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

That’s how Tara Simmons talks about those two sections of the brain. Throughout the year, Simmons, a community health nurse at Penn State Health, teaches educators, child therapists and others who work with children how trauma can manifest and result in reactive behavior.

Roughly speaking, Simmons said, 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 that Simmons and Toler present, Simmons said, can help halt the far-reaching effects of trauma, which, while not an illness, when left unacknowledged and untreated, can operate like a pathogen, inducing reactive behavior in a traumatized person, upending families and devastating lives for generations. And while the program is geared toward helping children, the lessons can help anyone of any age affected by trauma.

“When we think of trauma, we often think of capital T Trauma ― physical abuse, combat, etc.,” 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 at how to help 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, according to the Centers for Disease Control and Prevention, which estimates 64% of U.S. adults experienced at least one adverse event that could be linked to trauma before they turned 18. Nearly one in six experienced four or more events.

The work is necessary across the country, but Simmons said it is also 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 others 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 undergoing trauma response training from Toler and another representative of Samara, which helps children and families in the region cope with loss. The program is funded by PNC Bank.

During the training, Simmons learned 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.

According to Simmons, learning from Samara was like someone shining a spotlight on her own life. She recounted her time working as a high school English teacher, when difficult students sometimes didn’t pay attention. Little things caused her to become angry and lose patience, Simmons said, like it does for many adults who have experienced trauma. That reaction could then be perceived as threatening by a student, causing them to act out more, triggering the adult even more. It’s an unproductive and harmful cycle for everyone, Simmons said, because intellectual understanding of what’s being asked flies out the window when the instinctive brain takes over.

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

Simmons discovered that 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 decided to become a foster parent.

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 said she was angry, 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 eventually allowed her to break away from those feelings, she said, and 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 Simmons said a healing brain thrives on those qualities.

Doing better

When working with kids, it can be difficult to identify what will bring calmness, Simmons said. Part of Simmons and Toler’s arsenal during their training session includes a sensory 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. Any one of these items may be the ticket a child who appears stubborn may need to help calm their reactive instinct.  

“A light touch across the back of the neck might make you react as though there’s a bug crawling on you,” Simmons said, recounting how she trains teachers and therapists to understand how various sensory inputs can trigger different reactive feelings. “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 to better communicate and form relationships with 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 allow teachers and students to identify and acknowledge the long-ignored repercussions of traumatic events from their past, Simmons said.

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

“I just don’t live in a state of anger anymore, and I don’t react in anger when I fall into moments of grief,” she said. “In those moments, I am able to lean into the higher parts of my brain, recognizing how I feel and what I understand about my little girl and about my grief instead.”

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