Estimated costs of implementation

Average cost per family

The average cost per family for the full program is $7,760 (2020 AUD), or approximately $5,138 (2020 USD). This includes staff salaries and materials.
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Labor costs

Nurse salaries vary by state, implementing agency, nurse experience, and location (urban versus rural). On average, salaries for full-time nurses are $100,953 (2020 USD). Salaries for 0.5 full-time equivalent nurse supervisors average $55,549 (2020 USD).

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Purchase of model or operating license

Initial licensing fees for support services range from $170,000 to $500,000 (2020 USD), depending on the supports and training needed. The lower fee range reflects the cost of support services for local- or county-level implementation of MECSH, whereas the higher range reflects the cost for statewide implementation of MECSH. A reduced fee can be negotiated for sites participating in research. A network license is available.

In addition to the licensing fee, the implementing agency must meet the costs for data systems, program materials, resources, equipment, vehicles, and an office location for the home visiting team.

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Cost of materials and forms

The Learning to Communicate Parent Handbook, which each parent receives, costs $25 (2020 AUD), or approximately $16.50 (2020 USD).

Core MECSH materials, including the MECSH manual and Learning to Communicate manual—which each nurse, nurse coordinator, and supervisor receives—cost $105 combined (2020 AUD), or approximately $70 (2020 USD).

Family Partnership Model resources, where required, cost $256 (2020 AUD) per nurse home visitor, or approximately $175 (2020 USD).

Costs associated with materials and forms for focus modules vary, depending on the modules selected (if any).

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

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Cost of 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 costs

The implementing 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 costs

Clients are identified, assessed for eligibility, recruited, and retained through the care provided by the implementing agency’s maternal, child, and family health services systems.
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Implementation notes

The information contained on this page was last updated in July 2020. 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 February 21, 2020. 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 but licensees remain subject to ongoing provision of data every three months demonstrating fidelity of model provision.
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Pre-service staff training

Before the in-person training, nurse home visitors, supervisors, and other program staff must complete two of six online courses on the MECSH model. Nurse home visitors and supervisors then receive in-person training in the MECSH Foundation Course, which covers the core MECSH curriculum, the Learning to Communicate curriculum, and focus modules customized to local community needs. Nurse home visitors and supervisors also must receive training in the Family Partnership Model approach (or equivalent training and/or experience), which aims to help primary care health workers collaborate with families to address the psychological and social problems that commonly arise in all families. The total length of the in-person training varies from two to five days depending on the prior experience and training of the nurse home visitors.

Supervisors participate in a one-day, in-person training focused on the model’s clinical practice supervision techniques.

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In-service staff training

Within six months of starting to deliver the model, nurse home visitors and supervisors are required to have completed all six courses of the MECSH online training and the in-person training.

To meet staff training needs at the local level, MECSH consultants offer annual in-person refresher trainings and master classes focused on model delivery processes and curricula.

After 12 months of implementing the model, MECSH consultants identify staff to serve as local trainers. The local agency trainers participate in a seven-day in-person training and 12 months of mentoring.

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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 July 2020. 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 February 21, 2020. 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

Distinguished Professor Lynn Kemp, Ph.D.
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@westernsydyney.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.

Kemp, L. (2016, May). Adaptation and fidelity: A recipe analogy for achieving both in population scale implementation. Prevention Science, 17(4):429–438.

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.

The Centre for Parent and Child Support. (n.d.). Family Partnership Model. Retrieved July 9, 2020, from http://www.cpcs.org.uk/index.php?page=about-family-partnership-model.

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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 services

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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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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Prerequisites for implementation

Type of implementing program

MECSH is implemented by organizations providing maternal, child, and family health and social services. Implementing agencies must have existing mechanisms, such as a population assessment and referral pathways, to identify and enroll eligible families.
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Staffing requirements

The MECSH model is implemented by a team of nurses, a nurse coordinator, supervisors, managers, and administrative staff. A program site must be supported by health and human services professionals, including social workers, 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 experience with and postgraduate training in child and family health nursing (or equivalent). Supervisors must be formally trained and/or have extensive experience with reflective clinical practice, a process of contemplating experiences while they are happening and retrospectively. Health and human services professionals who support the program site must be trained to meet their profession’s local registration requirements. The developer does not have minimum requirements regarding the education or experience of management staff; agencies implement MECSH using their existing management systems.
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Supervision requirements

The developer requires that nurse home visitors receive monthly team supervision, and recommends monthly individual supervision (with more frequent sessions for staff new to the MECSH model) 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.

The ratio of supervisors to home visitors is based on the home visitor team structure and supervisor arrangements for each program 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 with 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 prenatal 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 12 months.
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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 agency implementing the model.
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Implementation notes

The information contained on this page was last updated in July 2020. 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 February 21, 2020. 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, a manual for delivering the Learning to Communicate curriculum, and resources for delivering selected focus modules.
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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 clients complete a risk assessment, a pre-post assessment of family capacity to adapt and self-manage, and a parent satisfaction and enablement questionnaire. Staff complete child health and development assessments, such as the Ages and Stages Questionnaire or equivalent. Program sites also must assess the outcomes of the focus modules.
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Curriculum

MECSH includes a core curriculum that focuses on child, parental, and family health and development; identifying family aspirations; goal setting; and building the parent’s capacity to adapt, self-manage, and parent effectively despite day-to-day difficulties. The curriculum also covers the focus modules the implementing agency and developer selected to meet local needs.

The nurse home visitors also use the Learning to Communicate curriculum. The curriculum is delivered monthly for 12 months beginning when the child is one month old. Each 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 implementing agency is required to have or develop 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 report and meet fidelity standards related to staff qualifications and training, implementation support, client enrollment, client participation, and client satisfaction:

  • 100 percent of nurse home visitors 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 human services professionals are supporting the program site
  • 100 percent of pregnant women and parents of newborns up to eight weeks post-discharge from the hospital who receive care from the local agency that provides maternal, child, and family health services 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 July 2020. 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 February 21, 2020. HomVEE reserves the right to edit the profile for clarity and consistency.

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Model overview

Theoretical approach

The MECSH model expands traditional postpartum care 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, health-promoting prevention model supports families using an individualized and strengths-based approach. The model strives to establish a sustained, trusting partnership between the family and the home visitor. To achieve the child’s and family’s potential, the home visitor supports the development of the family’s abilities to adapt and self-manage. MECSH also builds the skills of medical practitioners and the capacity of the health services system to promote positive outcomes in the broader community.
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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 usually implemented within the context of a universal maternal, child, and family health services system. In Australia, this system guarantees all women access to free prenatal care and free health care services for children from birth to age 5 years. However, the model can be adapted for different systems and to meet local needs (described under Model Components).

Consultants based in the United States and the Sydney, Australia, MECSH International Support Team support implementation of the model in the United States.

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

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Intended population

The model serves parents with children younger than age 2 years who are at risk of adverse parental and/or child health and development outcomes. Eligible clients are pregnant women (of any maternal age and with any number of children) or parents/caregivers of any gender who (1) have newborns up to eight weeks post-discharge from the hospital; (2) demonstrate psycho-, socio-, demographic, and/or health characteristics that place the child at risk of poor health and development; and (3) lack the ability to adapt and self-manage.

To determine eligibility, parents are assessed for the following risk factors: lack of support, history of mental illness or childhood abuse, depression, anxiety, 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 parents’ transition to parenthood as they learn to adapt and self-manage despite day-to-day challenges; improve parental and child health and well-being; help parents establish and achieve goals for themselves and their children; and help parents foster relationships within the family and community.

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Model services

MECSH provides individualized, home-based services focusing on parent education, maternal health and well-being, family relationships, and goal setting. MECSH includes a set of core elements—the MECSH core curriculum and Learning to Communicate curriculum—that agencies must implement. A series of modules using evidence-based curricula, called focus modules, may be added to the core model. The implementing agencies and developer work together to select focus modules to address local needs.

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. Home visitors also support families on issues such as housing and finances. 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

Ideally, families enroll prenatally. However, families may enroll up to eight weeks after their newborn has been discharged from the hospital. MECSH is designed to provide a minimum of 25 home visits for families who enrolled prenatally and 22 visits for families who enrolled postnatally. These visits continue until the child’s second birthday and last from 60 to 90 minutes.

Families enrolled prenatally receive three prenatal visits. After the baby is born, families receive weekly visits until the child is 6 weeks old, visits every two weeks until the child is 12 weeks old, and visits every three weeks until the child is 6 months old. Then visits are spaced incrementally further apart and continue until the child’s second birthday.

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Location

In the United States, MECSH is being implemented in Minnesota, Vermont, and Wyoming. MECSH is also offered to families in Australia, South Korea, and the United Kingdom.
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Adaptations and enhancements

MECSH has flexible elements that can be customized to meet local needs. As described under Model Components, the model comprises two required curricula, the MECSH core curriculum and the Learning to Communicate curriculum, and a series of focus modules that may be added to the core model to address local needs. The developer and implementing agencies work together to select appropriate focus modules.
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Implementation notes

The information contained on this page was last updated in July 2020. 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 February 21, 2020. HomVEE reserves the right to edit the profile for clarity and consistency.

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