Early prevention program improves child mental health and language

Special report by Daphne Gray-Grant

Reprinted with permission from SFU News

Findings from the Children’s Health Policy Centre’s (CHPC) scientific evaluation of the program Nurse-Family Partnership have shown that it improved maternal-reported child language and mental health at age two years.

Results from the long-term randomized-controlled trial—known as the BC Healthy Connections Project (BCHCP)—were published today in the Journal of Child Psychology and Psychiatry.

CHPC at Simon Fraser University (SFU) led the trial, in collaboration with McMaster University and other organizations.

“We are thrilled to have these significant positive findings,” said Nicole Catherine, co-principal investigator for the BCHCP, and assistant professor at SFU’s Faculty of Health Sciences (FHS). “We have shown that intervening very early in a child’s life—during pregnancy—can have enduring benefits.”

Nurse-Family Partnership aims to improve the lives of children born to young, first-time mothers. Developed nearly 45 years ago by researcher David Olds and colleagues in the United States, the program starts early—in pregnancy, before children are even born. It involves intensive home visits by public health nurses, continuing until children reach their second birthday. The program focuses on those who are coping with socioeconomic inequities.

Public health nurses provide the home visits—up to 64 in total over two-and-a-half years. Nurses delivering the program received extensive education. As well, they received resources to use in the visits, and ongoing supervision and support. ­

The study, which started in 2013, enrolled 739 pregnant girls and young women and their 737 children across the four participating regional Health Authorities (Fraser, Interior, Island and Vancouver Coastal Health. Northern Health was involved in a separate BCHCP NFP nursing pilot and process evaluation).

Approximately 200 Indigenous (including First Nations, Métis or Inuit) girls and young women, or 27 per cent, generously agreed to participate in this long-term trial. Some 237 BCHCP children, or 32 per cent, had an Indigenous mother or father.

“We acknowledge and thank the participating young moms and children who shared their experiences via data collected during 4,000 research interviews,” says Catherine. “They told us they wanted to help make a difference for young families like them.”

BCHCP co-principal investigator and FHS professor emerita Charlotte Waddell highlighted that the study represents millions of dollars and thousands of hours of work by hundreds of people over 13 years. “Our findings show the power of policy-practice-research collaboration in the service of common goals,” she said. “It’s the ideal way to address tough questions of public health importance.”

The study was funded by the BC Ministry of Health, with support from the BC Ministries of Children and Family Development and Mental Health and Addictions. Participating regional health authorities funded direct nursing costs while the Mowafaghian and Stern Foundations provided additional generous supports.

The CHPC with the BCHCP scientific team has previously published findings from its investigations into the impacts of the NFP program. An earlier paper, published in the CMAJ Open, had shown that NFP led to reduced prenatal cannabis use, and in smokers led to modest reductions in cigarette use. Further results that demonstrate NFP’s other impacts—such as reducing intimate-partner violence—will be published in the near future.

“All the findings show that longer term follow-up of our NFP cohort of children is warranted given that further benefits may emerge across childhood and adolescence,” Catherine said adding that the team is identifying new funding to follow the children over 10 years and beyond. “This kind of long-term follow-up is the best way to show the return on public investment in early childhood programs designed to prevent problems from occurring in the first place."

Read the full text of the JCPP paper here.