A sense of place

Studying the impact of asthma and other chronic diseases on developmental
and educational outcomes

by Stephanie Stemmler  •  October 30, 2020

Kimberly Wooden, school administrator (left), helps Kelly Harris, PhD, CCC-SLP (right), test the asthma survey before distributing to participants at Fairview Primary and Intermediate Schools in the Jennings School District.

With a master’s degree in speech-language pathology (SLP) from Northwestern University, Kelly Harris, PhD, CCC-SLP, was working in Chicago public schools when an experience with one particular student changed the trajectory of her career path.

“I was working with a student who was potentially going to fail sixth grade for a third time and was, therefore, unlikely to finish school,” recalled Harris. “But he was a smart kid and I spent a lot of extra time looking into this. He actually was doing 12th grade math, yet he was falling through the cracks. No one had taken the time to identify or understand his needs.”

What Harris soon realized was that the student was a true representation of the complexities of urban education. “In other words, we had to ask what impacted his ability to learn in the schools,” she said. “It’s not just intelligence. Ability to learn is embedded in our environments and experiences, where we live, and the resources available to us, including food, housing and health. It’s that social context that started to drive me towards education and health equity research.”

Harris soon moved back to her hometown of St. Louis, opening a private practice dedicated to speech-language therapy services, first regionally and then centered within the City of St. Louis. Again, she saw that home-based speech-language therapy services were impacted by other, more pressing needs in many of the families she served. She decided to pursue a doctoral degree in education from Washington University with a goal to study and understand the social context of education and the correlation between educational outcomes, health disparities and chronic diseases.

From speech-language pathology to occupational therapy

As a postdoctoral fellow, she joined the Program in Occupational Therapy’s Child Health and Education Laboratory of Allison King, MD, PhD. Both are interested in the environment’s influence on children’s development and participation, particularly in children diagnosed with chronic diseases such as asthma and sickle cell disease.

“Asthma is the primary reason why children miss school across the country,” said Harris. “It is also an urban issue because there are multiple environmental issues that drive the incidences of asthma in the urban community.”

In 2019, Harris published a study in Social Science & Medicine that identified a five- zip code “hot spot” in North St. Louis with childhood asthma rates more than double state and national averages. By examining associated issues of environmental and systemic inequities, Harris highlighted the need to address chronic diseases not only medically, but also related to the environments in which children may live and go to school.

Harris, now on faculty as an instructor in the Program and serving as a mentor for doctoral students in the Rehabilitation and Participation Science (RAPS) program, leads a new research laboratory within the Program called the Chronic Disease, Development and Educational Outcomes Research Laboratory. Research in the lab highlights the need for all providers —occupational therapists included—to understand “space” in the context of health needs and resources as well as in educational resources.

“Space is often an element that we fail to include in our research,” Harris explained. “Place is more than a dot on a map; it is where we exist in that space, what is our proximity to health care, how far we have to walk or can we obtain access to transportation, and what is the availability of other resources within our environment.”

She is purposeful in moving her research “upstream” beyond the provision of services to examine why prevalence rates and health-care utilization is high in some areas. She now is the recipient of two National Institutes of Health grants focused on evaluating the impact of asthma and other chronic diseases on developmental and educational outcomes. Just prior to restrictions put in place due to COVID-19, Harris and Jasmine Burris, MPH, director of school-based services and community partnerships for CareSTL Health, one of her community partners, pulled together a group of stakeholders in multiple school districts—parents, students, teachers, school-based nurses and community health organizations—to begin the process of assessing how asthma impacts children and how various school districts were collaborating with families and providers to help keep children with asthma healthy and in school. “We often assume that similar school districts have the same needs or characteristics; in fact, we found that goals and needs are different for each district despite their similarities or proximity to each other. We need to listen to these differences, learn how to identify and integrate needed resources, and then we need to share best practices with communities and school districts throughout the region and country.”

Rapid implementation is a huge part of Harris’s efforts. “The traditional timeline for moving evidence-based interventions into practice is about 17 years,” she stressed. “That’s an entire school cycle for children. We can’t wait that long. I want to identify needs in schools and families, understand what works and doesn’t work, and put interventions in practice so that children can thrive.”

She added, “I have a clinical background as a speech-language pathologist. From an occupational therapy perspective, these social and environmental barriers are the same things that we all clinically see. Our life doesn’t fit into neat, little boxes and you can’t intervene in just one spot. You have to intervene in multiple spots to break cycles.”