Reaching underserved children and families

December 10, 2021

Catherine NLA, Hjertaas K, Cullen A, Zheng Y, Amhaz H, Lever R, Gray-Grant D, & Waddell C. (2021). Reaching Underserved Children and Families: Lessons from the British Columbia Healthy Connections Project. Vancouver, BC: Children’s Health Policy Centre, Faculty of Health Sciences, Simon Fraser University.

Executive Summary:

It is crucial to reach and support children and families who are coping with multiple adversities — yet many are defined by researchers and providers as “hard-to-reach” and therefore are underserved. The British Columbia Healthy Connections Project (BCHCP) entails a randomized controlled trial evaluating Nurse- Family Partnership (NFP), an intensive home-visiting program for disadvantaged, young, first-time mothers and their children. The study team needed to sustain engagement with nearly 1,500 children and mothers for the two-and-a-half years of their participation. So we learned many lessons. The BCHCP is also a “real world” trial, embedded within BC’s public health system. Our findings may therefore have policy salience.

We found that a robust engagement protocol helped families to participate in the six research interviews that we planned. Participants taught us to make frequent contacts — ranging from an average of 6.5 to 14.3 attempts, including on evenings and weekends. More outreach was needed for those experiencing more adversities. Yet participants also told us that they appreciated us persevering so that they could be included. Texting was the most effective approach for reaching the families. As well, it paid off to invest in training and supporting study team members — enabling them to create rapport and sustain long-term relationships. These strategies led to us achieving our goal. More than 80% of families completed the study interviews.

We acknowledge that our findings and their implications may pose challenges for policymakers. Initial costs could be high, for example, involving resources for: training outreach staff and supporting digital inclusion by providing families with cellphones and data plans. Offering evening and weekend appointments may pose particular challenges. Yet we believe that the benefits would be substantial, permitting more equitable inclusion of children and families who are coping with multiple adversities and who can greatly benefit from enhanced programs. We also believe that addressing service barriers for populations in need is feasible. For example, during the COVID-19 pandemic, BC and other jurisdictions provided cellphones and data plans to populations in need — enabling greater remote/virtual service access. So enriched supports for families in need can be, and have been, implemented in BC and elsewhere.

Beyond feasibility issues, there is a collective ethical imperative to better reach and serve disadvantaged children and families. Delivering programs with an intensity that is proportionate to need will in turn help address avoidable adversities, such as socioeconomic disadvantage — and will help ensure healthy development and wellbeing for all children. These goals are also in keeping with collective aims to honour children’s rights by ensuring that they receive needed services.

Full text of this report is available here.