Research reported on this website was supported by the Robert Wood Johnson Foundation and the Commonwealth Fund
Glenn Flores, M.D.
Professor-
Acknowledgements
Contributors
- Glenn Flores, MD
- Christina Bridon
- Amanda Schulte, RN
- Laurie Smrz RN
- Molly Stevens
- Vanessa Brown
- Becca Schultz de Parra
- Sylvia Torres
- Ruth Perez
- UT Southwestern Medical Center
- Children’s Medical Center Dallas
- Medical College of Wisconsin
- Children’s Hospital of Wisconsin
- Aurora-Sinai Hospital
- St. Joseph’s Hospital
Funders
- The Commonwealth Fund
- Robert Wood Johnson Foundation
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Background Information
Asthma Epidemic
Asthma is:
- Most common chronic childhood disease in the United States
- The number one reason for missed school days
- The cause of 1/3 of all child emergency room visits
- The fourth most common cause of children’s visits to health care providers
Racial/Ethnic Disparities
Asthma affects minority children more than white children.
- Only 3% of white children have asthma, compared to 6% of African-American and 11% of Puerto Rican children
African-American children are hospitalized for asthma three times more often than white children - African-American children are three times more likely than white children to be seen in the emergency room for asthma
- The death rate from asthma among African-American children is almost five times higher than that of white children
Disparities: Poorer Health Care
Minority children receive poorer quality medical care for their asthma than white children:
- Of preschoolers hospitalized for asthma, Latinos are 17 times less likely than Whites or African-Americans to be given a nebulizer for home use
- Both African-American and Latino children are less likely than White children to be prescribed an inhaled steroid medication, one of the most effective asthma treatments
Reducing Disparities
- Little research has been done on why these disparities exist
- Parents Helping Parents Fight Asthma Project is the first program to try to eliminate asthma disparities between minority and white children using Parent Mentors
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Program Overview
What are Parent Mentors?
Experienced parents of a child with asthma trained by an asthma nurse specialist and program coordinator about asthma
Why Use Parent Mentors?
- Parents have different experiences and knowledge about childhood asthma than doctors and nurses.
- Experienced parents can teach what they know to other parents with asthmatic children, give them support, and understand feelings the parents are having
- Parent mentors can be a key component to effective management of a chronic illness
Parent Mentor Responsibilities
- Support and act as a resource for families with asthmatic children
- Help families work with doctors for best care
- Provide education about child’s asthma
- Assist with talking to doctors, making appointments, finding insurance, and primary care doctor (if needed)
- Help create a healthier home environment
- Provide support and network in the community
Program Goals
- Reduce asthma symptoms, attacks, ED visits, hospitalizations, kids’ missed school days, parents’ missed work days
- Improve quality of life for both parents and children
Recruitment
- At Children’s Hospital of Wisconsin
- At Aurora Sinai Hospital
- At St. Joseph’s Hospital
Participants randomized into control or intervention group at time of recruitment
Participants receive $50 incentive at time of recruitment
Children’s Hospital of Wisconsin
When Research team available:
- Child seen in ED
- Zip code and Race/ethnicity checked by Aurora staff member
- Approached by Hospital staff; if interested, staff member informs research team
- Research team determines eligibility, obtains consent, and completes baseline survey and contact form
After hours procedures for when research team unavailable:
- Child seen in ED
- Zip code and race/ethnicity checked by Hospital staff member
- Approached by Hospital staff; if interested, staff determines eligibility and obtains consent
- Staff places completed consent form in study binder
- Consents picked up by research team; family called to complete baseline survey and contact form
Aurora Sinai Hospital
When Research team available:
- Child seen in ED
- Zip code and Race/ethnicity checked by Aurora staff member
- Approached by Hospital staff; if interested, staff member informs research team
- Research team determines eligibility, obtains consent, and completes baseline survey and contact form
After hours procedures for when research team unavailable:
- Child seen in ED
- Zip code and race/ethnicity checked by Hospital staff member
- Approached by Hospital staff; if interested, staff determines eligibility and obtains consent
- Staff places completed consent form in study binder
- Consents picked up by research team; family called to complete baseline survey and contact form
St. Joseph St. Francis Hospitals
When Research team available:
- Child seen in ED
- Zip code and Race/ethnicity checked by Aurora staff member
- Approached by Hospital staff; if interested, staff member informs research team
- Research team determines eligibility, obtains consent, and completes baseline survey and contact form
After hours procedures for when research team unavailable:
- Child seen in ED
- Zip code and race/ethnicity checked by Hospital staff member
- Approached by Hospital staff; if interested, staff determines eligibility and obtains consent
- Staff places completed consent form in study binder
- Consents picked up by research team; family called to complete baseline survey and contact form
Other Recruitment Methods
- Recruitment displays hung in ED rooms and waiting room, including recruitment letter and contact form. Interested parents take letter and leave contact information. Research team recovers forms and calls families to continue recruitment
- Patients missed by research or hospital staff are identified using ED log, and sent recruitment letters
- Nursing staff wears recruitment buttons to catch the eye of potential participants
Parent Mentor Assignment
For participant randomized into intervention group
- Research staff pairs participate with Parent Mentor based on race/ethnicity and zip code
- Parent Mentor is called and given family contact information
- Mentor and Participant choose mutually convenient time to set up first home visit (within 3-5 days of recruitment)
- If mentor’s first home visit, research staff accompanies Parent Mentor to make sure both mentor and family are comfortable and to insure quality
First Home Visit
- 3-5 days after recruitment, parent mentor visits participant’s home
- Parent Mentor provides support to family, and augments the information and care received from healthcare providers
First Home Visit Checklist
View First Home Visit Checklist
Filled out by mentor 1st home visit and given to research staff
Topics covered:
- Asthma education
- Trigger identification and avoidance
- Medications and medication use
- Insurance / doctor’s visits
- Social support
Monthly Phone Call by Parent Mentor
Parent mentors call each family monthly to complete a monthly telephone checklist.
Checklist covered topics:
- Medications and medication changes
- Triggers
- Doctor’s appointments
- Asthma symptoms
English
Spanish
Community Meetings
- Presentation by Asthma Nurse Specialist or Asthma Educator
- Parent Mentor and family meet
- Parent Mentor and asthma nurse/educator meet
- Meal (and dessert)
- Childcare
- Time to socialize and network with others in the community in similar situations
- Meetings held at community sites in the City of Milwaukee
- Separate meetings held for each community (African-American and Latino)
- Meetings held several times monthly so participants can choose most convenient dates/ times
Second Home Visit
6 Months after initial home visit, parent mentors visit participant’s home again
Allows mentor to identify and address additional issues and concerns during second half of families participation
Second Home Visit Checklist
View Second Home Visit Checklist
Filled out during second home visit and given to research staff
Topics covered include:
- Triggers and trigger avoidance
- Medication and medication use
- Doctors appointments
Other Resources
Parent mentors provided with comprehensive Resource Manual with information on issues such as:
- Smoking cessation
- Energy assistance
- Family counseling
- Reduced price clothing and food
- Free clinics
Parent Mentors, asthma nurse specialists and research staff work closely with families to assist them and improve their overall quality of life, in addition to improving their child’s asthma.
Control Group
Participants randomized to the control group receive traditional asthma care
Evaluation
Surveys completed:
- PAMSES – Parent Asthma Management Self-Efficacy Scale (1st month only)
- Asthma Satisfaction survey (1st month only)
- PACQLQ – Pediatric Asthma Caregiver’s Quality of Life Questionnaire
- Monthly Outcomes
- PedsQL – Pediatric Quality of Life Inventory
- Parental Satisfaction (last month only)
Participants receive $5 each month for their time for this call
