I met with the Nurse Family Partnership team in Hamilton, Ontario, headed by NFP nurse supervisor, Dianne Busser. She is the also the Family Health Manager for the City of Hamilton. She has been in this role for over seven years, and prior to that worked in Public Health, Psychiatric nursing, and also the 24-hour nursing line. Her team of eight nurses come from a range of backgrounds prior to working in the Nurse Family Partnership – public health, labour and delivery, family health, and there was even an Australian nurse/midwife on the team.
Unlike the New York program, which admits pregnant women of any age on low incomes having their first baby, the Hamilton program adheres more closely to the original NFP program, admitting only women under 21, on low incomes, with “poor support”.
The City of Hamilton has nearly 6000 births per year, 21% of the population live in poverty, and there are a higher number of young pregnant women then in Canada overall.
Canada has a similar universal health program to Australia, and in order for the program to be introduced in a new health setting, there are three required steps for implementation.
Required steps for delivering NFP outside US
- Adaptation & Feasibility (completed in Hamilton, Ontario)
- Randomized Controlled Trial and process evaluation (underway in British Columbia – 2014-2018)
The NFP unit in Denver Colorado, which is headed by Professor Olds, has strict oversight over the NFP programs offered at sites around the world. NFP is now being implemented in Canada, The Netherlands, England, Scotland, Northern Ireland and Australia (I will describe more about the program in Australia in a following post).
The predominant maternal and child health program in Ontario is called Healthy Babies Healthy Children (HBHC), and is a delivered in a blended way by nurses and paid parenting support peers. It was originally universal, but is now offered to women following a risk assessment during the pregnancy, and if the women are “identified with risk”, then they are offered the HBHC program.
For women under 21, they are offered NFP instead of HBHC. The NFP nurses are required to maintain records for both the NFP program (paper record) and the Ontario Health Record, which is electronic.
The major difference between NFP in Canada and the US is the reduced case-load for Canadian nurses. The US nurses have a caseload of 25 clients, however, this is not sustainable in Canada, as the working conditions are different between the two sectors. In the US, nurses get 2 weeks annual leave, whereas in Canada the nurses get 6 weeks annual leave and up to 10 public holidays (eight weeks in total). With six less working weeks per year, the case-load cannot be maintained at 25 clients, so it has been reduced to 20.