… the Nurse-Family Partnership…
lfpress.com – news/local/health – The B.C. government committed $23 million to the Nurse-Family Partnership, a move applauded by a leading national official on setting children’s policy
June 12, 2013. By Jonathan Sher
Two Ontario ministries turned away a social program for at-risk mothers so grounded in evidence it went on to unite Democrats and Republicans south of the border.
The program had its Canadian birth in Hamilton where Dr. Chris Mackie, who has since become chief medical officer of health in London and Middlesex County, pushed the province between 2009-11 to get behind it in a big way.
It had been Mackie’s job as associate medical officer of health there to persuade the Ontario government to fund a $16-million provincewide research pilot to help at-risk moms in 10 health units, including London-Middlesex, taking it beyond Hamilton, where it had been solely operating.
Mackie sought funding for two years from the ministries of Health and Children and Youth Services.
“They weren’t willing to provide the research costs,” he said.
So while Ontario cosied up to the idea of the program, its benefits will be reaped by mothers and children elsewhere, including in B.C., where the government has committed $23 million to conduct a provincewide trial.
“(This) represents an enormous commitment to B.C.’s children,” Dr. Charlotte Waddell, Canada Research Chair in Children’s Health Policy, told organizers. “It means that B.C. is leading the country, frankly.”
The program is called the Nurse-Family Partnership.
It was created by a U.S. researcher who’d seen how the lofty goal of helping the less fortunate was too often built on a foundation of untested assumption.
So Dr. David Olds tested his program in American cities using randomized trials to compare mothers and children who used his program with those who did not. From poor whites in upstate New York to black children in Memphis, the program produced remarkable results, while a third trial in Denver showed nurses were far more effective than peers intervening with families.
The findings were so persuasive the program has since been adopted in at least 42 American states, Congress allocated $1.5 billion during President Barack Obama’s first term, Britain’s then-prime minister Tony Blair spread its use there and Australia is using it to help its aboriginal population.
By targeting first-time mothers and appealing to their instinct to help their children, the program steered many away from a path of abuse, drug-use, unemployment and crime — changes that saved so much money it appealed to conservatives too.
“It appeals to people’s minds and their hearts,” Olds said.
Ontario has its own program to help at-risk mothers, called Health Babies Health Children, but it’s less vigorous about selecting mothers, has had no scientific studies to measure its effect and employs far fewer resources per family with less visits.
The province instead is investing in full-day kindergarten, a venture that will cost billions to get up and $1.5 billion a year to run.
There’s little evidence to say whether you get more bang for the buck helping kids in their first two years or at ages 3 or 4, Mackie said.
What is clear is this: the Ontario government has placed nearly all its eggs in one basket.
Mackie remains hopeful Queen’s Park will take another look at the program and not wait five to 10 years for B.C. to complete its study. After all, the Youth Services Ministry let Hamilton use nurses who would otherwise work on Health Babies Healthy Children. The ministry also borrowed some of the scientifically-based methods used by the Nurse-family Partnership.
“I’d love to see Ontario move forward,” Mackie said.
The Childen Services Ministry is at least willing to discuss the program, it said in an e-mail to The Free Press.
“The ministry would be more than willing to meet with the Nurse-Family Partnership to see how we can work together towards our common goal of providing children with the best possible start in life,” wrote spokesperson Courtney Battistone.
The Ministry now spends $89.4 million on Healthy Babies Health Children, an increase of $21.7 million since 2003.
The health ministry was unable to arrange to answer questions fromThe Free Press Tuesday afternoon.
“Our ministry works with the Ministry of Children and Youth Services to make sure babies get the best start in life” a ministry spokesperson said.
The Nurse-based program intrigues the head of Childreach in London. “I’d absolutely embrace more discussion about that,” Executive Director Anne McKay said.
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THE NURSE-FAMILY PARTNERSHIP
- Nurses chose expectant moms at risk of being poor parents.
- Each mother is assigned a nurse who visits every two weeks, on average, from pregnancy until the child turns two.
- Studies in the Journal of the American Medical Association found adolescents who’d been in the program were less likely to run away, get arrested or use alcohol or tobacco. Child abuse reports were 50% lower.
- RAND Corp. estimated U.S. program saved $1.26 to $5.70 for every $1 spent, thanks to lower hospital, jail and social assistance costs.
- Children were hurt less often and better prepared for school. Mothers has fewer subsequent pregnancies and more often had a job.
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