Nurse-home visiting programs starting prenatally are a promising approach to preventing the intergenerational transmission of childhood adversities, including maltreatment. The purpose of the BC Healthy Connections Project (BCHCP) trial was to evaluate the effectiveness of Nurse-Family Partnership (NFP), a nurse-home visiting program, in improving child outcomes. The BCHCP involved 739 pregnant and new mothers and their 737 children by age two years (2013-2019). Nicole Catherine, Principal Investigator, with a national investigative team, is now leading efforts to evaluate longer-term program effectiveness across childhood and adolescence.
What were the main trial findings by child age two years?
The trial scientific team has published the main trial results showing NFP’s effectiveness by age two years. These findings show NFP reduced prenatal substance exposure. NFP did not reduce child injuries (primary outcome) or subsequent maternal pregnancies, but it did improve maternal-reported child language and mental health (problem behaviour) at age two years. Promising benefits were also observed for maternal-reported intimate partner violence exposure, income and mental health. The results of the BCHCP trial also highlight the need for enhanced interventions that serve pregnant and parenting Indigenous girls and young women, particularly in urban environments.
What worked, and for whom?
Understanding which families benefit most from prevention programs can help policymakers create more targeted and cost-effective strategies to improve outcomes for children. We are leveraging BCHCP trial data to gain a more nuanced understanding of how an early prevention program, such as NFP, may work differently for individuals and priority subgroups. Results to date indicate the following:
- Child benefits are greater when prevention programs are sustained and delivered as intended;
- Select maternal participant subgroups in early pregnancy have greater child outcomes (measured via causal forest machine learning approaches); and
- Maternal participants’ early adverse experiences in their own childhoods provide important context for how NFP impacts child outcomes.
For policymakers and practitioners, these findings underscore the need for renewed investment in screening and early prevention programs. Such investments are crucial to ensure these programs meet the needs of diverse children and families.
What are the sustained benefits across childhood?
The CHPC will be following the BCHCP children and mothers across childhood and adolescence to investigate the long-term effectiveness and cost-effectiveness of NFP on improving health and wellbeing.
Background
The Children’s Health Policy Centre (CHPC) led the trial, in collaboration with McMaster and other Universities. Between 2013 and 2016, we enrolled 739 pregnant girls and young women and their 737 children across the four participating regional Health Authorities (Fraser Health, Interior Health, Island Health and Vancouver Coastal Health). Northern Health was involved in an NFP nursing pilot and process evaluation. Many Indigenous (including First Nations, Métis or Inuit) girls and young women (200 or 27%) generously agreed to participate in this long-term trial. Many BCHCP children (237 or 32%) had an Indigenous mother or father.
The trial was conducted with rigour. The CHPC study team sustained engagement with the children and mothers for the 2.5 years of their participation—starting in pregnancy until children reached their second birthday. We conducted six research interviews with each family, either in-person or via telephone, completing more than 3,700 research interviews (>80% retention). Baseline findings showed that we reached the population that NFP was designed to benefit.
The BCHCP was funded by the BC Ministry of Health, with support from the BC Ministry of Children and Family Development. The participating regional Health Authorities funded nursing and program delivery costs. Funding was also provided by the Mowafaghian Foundation and the R & J Stern Family Foundation. Nicole Catherine is the ongoing lead Principal Investigator. For the original trial, Charlotte Waddell and Harriet MacMillan were the Nominated Co-Principal Investigators. Nicole Catherine, Susan Jack and Debbie Sheehan were also Co-Principal Investigators.
We also collaborated on two adjunctive studies: a nursing process evaluation, determining how NFP was delivered in select local health areas in BC (led by Susan Jack); and the Healthy Foundations Study, examining biological markers of NFP’s potential effect on child health (led by Andrea Gonzalez).
You can reach the BC Healthy Connections Project team by email at: chpc@nullsfu.ca
According to BC’s longstanding intentions, select regional Health Authorities are offering NFP to all eligible women — as a program embedded within other public health services. For more information on referrals to the program in the Fraser Health, Interior Health, and Island Health regions, or the public health prenatal program in Vancouver Coastal Health, please contact your family doctor, nurse practitioner or midwife, or local Health Authority.
BCHCP Publications
List of all BCHCP publications
