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

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 medical 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.

MECSH 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 services).

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

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

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.

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.

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.

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 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 beginning when the child is one month old. 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 flexible elements that can be customized to meet local needs. 

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.

The model developer requires implementing programs to report and meet fidelity standards related to staff qualifications and training, implementation support, client enrollment, client participation, and client satisfaction. Please contact the model developer for additional information about these guidelines.

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.

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.

The developer requires that nurse home visitors receive monthly team supervision and recommends monthly individual 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.

The model requires home visitors and supervisors to participate in pre-service 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. They must also receive training in working in partnership with 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. Please contact the model developer for additional information about the pre-service training requirement.

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 courses. Please contact the model developer for additional information about the ongoing professional development requirement.