FRECSH

Family Relationship Early Childhood Sustained Home-visiting (FRECSH)

Sustained nurse home visiting has, to date, been predominantly limited to birthing mothers, with programs ceasing delivery when children move to care by others or are adopted. MECSH-based programs do attempt to follow the child where this is feasible within geographic limits, and where the service supervising the child’s placement permit, however this has not been consistent practice. Further, nationally, the reach of sustained nurse home visiting programs is currently limited.

Consequently, children in out of home care and adopting families often miss out on the essential support for improved child and family outcomes that can be provided by child and family health nurses. This is particularly problematic as these children usually have experiences of trauma and disrupted attachment, and are in need of supportive ‘parenting’.

Investment needed: We are currently seeking to develop a sustained nurse home visiting program for children in out of home care and adopting families based on the successful MECSH program, which is currently being implemented in England, the USA and Australia.

Based on our collective experience and expertise there are seven areas that need to be developed to adapt the MECSH program to be specifically relevant to the Looked After Child (LAC) and Adoption contexts, with a focus on the family-type relationship between the carer and child: FRECSH. These include:

1. Adaptation of the model to allow LAC and adopting families to commence the program at any time within the first three years of the child’s life (rather than antenatally or immediately post-natally). The period of within the first three years has been chosen as this is the most common time point for children to enter care and will provide opportunity for an up to 2-year long intervention to be completed prior to the child’s entry into formal schooling.
2. Support of carers – including the importance of self-care and understanding of vicarious trauma.
3. Support of relationship between carers and biological parents/family of origin, as well as between carers and case.
4. An understanding of developmental trauma in children and strategies for managing children with a trauma background.
5. Understanding adverse childhood experiences (ACES), post-traumatic stress disorder (PTSD), trauma, and their epigenetic, behavioural, and emotional effects, to facilitate understanding of the biological family with specific tasks for training.
6. Prenatal substance exposure and its short and long-term effects on children.
7. Digital enabled delivery.

Much of this content can be specifically addressed within existing MECSH content and developed focus modules,^[1] however, this information will need to be adapted to the LAC context, including adaptation to meet the development needs and stages of older infants. Existing modules to adapt include:

• Learning to Communicate: a child development parent education module
• Healthy Beginnings: a healthy nutrition and physical activity module to address prevention of childhood obesity
• Promoting First Relationships: a parent/carer – child attachment and interaction module
• Maternal well-being plan: a parent/carer mental health promotion module
• Outcome surveys: including the Parent Satisfaction Questionnaire (measure of satisfaction with the program), Parent Enablement Index (measure of program impact on parenting confidence), and Adapt and Self-Manage tool (measure of ability to self-manage self and child health and wellbeing and adapt to changes).

Due to the high prevalence of ACES, PTSD, trauma and their epigenetic, behavioural, and emotional effects, new modules requiring development include:

• Prenatal substance exposure and its short and long-term effects on children
• Trauma modules that address both child and adult trauma

Other existing focus modules may be appropriate to include without adaptation, such as:

• Lift the Lip: a child oral health module
• Child safety: a module educating carers on developmentally appropriate measures to ensure home safety

^{[1] Focus modules refers to packages of content designed to address specific parenting, health and/or developmental concerns.}