Topic: Child Abuse, Parenting, Early Intervention, Case Management
Target Population: Parents
Sector: Community-Based
This program is delivered to mothers who are pregnant and parents who may be at risk of poor parental and/or child health and development outcomes, including individuals with low income; single parents or those lacking support; and those with limited education, substance abuse problems, mental health issues, or a history of child abuse or domestic violence, and is intended to impact parents and children.
Maternal Early Childhood Sustained Home-Visiting (MECSH), originally titled the Miller Early Childhood Sustained Home-Visiting Program, is a community-based, nurse home-visitation program that is designed to promote health and well-being by fostering positive transitions to parenting, developing parenting and problem-solving skills, encouraging parents to plan for their child's and their own futures, and creating healthy relationships and a supportive network.
Two peer-reviewed evaluations conducted in Sydney, Australia, between 2005 and 2008 have documented the results of a randomized controlled trial of 208 parent-child pairs. One study demonstrated positive outcomes for mothers in rates of unassisted vaginal births, general health, and feeling more enabled to cope and care for themselves and their children; however, this study only demonstrated sustained effects lasting until 1-month postpartum. The second study looked for effects lasting up to 2-years postpartum but found mixed results with emotional and verbal responsiveness and duration of breastfeeding trending toward positive results, but these results were not statistically significant. There were no effects for parent-child interaction or child mental, psychomotor, or behavioral development. There were also high attrition rates for measures conducted beyond the 1-month postpartum follow-ups.
MECSH uses a strengths-based approach where nurse home visitors foster the development of a family’s abilities to adapt and self-manage. The program consists of five core elements:
Group activities and referral to and engagement with outside services and supports are also provided. Families should initiate services before the child is born, but may enroll in the program until the child is 2 months old.
MECSH was developed in 2002 in Sydney, Australia, and has been implemented in South Korea; the United Kingdom; and in the United States in Minnesota, Vermont, and Wyoming.
MECSH is implemented by a team of registered nurses, supervisors, and staff. Training is mandatory, and a 3-year license must be obtained from the University of New South Wales, Australia. To gain licensure, all program staff must complete at least two of six online courses. Nurses and supervisors must complete all six online courses, as well as an on-site or virtual pre-service training within 6 months of the start of implementation. Training costs are included in the license fee. Please use details in the Contact section to learn more.
Considerations for implementing this program include understanding program costs may be extensive, ensuring facilitators have a suitable background and receive training, and realizing that forming a relationship with a social services champion or key leader would be an important element for implementing and sustaining this program.
The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu
If you are interested in implementing MECSH, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu
MECSH consists of at least 25 home visits that are 60 to 90 minutes each. Families receive three prenatal visits, and, after the child’s birth, families receive weekly visits until the child is 6 weeks old. Then, visits occur every 2 weeks until the child is 12 weeks old, every 3 weeks until the child is 6 months old, every 6 weeks until the child is 12 months old, and every 2 months until the child is 2 years old.
An operating license costs $170,000 to $500,000 in U.S. dollars, and licensed users can download manuals, assessments, and service delivery and fidelity forms at no cost. Other costs may include those for data systems, equipment, vehicles, and office space for the home-visiting team.
To move MECSH to the Promising category on the Clearinghouse Continuum of Evidence, at least one evaluation should be performed demonstrating positive effects lasting at least six months from program completion.
The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email Clearinghouse@psu.edu
Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email: Clearinghouse@psu.edu
You may also contact Dr. Lynn Kemp by mail Centre for Translational Research and Social Innovation, School of Nursing and Midwifery, Western Sydney University, Ingham Institute, 1 Campbell Street, Liverpool, NSW 2170, Australia, email tresi@westernsydney.edu.au, or visit https://homvee.acf.hhs.gov/models/maternal-early-childhood-sustained-home-visiting-program-mecsh
Kemp, L., Harris, E., McMahon, C., Matthey, S., Vimpani, G., Anderson, T., ... Aslam, H. (2013). Benefits of psychosocial intervention and continuity of care by child and family health nurses in the pre- and postnatal period: Process evaluation. Journal of Advanced Nursing, 69(8), 1850-1861. https://doi.org/10.1111/jan.12052
Kemp, L., Harris, E., McMahon, C., Matthey, S., Vimpani, G., Anderson, T., ... Zapart, S. (2011). Child and family outcomes of a long-term nurse home visitation programme: A randomised controlled trial. Archives of Disease in Childhood, 96(6), 533-540. https://doi.org/10.1136/adc.2010.196279
Bruce, T., Byrne, F., & Kemp, L. (2018). Using skype to support remote clinical supervision for health professionals delivering a sustained maternal early childhood programme: A phenomenographical study. Contemporary Nurse: A Journal for the Australian Nursing Profession, 54(1), 4-12. https://doi.org/10.1080/10376178.2018.1441732
Gregory, A., Wild, K., Aquino, D., & Robinson, G. (2024). ‘They got my back’: Thematic analysis of relationship building in nurse home visiting in aboriginal communities. The Australian Journal of Rural Health, 32(6), 1227-1238. https://doi.org/10.1111/ajr.13199
Kanda, K., Blythe, S., Grace, R., Elcombe, E., & Kemp, L. (2022). Does customised care improve satisfaction and positively enable parents in sustained home visiting for mothers and children experiencing adversity? BMC Health Services Research, 22(1), 1-1361. https://doi.org/10.1186/s12913-022-08759-9
Kemp, L. (2016). Adaptation and fidelity: A recipe analogy for achieving both in population scale implementation. Prevention Science, 17(4), 429-438. https://doi.org/10.1007/s11121-016-0642-7
Kemp, L., Grace, R., Comino, E., Pulver, L. J., McMahon, C., Harris, E., ... Mack, H. A. (2018). The effectiveness of a sustained nurse home visiting intervention for Aboriginal infants compared with non-Aboriginal infants and with Aboriginal infants receiving usual child health care: A quasi-experimental trial - the Bulundidi Gudaga study. BMC Health Services Research, 18(1), 599-13. https://doi.org/10.1186/s12913-018-3394-1
Kemp, L., & Harris, E. (2012). The challenges of establishing and researching a sustained nurse home visiting programme within the universal child and family health service system. Journal of Research in Nursing, 17(2), 127-138. https://doi.org/10.1177/1744987111432228
Zapart, S., Knight, J., & Kemp, L. (2016). ‘It was easier because I had help’: Mothers’ reflections on the long-term impact of sustained nurse home visiting. Maternal and Child Health Journal, 20(1), 196-204. https://doi.org/10.1007/s10995-015-1819-6
