Adaptation and Piloting of Nurse-Family Partnership (Canada)

Phase 1: Adaptation of Nurse-Family Partnership (NFP) to the Canadian Context

Learn more about how NFP public health nurses from Hamilton Public Health Services provide support through home visiting to pregnant women and first-time parents (p.12-16) in this article published in Registered Nurse Journal.

Adaptation of NFP to the Canadian context began in 2008 but is ongoing and continues today. NFP materials adapted to date include visit-to-visit guidelines, home visit facilitators and corresponding nurse instructions, program implementation manuals, nursing assessment forms, as well as an NFP curriculum to guide public health nurse and supervisor education. Specific content adaptations to NFP materials have involved the integration of Canadian standards of practice and best practice guidelines, augmentation of materials to meet localized needs or priority issues, and integration of new NFP innovations.

Funding to support the work of adapting or developing Canadian NFP program materials has been provided by the Public Health Agency of Canada, the Ontario Trillium Foundation, the Ontario Ministry of Health and Long-Term Care, as well as support from the Ontario Nursing Secretariat, and funds from the Provincial Centre of Excellence for Child and Youth Mental Health at Children’s Hospital of Eastern Ontario (CHEO).

Phase 2: Pilot Study to Determine NFP Feasibility and Acceptability

The overall objective of the Canadian pilot studies was to determine if it would be feasible to implement and deliver NFP as part of Canadian public health programming, and if this nurse home visitation intervention, that starts early in pregnancy and continues until the child’s second birthday, would be acceptable to a wide range of stakeholders.

The pilot study (2008-2012) involved a collaboration between McMaster University and City of Hamilton Public Health Services. In the pilot study, the NFP program was provided to 108 families and results demonstrated that it was feasible to carry out the NFP program in public health units with public health nurses delivering the intervention, and to enroll and home-visit the targeted population of young, first-time mothers who were experiencing social and economic disadvantage. An acceptability evaluation study found the program to be well received by participating mothers, nurses, family members and community partners.

Funding for the adaptation work and pilot studies was received from Catholic Children’s Aid Society of Hamilton, Community Child Abuse Council, Hamilton Best Start, Hamilton Community Foundation, Hamilton Public Health Services, McMaster Children’s Hospital, Offord Centre for Child Studies, Ontario Ministry of Health and Long-term Care, Ontario Nursing Secretariat, Ontario Provincial Centre of Excellence for Child and Youth Mental Health at Children’s Hospital of Eastern Ontario (CHEO), Public Health Agency of Canada, and The Children’s Aid Society of Hamilton.

Phase 3: Randomized Controlled Trial

In 2012, the British Columbia government began implementing NFP in most health authorities across the province and funded the BC Healthy Connections Project (BCHCP) to assess how well NFP works in BC. This randomized control trial (RCT) was the first scientific evaluation of NFP in Canada. Reports on outcome indicators are being published between 2020 and 2023. The RCT also has two adjunctive studies: a process evaluation to document how NFP was implemented and delivered in five health authorities, and a biological evaluation of NFP’s potential impact on biomarkers of stress in a sub-sample of RCT participants (Healthy Foundations Study).

Phase 4: Continued Refinement and Expansion

Following completion of the BCHCP randomized controlled trial and BCHCP process evaluation, health agencies across Canada are reviewing the outcomes and discussing next steps for ongoing refinement and expansion of the program in new jurisdictions.

In British Columbia, to learn more about the NFP program, including eligibility criteria and contact information for local Health Authorities offering the program: HealthLinkBC_Nurse Family Partnership

In Ontario, to learn more about how this program has been implemented as well as the public health units offering the program, please contact: Lindsay Croswell, Ontario Nurse-Family Partnership Nursing Practice Lead at [email protected]

Nurse-Family Partnership: A Policy Option to Address Provincial Needs and Priorities in Ontario

NFP is a targeted and intensive home visiting program with a strong evidentiary foundation and proven outcomes for families experiencing complex challenges. NFP is currently offered in seven (7) Ontario health units with frameworks in place to support scalability of the intervention including:

• a sustainable Canadian NFP education model;
• structures to support site implementation and oversight, including data collection and reporting; and
• processes to integrate NFP as a targeted intervention under the broader umbrella of the Healthy Babies Healthy Children (HBHC) program.

NFP is a scalable solution that can be implemented in local jurisdictions to address provincial needs and priorities. For more information  on how NFP can respond to the complex challenges experienced by priority populations, public health leaders have developed a policy brief titled: Nurse-Family Partnership: A Policy Option to Address Provincial Needs and Priorities.