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right@home

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    right@home is a nurse home visiting program designed to promote family wellbeing and child development. The program places nurses in children’s homes from birth to two years old, on a regular basis, to support mothers to develop parenting skills. 

    Background

    Research suggests one in five Australian children are born into disadvantage and by the time they start school are already behind their peers. The early years present a unique opportunity for early intervention to prevent disadvantage for children.

    A team of Australian researchers have developed right@home, an early intervention program that increases the number of visits women facing adversity receive from maternal child health nurses, from birth until their babies’ turn two. Mothers were offered the extra nurse home visits via the Maternal and Child Health Service – an existing universal service available to all Australian parents – to support parenting and children’s health and development.  Learn more about the importance of extra home visits with this The Conversation article.

    What researchers found

    Researchers followed up with mothers after their babies turned two and found there is strong evidence of program benefit, particularly for mother’s parenting skills and their capacity to care for themselves and their children. In the years after the right@home program ended for women, there were ongoing benefits to family functioning, mothers’ wellbeing, and the foundational skills necessary for children's school success.

    When considering the complexity of childhood inequities, right@home offers important, long-term protective benefits to Australian children and families. The research was led by the Centre for Community Child Health, a department of the Royal Children's Hospital and a research group of Murdoch Children’s Research Institute.

    right@home

    The right@home nurse home visiting program is based on the Maternal Early Childhood Sustained Home-visiting (MECSH) program and incorporates additional modules to help parents care for and respond to their children, and create a supportive home learning environment. right@home began in 2012 and was the largest randomised-control trial of nurse home visiting to be delivered through the existing Australian universal health service.

    The program ran at four locations in Victoria - Ballarat, Dandenong, Frankston and Whittlesea - and in three regions of Tasmania - Hobart, North and North West. 722 mothers experiencing adversity participated in right@home, with 363 in the intervention group receiving the extra nurse home visits and 359 in the control group receiving usual care via the Maternal and Child Health service.

    right@home aims to find out how the universal child and family health nursing service might be improved to better meet the needs of all families. 

    R@H snapshot

    Read the research snapshot

    Newsletter

    This final newsletter provides an overview of the right@home program, what families said about the experience and what comes next.  

    Access the newsletter

    Phase one: birth-2 years

    Now that the children have turned 2, the study has evaluated the impact of the nurse home visiting program on:

    1. parent care skills (e.g. feeding, sleeping and safety)
    2. responsivity as parents (bonding with baby)
    3. the home learning environment (to foster language and literacy)

    Findings

    After two years researchers followed up both the intervention group and the control group and found strong evidence of program benefit, particularly on mothers parenting skills, maternal mental health and children’s literacy. Mothers receiving extra nurse home visits had more regular child bedtimes, safer homes, warmer and less hostile parenting, and a more nurturing home learning environment. Mothers also said it improved their capacity to care for their children and themselves.

    Listen to Prof Sharon Goldfeld’s ABC interview to hear more about the findings

    Read an article published in Pursuit by the University of Melbourne, February 15 2019

      Access our findings from Phase 1 published in Pediatrics, the Official Journal of American Paediatrics.

      Phase two: 2 years to school entry

      Families and children took part in ongoing interviews until children turned 6 years old and started school (i.e., 4 years after the program ended). The study has evaluated the longer-term effectiveness of the right@home nurse home visiting program on:
      1. Children’s health and development, behaviour, language, and learning
      2. Women's parenting, mental health, and wellbeing
      3. Family functioning 

      Findings

      In the years after the program ended and children started school, we found evidence of consistent benefits across multiple domains of child mental health, parenting and family relationships, maternal mental health, and wellbeing and across foundational skills necessary for school success.

      Next research steps

      We will link with children's NAPLAN scores in Grade 3, to understand if the program impacts children’s academic abilities when they are 8-9 years old.

      The right@home research partnership

      right@home is a research collaboration between the Australian Research Alliance for Children and Youth (ARACY); the Translational Research and Social Innovation (TReSI) Group at Western Sydney University; and the Centre for Community Child Health (CCCH), which is a department of The Royal Children's Hospital and a research group of Murdoch Children’s Research Institute. The research lead investigator is Professor Sharon Goldfeld.

      What makes right@home different?

      The nurses who participated in right@home are specifically trained and supported to work with parents and carers facing adversity. This enabled them to establish  relationships with parents, and in turn, promote children’s development in the home. This training and support is the cornerstone of right@home.

      Who funded the study?

      Phase 1 of right@home is funded by a combination of financial and ‘in-kind’ support from the following institutions and departments:

      Phase 2 is funded by:

      Publications

      Research overview

      Research overview

      Literature reviews

      Peer-reviewed journal articles

      Developing the right@home program

      1. Goldfeld, S., Price, A., & Kemp, L. (2018). Designing, testing, and implementing a sustainable nurse home visiting program: right@ home. Annals of the New York Academy of Sciences, 1419(1), 141-159. 10.1111/nyas.13688
      2. Goldfeld, S., Price, A., Bryson, H., Bruce, T., Mensah, F., Orsini, F., ... & Kemp, L. (2017). ‘right@ home’: a randomised controlled trial of sustained nurse home visiting from pregnancy to child age 2 years, versus usual care, to improve parent care, parent responsivity and the home learning environment at 2 years. BMJ open, 7(3), e013307. 10.1136/bmjopen-2016-013307
      3. Price, A., Bryson, H., Mensah, F., Kemp, L., Smith, C., Orsini, F., ... & Goldfeld, S. (2019). A brief survey to identify pregnant women experiencing increased psychosocial and socioeconomic risk. Women and Birth, 32(3), e351-e358. 10.1016/j.wombi.2018.08.162
      4. Goldfeld, S., D'Abaco, E., Bryson, H., Mensah, F., & Price, A. M. (2018). Surveying social adversity in pregnancy: the antenatal risk burden experienced by Australian women. Journal of Paediatrics and Child Health, 54(7), 754-760. 10.1111/jpc.13860
      5. Price, A. M., Bryson, H. E., Mensah, F., Kemp, L., Bishop, L., & Goldfeld, S. (2017). The feasibility and acceptability of a population‐level antenatal risk factor survey: Cross‐sectional pilot study. Journal of Paediatrics and Child Health, 53(6), 572-577. 10.1111/jpc.13510

      The benefits and impact of the right@home program over time

      1. Goldfeld, S., Bryson, H., Mensah, F., Gold, L., Orsini, F., Perlen, S., ... & Kemp, L. (2021). Nurse home visiting and maternal mental health: 3-year follow-up of a randomized trial. Pediatrics, 147(2). 10.1542/peds.2020-025361
      2. Goldfeld, S., Price, A., Smith, C., Bruce, T., Bryson, H., Mensah, F., ... & Kemp, L. (2019). Nurse home visiting for families experiencing adversity: a randomized trial. Pediatrics, 143(1). 10.1542/peds.2018-1206
      3. Mudiyanselage, S. B., Price, A. M., Mensah, F. K., Bryson, H. E., Perlen, S., Orsini, F., ... & Gold, L. (2021). Economic evaluation of an Australian nurse home visiting programme: a randomised trial at 3 years. BMJ open, 11(12), e052156 . 10.1136/bmjopen-2021-052156
      4. Goldfeld S, Bryson H, Mensah F, Price A, Gold L, Orsini F, Kenny B, Perlen S, Bohingamu Mudiyanselage S, Dakin P, Bruce T, Harris D, Kemp L. Nurse home visiting to improve child and maternal outcomes: 5-year follow-up of an Australian randomised controlled trial, PLOS ONE, November 29 2022; 10.1371/journal.pone.0277773

      Program delivery

      1. Kemp, L., Bruce, T., Elcombe, E. L., Anderson, T., Vimpani, G., Price, A., ... & Goldfeld, S. (2019). Quality of delivery of “right@ home”: Implementation evaluation of an Australian sustained nurse home visiting intervention to improve parenting and the home learning environment. PLoS One, 14(5), e0215371. 10.1371/journal.pone.0215371
      2. Kanda, K., Blythe, S., Grace, R., Elcombe, E., & Kemp, L. (2022). Variations in sustained home visiting care for mothers and children experiencing adversity. Public Health Nursing, 39(1), 71-81. 10.1111/phn.13014

      Women’s experiences of, and involvement in, right@home

      1. Bennetts, S. K., Mensah, F. K., Green, J., Hackworth, N. J., Westrupp, E. M., & Reilly, S. (2017). Mothers’ experiences of parent-reported and video-recorded observational assessments. Journal of Child and Family Studies, 26(12), 3312-3326. 10.1007/s10826-017-0826-1
      2. Price, A., Bryson, H., Smith, A., Mensah, F., & Goldfeld, S. (2019). Processes for engaging and retaining women who are experiencing adversity in longitudinal health services research. BMC health services research, 19(1), 1-12. 10.1186/s12913-019-4698-5
      3. Morris S, Price A, McKenzie V, Kemp L. “You do need to do the interaction”: Mothers’ perceptions of responsive parenting following a home-based parenting intervention. In press with the Infant Mental Health Journal.

      Understanding Australian women’s mental health, including during the pandemic

      1. Bryson, H., Perlen, S., Price, A., Mensah, F., Gold, L., Dakin, P., & Goldfeld, S. (2021). Patterns of maternal depression, anxiety, and stress symptoms from pregnancy to 5 years postpartum in an Australian cohort experiencing adversity. Archives of women's mental health, 24(6), 987-997. 10.1007/s00737-021-01145-0
      2. Bryson H, Mensah F, Price A, Gold L, Mudiyanselage SB, Kenny B, Dakin P, Bruce T, Noble K, Kemp L, Goldfeld S. Clinical, financial and social impacts of COVID-19 and their associations with mental health for mothers and children experiencing adversity in Australia. PLoS One. 2021 Sep 13;16(9):e0257357. doi: 10.1371/journal.pone.0257357. PMID: 34516564; PMCID: PMC8437268.
      3. Price, A. M., Middleton, M. M., Matthey, A. A. P. S., Goldfeld, S., Kemp, L., & Orsini, M. F. (2021). A comparison of two measures to screen for mental health symptoms in pregnancy and early postpartum: the Matthey Generic Mood Questionnaire and the Depression, Anxiety, Stress Scales short-form. Journal of Affective Disorders, 281, 824-833. 10.1016/j.jad.2020.11.055.

      Understanding Australian children’s language development

      1. Lim, S., Levickis, P., & Eadie, P. (2022). Associations between Early Childhood Education and Care (ECEC) attendance, adversity and language outcomes of 2-year-olds. Journal of Early Childhood Research.  10.1177/1476718X221087078
      2. Smith J, Levickis P, Neilson R, Mensah F, Goldfeld S, Bryson H. Prevalence of language and pre-literacy difficulties in an Australian cohort of five-year-old children experiencing adversity. International Journal of Language and Communication Disorders. Published online 11 March 2021. doi: 10.1111/1460-6984.12611
      3. Smith, J., Levickis, P., Goldfeld, S., Kemp, L., & Conway, L. (2021). Maternal linguistic input and child language in a cohort at risk of experiencing social adversity. Language Learning and Development, 17(3), 254-271. 10.1080/15475441.2021.1875831
      4. Smith, J., Levickis, P., Eadie, T., Bretherton, L., Conway, L., & Goldfeld, S. (2018). Concurrent associations between maternal behaviours and infant communication within a cohort of women and their infants experiencing adversity. International Journal of Speech-Language Pathology, 20(5), 516-527. 10.1080/17549507.2017.1329458
      5. Smith, J., Levickis, P., Eadie, T., Bretherton, L., Conway, L., & Goldfeld, S. (2018). Associations between maternal behaviors at 1 year and child language at 2 years in a cohort of women experiencing adversity. Infancy, 23(1), 74-102. 10.1111/1460-6984.12435
      6. Smith, J., Eadie, T., Levickis, P., Bretherton, L., & Goldfeld, S. (2018). Predictive validity of verbal and non‐verbal communication and mother–child turn‐taking at 12 months on language outcomes at 24 and 36 months in a cohort of infants experiencing adversity: a preliminary study. International Journal of Language & Communication Disorders, 53(5), 969-980. 10.1111/1460-6984.12408
      7. Smith, J., Levickis, P., Eadie, T., Bretherton, L., Conway, L., & Goldfeld, S. (2019). Associations between early maternal behaviours and child language at 36 months in a cohort experiencing adversity. International Journal of Language & Communication Disorders, 54(1), 110-122. 10.1111/1460-6984.12435

      Hair cortisol and the experience of social adversity

      1. Bryson, H. E., Price, A. M., Goldfeld, S., & Mensah, F. (2021). Associations between social adversity and young children’s hair cortisol: A systematic review. Psychoneuroendocrinology, 127, 105176. 10.1016/j.psyneuen.2021.105176
      2. Bryson, H. E., Mensah, F., Goldfeld, S., Price, A. M., & Giallo, R. (2021). Hair cortisol in mother–child dyads: examining the roles of maternal parenting and stress in the context of early childhood adversity. European child & adolescent psychiatry, 30(4), 563-577. 10.1007/s00787-020-01537-0
      3. Bryson H, Middleton M, Huque H, Mensah F, Goldfeld S, Price AMH. Examining longitudinal associations between self-reported depression, anxiety and stress symptoms and hair cortisol among mothers of young children. Journal of Affective Disorders. 2021; 282:921-929. doi: j.jad.2020.12.144. 10.1016/j.jad.2020.12.144
      4. Bryson, H. E., Goldfeld, S., Price, A. M., & Mensah, F. (2019). Hair cortisol as a measure of the stress response to social adversity in young children. Developmental Psychobiology, 61(4), 525-542. 10.1002/dev.21840
      5. Bryson, H. E., Mensah, F., Goldfeld, S., & Price, A. M. (2020). Using hair cortisol to examine the role of stress in children's health inequalities at 3 years. Academic Pediatrics, 20(2), 193-202. 10.1016/j.acap.2019.05.008

      The potential cumulative benefit of ‘stacking’ early programs

      1. Price A, Mudiyanselage SB, Schembri R, Mensah F, Kemp L, Harris D, Goldfeld S. The Impact of Nurse Home Visiting on the Use, Dose and Quality of Formal Childcare: 3-Year Follow-Up of a Randomized Trial. Acad Pediatr. 2021 Aug 5:S1876-2859(21)00387-9. 10.1016/j.acap.2021.07.022

      Contact

      If you have questions about the right@home study, email:

      right.home@mcri.edu.au

     

    Murdoch Childrens Research Institute

    The Centre for Community Child Health is a department of The Royal Children’s Hospital and a research group of Murdoch Childrens Research Institute.