When the Soul Goes Missing: Trauma-Informed Care Beyond the Checklist

“Care is not a checklist—it is a shared becoming. When we reduce it to tasks, we risk losing the soul of what heals.” — Mary Coughlin

I’ve spent the better part of my career trying to make care in the NICU more humane, more intentional, more connected. Not just safer—but softer. Not just developmental—but relational. Not just neuroprotective—but healing.

What I didn’t expect was how easily even the most meaningful frameworks could be repackaged in ways that look familiar but feel fundamentally altered—reflected back as shadows of their original intent.

Lately, I’ve been watching the rise of frameworks branded as neuroprotective developmental care. And while I recognize elements that mirror my own early work—particularly the 5 Core Measures of Developmental Care introduced back in 2009—what strikes me most is not the similarity. It’s the absence. The absence of soul. The absence of trauma language. The absence of what makes this work so necessary and so deeply human.

From Framework to Formula

Let me be clear: I believe in structure. I believe in evidence-based practice. But there’s a critical distinction between a framework and a formula.

Frameworks offer us containers for growth. They hold the complexity of what it means to show up—not just with our skills, but with our presence. Formulas, on the other hand, reduce care to steps and metrics. They might increase consistency, but they often do so at the expense of connection.

When care is stripped down to a series of tasks—even well-intentioned ones—it begins to lose its relational resonance. It becomes transactional. Efficient, maybe. But not healing.

The Shared Interface of Care: A Moebius Moment

Years ago, neonatologist Steven Hoath (a co-author on the original paper) described something that still takes my breath away.

He spoke of the shared interface of care—that moment when clinician and patient meet at the skin. Not as two separate entities, but as something more. He likened it to a Moebius strip, that beautiful, paradoxical surface where inside becomes outside, where beginning and end dissolve into one continuous form.

In this shared interface, he said, the boundaries blur. You don’t end where I begin. The roles of healer and healed become fluid. And in that sacred encounter—whether it’s skin-to-skin, eye-to-eye, or soul-to-soul—something larger than either one of us emerges.

That vision changed me. It named what I had felt but didn’t yet have language for. That true care is not a transaction—it’s a transformation. And it happens only when we show up fully, when we make space for reciprocity, when we let ourselves be changed by the moment.

This is what checklists can’t measure. What formulas can’t hold.
This is the soul of care.

The Difference That Matters

The core measures we created and have since evolved for Trauma-Informed Developmental Care were always more than technical guidelines. They were an invitation to shift our stance—to understand trauma as not just a clinical diagnosis, but a lived experience of disconnection, threat, and overwhelm. And to recognize our role as clinicians not just as providers of care, but as buffers of distress, as co-regulators, as witnesses to both suffering and strength.

When I look at some of the newer models, I see familiar components: healing environments, protected sleep, attention to pain, collaborative caregiving. These are all important. But without the grounding in trauma, without the why, something vital gets lost.

We trade soul for structure. We trade depth for digestibility.

Naming What’s Missing

What’s missing is the language of trauma.
What’s missing is the acknowledgment of emotional labor, moral distress, and the invisible wounds that accumulate in babies, families and clinicians.
What’s missing is the invitation to reflect, to feel, to repair.
What’s missing is the courage to say: This is hard. This matters. This changes us.

When we fail to name trauma, we miss the opportunity to metabolize it. To transform it. To offer care that doesn’t just protect the brain—but nurtures the whole human being.

This Isn’t About Ownership—It’s About Integrity

I’m not writing this to lay claim to concepts. Ideas evolve, and I welcome that. But we must stay vigilant about the soul of this work.

Trauma-informed developmental care was never meant to be a checklist. It was a call to consciousness. A practice of radical presence. A commitment to seeing and soothing what’s beneath the surface.

If we reduce it to a procedural toolkit, we miss the opportunity to heal.

Reclaiming the Soul of Our Work

The NICU is a place of paradox—where high technology meets high vulnerability. Where fragility is met with fierce love. Where we can either perpetuate trauma or become part of the repair.

So let us not settle for frameworks that forget the why. Let us not become so obsessed with measurable outcomes that we lose the immeasurable moments: the hand held, the silence honored, the rupture gently repaired.

This work is not just clinical—it is sacred.

And it’s time we stopped apologizing for saying so.

A Gentle Invitation: From Buffering Tasks to Being a B.U.F.F.E.R.

This is exactly why I created B.U.F.F.E.R.
Not as a step-by-step protocol, but as a relational framework—one rooted in the truth that healing is not linear, and connection is not a checkbox.

Each element of B.U.F.F.E.R. holds a sacred invitation:

• Belonging reminds us that presence matters more than perfection.

• Understanding invites us to listen beneath behavior.

• Forgiveness honors the humanity in rupture and repair.

• Frameworks, not formulas, help us hold space for complexity without collapsing into chaos.

• Equanimity grounds us in the sacred balance of doing and being.

• Respect is the soil in which every healing interaction is planted.

These aren’t interventions. They are ways of being.
And they are what keep the soul from going missing in our work.

Let’s not forget the science. But let’s also remember the soul.
Let’s remember why we came into this work in the first place.
And let’s keep caring like it still matters.

Because it does.

In the space where healing begins,
Mary

P.S. If this message stirred something in you—if you’ve felt the dissonance between what you do and why you care—you’re not alone. That’s exactly why I created the Trauma-Informed Professional (TIP) 2.0 Certificate Program.

It’s more than a certification. It’s a reclaiming of your soul in the work.

You can learn more about TIP 2.0 HERE!