A relationship-based model of sustained nurse home visiting delivered by highly trained professionals and embedded in the universal health service to improve outcomes for children and their families.
The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness from this review. It does not necessarily reflect all the evidence about the program. The research was selected and assessed for inclusion on the Menu and towards the evidence rating because it met selection criteria related to the specific topic area, study design, quality assessment and the outcomes of interest.
Overview
Evidence Rating
Pathway
- Early help
Australian Study
Risk of Bias
Cost
Target Age Group
About
right@home is an Australian nurse home visiting program specifically targeted to improve outcomes for children and their families. The program builds parents’ capacity to provide safe, responsive care and a home environment that supports children’s learning. It is designed for the Australian context to integrate with and sustainably strengthen the existing universal Maternal and Child Health (MCH) service. Beginning during pregnancy and continuing until the child reaches age 2, parents who take part in right@home receive 25 home visits by a specially trained MCH nurse, who is further supported by a social worker.
Aims
- Improve child health and development
- Improve maternal outcomes
- Improve the home learning environment
- Increase parents’ competence to care for and respond to their children
- Improve parental stress and mental health
- Improve access to community support and resources.
Impact
Evidence shows a mix of results or no effect or difference across most outcomes. There is evidence of implementation efficacy with participants in the intervention reported being more satisfied with the program and better able to care for themselves and their children than those receiving usual care. No evidence was found for changing parent mental health and behaviours, their education, substance abuse, employment and family functioning.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| Child | Mental health/behaviour | Yes | Yes | Not found |
| Child | Wellbeing | Yes | Yes | Yes |
| Family | Employment | Not found | Yes | Not found |
| Cost | Functioning | Not found | Yes | Not found |
| Parent/caregiver | Education | Not found | Yes | Not found |
| Parent/caregiver | Mental health/functioning | Not found | Yes | Not found |
| Parent/caregiver | Parenting skills | Yes | Yes | Not found |
| Parent/caregiver | Substance abuse | Not found | Yes | Not found |
| Parent/caregiver | Wellbeing | Yes | Yes | Not found |
| Implementation | Satisfaction | Yes | Not found | Not found |
How to read the table:
When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Using the Menu page.
right@home has an evidence rating of Supported+.
This means that right@home has evidence from one randomised controlled trial (RCT) or quasi-experiment (QE) demonstrating positive, long-term impact on at least one child and family outcome.
This assessment is based on one research output of RCT design. right@home has not received a Well-supported rating as it has not yet replicated its results in another RCT or QE with a different population or setting.
| Study design | Number of research outputs included |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | 1 |
| Quasi-experiment | Not identified or included |
The evidence has some concerns with risk of bias.
We can be reasonably confident about the results and quality of evidence from the included study.
The study was conducted in Australia but we do not have sufficient information to know if Aboriginal children and families were included in the study.
Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.
Location
- The RCT was conducted in Victoria and Tasmania, Australia.
Sample characteristics
- 722 mothers (363 intervention, 359 control) were enrolled in the trial.
- The mothers were pregnant women attending public hospital antenatal clinics and experiencing a range of psychosocial and socioeconomic adversity. They reported lower levels of tertiary qualifications, were less likely to be married or living with a partner, were more likely to live in the most socially disadvantaged areas and had poor mental health.
- Women in the intervention group were offered about 25 nurse visits (60 to 90 minutes each based on content in the protocol), which commenced antenatally and were delivered mostly by the same trained right@home nurse. The intervention also included about one visit by the program social care practitioner, who supported the nurse to deliver the intervention and provided brief counselling interventions and case management for families as needed.
- The control group received usual care via the MCH service. The usual care services included 6 consultations in Tasmania and 9 in Victoria up until the child turned 2. The first was offered in families’ homes, and successive consultations occurred at the local centre, with some limited program flexibility depending on family need.
- The study was conducted in Australia, but we were unable to locate information on sample characteristics specific to Aboriginal children and families.
Implementation
Delivery model, mode and setting
- right@home is delivered in-person, to the parent only, in their home.
Target cohort
- Antenatal mothers experiencing adversity
- Children up to age 2.
Program delivery
- right@home based on the Maternal Early Childhood Sustained Home-visiting (MECSH) program, a structured program of sustained nurse home visiting for families at risk of poorer maternal and child health and development outcomes.
- The program is underpinned by evidence-based strategies across the content areas of sleep, safety, nutrition, regulation and bonding and/or relationship; and using the delivery processes video feedback and motivational interviewing strategies.
- right@home is delivered by highly trained MCH nurses and is embedded in the universal system to improve outcomes at child age 2; specifically changes in parent care and home learning environment.
- It includes additional modules to help parents care for and respond to their children, and to create a supportive home learning environment. All right@home teams include a social worker who offers additional support to the nurses and families.
- right@home is a collaborative partnership that draws on the strengths of 3 organisations: the Australian Research Alliance for Children and Youth (ARACY), the Centre for Community Child Health and the Translational Research and Social Innovation Group (TReSI) at Western Sydney University.
Manuals and guides
- We were unable to locate any manuals or guides to implement right@home.
Additional information
- The Australian Research Alliance for Children and Youth (ARACY) website has more information about the program, including local research.
To our knowledge, right@home is available in Queensland to families living in the Logan, Beenleigh and Browns Plains, Pine Rivers and Caboolture areas. A formal referral from midwives, GPs or child health nurses is required to access this service.
right@home was implemented in Victoria and Tasmania as part of the RCT, but recruitment is no longer ongoing.
Cost
Combined intervention costs of Maternal and Child Health (MCH) staff training, supervision and visits delivered over the full program averaged $9,385 per intervention group participant and $1,879 per control group participant. This equates to an additional cost of approximately $7,500, which reflects the differential number of home visits received.
References
Studies identified and included in the review
- Goldfeld S, Price A, Smith C, Bruce T, Bryson H, Mensah F, Orsini F, Gold L, Hiscock H, Bishop L, Smith A, Perlen S & Kemp L (2019). Nurse home visiting for families experiencing adversity: A randomized trial. Pediatrics, 143(1):e20181206.
Studies identified but not counted towards the evidence rating due to study quality
No studies that were identified were excluded due to study quality.