A structured nurse home visiting program for families at risk of poor maternal and child health and development outcomes.
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
- Targeted and specialist
Australian Study
Risk of Bias
Cost
Target Age Group
About
The Maternal Early Childhood Sustained Home-visiting (MECSH) program is a structured early intervention program of sustained nurse home visiting for families at risk of poor maternal and child health and development outcomes. It was developed as an effective intervention for vulnerable and at-risk mothers living in areas of socio-economic disadvantage. MECSH is delivered as part of a comprehensive, integrated approach to services for young children and their families, by child and family health nurses who are embedded within the universal child and family health services system.
Aims
- Improve mothers’ transition to parenting through pregnancy
- Improve maternal health and wellbeing
- Improve child health and development
- Support parents’ effective life skills
- Support problem solving skills
- Improve family and social relationships and networks
- Foster relationships within the family and with other families and services
- Prevent and reduce child maltreatment and neglect.
Impact
Evidence suggests that MECSH had no effect on most child, family and parent/caregiver outcomes. Evidence is mixed for other outcomes such as child wellbeing and parenting skills.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| Child | Mental health/behaviour | Not found | Yes | Not found |
| Child | Wellbeing | Yes | Yes | Not found |
| Family | Functioning | 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 | Social support | Not found | Yes | Not found |
| Parent/caregiver | Substance abuse | Not found | Yes | Not found |
| Parent/caregiver | Wellbeing | Not found | Yes | 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.
MECSH has an evidence rating of Supported+.
This means that MECSH 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. MECSH 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.
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 trial was conducted in New South Wales, Australia. The study was jointly funded by the Australian Research Council, Sydney South-West Area Health Service, New South Wales Department of Community Services and New South Wales Department of Health.
Sample
- A total of 208 mothers (111 intervention, 97 control) were enrolled in the study.
- Participants were pregnant, at-risk mothers who lived in multicultural, socio-economically disadvantaged urban suburbs in the greater Sydney area. Mothers presenting with one or more risk factors for poorer coping as a parent, when seen in the hospital antenatal clinic, were defined as at-risk.
- 102 participants (55 intervention, 47 control) were born overseas, in 31 different countries worldwide.
- 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
- MECSH is delivered in-person, to the parent only, through home-based services.
Target cohort
- New mothers at risk of poor maternal and child health and development outcomes, preferably identified before 20 weeks gestation.
Program delivery
- MECSH provides individualised, home-based services focusing on parent education, maternal health and wellbeing, family relationships and goal setting.
- Eligible families are contacted by the program nurse to participate in the program.
- MECSH uses a tiered service model, which encompasses the primary health care and more specialised services that families may need –
- Tier 1: Primary level of care to identify problems early in children’s development and provide general advice and health promotion and prevention.
- Tier 2: Service provided by professionals relating to workers in primary care to train and support professionals within tier one and support delivery of prevention and early intervention programs with families, including psychosocial support for families.
- Tier 3: A specialised service for more severe, complex or persistent issues, including assessment, treatment and assessment for referrals to tier 4.
- Tier 4: Tertiary level services such as day units, highly specialised outpatient teams and inpatient units to provide specialist treatment services.
- The original MECSH program used the Learning to Communicate program delivered by nurse home visitors 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 and child health service system as necessary.
- In addition to home visiting, MECSH provides group activities, such as parenting groups, and links families to events within the community.
- MECSH is licensed by the University of New South Wales and is currently offered to families in Australia, South Korea, the United Kingdom, and the United States.
Duration and intensity
- Services are delivered to families monthly over 12 months.
Manuals and guides
- We were unable to locate any manuals or guides to implement MECSH.
Additional information
- The Early Childhood Connect website has more information about the MESCH program and its program components.
We were unable to locate any information on staff and training requirements.
To our knowledge, MECSH is available in the Northern Territory. It has been implemented in Victoria, New South Wales and Tasmania.
In the Northern Territory, MECSH is being implemented as part of the government’s early childhood plan in East Arnhem, Katherine and Tennant Creek regions. Evaluation of the program’s sustainability and effectiveness is occurring from 2019 to 2024.
Cost
We were unable to locate any information on the cost of MECSH.
References
Studies identified and included in the review
- Kemp L, Harris, E, McMahon C, Matthey S, Vimpani G, Anderson T, Schmied V, Aslam H & Zapart S (2011). Child and family outcomes of a long-term nurse home visitation programme: a randomised controlled trial. Archives of Disease in Childhood, 96(6):533-54.
Studies identified but not counted towards the evidence rating due to study quality
No studies that were identified were excluded due to study quality.