Reimagining Care: Integrating Shawn Ginwright’s Four Pivots into Trauma-Informed Developmental Care

"Healing begins where awareness meets action, where connection fosters trust, and where presence invites transformation. By embracing the science of resilience and the soul of care, we create spaces where even the tiniest lives can thrive—and so can we." - Mary Coughlin

In the fast-paced, high-stakes environment of neonatal and pediatric care, it’s easy to focus solely on outcomes—milestones, metrics, and measurable progress. Yet, the transformative work of Trauma-Informed Developmental Care (TIDC) reminds us to return to the humanity behind these numbers: the delicate balance of science and soul that shapes our care.

Recently, I’ve been reading The Four Pivots by Shawn Ginwright, a powerful exploration of how shifting our paradigms can lead to deeper healing and connection. Ginwright’s pivots—Awareness, Connection, Vision, and Presence—align seamlessly with the principles of TIDC. Together, they offer an invitation to care not just for the babies and families in our NICUs, but also for ourselves and each other as clinicians.

Here’s how these pivots intersect with TIDC and how they can deepen our practice—and our shared humanity.

Pivot 1: Awareness – From Lens to Mirror

Ginwright challenges us to move from seeing the world through a lens to seeing ourselves in a mirror. This pivot calls us to examine how our own beliefs, biases, and unspoken assumptions influence our care.

In TIDC, this mirrors the principle of Equity, Anti-Bias Efforts, and Cultural/Gender Affirmation. To truly honor the unique needs of each baby and family, we must first examine the unconscious biases we carry. Are we unintentionally imposing cultural norms or medical routines that clash with a family’s values? By pivoting to self-awareness, we can cultivate a practice rooted in humility and respect.

Reflection Prompts:

• What aspects of my identity, culture, or experiences shape how I approach care?

• When was the last time I questioned an assumption I had about a patient, family, or colleague? What did I learn?

• How can I create spaces where families feel safe to express their unique needs and values?

Pivot 2: Connection – From Transaction to Transformation

Healthcare often feels transactional—charts, checklists, and protocols dominate our days. Ginwright urges us to shift to transformation, to recognize relationships as central to healing.

This resonates deeply with TIDC’s Compassionate Collaborative Relationships. Babies in the NICU don’t just need medical interventions; they need loving connections. Families need to feel seen, heard, and empowered as advocates for their children. Clinicians, too, need spaces to connect with one another, sharing burdens and joys in a supportive community.

Reflection Prompts:

• How do I ensure that families feel like true partners in their baby’s care?

• When have I experienced a moment of genuine connection with a family or colleague? What made it meaningful?

• What would it look like to build stronger relational networks within my team or unit?

Pivot 3: Vision – From Problem to Possibility

When facing the challenges of early life adversity, it’s easy to see problems everywhere—disparities, trauma, and limitations. Ginwright encourages us to shift from focusing on problems to imagining possibilities.

In TIDC, this aligns with Empowerment, Voice, and Choice. Families who have faced immense challenges often carry untapped resilience. Clinicians, too, possess the creativity and expertise to innovate solutions. By envisioning a world where every baby has the best start possible, we can move beyond limitations and step into transformative care.

Reflection Prompts:

• What strengths do I see in the babies, families, and colleagues I work with every day?

• How can I create opportunities for families to lead the conversation about their baby’s care?

• What would a future rooted in equity, resilience, and healing look like for my NICU or practice?

Pivot 4: Presence – From Hustle to Healing

Ginwright’s final pivot invites us to slow down and embrace presence. In the NICU, where alarms beep incessantly and schedules drive every action, this can feel counterintuitive. Yet, healing requires presence—not just physically, but emotionally and spiritually.

This is the heart of TIDC’s Healing Environment. When we slow down, we can notice the subtle cues a baby gives, honor the rhythm of a family’s journey, and attend to our own needs as caregivers. Presence allows us to create spaces where safety, trust, and love can flourish.

Reflection Prompts:

• What are the cues—big or small—that indicate when I am operating on autopilot?

• How can I ground myself in moments of overwhelm or stress during my day?

• What practices can I introduce to cultivate presence and mindfulness in my care?

An Invitation to Pivot Together

Shawn Ginwright’s work reminds us that transformation doesn’t happen in isolation. In the same way, TIDC invites us to reimagine healthcare not as an individual pursuit but as a collective effort. By embracing awareness, connection, vision, and presence, we can build systems that heal—not just babies and families, but ourselves as clinicians and our communities at large.

Are you ready to take the next step in this transformative journey?

Join the Trauma-Informed Professional (TIP) Program

Becoming a Trauma-Informed Professional means more than adopting new strategies—it’s a commitment to embodying the principles of healing, equity, and connection. Whether you're new to TIDC or deepening your expertise, the TIP program is designed to:

• Equip you with the science, skills, and soul of trauma-informed care.

• Foster a supportive community of like-minded clinicians.

• Transform the way you approach care—for babies, families, and yourself.

Next Steps:

1. Enroll in TIP 2.0: Join a global network of professionals transforming care with trauma-informed principles. Flexible payment options are available to make this journey accessible.

2. Host a Book Club or Workshop: Use The Four Pivots as a springboard for conversations about TIDC in your unit.

3. Take a Reflective Moment: Start each shift with a moment of mindfulness, focusing on the pivots that resonate with you most.

Ready to begin? Click here to learn more about TIP 2.0 and take your first step toward transformation.

Transformation begins with small steps. Together, let’s pivot toward a world of deeper healing, connection, and care.

Take care and care well,

Mary

I’d love to hear your thoughts on how The Four Pivots connects with Trauma-Informed Developmental Care! Share what resonated with you, inspired you, or sparked new ideas—your insights can help keep this transformative conversation going.