Effectiveness of Nurse-Family Partnership (NFP) in BC
Conditions
Brief summary
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.
Interventions
BEHAVIORALNurse-Family Partnership (NFP)
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.
BEHAVIORALExisting services
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.
Sponsors
McMaster University
Ministry of Health, British Columbia
Ministry of Children and Family Development, British Columbia
University of British Columbia
University of Victoria
Public Health Agency of Canada (PHAC)
Simon Fraser University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
FEMALE
Age
No minimum to 24 Years
Healthy volunteers
No
Inclusion criteria
1. Aged 24 years or under 2. First Birth 3. Less than 27 weeks gestation 4. Competent to provide informed consent, including conversational competence in English 5. 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
1. Planning to have the child adopted 2. Planning to leave the NFP catchment area (for three months or longer)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Average number of childhood injuries | 2, 10, 18 and 24 months postpartum | 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 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Prenatal substance use | Baseline (before 28 weeks gestation), 34-36 weeks gestation | Tobacco and alcohol use |
| Child development | 24 months postpartum | Cognitive ability and language development |
| Child mental health | 24 months postpartum | Behaviour problems |
| Maternal life course | 2, 10, 18 and 24 months postpartum | Number of subsequent pregnancies by 24 months postpartum |
Countries
Canada
Outcome results
None listed