Prerequisites for Implementation

Type of Implementing Agency

MECSH is implemented by the local primary health care service.

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Staffing Requirements

The MECSH model is implemented by a team of nurses, a nurse coordinator, and a social worker, as well as supervisors, managers, and administrative staff. A program site must be supported by health and child welfare professionals, including perinatal psychiatrists, dieticians, and drug and alcohol counselors.

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Staff Education and Experience

Home visits are provided by registered nurses with a bachelor’s degree (or equivalent) and postgraduate training and experience in child and family health nursing (or equivalent). Supervisors should be formally trained and skilled in reflective clinical practice, a process of contemplating experiences while they are happening and retrospectively. Health and child welfare professionals who support the program site must be trained to meet their profession’s local registration requirements.

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Supervision Requirements

The developer recommends individual and team supervision to support reflection on clinical practices that the nurses deliver in the home. Clinical supervisors should oversee the home visitors and managers should provide supervision related to program management. Individual supervision sessions should occur at least monthly, with more frequent sessions for staff new to the MECSH model. Team supervision should occur monthly.

The ratio of supervisors to home visitors is based on the home visitor team structure and supervisor arrangements for each site.

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Staff Ratio Requirements

Full-time nurse home visitors manage a caseload of up to 30 families. Part-time home visitors and those with a higher proportion of families with very complex needs or families in rural areas that require additional travel time have smaller caseloads. Caseloads should include a mix of families at varying program stages. The developer suggests 6 antenatal families, 6 families with children 0 to 6 months old, 6 families with children 6 to 12 months old, and 12 families with children older than 1 year.

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Data Systems/Technology Requirements

MECSH requires a data system to record key fidelity measures, including client eligibility, recruitment, retention, model delivery, and client impact. The data system should be established within the administrative data systems of the primary health care service agency implementing the model.

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Implementation Notes

The information contained on this page was last updated in April 2018. Recommended Further Reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by Dr. Lynn Kemp at the Western Sydney University on January 8, 2018. HomVEE reserves the right to edit the profile for clarity and consistency.

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Materials and Forms to Support Implementation

Operations Manuals

Licensed users receive the MECSH operations manual and a manual for operating the Learning to Communicate curriculum.

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Service Delivery Forms

The model developer provides licensed users with information sheets and consent forms for clients, and checklists for recording the activities completed during home visits.

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Assessment Tools

All participants complete a risk assessment, the Edinburgh Postnatal Depression Scale, and a parent satisfaction and enablement questionnaire.

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Curriculum

The nurse home visitors use the Learning to Communicate curriculum. The curriculum is delivered monthly for 12 months beginning when the child is one month old. Each participating family receives a copy of the Learning to Communicate Parent Handbook and access to online support materials.

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Available Languages

Materials are available in English and Korean.

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Fidelity Measurement

The primary health care service agency is required to provide a system for recording fidelity. The developer provides an online database for transmitting the collected fidelity data every three months as required under the licensing agreement. Implementing agencies receive feedback on their performance.

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Fidelity Standards

The model developer requires implementing agencies to meet and report fidelity standards related to staff qualifications and training, implementation support, client enrollment, client participation, and client satisfaction:

  • 100 percent of nurses have child and family health (or equivalent) qualification
  • 100 percent of key program staff receive training in the MECSH model, working in partnership with families (Family Partnership Model or equivalent), and the Learning to Communicate curriculum
  • 100 percent of nurses receive clinical supervision
  • Health and welfare professionals are supporting the program
  • 100 percent of pregnant women who receive routine care from the universal maternal, child, and family health services system are assessed for eligibility
  • 100 percent of eligible families are offered the program
  • More than 75 percent of families offered the program agree to participate
  • More than 65 percent of recruited families remain in the program when their children are 12 months old
  • More than 50 percent of families complete the program when their children are 2 years old
  • 100 percent of families are receiving the minimum number of scheduled visits of appropriate duration
  • Primary caregivers score greater than 20 on the modified Patient Satisfaction Questionnaire (PSQ-18) and greater than 4 on the modified Patient Enablement Instrument (PEI)
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Implementation Notes

The information contained on this page was last updated in April 2018. Recommended Further Reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by Dr. Lynn Kemp at the Western Sydney University on January 8, 2018. HomVEE reserves the right to edit the profile for clarity and consistency.

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Estimated Costs of Implementation

Average Cost per Family

The average cost per family for the full program is $6,435 (2018 AUD), or approximately $4,763 (2018 USD). This includes staff salaries and materials.

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Labor Costs

Salaries for nurses are $88,962 and salaries for social workers are $88,627 (2018 AUD), or approximately $65,842 and $65,594, respectively (2018 USD).

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Purchase of Model or Operating License

Initial licensing fees for support services range from $150,000 to $300,000 (2018 AUD), or approximately $111,017 to $222,034 (2018 USD), depending on the supports and training needed. A reduced fee can be negotiated for sites participating in research. A network license is available.

In addition to the licensing fee, the primary health care service agency must meet the costs for data systems, program materials, resources, equipment, vehicles, and accommodation for the home visiting team.

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Materials and Forms

The Learning to Communicate Parent Handbook, which each parent receives, costs $20 (2018 AUD), or approximately $15 (2018 USD).

The MECSH manual and Learning to Communicate manual, which each nurse and nurse coordinator receives, cost $60 combined (2018 AUD), or approximately $44 (2018 USD).

Licensed users can download manuals, and assessment, service delivery, and fidelity forms free of charge.

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Training and Technical Assistance

The costs of online and in-person training and technical assistance are included in the license’s support service fee.

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Infrastructure

The primary health care service agency must meet the costs of providing data systems to track fidelity. The online fidelity reporting data system is included in the license’s support service fee.

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Recruitment and Retention

Clients are identified, assessed for eligibility, recruited, and retained through the routine care provided by universal maternal, child, and family health services systems.

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Implementation Notes

The information contained on this page was last updated in April 2018. Recommended Further Reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by Dr. Lynn Kemp at the Western Sydney University on January 8, 2018. HomVEE reserves the right to edit the profile for clarity and consistency.

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Training to Support Implementation

Requirements for Program Certification

MECSH is a licensed program of Western Sydney University under agreement with the University of New South Wales, Australia. Licensees are granted a three-year, nonexclusive, nontransferable license to implement the MECSH model subject to (1) payment of a support service fee for implementation support and (2) regular provision of data every three months demonstrating fidelity of model provision. After the first three years, the license may be renewed and no further fees are required subject to ongoing provision of data every three months demonstrating fidelity of model provision.

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Pre-Service Staff Training

Nurse home visitors and supervisors are required to receive training in the Family Partnership Model approach (or equivalent), which aims to help primary care health workers collaborate with families to address the psychological and social problems that commonly arise in all families; they also receive training in the Learning to Communicate curriculum.

Nurses, supervisors, and other program staff are also required to complete two modules of online training in the MECSH model before working in the program. Supervisors are trained in reflective clinical practice supervision techniques.

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In-Service Staff Training

Within six months of starting to work in the program, nurses and supervisors are required to complete six modules of online training and an in-person, two-day training.

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Training Materials

An online and in-person training program is available through the model developer.

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Qualified Trainers

MECSH includes an on-site visit, training, and online access to the model developer and consultants.

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Technical Assistance

MECSH support service includes technical assistance and support for fidelity monitoring.

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Implementation Notes

The information contained on this page was last updated in April 2018. Recommended Further Reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by Dr. Lynn Kemp at the Western Sydney University on January 8, 2018. HomVEE reserves the right to edit the profile for clarity and consistency.

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More Information About the Model

Where to Find Out More

Lynn Kemp, Ph.D.
Translational Research and Social Innovation Group
School of Nursing and Midwifery
Western Sydney University
Ingham Institute
1 Campbell Street
Liverpool, NSW 2170
Australia
Email: lynn.kemp@westernsydney.edu.au

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Recommended Further Reading

The following references were sources for the implementation profile or were recommended by the model developer for further reading.

Family Partnership Training Australia. (2009). Introduction to the Family Partnership Training Program (FPTP). Retrieved May 1, 2012, from http://www.fpta.org.au/?page=about.

Kemp, L. (2011, May). Sustained nurse home visiting research and intervention programs in New South Wales. Presented at the 2011 Australian Research Alliance for Children and Youth forum. Retrieved from http://www.aracy.org.au/index.cfm?pageName=aracy_2011_forum.

Schmied, V., Homer, C., Kemp, L., Thomas, C., Fowler, C., and Kruske, S. (2008). The role and nature of universal health services for pregnant women, children and families in Australia. Collaboration for Research into Universal Health Services for Mothers and Children. Retrieved from http://www.aracy.org.au/cmsdocuments/Towards_seamless_services_literature_review.pdf.

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Implementation Experiences

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 Studies for Implementation Experiences for a list of the studies and to link to the characteristics of the samples examined in the effectiveness 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 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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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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Model Adaptations or Enhancements

None of the studies discussed 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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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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Model Overview

Implementation Support

The Maternal Early Childhood Sustained Home-Visiting (MECSH) program* is a program of Western Sydney University (under license with the University of New South Wales), Australia, which provides implementation support. MECSH is implemented within the context of a universal maternal, child, and family health services system. This system guarantees all women access to free prenatal care, and children from birth to age 5 receive free health care services.

* The model was formerly known as the Miller Early Childhood Sustained Home-Visiting program.

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Theoretical Model

The MECSH model expands traditional postpartum care in Australia by providing home visiting services during and after pregnancy that are designed to enhance maternal and child outcomes. Based on an ecological framework, MECSH addresses issues at the individual, family, and community levels that affect the health and well-being of families and children. The child-focused prevention model supports families using an individualized, strengths-based approach and strives to establish a sustained, trusting partnership between the family and home visitor.

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Target Population

The model targets disadvantaged, pregnant women at risk of adverse maternal and/or child health and development outcomes. To determine eligibility, women are assessed for the following risk factors: lack of support, history of mental illness or childhood abuse, depression, life stressors, history of domestic violence, or alcohol or drug use in the home.

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Targeted Outcomes

MECSH is designed to support women’s transition to parenthood as they learn to adapt and self-manage despite the day-to-day challenges they face; improve maternal and child health and well-being; help mothers establish and achieve goals for themselves and their children; and help mothers foster relationships within the family and community.

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Model Components

MECSH provides individualized, home-based services focusing on parent education, maternal health and well-being, family relationships, and goal setting. In addition, the nurse home visitors implement the Learning to Communicate curriculum when the child is one month old. The curriculum is designed to foster children’s development and is delivered monthly for 12 months. The home visitors also support families on issues such as housing and finances. The home visitors receive support from and refer families to practitioners within the maternal, child, and family health services system as necessary.

In addition to home visiting, MECSH provides group activities, such as parenting groups, and links families to events within the community.

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Model Intensity and Length

MECSH is designed to provide a minimum of 25 home visits, which begin during pregnancy and continue to the child’s second birthday. The visits last from 60 to 90 minutes.

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Location

MECSH is offered to families in Australia, South Korea, the United Kingdom, and the United States.

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Adaptations and Enhancements

No adaptations or enhancements have been made to the model.

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Implementation Notes

The information contained on this page was last updated in April 2018. Recommended Further Reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by Dr. Lynn Kemp at the Western Sydney University on January 8, 2018. HomVEE reserves the right to edit the profile for clarity and consistency.

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