Catherine, N.L.A., Zheng, Y., Xie, H., Boyle, M., Jack, S., MacMillan, H., & Waddell, C. (Forthcoming). Effectiveness of Nurse-Family Partnership on child outcomes by patterns of program intensity: Secondary evidence from a randomized controlled trial (British Columbia Healthy Connections Project). Child Abuse & Neglect.

Research Overview

This forthcoming paper examines how program intensity influenced child outcomes in the Canadian scientific evaluation of the Nurse-Family Partnership (NFP) program. Led by Nicole Catherine, Associate Director of the Children’s Health Policy Centre, the research team found that when NFP was delivered as intended, with sustained intensity — meaning families received the majority of recommended nurse-home visits consistently throughout the program — children experienced greater benefits in language and mental health-problem behaviour by age two years.

Methodology

• The researchers conducted secondary analysis of data from the British Columbia Healthy Connections Project (BCHCP), a randomized controlled trial evaluation of NFP involving 739 maternal participants and their 737 children in British Columbia.
• Participants in the BCHCP were enrolled in early pregnancy and randomly assigned, like flipping a coin, to two different groups — NFP versus Comparison (the existing services on offer in BC) — to investigate whether NFP provided greater benefits for mothers and children by age two years.
• The BCHCP study team collected data at regular intervals across pregnancy and early childhood (2013 to 2019) including on child injuries, language, cognition and problem behaviour (mental health) at age two years.

Key Findings

• Delivering NFP as intended, with sustained intensity, led to greater benefits regarding maternal-reported child language and mental health-problem behaviour.
• Importantly, the research team also found benefits using a rigorous measure of child language development (Bayley Scales of Infant Development), where children were observed directly in the home. This method is considered less biased than mothers’ self report of their children’s language development.

Implications

• Benefits for kids: Sustaining long-term program engagement with young families experiencing disadvantage can make a difference for children. Improvements in language and mental health — as early as age two years — are associated with longer term benefits across childhood and the school years.
• Longitudinal research: It is important to follow the participating children across adolescence to assess long-term program effects on mental health and academic functioning.
• Funding priorities: Policymakers should fund evidence-informed prevention programs that commence early in pregnancy at adequate levels of intensity to maximize benefits for children in need and for society as a whole.