Nurse home visiting programs have potential to reduce intimate partner violence exposure and increase outcomes for young, first-time mothers and children experiencing disadvantages, a new Children's Health Policy Centre study from Simon Fraser University finds.
A study of one such program in British Columbia, published in the British Medical Journal Open, showed a 16 per cent increase in annual income ($1,629.74) and fewer mental health problems for mothers by the time their children were age two years. Fewer mothers also reported intimate partner violence exposure.
"These findings are a promising sign that intervening early in pregnancy can improve the lives of mothers and children experiencing adversities," says lead author Nicole Catherine, associate director of the Children's Health Policy Centre and assistant professor of health sciences at SFU. "Increasing income, reducing intimate partner violence, even by a small amount - these are meaningful differences in children's lives, and it tells us we need to continue investing in these kinds of prevention programs."
The study was part of the BC Healthy Connections Project (BCHCP), a randomized controlled trial conducted across four regional health authorities between 2011 and 2022. The trial evaluated the Nurse-Family Partnership (NFP) - an intensive nurse home visiting program for first-time mothers experiencing socioeconomic disadvantage - as a way to address long-term child health inequities.
Participating girls and young women in the NFP group received regular visits from public health nurses over the course of their pregnancy and the first two years of their children's lives. The comparison group were eligible for the existing services on offer in B.C. Over a six-year data collection period, the trial followed 739 pregnant girls and young women and their 737 children. Of those, 27 per cent identified as Indigenous (First Nations, Mètis or Inuit).
"We are extremely grateful to the girls and young women who participated in this long-term study, many shared that they wanted to make a difference for families in similar circumstances," Catherine says.
Upon study entry, during pregnancy, many reported adversities such as intimate partner violence exposure (37.6 per cent) and psychological distress (31.9 per cent). Their mean annual income was less than $10,000 - in a province where costs for essentials such as housing and food are among the highest in the country.
In Canada, intimate partner violence is occurring at epidemic proportions, while child poverty rates remain unacceptably high.
"These early adversities, along with maternal mental health problems, pose significant risks to children's healthy development and wellbeing," says Catherine.
According to Catherine, the current solutions to these problems too often focus on aftercare rather than prevention.
"It's well established that early prevention efforts are more effective than providing costly treatment for problems later in life," says Catherine, "but policymakers need rigorous evidence about program effectiveness in order to invest in them. That's what this study, and the larger BC Healthy Connections Project, aimed to provide."
The findings, along with previously published prenatal and child health benefits, underscore the need for greater investment in early childhood intervention programs and long-term research to evaluate their effectiveness - particularly as children grow.
"This is where we will see the true value of intervening early," Catherine says. "We are eager to re-engage the BCHCP families, as children are now reaching age 11, to see how they are doing and whether these early investments made a difference in their lives."
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NICOLE CATHERINE, associate director, Children's Health Policy Centre, assistant professor, Canada Research Chair Tier II in Child Health Equity and Policy, health sciences
