Maternal Early Childhood Sustained Home-Visiting Program (MECSH)

Developed in Australia, the Maternal Early Childhood Sustained Home-Visiting (MECSH) program is designed to enhance maternal and child outcomes by providing prenatal and postnatal services. The model can be adapted for systems outside of Australia and to meet local needs. MECSH serves parents or caregivers at risk of adverse parental and/or child health and development outcomes. Registered nurses with experience with and/or postgraduate training in child and family health conduct a minimum of 22 (for postnatal enrollment) to 25 (for prenatal enrollment) 60- to 90-minute home visits. Nurse home visitors deliver services until the child’s second birthday. During the visits, nurses focus on parent education, child development, parent-child relationships, maternal health and well-being, family relationships, goal setting, and other issues such as housing and finances. Also available are parenting groups, activities to link families to the community, and referrals to other specialized care (such as dietitians and drug and alcohol counselors).

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The Maternal Early Childhood Sustained Home-Visiting Program (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 health practitioners and the capacity of the health services system to promote positive outcomes in the broader community.

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

The University of New South Wales, Sydney, Australia, developed the MECSH model. Western Sydney University 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 services).

The MECSH International Support Team along with consultants based in the United States support implementation of the model in the United States.

MECSH support services include clinical support, guidance on adapting the model, MECSH curriculum training, technical assistance, and support for fidelity monitoring and facilitating a community of practice.

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 who are 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.

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; support and model positive parent-infant interaction; promote positive parent-child relationships; help parents establish and achieve goals for themselves and their children; and help parents foster relationships within their family and community.

MECSH provides individualized, home-based services focusing on parent education, maternal health and well-being, parent-child relationships, family relationships, and goal setting. MECSH includes a set of core elements—the MECSH core curriculum, the Learning to Communicate curriculum, and components of the Promoting First Relationships^® curriculum—that agencies must implement.

The MECSH core curriculum 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. A series of modules using evidence-based curricula, called focus modules, may be added to the core model. The program sites and developer work together to select focus modules to be implemented alongside the core curriculum to address local needs.

The Learning to Communicate curriculum is designed to foster parent-child relationships and children’s development and is delivered monthly for 12 months beginning when the child is one month old. Components of Promoting First Relationships^®, including the handouts and video-feedback techniques, are also delivered to support positive parent-child interactions.

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.

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.

MECSH has a core structure that all sites must implement, but the model has embedded flexibility so sites can add elements (focus modules) to meet the needs of the community being served. Existing local programs can be integrated into the MECSH curriculum. For example, Minnesota has an existing family health evaluation program that offers services such as intimate partner violence and depression screening and breastfeeding and immunization advice. This program is integrated into the Minnesota MECSH program alongside the MECSH core curriculum. All adaptions and enhancements are co-designed with each site.

MECSH is implemented by organizations that provide maternal, child, and family health and social services. Program sites must have existing mechanisms, such as a population assessment and referral pathways, to identify and enroll eligible families.

The model developer requires program sites to report and meet fidelity standards related to staff qualifications and training, implementation support, client enrollment, client participation, and client satisfaction. MECSH fidelity monitoring can be built into sites’ existing data systems, or the developer can provide a quality monitoring system. Please contact the model developer for additional information about these standards.

The MECSH model is implemented by a team of nurses, a nurse coordinator, supervisors, managers, and administrative staff. The developer recommends that a program site have community partnerships with health and human services professionals, including social workers, perinatal psychiatrists, dietitians, and drug and alcohol counselors.

Home visits are provided by registered nurses with a bachelor’s degree (or equivalent) and experience with and/or postgraduate training in child and family health nursing (or equivalent). Supervisors must be formally trained in the MECSH supervision model and have experience with reflective clinical practice, a process of contemplating experiences both retrospectively and while they are happening.

The developer requires that nurse home visitors receive regular team supervision and recommends individual supervision to support reflection on clinical practices that the nurses deliver in the home. Clinical supervisors support the home visitors and managers should provide supervision related to program management. Please contact the model developer for information about whether supervision or support is offered to clinical supervisors.

The model requires home visitors and supervisors to participate in the 30-hour pre-service MECSH Family Partnership Model Foundation training and MECSH eLearning, a series of online courses. Supervisors participate in a one-day training focused on the model’s clinical practice supervision techniques. Please contact the model developer for additional information about the pre-service training requirement and for information about ongoing professional development requirements.

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

Lorna Corbett, BS, BSN, RN
MECSH USA Implementation Consultant
Email: lornacmecshusa@outlook.com

Website: Early Childhood Connect MECSH