Research Spotlight: Maternal and child health

How do you dramatically improve the health of vulnerable children and mothers in Canada? Will home visits by public health nurses help? Dr. Susan Jack of the School of Nursing aims to find out.

How do you give children a healthy start in life? Do you begin in grade school? In daycare? At birth?

How about in the womb?

Providing health education and guidance to mothers during their pregnancies can lead to healthier babies. This is just one goal of the Nurse-Family Partnership (NFP), a home-visiting program developed in the United States that is now being tested in Canada.

Researcher and Associate Professor, Dr. Susan Jack, of the School of Nursing at McMaster University, is a co-principal investigator on several projects in BC and Ontario to adapt and evaluate NFP within Canada. “If NFP demonstrates positive benefits for mothers and children,” says Jack, “then we will have the evidence to recommend that this program be available for other public health units in Canada to offer to vulnerable families in their communities.”

How does the Nurse-Family Partnership program work?

NFP pairs young, socially and economically disadvantaged pregnant women with public health nurses. To support mothers, and often their partners, to prepare to parent for the first time, nurses visit families in their home, starting in pregnancy and continuing until the child’s second birthday.

“The nurse-client relationship is at the heart of NFP. To establish this relationship, the nurse and the mother meet frequently to build trust. Nurses focus on identifying mothers’ strengths and encouraging them to follow their hearts’ desires to build a healthy future for their families,” says Jack.

What is the purpose of the program?

The program has three main goals.

Jack explains. “The first goal is to support young, first-time mothers to have healthy pregnancies. The second goal is to improve child health and development. Moms learn to recognize the normal developmental milestones of their babies, normal behaviours, how to react to their infants in a really positive, supportive way. The third goal is to provide guidance to mothers so they can become more economically self-sufficient.”

How was NFP developed?

The NFP was developed by Dr. David Olds, an American psychologist, in the early 1970s, says Jack. “He did three trials. By comparing families who had nurses visit compared to families who didn’t, they were able to demonstrate some significant outcomes, such as improved prenatal health and fewer subsequent pregnancies. Children of mothers who were home-visited showed better school readiness and better health. Internationally, NFP is identified also as a program that can prevent child abuse and neglect.  There are long-term benefits as well. Mothers and their children are less likely to die from preventable causes up to 20 years after being in NFP.”

Why and how is NFP being “tested” in Canada?

Canada is not the US, though. Will the program have the same results in Canada?

To find out, Dr. Jack, Dr. Harriet MacMillan, and Debbie Sheehan (past Director, Family Health, Hamilton Public Health Services) were the first to bring NFP to Canada in 2008. Their goals were to adapt NFP to reflect Canadian standards, to determine if it would be feasible to deliver it through public health, and if it would be acceptable to young mothers. It was – and the program is a huge success. Since 2008, the team of NFP nurses at Hamilton Public Health has enrolled 436 mothers and celebrated the graduation of 165 families from the program.

The program is now being tested on a larger scale in BC under the name “BC Healthy Connections Project (BCHCP)”. To show if NFP is effective compared to existing services, Dr. Charlotte Waddell at Simon Fraser University, Sheehan, Jack and MacMillan are leading a study that will involve 1,040 women; 520 will get NFP home visits and 520 will access existing healthcare and social services.

The BCHCP includes two other studies. Jack is leading a process evaluation to understand how NFP is being uniquely delivered in different regions, particularly in rural areas. “This study will also increase our understanding of how public health nurses can support women who are trying to parent within difficult circumstances whether it be living in poverty, managing a mental health condition, or protecting their child from exposure to violence,” she says. To understand if NFP can affect how babies and their mothers cope with stress, Dr. Andrea Gonzalez is leading the Healthy Foundations study.

What have researchers discovered so far?

The researchers have already made some interesting discoveries. Public health nurses in the program describe how “transformative” this work can be. “They’re working at the full scope of their nursing practice,” says Jack. “They are working autonomously, using critical thinking, making important decisions … they have to rely on all of their nursing skills to engage with this vulnerable population. While it’s difficult work, it can be very rewarding.”

“The nurses also remind us how vulnerable and how resilient many of their clients are. They’re determined to be really great mothers and to do the best they can for their infants.”

For BCHCP, core study funding is provided by the BC Ministry of Health with support from the BC Ministry of Children and Family Development and from Fraser Health, Interior Health, Island Health, Northern Health and Vancouver Coastal Health. Additional funding to support the Process Evaluation is provided by the Public Health Agency of Canada.  The Healthy Foundations Study is funded by Canadian Institutes of Health Research.

If you have news to share, please contact spenceg@mcmaster.ca.