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

Model implementation summary last updated: 2020

The information in this implementation report reflects feedback, if provided, from this model’s developer as of the above date. The description of the implementation of the model(s) here may differ from how the model(s) was implemented in the manuscripts reviewed to determine this model’s evidence of effectiveness. Inclusion in the implementation report does not mean the practices described meet the HHS criteria for evidence of effectiveness. Please see the Effectiveness button on the left for more information about any research on the effectiveness of the model, including any version(s) of the model with effectiveness research. Versions of the model that are described in the Adaptations and enhancements section of this implementation report may include (1) versions that were identified by the model’s developer and (2) versions that have been implemented by researchers and have manuscripts that HomVEE rated high or moderate, but that are not supported by the model’s developer.

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 in February 2020. HomVEE reserves the right to edit the profile for clarity and consistency.

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