BC Healthy Connections Project

Study Overview
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Brief Summary
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Nurse-Family Partnership (NFP) is a primary prevention program that was developed by Dr. David Olds in the United States (US) with the goal of helping vulnerable young first-time mothers and their children. The program involves public health nurses (PHNs) visiting mothers in their homes, providing intensive supports starting in pregnancy and continuing until children reach their second birthday. Studies in the US have shown that NFP significantly reduces child maltreatment and child behaviour problems, while also improving children's early learning and mother's economic self-sufficiency. Economic studies have also shown that the program pays for itself over the long-term. However, NFP has never been tested in Canada. Due to major differences in our populations and in our public services, we do not know whether NFP will show the same benefits here. We therefore plan to conduct a scientific evaluation of NFP's effectiveness in British Columbia (BC), in close collaboration with the BC government and BC's Health Authorities. Using randomized-controlled trial methods, NFP's effectiveness will be specifically evaluated in comparison with existing perinatal services in BC regarding outcomes across three fundamental domains: 1) pregnancy and birth; 2) child health and development; and 3) maternal health and life course. Findings from this evaluation will be used to improve the NFP program - to better meet the needs of vulnerable young mothers and their children in BC.

Official Title
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A Scientific Evaluation of the Nurse-Family Partnership (NFP) Program in British Columbia

Conditions
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Effectiveness of Nurse-Family Partnership (NFP) in BC

Intervention / Treatment
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* Behavioral: Nurse-Family Partnership (NFP)
* Behavioral: Existing services


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged 24 years or under First Birth Less than 27 weeks gestation Competent to provide informed consent, including conversational competence in English Experiencing socioeconomic disadvantage (must meet 5a or 5b): 5a. Aged 19 years or younger (eligible) 5b. Aged 20-24 (eligible if has TWO of the following): 5.1. Lone parent (is not married or living common-law, i.e., not living with the same person for more than one year) 5.2. Less than grade 12 (does not have BC's Dogwood certificate, General Education Development [GED] Credential or other diploma equivalent to grade 12; note that the Evergreen Certificate is not equivalent to grade 12) 5.3. Low income (based on answering yes to any ONE of the following) 5.3a. Do you receive income assistance (e.g., disability, social assistance, employment insurance, or BC Medical Services Plan Premium Assistance)? 5.3b. Do you find it very difficult to live on your total household income, particularly regarding food and rent? 5.3c. Do you live in a group home, shelter, or institutional facility (e.g., treatment center)? Exclusion Criteria: Planning to have the child adopted Planning to leave the NFP catchment area (for three months or longer)

Ages Eligible for Study
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Maximum Age: 24 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Nurse-Family Partnership (NFP)<br> | Behavioral: Nurse-Family Partnership (NFP)<br>* Trained Public Health Nurses (PHNs) will deliver Nurse-Family Partnership (NFP) using specified pregnancy, infancy and toddler curricula. Following enrollment in the study, NFP PHNs will provide regular home visits to participants throughout the remainder of the participant's pregnancy, continuing through until the child's second birthday. In addition to offering standard care during each visit, PHNs will deliver NFP content using program materials relevant to the following domains: personal health, maternal role, environmental health, family and friends, life course development, and health and human services.<br>|
| Active Comparator: Existing services<br> | Behavioral: Existing services<br>* Participants allocated to the comparison group will receive all the usual perinatal programs and services offered within their Health Authority, including primary care and specialist physician services covered under BC's public healthcare system. These services vary across the province but may include: standard primary healthcare services; public health programs including prenatal classes, pregnancy outreach and home visiting by nurses or paraprofessionals; and a variety of targeted and universal parenting and early child development programs.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Average number of childhood injuries | The average number of physician/health care provider encounters per child for injuries (intentional or unintentional), measured in community/outpatient, emergency room (ER) and hospital settings, from birth through 24 months postpartum | 2, 10, 18 and 24 months postpartum | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prenatal substance use | Tobacco and alcohol use | Baseline (before 28 weeks gestation), 34-36 weeks gestation | 
| Child development | Cognitive ability and language development | 24 months postpartum | 
| Child mental health | Behaviour problems | 24 months postpartum | 
| Maternal life course | Number of subsequent pregnancies by 24 months postpartum | 2, 10, 18 and 24 months postpartum |