New findings from the Children’s Health Policy Centre’s scientific evaluation of the Nurse-Family Partnership (NFP) program show promising benefits for mothers regarding exposure to intimate partner violence, income, mental health and self-efficacy — warranting follow up of longer-term benefits across childhood.

The scientific team behind the BC Healthy Connections Project, or BCHCP, published these findings in the British Medical Journal Open. According to the study, NFP may help reduce adversities faced by mothers, including intimate partner violence, by the time their children are two years old.

For children, exposure to intimate partner violence is a serious form of maltreatment with long-term mental health consequences. Intimate partner violence is occurring at epidemic proportions, and rates are higher for lone mothers experiencing marginalization. Yet despite known harms to both children and mothers, efforts often focus on aftercare rather than prevention.

“These are important, encouraging findings on how to address early adversities,” said Nicole Catherine, BCHCP co-principal investigator, who holds the Canada Research Chair in Child Health Equity and Policy, Tier II. “We need greater investments in early prevention — well before children are born.”

BCHCP co-principal investigator Charlotte Waddell added that this landmark initiative has been a long-term priority for researchers in British Columbia (BC). It commenced in 2011 as the BC government prioritized early prevention of childhood adversities — leading to the BCHCP (2011-2022). “Our findings contribute further evidence that intervening in early childhood is a powerful policy mechanism to promote healthy child development,” said Waddell.

The Children’s Health Policy Centre (CHPC) at Simon Fraser University led the BCHCP randomized controlled trial, or RCT, in collaboration with McMaster University and other organizations.

A province-wide initiative, the BCHCP intended to address long-term child health inequities beginning before children were born. To do this, the trial was embedded within BC’s universal public health system. Four participating regional health authorities — Fraser, Interior, Island and Vancouver Coastal — were responsible for trial referrals, nursing and program costs. All five health authorities, including Northern Health, participated in a pilot nurse-guiding study and an adjunctive nurse-process evaluation. “BC showed tremendous leadership and foresight in investing in prevention of early childhood adversities,” said Catherine.

The study team was centrally located at the Children’s Health Policy Centre and supported scientific field interviewers across all four regional health authorities. Catherine provided scientific interviewers with intensive training and mentorship to ensure successful reach and sustained engagement with 739 pregnant girls and young women and their 737 children during each family’s 2.5-year participation.

The study included 200 Indigenous (including First Nations, Métis or Inuit) girls and young women. Making up 27% of the total participants, they generously agreed to participate in this long-term trial. Some 237 BCHCP children, or 32%, had an Indigenous mother or father.

“We are grateful to the participants for sharing their experiences with us while preparing to parent for the first time. Many shared how they wanted to make a difference for other children and mothers in similar circumstances,” said Catherine. Previous BCHCP reports have shown the strengths of the participants in seeking prenatal services while coping with cumulative adversities such as unstable housing and living on less than $10,000 per year.

The study was funded by the BC Ministries of Health, and Children and Family Development. The Mowafaghian and Stern Foundations provided additional generous supports.

Nurse-Family Partnership aims to improve the lives of children born to young, first-time mothers. The program focuses on families dealing with socioeconomic inequities. It begins in pregnancy and involves a program of home visits by public health nurses, continuing until children are two years old. NFP was developed in the United States by researcher David Olds and colleagues.

Earlier findings from the BCHCP research team had shown that NFP reduced prenatal substance exposure (nicotine and cannabis) and improved child mental health and language development by age two years. The BCHCP also involved an adjunctive biomarker sub-study.

“There is increasing interest and policy investments in delivering enhanced early prevention programs such as NFP in BC and Canada — all with expectations of sustained benefits. But we have yet to see if these benefits at age two years translate into sustained benefits across childhood and adolescence. This is where we will see the true value of intervening early,” Catherine said. “We are eager to re-engage the BCHCP children to see how they are doing and whether these investments made a difference in children’s lives, and to understand if they were cost-effective.”

Text of the BMJ Open paper is available here.