Kinship Health Visits: A Nurse-Led Program Plan for Grandparents Raising Grandchildren in a Rural County
Student Name
American College of Education
NUR4043: Community Health and Vulnerable Populations
Module 5 Assignment
Instructor Name
June 1, 2026
Problem, Aggregate and Goal
The aggregate comes from the first module of this course: grandparents in Ashford County, the course's invented rural county, who share a home with grandchildren under 18 and carry the main day-to-day responsibility for them. Survey data put the group near 1,140 people, and the margin of error allows anything from roughly 900 to 1,400. The research on custodial grandparents describes a group carrying heavier burdens of low mood, long-term illness and money worries than their peers, and a habit of putting their own appointments last (Hayslip & Kaminski, 2005). In Ashford County, school nurses describe grandparents who manage a grandchild's asthma plan carefully while missing their own blood pressure checks for years.
The goal of the program is to improve the physical and mental health of grandparent caregivers in the county by connecting them with primary care, supporting them in managing their own chronic conditions and reducing the isolation and legal uncertainty that make caregiving harder. The program is designed around a simple observation: these grandparents reliably show up for the children, so the program must reach them where the children already bring them into contact with services.
The Evidence Behind the Design
The program is modeled on a nurse and social worker home visiting intervention evaluated by Kelley et al. (2010). In that program, grandmothers who were the only parental figures in the household received home visits from registered nurses and social workers over twelve months, along with support services such as legal assistance, parenting education and support groups. Among 529 caregivers, mean scores on a standard health survey improved significantly after twelve months for vitality, mental health and the physical and emotional effects of health on daily roles. The study used a pretest and posttest design without a comparison group, so it cannot rule out improvement that would have occurred anyway, and its participants were mostly low-income African American women in a large city. Its results are therefore promising rather than conclusive for a rural county.
Two design decisions follow from that evidence. First, the program keeps the pairing of a nurse and a social worker, because the health problems these grandparents face are bound up with legal, financial and family problems that a nurse alone cannot address. Second, it builds a comparison into its own evaluation, described later, so that the program adds to the evidence rather than simply relying on it.
Partners and What Each Contributes
The county health department is the lead agency. It employs the program's two part-time public health nurses, holds the budget and reports to the county board of health. The regional Area Agency on Aging contributes a social worker for 0.5 of a full-time position and access to its caregiver support funds, which can pay for respite care. The school district's family resource coordinators are the main referral route, because they already know which students are being raised by grandparents from enrollment records. The federally qualified health center in the regional town agrees to reserve two new-patient appointments a week for program participants and to share, with consent, whether a referred grandparent completed a visit.
Two further partners fill specific gaps. Legal aid attorneys from the regional office hold a monthly clinic in the county on custody, guardianship and consent for a grandchild's medical care, questions that the program's grandparents raise often and that nurses cannot answer. Three churches in the county's larger towns host a monthly support group and provide space for it at no cost. Every partner is chosen because it already reaches these grandparents or already holds something they need; none is asked to create a new service from nothing.
Activities and First-Year Budget
Enrollment begins with a referral from a school coordinator, the health center, the child welfare office or the grandparent directly. Within two weeks, a nurse and the social worker make a joint first home visit, where the nurse completes a health history, blood pressure, a medication review and depression screening, and the social worker assesses legal, financial and respite needs. Each grandparent then receives monthly home visits for twelve months, alternating between the nurse and the social worker, with telephone contact between visits. The nurse's work centers on connecting the grandparent to primary care, supporting chronic disease self-management and teaching about the grandchildren's health needs when the grandparent asks. The goal for the first year is to enroll 60 grandparents, about 5 percent of the estimated aggregate.
The first-year budget is estimated at $168,000. Two part-time public health nurses at 0.6 of a full-time position each, with benefits, account for about $104,000. Mileage for roughly 720 home visits in a rural county, at an average round trip of 30 miles and the federal reimbursement rate, accounts for about $15,000. Respite care vouchers, at up to $300 per family, account for $18,000. Blood pressure monitors for participants who need them, educational materials and support group supplies account for about $6,000. Evaluation, including data entry and a part-time analyst, accounts for $25,000. The social worker's time and the legal clinic are contributed by partners and are not included in this total. A state kinship care grant and county general funds are the proposed sources, with the health center's billing for visits it provides handled separately.
Evaluation and the Population Measure
The program will be evaluated using the RE-AIM framework, which asks whether a program reaches its intended population, is effective, is adopted by the settings involved, is implemented as planned and is maintained over time (Glasgow et al., 1999). The framework suits this plan because a program that helps the families it enrolls but reaches only a small fraction of the aggregate has limited public health impact, and RE-AIM makes that distinction visible.
The population measure the program will be judged by is reach: the number of grandparent caregivers enrolled as a proportion of the estimated 1,140 in the county, with a first-year target of 5 percent and a three-year target of 20 percent. Effectiveness will be measured among enrolled grandparents by the proportion with a primary care visit in the past twelve months, from a baseline recorded at the first visit to the twelve-month visit; the share of hypertensive participants whose readings fall under 140/90 mm Hg; and change in depression screening scores. To address the main weakness in the evidence the program is based on, grandparents on the waiting list during the first year will complete the same baseline measures, giving a comparison group for the first cohort. Implementation will be tracked through the number of visits completed as planned, and maintenance through whether partners renew their commitments at the end of year one.
Conclusion
Kinship Health Visits brings a tested model of nurse and social worker home visiting to a rural aggregate that no single agency currently serves. It relies on partners who already reach these grandparents, costs about $168,000 in its first year and sets targets that can be checked against the county estimate of the aggregate's size. Its success will be judged by two questions: whether the grandparents it enrolls are healthier and better connected to care after a year, and whether it reaches enough of the county's grandparent caregivers to change the health of the aggregate rather than a few households within it.
References
Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327. https://doi.org/10.2105/AJPH.89.9.1322
Hayslip, B., Jr., & Kaminski, P. L. (2005). Grandparents raising their grandchildren: A review of the literature and suggestions for practice. The Gerontologist, 45(2), 262-269. https://doi.org/10.1093/geront/45.2.262
Kelley, S. J., Whitley, D. M., & Campos, P. E. (2010). Grandmothers raising grandchildren: Results of an intervention to improve health outcomes. Journal of Nursing Scholarship, 42(4), 379-386. https://doi.org/10.1111/j.1547-5069.2010.01371.x
How this NUR 4043 Module 5 example is structured
NUR 4043 Module 5 usually builds the program plan, its partners and the population measure it will be judged by; the exact template, whether a logic model or a narrative plan, comes from your classroom. This example states the problem and goal in one place, grounds the program in published evidence, then gives partners, activities and the first-year budget their own sections so each can be checked. The evaluation section separates measures of reach from measures of health, because a program can succeed with the families it serves and still miss most of the aggregate. The plan builds on the aggregate defined earlier in the course, which is how many sections expect the modules to connect.
NUR4043 Module 5 questions, answered
What does NUR4043 Module 5 usually ask for?
NUR4043 Module 5 usually asks for a community health program plan for the aggregate chosen earlier in the course, including partners, activities, resources and the measure the program will be judged by. Some sections ask for a logic model, others for a narrative plan. Your classroom's instructions decide the template, the budget detail and the evaluation framework.
What is the difference between a population measure and an outcome measure?
An outcome measure describes change among the people a program serves, such as better blood pressure control among participants. A population measure describes the program's effect on the whole aggregate, such as the proportion of all eligible people reached. A strong plan includes both, because a program can help its participants while reaching too few people to change population health.
How detailed should the budget be in a program plan?
Detailed enough that a reader can check it. List the main cost lines, such as staff time, travel, supplies and evaluation, and show the assumption behind each, for example visits multiplied by miles multiplied by the reimbursement rate. Name resources contributed by partners separately rather than leaving them out or adding them to the total.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.