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Implementing Maternal Early Childhood Sustained Home-Visiting Program (MECSH)

Meets DHHS criteria for an evidenced based model

Implementation Experiences

Last Updated

November 2013

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Summary of Sources

Information in this section is based on studies included in the HomVEE review. For the Maternal Early Childhood Sustained Home-Visiting (MECSH) program, we reviewed two randomized controlled trials (RCTs) and two standalone implementation articles. (Please see the study database for a list of the studies.)

The two RCTs examined the same group of participants being served by the same set of program sites. As a result of this overlap, we refer to these as only one study throughout the rest of this section. An earlier implementation study focused exclusively on the prenatal stage of the same MECSH trial.

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Characteristics of Program Model Participants

One study reported that the MECSH trial enrolled 111 pregnant women with at least one psychosocial risk factor in. Another study focused exclusively on the prenatal stage of the program reported characteristics for 91 women of the women.

In the study that reported participant demographics for all 111 participants, the women enrolled averaged 28 years of age, and more than a quarter were first-time mothers. In addition, one study reported that about half of the participants were born in Australia, whereas the rest were born elsewhere. The vast majority (81 percent) of women were married or living with their partner, and 83 percent completed high school. Almost 70 percent of the women were employed either full- or part-time. Half of the women had at least one psychosocial risk factor; depressive symptoms were most common (41 percent).

According to all the studies reviewed, participation in MECSH was voluntary.

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Location and Setting

The studies reported that the MECSH trial was implemented in Sydney, Australia.

One study described the intervention setting as suburban.

The study also reported that MECSH was embedded in the country’s universal health service system and nurses employed by local child and family health nursing services delivered the intervention.

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Staffing and Supervision

In all three studies, registered nurses with additional training in child and family nursing implemented MECSH. One study also reported that the program was supported by a social worker, a perinatal psychiatrist, and other health and child welfare professionals.

Two of the three studies discussed the home visitors’ experience. In one study, the nurses had between 5 and 15 years of experience as a community child and family health nurse and all were trained in establishing trusting partnerships with families. The other study reported that all the home visitors had at least 9 years of nursing experience and most of them had more than 5 years of experience in community-based nursing. All were also trained on establishing trusting partnerships with families.

One study reported nurses received training in the MECSH model. None of the studies provided details on staff training or information on supervision.

One of the studies reported that each home visitor could manage a caseload of 25 families at any given time.

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Program Model Components

One study reported that MECSH included home visits, hospital-based prenatal care, and group activities. Two studies reported that the intervention was designed to be initiated during pregnancy and continue to the child’s second birthday, for a total duration of about 2.5 years. According to one of the studies, all women in the region were expected to receive a universal health service home visit by a child and family health nurse within two weeks of giving birth. MECSH nurses conducted the visits for women enrolled in the program.

Two studies reported that the program covered general domains such as parenting, maternal mental health, preventive health, family well-being, infant well-being, safety, planning and goal setting, and housing and child care issues. One of the studies also noted that hospital staff held primary responsibility for preparing mothers for birth, and MECSH nurses provided additional and reinforcing messages.

According to one of the two studies, the following topics were addressed with more than 50 percent of the participants during the prenatal stage of the intervention: maternal health and nutrition, maternal mood, partnership issues, family’s social support network, relationship with extended family, relationships with other children, caregiver’s goals for coming weeks, caregiver’s aspirations for self, expectations of having a baby, caregiver’s aspirations for baby, infant feeding, contraception/conception, pregnancy/childbirth terminology, finance/budget, and housing/physical environment. The other study also reported that most mothers received information and advice on infant feeding and added that most were also provided information about infant sleeping (including sudden infant death syndrome [SIDS] risk reduction).

One study reported that the home visitors used a standardized curriculum, Learning to Communicate, designed to foster children’s development. The curriculum was delivered monthly for 12 months, beginning when the child was one month old. In addition, the program provided group activities such as parenting groups and linked families to events within the community.

Two studies reported that the program obtained information on psychosocial risks and depressive symptoms from obstetrical administrative records.

None of the studies described whether the program was implemented in languages other than English.

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Program Model Adaptations or Enhancements

None of the studies discussed program model adaptations or enhancements.

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Dosage

Of the two studies that discussed the actual level of services received, both reported that home visits began on average at 26 weeks gestation (range 12–40). On average, women received 16 visits (range 0–52), including 2 or 3 prenatal visits, of 60 to 90 minutes duration and participated in the program until their children were a little over a year (range 0–122 weeks). One of the studies added that 82 percent of participants were visited prenatally, 95 percent were visited in the first year, and 53 percent were visited in the second year.

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Fidelity Measurement

None of the studies reviewed discussed how the program measured fidelity to the model.

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Costs

None of the studies reviewed estimated program costs.

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Lessons Learned

Two of the three studies reported lessons learned about implementing the program.

One study's authors found no differences between first-time mothers and multiparous mothers on a number of outcomes, suggesting that the benefits of home visiting programs are not limited to first-time mothers.

One study examined successful approaches to establishing a trusting partnership with families in which they feel comfortable sharing sensitive personal information. The study described the following lessons.

  • The relationship involves a constant give and take between the nurse and the family. The home visitor responds to a family’s display of trust by providing additional practical support. The nurse may also reciprocate by sharing some of her personal experiences.
  • The home visitors need to cultivate the skill of being “actively passive.” Through patient, unobtrusive observation, the nurse becomes attuned to the family’s signals.
  • The family is the initiator in the relationship. The mother decides when and how much information she wants to share with the home visitor. She cannot be pushed into divulging personal information and should not be punished for choosing not to share.
  • The disclosure of personal information is not necessarily a sign that the nurse has been able to establish a trusting partnership with the family. Families may share information if a relationship has not been established or choose not to disclose information if they have established a trusting relationship with the home visitor. The critical element is that the family is able to speak with someone, whether it is the nurse or someone else, about their personal issues.
  • The families, not the nurses, choose their goals and strategies. The continuity of a sustained relationship is also important to the development of a trusting partnership.

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