Experiences from conception to age six have the most important influence of any time in the life

Helping Early Adjustment and Relationships to Thrive (HEART)

Helping Early Adjustment and Relationships to Thrive (HEART) Project

Summary of the Project

The HEART Study is a quasi-experimental (pre/post) evaluation of the HEART Program, already being employed in selected centres in Ontario and Alberta that serve high risk parents (Aboriginal, teenage, and those known to Child Welfare). Developed by the Infant Mental Health Promotion Program at the Hospital for Sick Children (key program partner), HEART is designed to augment other supports offered by partner agencies by providing all caregivers of children exposed to toxic stressors with detailed reports and developmental guidance on their child's current milestones in social-emotional adjustment. In other words, caregivers are taught to be sensitive and respond to their children in targeted ways that will promote their children's mental health and behavioural adjustment. Caregivers are supported to do so over the 4 month program. Pilot data on 33 children suggest modest effect sizes from the intervention. If found to be effective, the HEART program is ready for wide-spread adoption.

Leading experts in population health and health equity recommend intervening early to promote child development, including “cognitive or linguistic development but also, crucially, social and emotional development”. This recommendation is drawn from abundant evidence linking stressful early experiences with parents/primary caregivers and poor quality parent-child relationships to social-emotional adjustment problems in children. Children who experience early abuse or neglect are particularly vulnerable to social-emotional adjustment, cognitive and language problems, placing them on a trajectory of risk for later mental disorders. Children at highest risk are those known to the child welfare system, and children of adolescent and Aboriginal parents. While some existing intervention programs effectively improve at-risk children’s health and development and parent-child relationship quality; often, these are not feasible for public health and social service agencies to offer as sustainable services, due to intense, time-demanding training, specialized education requirements for service providers, and high costs of delivery. In contrast, the HEART program, already offered and piloted in Ontario, is feasible to implement, aimed at a wide variety of health and social service providers and requires brief training. Thus, we propose to test the HEART Program, designed primarily to address at-risk children’s social-emotional adjustment and relevant gaps in service provider knowledge and skill. The HEART program stands to promote social-emotional adjustment, and cognitive and language development of Canada’s most vulnerable citizens and thus contribute to overall population health equity and population health.

Goals and Objectives

• What is the effect of the innovative HEART intervention for children known to child welfare on young children's (6 months to 3 years) mental health and behaviour?

In close collaboration with community partners, our primary aim (1) is to test of the efficacy of the innovative, existing HEART program on at-risk children’s social-emotional adjustment. Our secondary aims include: (2a) testing the efficacy of the HEART program on at-risk children’s cognitive and language development; and (2b) assessing the influence of the HEART program on service providers’ knowledge and capacity to support at-risk infants’ and children’s social-emotional adjustment, cognitive and language development, as a measure of intervention fidelity. 

Data showed the program to be effective. Additional intervention and evaluation is ongoing in partnership with Dr. Chaya Kulkarni and local researcher Dr Jennifer Zwicker.

Funded by: 

Anonymous Donor

Members of the Team


Name and Title: Dr. Nicole Letourneau (PI), Professor and ACHF Research Chair in Parent-Infant Mental Health
Email Address: Nicole.Letourneau@ucalgary.ca

Name and Title: Chaya Kulkarni, Director of Infant Mental Health Promotion (IMHP), The Hospital for Sick Children, Toronto
Email Address: chaya.kulkarni@sickkids.ca


Name and Title: Jon Reeves, Executive Officer/Regional Director, Southern Alberta Child Intervention Services
Name and Title: Brenda Packard, Children’s Aid Society of Toronto (Infant Mental Health and Family Law Initiative Chair)
Name and Title: Marg Cutler, Acting Associate Director | Calgary and Area Child and Family Services, Government of Alberta