NURS 6720 Week 10 program proposal example

Finishing What Screening Started: A Proposal to Complete Catch-Up Vaccination for Resettled Children Through Language-Matched Outreach

Student Name

College of Nursing, Walden University

NURS 6720: Population-Based Public Health Nursing Interventions

Instructor Name

Month Day, Year

Finishing What Screening Started: A Proposal to Complete Catch-Up Vaccination for Resettled Children Through Language-Matched Outreach

Proposal Summary

Applicant: county health department, with a resettlement agency and a mutual assistance association as partners. Funder: an invented community foundation, using its published application sections. Request: two years of funding for two community health workers, family transport and program supplies.

Children who arrive as refugees usually begin catch-up vaccination at their first health screening in the United States. In our city, more than half of the 298 children under 12 who began a catch-up series in the past three years have not finished it, according to the state immunization registry. Their families are willing; they are held back by shift work, bus schedules, changing phone numbers and records that split one child into two. We propose a program that cleans the registry list, has community health workers who speak families' languages call and meet them to book appointments at evening and Saturday times, and sends a public health nurse to the homes of families the calls do not reach. We expect at least 45% of contacted children to finish their series within six months of first contact, against about 22% now, and we will hand leadership of outreach to the mutual assistance association in year two so the work continues after the grant.

Statement of Need

For refugee children, the health screening after arrival and the catch-up vaccination it starts are central to early care in the United States (Phung, 2023). In the composite city, 412 children under 12 arrived as refugees in the past three years, 298 began a catch-up series at screening, and 171 series remained open in the registry at the last extract, after a first review for duplicate records. Most families speak one of four languages at home, live in two neighborhoods with limited evening and weekend bus service, and include parents working shifts that overlap clinic hours.

Some of the gap reflects the records themselves. Children assigned placeholder birth dates on arrival, and names transliterated differently by different clinics, can appear twice in the registry, making completed series look open. Immunization registries are an effective tool for finding children who are due or overdue, but only when their records are accurate (Groom et al., 2015). The need, then, is twofold: to correct the records and to reach families whose children truly still need doses.

Approach

The program's core pairs client reminder and recall with home visits, two approaches endorsed in the federal Task Force's evidence reviews on childhood vaccination coverage (Briss et al., 2000). Every quarter, the state's registry analyst pulls the names of eligible children whose series are still unfinished, once suspected duplicates have been checked. Two outreach workers, drawn from the families' largest language groups, then phone each household or leave a recorded message in its own language, and meet parents at the resettlement agency on two evenings a week. They explain what the registry shows as still due and book a visit at an hour the parent picks, with weekday evening and Saturday morning slots held at a partner health center. When three tries fail, or a booked child has not come in within six weeks, the case passes to the public health nurse, who goes to the home.

An advisory group of families shaped several features before launch. Messages are spoken rather than written, since some parents do not read the script their language is printed in. Doses already documented on overseas cards are entered before anyone is called, so no parent is asked to redo them. A worker the household already knows calls ahead of any home visit, and the nurse makes clear on arrival that the only topic is the child's immunization history. The two components the evidence rests on, the reminder cycle and the nurse's follow-up, were left as designed (Castro et al., 2004).

Objectives

The program has one goal, that refugee children who begin catch-up vaccination at screening finish their series and finish sooner, and five objectives, reproduced unchanged in Attachment C with their baselines and data sources. In brief: two outcome objectives set targets for completion within six months of first contact (45% by the end of year one) and for the median time from screening to final dose (from 14 to 9 months by the end of year two). Three process objectives set targets for contact in the family's preferred language (80% of families on the first list within six months), home visits for referred families (75% within nine months) and review of every open record for duplication within the first three months.

Implementation

Work begins in three stages. During the first quarter, the registry analyst reviews and corrects the open-series list; no calls are made until this is done. From month four, community health workers begin contact. From month five, the nurse begins home visits. Staffing is a half-time public health nurse, two full-time community health workers, about 16 hours a month of registry analyst time and an interpreter line. A data sharing agreement with the resettlement agency provides current contact details. The staffing, delivery and resource tables are in Attachment D.

Evaluation

The evaluation uses the six-step public health evaluation framework published by the CDC in 1999 and the RE-AIM model, which asks about reach, effectiveness, adoption, implementation and maintenance (Glasgow et al., 1999). Registry reports and program logs supply every measure. A stopping rule is fixed now, before any data exist: should under 15% of contacted children show a new catch-up dose within three months of first contact when the second full quarter closes, outreach is paused for a month so the three partners can locate the failure and correct it. Families hear the results in their own languages at association meetings. Attachment B holds the full table of measures.

Budget Justification

Each cost category is labeled known, estimated or assumed. Vaccine for eligible children is known, supplied through the federal Vaccines for Children program to our partner clinic, which is enrolled (Zhou et al., 2024); no grant funds are requested for vaccine. Community health worker salaries and benefits, the largest request, are assumed to come from this grant, because no other source exists for the positions. Phones, mileage for home visits and bus passes for families' appointment trips are requested from this grant. The public health nurse's half-time salary and the interpreter line are estimated as in-kind contributions from the county health department, and registry analyst time is assumed as an in-kind contribution from the state immunization program. Evening and Saturday clinic staffing is estimated as the partner health center's contribution, paid through each family's coverage or the center's income-based fees.

Sustainability

Continuation after the grant is planned, not hoped for. The health department runs every function in year one. In year two, outreach passes to the mutual assistance association, a community group led by former refugees, which will employ and direct the two workers while the nurse trains them and handles clinical questions. Registry work and home visits stay with the health department, since both need legal authority and licensed staff. Programs last partly by building a community's own capacity (Shediac-Rizkallah & Bone, 1998), and the association will present the evaluation findings when it seeks its own funding for outreach.

Attachments

Attachment A: Logic model. Attachment B: RE-AIM measures table. Attachment C: Goal and objectives, as written. Attachment D: Staffing, delivery and resource tables. Attachment E: [Letter of support from the resettlement agency: placeholder for a letter to be requested]. Attachment F: [Letter of support from the mutual assistance association: placeholder for a letter to be requested]. Attachment G: [Letter of support from the partner health center: placeholder for a letter to be requested].

References

Briss, P. A., Rodewald, L. E., Hinman, A. R., Shefer, A. M., Strikas, R. A., Bernier, R. R., Carande-Kulis, V. G., Yusuf, H. R., Ndiaye, S. M., & Williams, S. M. (2000). Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. American Journal of Preventive Medicine, 18(1, Suppl.), 97-140. https://doi.org/10.1016/S0749-3797(99)00118-X

Castro, F. G., Barrera, M., Jr., & Martinez, C. R., Jr. (2004). The cultural adaptation of prevention interventions: Resolving tensions between fidelity and fit. Prevention Science, 5(1), 41-45. https://doi.org/10.1023/B:PREV.0000013980.12412.cd

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

Groom, H., Hopkins, D. P., Pabst, L. J., Murphy Morgan, J., Patel, M., Calonge, N., Coyle, R., Dombkowski, K., Groom, A. V., Kurilo, M. B., Rasulnia, B., Shefer, A., Town, C., Wortley, P. M., & Zucker, J. (2015). Immunization information systems to increase vaccination rates: A Community Guide systematic review. Journal of Public Health Management and Practice, 21(3), 227-248. https://doi.org/10.1097/PHH.0000000000000069

Phung, B. (2023). Caring for resettled refugee children in the United States: Guidelines, challenges and public health perspectives. Frontiers in Public Health, 11, Article 1046319. https://doi.org/10.3389/fpubh.2023.1046319

Shediac-Rizkallah, M. C., & Bone, L. R. (1998). Planning for the sustainability of community-based health programs: Conceptual frameworks and future directions for research, practice and policy. Health Education Research, 13(1), 87-108. https://doi.org/10.1093/her/13.1.87

Zhou, F., Jatlaoui, T. C., Leidner, A. J., Carter, R. J., Dong, X., Santoli, J. M., Stokley, S., Daskalakis, D. C., & Peacock, G. (2024). Health and economic benefits of routine childhood immunizations in the era of the Vaccines for Children program: United States, 1994-2023. Morbidity and Mortality Weekly Report, 73(31), 682-685. https://doi.org/10.15585/mmwr.mm7331a2