Could It Run Twice? A Sustainability Analysis of a Nurse-Led Home Visiting Program for Grandparent Caregivers After Its First Year
Student Name
American College of Education
NUR4043: Community Health and Vulnerable Populations
Module 6 Assignment
Instructor Name
June 8, 2026
The First Year Against Its Targets
Kinship Health Visits was planned earlier in this course as a nurse and social worker home visiting program for grandparents raising grandchildren in Ashford County, the invented rural county used throughout. Its population measure was reach, with a first-year target of enrolling 60 grandparents, about 5 percent of the county's estimated 1,140 grandparent caregivers. The figures in this section are composite results written for this assignment, set out as a program would report them after twelve months.
The program enrolled 47 grandparents, 78 percent of its target and about 4 percent of the estimated aggregate. Of those, 38 remained enrolled for the full twelve months; six withdrew, and three left the county. Among the 38 who completed the year, the count who had seen a primary care clinician within the prior year rose from 18 of 38 at enrollment to 32 of 38 at the final visit. Among the 21 with hypertension, the number with blood pressure under 140/90 mm Hg rose from 8 to 14. The waiting-list comparison group of 19 grandparents showed little change on either measure over the same period. The program appears to work for the families it reaches; the harder question is whether it can keep reaching them once the conditions of its first year are gone.
Those conditions were favorable. A one-time state kinship grant paid for most of the budget, one exceptionally engaged school coordinator made 29 of the 47 referrals, and the health center reserved appointments because its medical director had a personal interest in the program. None of those conditions is guaranteed to last.
A Framework for Sustainability
Sustainability is often treated as a question of funding alone, but the research on public health programs suggests a broader view. Scheirer and Dearing (2011) define sustainability as the continued use of program components and activities to achieve the desired outcomes, and they point out that a program can continue in name while losing the elements that made it effective, or survive in altered form inside another organization. That definition is useful here because it asks not only whether Kinship Health Visits will exist next year, but whether the parts that produced its results will.
Schell et al. (2013) developed a framework that describes a public health program's capacity for sustainability across eight domains: environmental support, funding stability, partnerships, organizational capacity, program evaluation, program adaptation, communications and strategic planning. The framework was built from a review of the literature and consultation with experts, and its purpose is practical: to help program staff see where their capacity is strong and where it is thin. Applied to Kinship Health Visits after one year, it shows capacity that is strong in some domains and dangerously narrow in others.
Applying the Framework
Program evaluation is the program's strongest domain. The first year produced baseline and follow-up measures, a comparison group and results that can be shown to funders and the county board. Partnerships are also strong on paper, with written agreements from the Area Agency on Aging, the health center and legal aid. Environmental support is moderate: the county board of health approved the program, but no elected official has spoken for it publicly, and grandparent caregivers have no organized voice in the county.
Funding stability is the weakest domain. The state grant that paid for 85 percent of the budget was a one-time award, and the county's contribution covered only evaluation. Organizational capacity is also narrow. The two part-time nurses are the only staff trained in the program's visit protocol, and one has said she may not continue if the positions remain part time. Program adaptation has barely been tested: the visit schedule has not changed since the plan was written, even though grandparents who work told the nurses that daytime visits were difficult. Communications and strategic planning are the least developed domains, with no plan for reporting results beyond the grant report and no written strategy for year two.
Maintenance for Families and for the County
The RE-AIM framework that guided the program's evaluation treats maintenance at two levels: whether individuals keep the gains they made after a program ends, and whether settings keep delivering the program over time (Glasgow et al., 1999). Both levels matter for Kinship Health Visits, and they call for different kinds of evidence. At the individual level, the question is whether the 32 grandparents now connected to primary care keep their appointments once the monthly visits stop. The program has no data on that yet, so the plan for year two includes a six-month follow-up telephone call to each graduate, asking about visits kept and blood pressure checks.
At the setting level, the question is whether the health department, the health center and the schools continue to play their parts when the program is no longer new. The model the program was built on reported its results after twelve months of home visits but did not describe what happened to the program afterward (Kelley et al., 2010), which is common in the published literature and is one reason sustainability is hard to plan. Kinship Health Visits can add to that evidence by reporting its second year as carefully as its first, including what was lost and what was kept. Measuring maintenance is how a program learns whether its first year was a result or an accident.
Five Changes Before a Second Run
The analysis points to five changes that would have to happen before the program could run a second time with its effective components intact. First, funding has to shift from a single grant to at least two sources. The most promising is to have the health center bill for the nurse visits that qualify as care management for participants with chronic conditions, which would cover part of one nurse's time, while the county considers a line in the health department's base budget in exchange for the evaluation results already in hand.
Second, the referral route has to stop depending on one person. The program will ask every school's family resource coordinator, the child welfare office and the health center's front desk to use a single one-page referral form, and it will train two additional coordinators before the start of the school year. Third, the nursing positions have to be consolidated into one full-time role with a written visit protocol, so that the program's method survives a change in staff. Fourth, the program has to adapt to what grandparents said, adding early evening visits one day a week and allowing every third visit to be completed by video for grandparents who prefer it.
Fifth, the program needs a communications plan that reaches decision makers and the aggregate itself. A two-page results summary will go to the county board, the state kinship office and the local newspaper, and two grandparents who completed the program have agreed to speak at the board's budget hearing. A program that only its staff and its funder know about is sustained by luck; one that its community has heard about has a constituency.
Conclusion
The first year of Kinship Health Visits suggests that nurse and social worker home visits can improve the health of grandparent caregivers in a rural county, but it also shows how much of that success depended on a one-time grant, one determined referral source and one sympathetic medical director. Applying a sustainability framework makes those dependencies visible and turns them into five specific changes. If they are made, a second year would reach more grandparents with the same method, at a cost the county could plausibly carry. If they are not, the program is likely to follow a familiar path, remembered as a good pilot rather than continued as a service.
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
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
Scheirer, M. A., & Dearing, J. W. (2011). An agenda for research on the sustainability of public health programs. American Journal of Public Health, 101(11), 2059-2067. https://doi.org/10.2105/AJPH.2011.300193
Schell, S. F., Luke, D. A., Schooley, M. W., Elliott, M. B., Herbers, S. H., Mueller, N. B., & Bunger, A. C. (2013). Public health program capacity for sustainability: A new framework. Implementation Science, 8, Article 15. https://doi.org/10.1186/1748-5908-8-15
How this NUR 4043 Module 6 example is structured
NUR 4043 Module 6 commonly asks what would have to change before a community plan could run twice; your classroom's instructions decide whether the plan is your own from earlier modules and how the analysis is framed. This example opens with first-year results against the targets that were set, because sustainability cannot be judged without knowing what worked. It then introduces a sustainability framework and applies it domain by domain, singles out the five changes that matter most and ends with what would be different in year two. Separating results, framework and required changes lets the grader see the reasoning rather than a list of hopes.
NUR4043 Module 6 questions, answered
What does NUR4043 Module 6 usually ask?
NUR4043 Module 6 commonly asks students to consider what would have to change before a community health plan could run again, which is a question about sustainability. Many sections build on the program designed in earlier modules. Your classroom's instructions decide whether you analyze your own plan or a published program and which framework, if any, is required.
Is sustainability just about funding?
No. Funding matters, but research on public health programs also points to partnerships, organizational capacity, evaluation, adaptation, communication and planning. A program can keep its funding and still lose the staff or referral routes that made it work. Using a framework with several domains helps you find the weak points that a funding-only analysis would miss.
Can I use invented results in a sustainability paper?
If your program was never implemented, many instructors accept projected or illustrative results as long as you say clearly that they are illustrative. Report them the way a real program would, with targets, numerators, denominators and attrition. Check your rubric, because some sections prefer you analyze a published program with real outcomes instead.
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.