Heads, necks, hearts, minds: Penn State Health community nurse helps others process effects of trauma

Happy African American preschool teacher high fiving a student entering the classroom - back to school concepts

Sometimes, the key to helping a seemingly unreachable child is appealing to the backs of their necks instead of the tops of their heads.

September 12, 2023Penn State Health News

Throughout the year, Tara Simmons, a community health nurse at Penn State Health, teaches educators, child therapists and others who work with children about those two sections of the human scalp. Or, more accurately, the mind beneath.

Roughly speaking, Simmons says, the top and front portions of your brain are the parts that process information like instructions. The section of brain at the base of the skull is what takes over when you need to react quickly to protect yourself. When a child suffers from the effects of trauma, often that’s the part of the brain that’s in control.

The results can create problems. People who have suffered traumas can become loud or aggressive. Sometimes they’ll run away or become detached, all in an unconscious effort to protect themselves from what they’re conditioned to think are threats. Children find themselves at odds with authority figures over behavior they can’t control. But the good news, to which Simmons can attest, is that teachers can break through by appealing directly to that lower portion of the brain.

Armed with a presentation entitled “Understanding and Supporting Children with Complex Emotional and Sensory Needs,” Simmons and Nikki Toler, an occupational therapist at a Harrisburg-based nonprofit called Samara, travel around central Pennsylvania helping teachers, therapists and others understand how children who have experienced trauma behave – and the best ways to reach them.

The strategies, Simmons says, can help halt the far-reaching effects of trauma, which operate almost like a pathogen, passing from person to person unrecognized, upending families and devastating lives for generations. And while the program is geared to help children, the effects of trauma can be felt by anyone.

“When we think of trauma, we often think of abuse,” said Ashley Visco, Penn State Health’s community health director, “but the entire pandemic was a trauma for everyone. That trauma looked different to different people, but the experience was a trauma and, while the training is directed toward kids, it can be helpful for adults as well.”

Penn State Health’s approach to help people living with the effects of trauma addresses one thread in a tangled web of mental health care needs in the region. In a 2021 Penn State Health survey of six central Pennsylvania counties, 60% of respondents had a least one poor mental health day in a month. One in 10 reported 15 or more days of poor mental health. Some of those in the survey turned to alcohol or drugs. A majority – 61.8% of those surveyed – listed mental health disorders as the top health concern residents face.

Children dealing with trauma is a nationwide epidemic. A 2016 study by the Substance Abuse and Mental Health Services Administration found that 46% of U.S. children younger than 17 report experiencing at least one traumatic event.

For Simmons, the work is personal. She’s battled the effects of trauma in her own life. And now she’s using her own journey to find peace to help curb the damaging effects.

Personal connection

Penn State Health began its involvement with the program during the COVID-19 lockdown. Simmons was among a group of community nurses to learn about trauma training from Toler and another representative of Samara, which helps children and families in the region deal with loss. The program is funded by PNC Bank.

People of all ages experience lasting effects of distressing events. For example, during younger, formative years the loss of a loved one or an important relationship can cause the brain to go into a protective mode that can dictate reactions for years to come.

For Simmons, learning from Samara was like someone shining a spotlight on her own life. For one thing, she remembered her time working as a high school English teacher. Difficult students sometimes didn’t pay attention. Often, stimuli firing off in the hind brain had other ideas.

“Often, that’s here,” she says, clutching the back of her neck.

Intellectual understanding of what’s being asked flies out the window when the hind brain takes over. And for a child who has experienced trauma, the situation is more acute. Anything can trigger that kind of reaction. Even more complicated, some teachers resort to yelling to correct a child, which can be an ingrained reaction to the teacher’s own conditioning to trauma. The child becomes triggered to respond to a threat, and that triggers the teacher, and in the end everything worsens.

During her teaching days, Simmons said, little things caused her to become angry and lose patience. And, she discovered, some of her anger was driven by key moments in her life. When she was a teenager, she lost her younger brother to childhood cancer. At the time, her grieving parents weren’t able to give her the support and care she needed. After seeing so many other children in similar circumstances, Simmons made up her mind to become a foster parent to a child.

She and her husband fostered a little girl for several years. They formed a bond with her and ultimately decided to adopt the child. They had just begun the process when a distant relative of the child was granted custody by a judge.

It felt like a death, Simmons said. “I mourned her for 20 years,” she said.

Those losses conditioned Simmons’ brain to react. Though she never became abusive, Simmons’ anger was a symptom of her brain trying to protect itself. “You can’t get to a level of healing unless your brain becomes calm,” Simmons said.

Circumstances allowed her to break away from those feelings. She began to exercise. She became calmer – even though she didn’t realize that was exactly what she needed. Exercise is rhythmic and repetitive, and a healing brain thrives on those qualities.

Doing better

When working with kids, appealing to hind brain might seem counterintuitive. Part of Simmons’ and Toler’s arsenal during their training session includes a kit that features cushions, a sensory toy called a popper that acts like bubble wrap, a stuffed bear with a soothing scent and other odds and ends that get through to kids with seemingly stubborn personalities in ways that look ethereal but are really calming the part of the brain at the base of the skull.

“A light touch across the back of the neck might make you react as though there’s a bug crawling on you,” Simmons tells the teachers and therapists she trains once a month. That’s the back part of your brain reacting. “But pressure, like from a weighted blanket, might make you feel secure.”

No approach fits every child. The kit gives teachers and therapists a variety of tools they can use in a classroom or elsewhere to try to help students with different sensory needs.

The goal is to create calm and help children cope with triggers so real communication and relationships can happen between children and the people there to help. Teachers learn to look for clues from their students about what they need to facilitate communication.

“Authentic connection is defined by what the child perceives as the connection, not by what we intend as the connection,” she told a group of occupational therapists on a recent training session in Lancaster County. “So, you’re looking for their cues. We’ve got to slow down and meet them where they are.”

Often the sessions and the resulting sense of calm uncover long-ignored repercussions of traumatic events from the teachers’ past.

And thinking about it has been life-changing for Simmons. Now when she feels triggered, she knows to do something. Go for a bike ride. Communicate.

Simmons no longer yells or gets angry. Those who know her see the difference.

She doesn’t like to tell the stories of her past trauma. She can still feel the memories tightening her muscles and causing the stress to well up inside of her.

“I know [it feels like] there’s a threat,” she said, pointing to the back part of her neck. Then she taps the top of her head. “But years later I’ve learned there is no threat.”

Helping families overcome the lingering effects of trauma is one of many ways Penn State Health is addressing mental health concerns in its community. Learn more in the Penn State Health Community Health Needs Assessment and Implementation Plan.


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