A new Simon Fraser University research project that starts Tuesday will match nurses with 500 pregnant, disadvantaged women with the goal of increasing the health, safety, and economic stability of the families.
The Nurse-Family Partnership has achieved impressive results in the U.S. for 30 years 鈥� reducing child maltreatment, lowering foster care rates and improving test grades in school 鈥� but this is the first time it will be tested in Canada.
The B.C. Ministry of Health and the province's five health boards will announce Tuesday they are looking for young, poor, first-time mothers to work with nurses, who will give support throughout the pregnancy and for the baby's first two years of life.
"These are very disadvantaged young parents, who themselves have not had many of their needs met, and so we're intervening to try to meet some of those needs before the baby's born and in the first two years of life, which is much earlier than a lot of previous programs have tried to intervene," Dr. Charlotte Waddell, who leads the study as its nominated co-principal investigator, said in an exclusive interview.
"Those are really critical years ... It gives intensive support when, frankly, it is most needed."
Health authorities will start signing up 1,000 volunteers to participate in the B.C. project; a computer program will randomly select only half to receive support from the nurses.
The other half, called the control group, will rely on existing services in the community.
They will be tracked by the researchers to see if those getting help from the nurses fare better.
In the U.S. program, created by Dr. David Olds, children who received support from nurses showed "robust" improvements in areas such as behaviour, compared with those in the control group.
"When the kids were little, like two years old, [Olds] found reductions in behaviour problems. ... Then he tracked those kids and found in the teenage years a significant reduction in measures of youth crime," said Waddell, director of SFU's Children's Health Policy Centre.
"We need to see if we get the same results [in Canada]."
Waddell noted the baseline health care and social safety net is generally better for disadvantaged 91原创s than their counterparts south of the border.
She is confident the B.C. study will see an improvement for children in their early years, but won't know for years whether it will mimic the longterm, major impact seen in the U.S..
B.C. women, who can sign up by contacting public health units or their doctors, must meet strict criteria, including:
24 years old or younger;
First-time pregnancy;
Less than 27 weeks pregnant;
Struggling financially.
While pregnant, the participants will receive guidance about many topics, including attending doctors' appointments, stopping smoking and other substance use, ending spousal violence, and learning about parenting and breastfeeding.
After the birth, they learn about keeping their surroundings safe for the baby, knowing about and reaching the infant's developmental stages, and encouraging more human interaction through actions such as talking and reading books.
Fifty-two nurses from across B.C. have been trained to deliver the services in small and large communities. Debbie Sheehan, a nurse and the co-principal investigator for the B.C. research project, has worked with women who were part of small pilot trials in Hamilton, Ont. and B.C. that were held earlier to test out whether the concept would work in Canada and to train the nurses.
She said participants are visited weekly by the nurses in their early pregnancy and after they give birth, and every other week for the rest of the project. The clients in the two early pilot trials formed bonds with the nurses and said they learned better parenting skills, she added.
"This is a really important study that will have impact down the road for all mothers in B.C. ... and elsewhere in Canada because other provinces are paying attention to this trial," said Sheehan, SFU's senior nursing consultant.
The study will be funded by the ministries of health and children and family development, and is estimated to cost $28 million over five years, which will mainly cover the salaries, training and expenses for the nurses.
Although there are significant upfront costs to this program, Waddell said, analysis in the U.S. shows it can save taxpayers money in the long run.
"When you calculate in savings on things like reduced foster care, reduced health care, reduced youth justice, it looks like it more than pays for itself, and might even generate between $3 and $6 for every dollar invested. But that's taking the long view," she said.
Waddell, who is also a child psychiatrist, wanted to pursue this project after witnessing the challenges faced by her young patients, most of whom are in trouble with the law or in foster care.
"Almost every single one of those young people, and I've seen thousands of them now, has experience right from birth with enormous adversities ... everything from extremes of poverty, to incredible child neglect and terrible abuse stories, to simply the absence of having one adult who cares for them," she said.
"We need to prevent this scenario from ever developing. ... Let's intervene really early, let's intervene prenatally, so the next generation of young people doesn't have to go through this."
Home visits result in better health outcomes
The Nurse-Family Partnership started in the U.S. 30 years ago, with nurses making home visits to disadvantaged women from the start of their pregnancies until their children turned two years old. Three scientific research trials were conducted in Denver, Colo., Memphis, Tenn., and Elmira, N.Y. Compared to a control group of other disadvantaged mothers and babies who received no help from the program, the American researchers found many of those receiving home visits from the nurses had much better outcomes:
Decreases in prenatal cigarette smoking;
Reductions in high blood pressure during pregnancy;
Fewer closely-spaced subsequent pregnancies;
Improved diets and significantly fewer kidney infections;
Reductions in child abuse and neglect;
Less emergency room visits and hospital stays for injuries and ingestions;
Fewer deaths in the first nine years of the children's lives;
Better cognitive and language development; Higher test scores in reading and math; Reduced use of welfare and other government assistance;
Greater employment for the mothers;
Increases in father presence and partner stability.
The American researchers continued to monitor the families, and found that by age 15 the children who had received home visits from the nurses (compared to the control group who did not) had:
Less instances of running away from home;
Fewer arrests, convictions and violations of probation;
Fewer sex partners;
Fewer cigarettes smoked per day;
Less alcohol consumption.
A 2006 American research paper says the program saves taxpayers money. By the time the children were 12, nurse-visited mothers (compared to the control groups):
Were impaired less often by alcohol and drugs;
Had longer partner relationships;
Relied less on food stamps, Medicaid, and welfare 鈥� a savings of $12,300 US annually per family, compared with a program cost of $11,511 US.
Source: www.nursefamilypartnership.org
