-visiting program for young, disadvantaged families, compares with existing health and social services in British Columbia.

Upon notice of the first lockdown, researchers at Simon Fraser University began working from home. Similar to other researchers around the world, they met via Zoom or telephone. Team members could get access to some protected data only by going into their offices and they received special permission to do that, from time to time.

Since the start of the pandemic, the team has published a paper in the Canadian Medical Association Journal Open, showing that delivery of NFP led to a reduced prenatal use of cannabis and, a modest reduction in cigarette use by smokers.

The team is continuing to analyze the data, currently looking at whether NFP has reduced childhood injuries, as well as improving child mental health and development by age two years. “We will know the results later this year,” Dr. Catherine says.

Early child development programs can improve school readiness. Yet they can also do much more. For example, the Perry Preschool program, which was delivered to disadvantaged three- to four-year-olds, resulted in significant benefits up to 35 years after the program ended. These benefits included significantly less criminal involvement and less cannabis and heroin use. For more information, see Vol. 5, No. 4 of the Children’s Mental Health Research Quarterly.

When children have to enter foster care they often face significant new challenges, such as repeatedly changing foster homes. Specialized training and increased supports for foster parents can help — and have been shown to improve children’s behavioural well-being, school functioning and residential stability. For more information, see Vol. 6, No. 3 of the Children’s Mental Health Research Quarterly.

Intimate relationships should be meaningful and enjoyable, not dangerous. Yet about one in 10 young people experience violence in their dating relationships. This form of violence can be prevented, however, setting the stage for healthy and respectful relationships in early adulthood and beyond. Two programs stand out — Fourth R and Youth Relationships — for having proven success in teaching positive relationship skills to Canadian teens.  For more information, see Vol. 7, No 1 of the Children’s Mental Health Research Quarterly.

In conducting a scientific evaluation of a program designed to help young first-time mothers, a research team from the BC Healthy Connections Project went to extra effort to make connections. The team was prepared to contact each participant five or more times to schedule interviews. This ‘extra effort’ was deemed important in reaching participants who were often struggling with issues such as insecure housing and mental or physical health challenges. The scientific evaluation, which started in 2011, looked at the Nurse-Family Partnership, a landmark US program focusing on children born to girls and young women who are facing disadvantages such as low income. The program starts early — in pregnancy, before children are even born — and involves intensive home visits from public health nurses. In Canada and elsewhere, policy-makers and practitioners have traditionally struggled to reach, engage and maintain connections with populations who are facing socioeconomic disadvantage. The BC Healthy Connections Project team has provided a detailed case example, offering strategies for how to make better connections, that last. The team hopes that their paper, which can be seen in the journal, Trials, will inform a shift for researchers, policy-makers and practitioners alike—from seeing disadvantaged populations as “hard-to-reach” to viewing them as “need-to-reach.”

Parents are crucial in promoting children’s positive behaviours. Parents can do this by interacting in ways that are sensitive and warm, being highly connected to children and setting effective limits. For more information, see Vol. 9, No. 4 of the Children’s Mental Health Research Quarterly.

Positive relationships can protect children from problematic anxiety. For example, young people who feel accepted and respected by their parents and cared for by their friends are less likely to develop anxiety problems.For more information, see Vol. 10, No. 2 of the Children’s Mental Health Research Quarterly.

The Nurse-Family Partnership (NFP) program is a leading example of how intervening very early in life can bring many long-term benefits. This intensive home-visiting program focuses on young first-time mothers-to-be who are coping with socio-economic disadvantage. It begins in early pregnancy and continues until children reach age two, and can produce life-changing benefits. A recent paper — by researchers from the Children’s Health Policy Centre and published in the Canadian Medical Association Journal OPEN — suggests some encouraging results. In a randomized controlled trial in BC, NFP led to reduced prenatal cannabis use, and in smokers it led to modest reductions in cigarette use. As a result, it is thought that NFP may hold promise for reducing some types of prenatal substance use in disadvantaged populations.

This is a good time to remember that reducing inequality in society has been shown to reduce maltreatment of children. In particular, policies that redistribute wealth to ensure that more children have their basic needs met can contribute to reducing important problems such as child maltreatment. For more information on preventing and treating child maltreatment, see Vol. 3, No. 2 of the Children’s Mental Health Research Quarterly.

When a child has depression, families should have easy access to effective psychosocial treatments such as Cognitive-Behavioural Therapy. Interpersonal Therapy can also be effective. Then, if medication is needed, fluoxetine is the first choice, given robust research evidence supporting its use. For more information, see Vol. 11, No. 4 of the Children’s Mental Health Research Quarterly.