EIF PROGRAMME REPORT MATERNAL EARLY CHILDHOOD SUSTAINED HOME-VISITING (MECSH) JULY 2016
2 How to read an EIF Programme Report This Programme Report should be read in conjunction with our guidance on How to read an EIF Programme Report, which provides an explanation of the contents of the summary material. This can be found on the EIF website. Scope This assessment is based on information gathered through the EIF s review of What Works to support parentchild interaction in the period from conception to age 5 years in order to improve child development. The child outcomes reviewed were limited to impacts on attachment and/or parent sensitivity; behaviour and social and emotional skills; and cognitive development, in particular early literacy and use of language. The rating included represents an assessment in relation to these outcomes only. Disclaimer The information in this report and the rating of impact is designed to provide information for those developing early intervention programmes and systems. The evidence can be used to inform and assist professional judgement, but it is not a substitute for it. This Report does not purport to contain all the information that may be required by third parties in order to exercise their judgement. Evidence about what has worked in the past offers no guarantee that an approach will work in all circumstances. Every effort has been made to ensure the accuracy of the information, but no legal responsibility is accepted for (i) any errors or omissions (negligent or otherwise); and (ii) any consequences resulting from the use of or reliance on this Report. The Report includes reference to research and publications of third parties: the Early Intervention Foundation is not responsible for, and does not guarantee the accuracy, completeness, timeliness or availability of, those third party materials or any related material. The Early Intervention Foundation does not perform an audit and undertakes no duty of due diligence or independent verification of any information (including, but expressly not limited to, information about costs of the programmes) it receives from third parties including the programme providers. The rating is an independent judgement based on the facts reported to EIF as of the date expressed. It is not a recommendation or a statement of fact. This Report is provided on an as is basis without warranty of any kind, either express or implied.
3 Summary: Maternal Early Childhood Sustained Homevisiting (MECSH) Programme Description Brief Description Based on the version of the programme evaluated in its best evidence. Primary Outcome Domain: Attachment; Cognitive Delivery Model: Home Visiting Child Age: Perinatal Level of Need: Targeted Selective Full Description Based on information agreed with the programme developer, this section describes the programme more generally in terms of recommended or typical implementation. Maternal Early Childhood Sustained Home-visiting (MECSH) is a home-visiting programme delivered to pregnant women who are considered at risk of adverse maternal and/or child outcomes. The MECSH model has some commonality with Family Nurse Partnership (FNP), but involves a broader population including older mothers and a wider range of other risk factors. The programme is delivered by MECSH-trained Health Visitors within a proportionate universal healthy child programme. The programme begins before birth and ends when the child is two-years old. The antenatal home visits occur fortnightly. Postnatal visits begin within one week of birth and occur weekly until the child is six-weeks old, fortnightly until the child is 12-weeks old, every three weeks until the child is six-months olds, every six weeks until the child is one-year old, and bi-monthly until the child is two-years old. Each visit is between 60 and 90 minutes. The antenatal component focusses on coping, problem solving, parents aspirations for themselves and their children and positive parenting skills. Mothers are also encouraged to access community resources and increase their social networks. The postnatal component focusses primarily on increasing parents capacities to parent effectively and support their child s development. MECSH also sponsors group activities and community links to facilitate parent networking. Ratings Summary Strength of Evidence of Child Outcomes NE MECSH found to have no effect on a child outcome in at least one rigorously conducted study that is also its best study (Kemp et al. 2011). MECSH s best evidence comes from a single rigorously conducted RCT which considered the programmes effectiveness on a variety of child and parent outcomes, including infant birth weight, maternal smoking, breastfeeding duration, mental health, sensitivity towards their infant the quality of the home environment, children s responsivity (and other attachment behaviours) and early cognitive development. The study observed four statistically significant maternal benefits for the entire sample of families: reduced pregnancy hypertension increased maternal SIDs prevention knowledge increased breastfeeding duration improved parental responsivity on one of the six HOME subscales. Subgroup analyses suggested that these effects were more pronounced amongst various groups of mothers, including first time mothers and mothers experiencing greater psychological distress. The study also observed some improvements in the mental development of a subgroup of children whose mothers experienced greater psychosocial stress during the antenatal period. This evaluation satisfies EIF s criteria for a methodologically robust study. However, the study observed no main effect on any child outcome within the scope of the Foundations for Life review. A rating of NE does not mean that the programme will never achieve the child outcomes assessed by the EIF review, but that the programme in the form implemented in this evaluation did not improve the child outcomes assessed.
4 Programme Costs On the basis of information about resource requirements submitted by the provider, EIF has estimated the relative cost of programmes per family or child. The specific resource requirements are described in the next pages of this report. The cost scale runs from 1 to 5, with 1 being the least costly to set up and deliver, and 5 being the most costly. Our standard approach is to focus on the additional cost required to implement a programme, over and above the cost of business-as-usual programmes and provision. In the case of MESCH, it has not been possible to arrive at a satisfactory and representative estimate of the practitioner time and other inputs required to deliver business-as-usual health visiting that would be in place in the absence of MESCH. This may be highly variable across different local areas. Therefore we cannot accurately and representatively quantify the additional practitioner time and inputs that are specific to the delivery of MESCH. As a result, the cost rating we present for MESCH should be interpreted as inclusive of the costs of practitioner time and other inputs involved in general health visiting. It does not convey the cost of MESCH on top of general health visiting. This explains why MECSH has a cost score of 4, meaning that this programme is estimated to be medium-high cost to set up and deliver compared to other interventions reviewed by EIF. Impact There were no significant differences between the groups on the majority of measured outcomes (including infant development) with the preponderance of the evidence demonstrating no direct benefits for the child. 4 Implementation Summary Based on information provided by the programme developer, this section describes the programme more generally in terms of recommended or typical implementation. MECSH is delivered in 25 sessions of one-hour duration by one home visitor with QCF-6 qualifications (with 12 hours of programme training). It is delivered to individual mothers/families, plus group activities. It is recommended that practitioners are supervised by two host-agency supervisors (with 4 hours programme training each). There is a licensing requirement to run this programme. In Detail Level of need Low need X Moderate need High need Classification Universal X Targeted: Selective Targeted: Indicated Specialist Programme requirements Highly Specialist X Format Sessions Home visiting delivered to individual mothers/families 25 sessions, 1-hour duration each
5 Number of practitioners required to deliver it 1 Practitioner requirements Job Title or Profession of Practitioner 1st Health Visitor Qualification Level 1st QCF 6 Hours of programme training 1st Accreditation/certificati on required? 12 hours Yes Booster training? No Supervision requirements Number of supervisors 2 Type of supervisor 1st Host-agency supervisor, providing case-management supervision Qualification level 1st QCF 6 Training 1st Type of supervisor 2nd 4 hours Host-agency supervisor, providing reflective practice supervision Qualification level 2nd QCF 6 Training 2nd 4 hours Host agency requirements Licensing fee Yes
6 Evidence Details Maternal Early Childhood Sustained Home-visiting has evidence from one RCT conducted in Australia. Summary of impact evaluation informing the EIF evidence assessment Study Design Country of Origin Sample Child Outcomes Parent Outcomes 1. Kemp et al. (2011). RCT Australia 208 mothers with an identified risk factor None Improved quality of home environment for child development (one of six subscales - emotional and verbal responsivity to child) Kemp et al. (2012). Same as above Same as above Increased breastfeeding duration Same as above None Reduced pregnancyinduced hypertension Improved SIDS prevention risk knowledge Improved perinatal maternal health (at 4 to 6 weeks) Improved postnatal maternal enablement References References of main studies informing the EIF evidence assessment 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 Diseases in Childhood, 96, 533-540. Kemp L., Harris E., McMahon C., Matthey, S., Vimpani, G., Anderson, T., Schmied, V., & Aslam, H. (2012). Benefits of psychosocial intervention and continuity of care by child and family health nurses in the preand postnatal period: process evaluation. Journal of Advanced Nursing, 69, 1850-1861.