In the early days of his pediatric residency in New York, Glenn Flores, M.D., F.A.A.P., earned a reputation as one of the few bilingual physicians in the hospital’s primary care clinic—and his waiting room quickly filled up with Latino parents who were desperate to find a doctor with whom they could communicate.
The crowded clinic gave Flores an early glimpse of what he describes as a “tremendous unmet need” for health care services for Latinos and other underserved populations. Meeting that need has been the driving force behind his work ever since.
Now a professor of pediatrics and public health at the University of Texas Southwestern Medical Center and Children’s Medical Center of Dallas, Flores is exploring disparities in the treatment of asthma, a disease that disproportionately afflicts minorities. African-American and Latino children, he notes, are far more likely than white children to be diagnosed with asthma, receive poor treatment for it, be hospitalized because of it and die from it.
Flores calls this gap “particularly striking” in light of recent advances in asthma treatment and an overall decline in mortality for most other childhood conditions. “There’s a disconnect,” he says. “The overall population is doing better, but minorities are doing worse.”
A member of the National Advisory Committee of the Robert Wood Johnson Foundation (RWJF) Harold Amos Medical Faculty Development Program, Flores has found a way to help narrow this gap: the use of parent mentors.
For his study, experienced parents of minority asthmatic children were trained to assist their peers in treating and preventing asthma attacks in their children. Flores published the results of a randomized trial evaluating this intervention in the December issue of Pediatrics, the official journal of the American Academy of Pediatrics.
In visits at home, in the community and over the phone, parent mentors give less experienced minority parents of asthmatic children a crash course in Asthma: 101. They teach parents about the basic elements of the condition, how to avoid the usual triggers of asthma attacks, and where to go when emergencies occur.
Parent mentors, he notes, are excellent teachers because, unlike doctors, they communicate in lay terms and speak from the perspective of a parent rather than a provider. In addition, recruiting and training parent mentors is relatively inexpensive and can even boost local employment rates, Flores says—making the intervention a “triple win” for children, parents and their communities.
Flores tested his idea in a randomized control trial in Milwaukee. After an intensive 2.5-day training that covered the basics of asthma treatment as well as information for patients without health insurance or with unmet housing needs, parent mentors met monthly with up to 10 asthmatic children and their families at community sites, phoned parents monthly, and made two home visits with parents of asthmatic minority children.
Flores Finds Parent Mentors Help Reduce Wheezing, Complications, ED Visits
He found that asthmatic minority children experienced less wheezing and complications of asthma and made fewer trips to the emergency department as a result of this intervention. Parents of asthmatic children benefited too. They missed fewer days of work and were able to better treat and prevent asthma attacks in their children.
The program cost an average of $60 per month per patient and resulted in a net cost savings, thanks to lower medical bills. “That makes it powerful,” he says. “If an intervention costs thousands of dollars per patient, then policy-makers may say ‘This isn’t budget-neutral and, in these tough economic times, we can’t invest it.’” But this intervention, he says, is doable because it is cost-effective.
Flores’ most recent work builds on a long career investigating health disparities.
As an RWJF Clinical Scholar at Yale University in the early 1990s, Flores dug deep into health disparities among Latinos and was the first to document differences in health status and access to health care among subcategories of Latino children, including Puerto Ricans, Mexican-Americans and Cuban Americans. He published the findings in the American Journal of Public Health in 1999. He has examined preventable hospitalizations in asthmatic children in subsequent studies.
In the future, Flores hopes to expand on his work with parent mentors. To start, parent mentors could help parents enroll their children in government health insurance programs for the poor. About two-thirds of the children who are eligible for Medicaid or the Children’s Health Insurance Program (CHIP), he notes, are not enrolled in either program.
But he is quick to add that there are countless ways parent mentors or peer educators can help people navigate today’s complex health care system. “This is a great model for any number of chronic diseases for children or adults,” he says.