ORIGINAL PAPER

Changing systems by changing individuals: the incubationapproach to systems change

Susan L. Staggs Æ Marlita L. White Æ Paul A. Schewe ÆErica B. Davis Æ Ebony M. Dill

Published online: 5 April 2007

� Springer Science+Business Media, LLC 2007

Abstract This article describes and evaluates the imple-

mentation of an innovative approach to systems change, the

incubation approach, which was developed on a systems

change project designed to increase the capacity of multi-

ple systems (e.g., law enforcement, child protection,

domestic violence, mental health, early education) to re-

spond to children’s exposure to violence. The incubation

approach encourages change agents to collaborate with

project staff to gently nurture, or ‘‘incubate,’’ feasible and

warranted change in target systems. Project staff gain

concrete commitment from motivated and accessible

change agents and collaborate with those agents to imple-

ment change actions. This approach works well with

committed, executive-level change agents in target sys-

tems, with stable systems that have low turnover and well-

integrated subsystems, and when seed funds are provided

to key organizations.

Keywords Children’s exposure to violence �Systems change � Intervention theory � Intervention method �Non-profit organizations

The incubation approach: changing systems by

changing individuals

Child exposure to violence is the result of a child expe-

riencing violence, whether through their direct experience

in the cases of child abuse and neglect, or as a bystander

or witness. This violence may include intimate partner

violence, family or community violence, sexual assault, or

child abuse/neglect. This is an astonishing amount of

violence, given that each year, 10–20% of the children in

the United States are exposed to intimate partner violence

alone (Carlson, 2000). Although the impact of children’s

exposure to violence (CEV) varies as a function of indi-

vidual, familial, and environmental factors, its effects can

include severe and long-term neurological, developmen-

tal, academic, social, and psychological difficulties

(Ehrensaft et al., 2003; Fantuzzo & Mohr, 1999; Margolin

& Gordis, 2000; Osofsky, 1995; Whitfield, Anda, Dube,

& Felitti, 2003). Yet despite the serious impact of CEV,

services for the ‘‘forgotten victims’’ who are ‘‘caught in

the crossfire’’ of violent events are virtually non-existent

(Ceballo, Ramirez, Maltese, & Bautista, 2006; Johnson,

1998, p. 271; Rivett & Shaun, 2006). Clinical practice has

historically focused on treating victims of violence; unless

child witnesses have diagnosable (i.e., reimbursable)

psychological problems, services for these children are

largely unavailable (Graham-Bermann & Hughes, 2003;

Groves, 1997; Lynch, 2003). Thus, although exposure to

violence has been documented as a major public health

problem, many exposed children do not have access to

needed services, which may serve to perpetuate the in-

tergenerational transmission of violence by leaving a

population of children with psychological and relational

vulnerabilities unidentified and untreated (Rivett & Shaun,

2006).

S. L. Staggs (&) � P. A. Schewe

Department of Psychology (MC 285), University of Illinois at

Chicago, 1007 W. Harrison St., Chicago, IL, USA60607

e-mail: sstagg1@uic.edu

M. L. White � E. B. Davis � E. M. Dill

Office of Violence Prevention, Chicago Department of Public

Health, 333 South State Street, Suite 320, Chicago, IL 60604,

USA

123

Am J Community Psychol (2007) 39:365–379

DOI 10.1007/s10464-007-9103-6

Here we provide an overview of the problem of CEV,

describe the implementation of an innovative approach to

systems change designed to enhance capacity to respond to

the problem of exposure to violence in systems that touch

the lives of children and/or their caregivers, such as law

enforcement and court services, child welfare services,

domestic violence service providers, family and mental

health support service providers, and early education sys-

tems. We describe the theoretical and methodological basis

of the approach and evaluate its effectiveness.

The problem of children’s exposure to violence

CEV involves children who directly observe, hear, or learn

about the abuse of another person (child, relative, care-

giver, or individual) as well as those children who directly

experience abuse and neglect in the community or in the

home. The effects of exposure to violence on young chil-

dren can negatively impact individuals across the lifespan.

Childhood impacts include a higher risk of neurological

dysfunction, cognitive and behavioral problems, and post-

traumatic stress disorder, while adult impacts include in-

creased risk of future abuse perpetration or victimization

(Edelson, 1999; Mabanglo, 2002; Whitfield et al., 2003).

A 20-year prospective study found that exposure to

violence as a child was the strongest predictor of domestic

violence victimization as an adult and a strong predictor of

perpetration as an adult, and a recent review of 21 studies

found that exposed children were at increased risk of

developing violence-condoning attitudes, internalizing

problems such as depression and anxiety, and externalizing

problems such as aggressiveness and antisocial behavior

(Ehrensaft et al., 2003; Edelson, 1999). Very young chil-

dren (ages 0–6) may be especially traumatized as result of

their exposure to violence. Even before they have the

ability to verbalize, infants and young children are found to

be sensitive and responsive to the fears and emotions of

their caregivers and may suffer anxiety, increased aggres-

siveness, and developmental delays (Shonokoff & Phillips,

2000); Zeaneah, 1993). Yet research also documents a

severe lack of services available for such children and

their families, especially for infants and toddlers (Graham-

Bermann & Hughes, 2003; Groves, 1997; Lynch, 2003;

Osofsky, 2003).

Most service providers are not aware of the impact of

exposure to violence or how to identify children who have

been exposed, and few are currently equipped to intervene

with children exposed. Further compromising effective

response efforts are limited specialized intervention and

treatment resources addressing CEV, and a limited public

policy focus on the issue (Benjamin, 1998). A complicating

factor is that the most important resource protecting

children from the negative effects of exposure to violence

may be a strong relationship with a competent, caring,

positive adult, most often a parent. Yet when parents are

themselves witnesses to or victims of violence, they may

have difficulty fulfilling their caregiver roles and lack ac-

cess to appropriate services (Osofsky, 2003).

The impact of exposure to violence on children and the

current dearth of available system resources for addressing

this problem indicate the urgent need to build capacity to

address exposure within and across a vast, diverse array of

existing systems that touch the lives of these children and

their caregivers. However, introducing additional programs

into over-worked, resource-poor government and nonprofit

systems, many entrenched in highly bureaucratic and

deeply ingrained ways of working that often center on

service delivery to niche populations, is a daunting task

indeed. This article details one such initiative and presents

an evaluation of methodological and theoretical compo-

nents of an innovative method of systems change, the

incubation approach.

Method

Intervention description

In recognition of the need to increase systemic respon-

siveness to CEV, the National Institutes of Justice’s

Department of Juvenile Justice created the Safe Start Ini-

tiative and requested proposals for demonstration project

grants in 2000. These grants provided about five years of

funding for eleven grantees to address problems faced by

young children exposed to violence within homes, schools

and communities. A large midwestern city’s Department of

Public Health received funding as one of the eleven sites

and aimed to reduce the impact of exposure to violence on

children ages zero to six in two low-income, high-crime,

predominantly African American communities. The

department applied for the grant based on its access to a

large infrastructure capable of housing a multi-system

collaborative, its history of and commitment to health

advocacy, and its existing relationships with key target

systems.

A system is defined for the purposes of this project as a

group of organizations with similar missions that are for-

mally or informally attached to each other. For systems

change to occur, at least one of seven incubation actions

must be implemented and likely to impact multiple orga-

nizations within the system. For example, providing CEV

training to one domestic violence service organization

would not qualify as domestic violence system change

because it would not impact multiple organizations in the

domestic violence system. But CEV training in the city’s

366 Am J Community Psychol (2007) 39:365–379

123

police department would count as systems change in the

first responder system, because the police department

comprises several organizations (i.e., divisions) throughout

the city. The project’s system change goal was to incubate

‘‘CEV responsiveness’’ in existing systems by implanting

in those systems the notion that CEV responsiveness can

and should be part of the target system’s mission. That

notion would then be grown, nurtured, and protected until

it reached maturity and was translated into concrete and

lasting systems change. The project collaborates with

change agents in target systems to embed feasible, war-

ranted CEV incubation into those systems in a relational,

non-coercive fashion.

Internal project structure

The project was housed in the city’s Department of Public

Health. Project staffing at its largest consisted of 3 full-time

positions (Project Director, Education Coordinator, and

Implementation Coordinator) and 3 part-time consulting

positions (Evaluation, Implementation/Systems and Tech-

nology/Information). Implementation activities were coor-

dinated through an Implementation Advisory Board (IAB),

a large collaborative composed of representatives from, on

average, 24 child and family serving systems. There were

about 200 people on the official IAB roll, although about

30 people comprised the core group of stakeholders. Par-

ticipation of the other official members waxed and waned

over the years depending on their connection to the issue,

access to funding, and ability to balance many competing

priorities. These partners were recruited based on their

understanding of cross-system issues and their ability to

facilitate change processes within their own systems. The

project capitalized on existing relationships with system

representatives and existing commitments to violence

prevention, children’s mental health, and related concerns

to recruit people onto the IAB. The IAB has met on a

quarterly basis since its inception and organized eight

workteams, each with a specific charge. Each team met

monthly or bi-monthly, and meetings were facilitated and

documented by the project staff. The Direct Service

Implementation Team defined the components of the

family support services and mental health services to be

provided. The First Responder/Incident-Based Implemen-

tation Team developed procedures and protocols for first

responders to identify and refer children for treatment. The

Training Collaborative developed curricula and collabo-

rated with potential institutional partners to carry out re-

search, training, and capacity building activities for service

providers and first responders. The Evaluation and Data

Collection Implementation Team provided consultation

and support to the local evaluation team, ensuring that

appropriate outcomes were evaluated. The Court Action

Implementation Team advocated for program and policy

development across various court offices and initiatives.

Protection of human participants on the project was en-

sured by review and approval of all project protocol by the

Department of Public Health’s Institutional Review Board

as well as review boards for participating service providers,

which included board members from the target communi-

ties as well as research and treatment professionals.

Systems change theory

The project’s approach to systems change was to work with

influential and motivated individuals in target systems to

create within those individuals a personal commitment to

becoming ‘‘personal incubators’’ for change in their sys-

tems. These individuals worked with project staff to

spearhead a drive within and, when appropriate, across

their systems to incubate CEV responsiveness into target

systems. At first, such changes could be small, but would

snowball to become progressively larger and more im-

pactful as more and more individuals in the target systems

were engaged in CEV-related actions.

Dunphy’s (1996) five components of a comprehensive

systems change theory provide theoretical insight into

this approach. Dunphy states that although organizational

change theory is at a nascent developmental state where

many theoretical orientations and diverse approaches are

advocated by leading change theorists, five components

appear essential to any comprehensive theory of systems

change: (1) a metaphor for the nature of the change and

organization, (2) an analytical framework for under-

standing change, (3) a model of the ideal organization,

(4) an intervention theory, and (5) a definition of the role

of change agents. The incubation approach possesses

each of these components; the nature of each is described

below.

The use of metaphor to communicate with and engage

system representatives in change efforts is a necessary and,

if compelling, powerful way to change individual minds

about the need for change in a static system. Metaphors

work by connecting the change effort to existing schema in

the minds of those involved, which helps them to easily

grasp the essential purpose of the change. For example, if

the objective of a change effort is to ‘‘fix’’ a ‘‘broken’’

organization, change agents could be thought of as

‘‘maintenance workers’’ and the system could be thought

of as a ‘‘repair shop’’ (Akin & Palmer, 2000; Armenakis &

Bedeian, 1992; Armenakis, Fredenberger, Giles, & Cher-

ones, 1996; Dunphy, 1996; Marshak, 1993, p. 49). The

metaphor for change on the project was, clearly, the idea of

change agents and systems as incubators for change, a

‘‘build and grow’’ metaphor consistent with the develop-

mental nature of the approach (Marshak, 1993, p. 49).

Am J Community Psychol (2007) 39:365–379 367

123

The framework for understanding the change process

must describe the structures, relationships, and processes

critical to the change process (Dunphy, 1996). The key

structure in this change process was the IAB and its

workteams, but relationships were critical and the key

leverage points for change. Existing relationships, both

personal and professional, were seen as instrumental in

recruiting individuals from target systems to serve on the

IAB, and in motivating individuals to take personal and

professional risks in what was anticipated to be a lengthy,

protracted struggle to change their systems. Three pro-

cesses were seen as critical to the intervention, two of

which were interpersonal, reflecting the importance of

relationships to the change effort. Interpersonal relation-

ship processes between IAB members and decisionmakers

in target systems were important in securing ongoing par-

ticipation in the change effort. The outcome of negotiation

processes between change agents and decisionmakers in

their systems was hypothesized to be a major factor in

determining the ultimate success of the intervention in

particular systems. Lastly, we hoped that mutually sup-

portive interpersonal processes among fellow change

agents would foster cross-system collaboration and keep

commitment levels high.

An ideal model suggests the direction of change and

how the success of the change effort should be evaluated

(Dunphy, 1996). The Incubation approach’s ideal model of

an effectively functioning system is reflected in the seven

incubation actions. An effectively functioning incubation

system has implemented one or more incubation actions, as

evaluated by transmission to the project of relevant data

such as the number and characteristics of children identi-

fied as exposed to violence, the number of referrals to CEV

service providers, and the outcomes of CEV screenings.

Directionality is specified through the stipulation that an

incubation action must build system capacity for address-

ing CEV – systems must commit to go beyond what they

already do. For example, domestic violence service agen-

cies providing play therapy to children residing in shelters

would have to increase their capacity to address CEV be-

yond the provision of therapy by instituting a CEV

screening protocol for children or implementing some

other incubation action.

Intervention theorists have outlined two basic ap-

proaches to systems change into which most existing the-

ories of change can fit: evolutionary, or continuous,

approaches and revolutionary, or episodic, approaches.

Revolutionary, episodic approaches seek to radically

change the status quo by creating a temporary but signifi-

cant upheaval, whereas evolutionary, continuous ap-

proaches seek to implement slow, continuous, non-

disruptive change processes (Corrigan & Boyle, 2003;

Weick & Quinn, 1999).

The incubation approach is an evolutionary, continuous

approach to change rather than a revolutionary, episodic

approach. The project’s reliance upon a large multi-system

collaborative for guidance reflects its embrace of the evo-

lutionary approach, a ‘‘slow process that requires consen-

sus among all levels of stakeholders.’’ Contrasted with the

chaotic, abrupt, seemingly irrational revolutionary ap-

proach to change, the evolutionary approach is develop-

mental in nature, logical and rational, requiring a change in

content rather than context (Corrigan & Boyle, 2003, p.

381; Weick & Quinn, 1999). This fits with the incubation

metaphor of slow, nurtured growth of CEV responsiveness

and its desire to embed CEV responsiveness within the

existing protocols of target systems.

Also at work in understanding the change process are

the concepts of relational systems change (Markoff, Fin-

kelstein, Kammerer, Kreiner, & Prost, 2005) and the

learning lens perspective (Rajagopalan & Spreitzer,

1997). Relational systems change uses relationships (ra-

ther than, say, executive directives) as the primary change

vehicle, which the project has done by working through a

large collaborative and concentrating on developing last-

ing relationships with system representatives. The col-

laborative nature of the incubation approach relationally

bonds system representatives to the project in a shared

ideological commitment to help vulnerable children. It is

a friendly, cooperative approach rather than adversarial,

confrontational approach. The project also uses a rela-

tional approach by capitalizing on the relationships its

more powerful collaborative members have with influen-

tial people outside the immediate project network to

incubate change. The ‘‘learning lens’’ theory also illu-

minates the incubation approach’s understanding of the

change process. In contrast to a rational lens perspective

on change as a ‘‘sequential, planned search for optimal

solutions to well-defined problems based on previously

defined firm objectives,’’ the learning lens perspective

sees change as an incremental series of small steps

undertaken from within a dynamic, ever-changing system

environment (Rajagopalan & Spreitzer, 1997, p. 50). The

steps of the incubation approach reflect its incremental

nature. Target systems are encouraged to choose from a

diverse menu of possible change actions requiring more

or less of a firm commitment on the part of the target

system. Something as simple as a one-time commitment

to train system representatives on CEV qualifies as a

change action under the incubation approach, but the

approach also encompasses more pervasive goals for

change such as instituting a referral protocol for children

exposed to violence throughout the service network of the

public health system. But even the most substantive

change actions in the incubation approach usually occur

in a staged, incremental manner.

368 Am J Community Psychol (2007) 39:365–379

123

Definition of change agent role

The definition of the change agent in the incubation ap-

proach depends on the personal commitment of individual

representatives from target systems to creating change in

their systems. Sometimes, the IAB workteams or the pro-

ject staff functioned as change agents in systems where no

representative from the target system could be engaged.

But the preferred role of change agents was as ‘‘tempered

radicals,’’ or ‘‘individuals who identify with and are

committed to their organizations, and are also committed to

a cause, community, or ideology that is fundamentally

different from, and possibly at odds with, the dominant

culture of their organization (Meyerson & Scully, 1995, p.

586).’’ This was thought to be the case with many potential

change agents. While target systems were generally seen as

sympathetic to the notion that addressing CEV was

important, CSS was concerned that system representatives

might not view becoming a CEV incubator as a high pri-

ority. As result, we anticipated a need to steward the pro-

cess with the agency representative if needed. Additionally,

the IAB was very conscious of documenting and adver-

tising the gains of any system as a way of encouraging

similar efforts across the board.

Incubation procedure

The incubation procedure is a multi-level procedure;

individuals, organizations within target systems, and entire

systems may become incubators. Individuals become

incubators by making a written, personal commitment,

usually at the end of a training session, to complete the

steps on a personal action plan for CEV advocacy. Orga-

nizations become incubators when they either implement

one of seven incubation actions and/or sign a memorandum

of understanding to become an incubator. Systems-level

incubation is defined as two or more organizations within a

target system working together to create change across

organizations, as evidenced by documentation of the cross-

organizational working arrangement.

Incubation is defined as a supported effort to integrate

heightened awareness of and responsiveness to young

children’s (0–6 years) exposure to violence into standard

and ongoing practices of individuals, target systems, and

organizations within those systems. The project began

using the incubation approach in 2002 and continues to

refine it in current systems change work. Individuals,

organizations, or whole systems can become incubators for

change by entering into a thoughtful, collaborative process

wherein the project staff partner with at least one system

representative for the express purpose of developing and

implementing a plan to integrate heightened awareness

of and responsiveness to young children’s (0–6 years)

exposure to violence. The incubation approach emerged

organically as the most appropriate method for systems

change because it is relational and non-threatening, has

been embraced by key system representatives, and is

equally suitable for use both with bureaucratic govern-

mental systems that have entrenched ways of working as

well as with smaller and more agile systems.

While the incubation process varies depending on the

unique needs of each target system, it generally includes

five commitment steps and seven incubation actions. The

five commitment steps are: (1) identify target system (2)

engage change agents in preliminary planning process (3)

gain formal commitment to the change process from the

target system (4) collaborate with systems representatives

to develop and implement an action plan and (5) Develop

monitoring and evaluation processes for each selected ac-

tion. The seven incubation actions are: (1) Assess current

(baseline) policy and/or practice (2) identify policies that

might be enhanced or changed (3) Host CEV training or

train-the-trainer sessions (4) enhance capacity to identify

exposed or at-risk children (5) enhance capacity to refer

exposed or at-risk children for CEV services (6) enhance

capacity to screen exposed or at-risk children and (7) en-

hance capacity to treat children exposed to violence or their

caregivers.

Commitment steps

In the first step, the project collaborative identified seven-

teen target systems based upon the system’s connection to

the issue, to the client population (age or type of need), or

to communities that are impacted by the issue. Interested

persons may also emerge to facilitate the linkage between

the project’s efforts and systems not previously identified.

Systems were targeted for change and categorized based on

their potential to identify, refer, screen, or treat CEV, to

implement policy, or to provide funding. State government

agencies, county and city government agencies, and

grantmaking foundations were targeted as systems that

could implement policy or provide funding. Systems with

the potential to identify, refer, screen, or treat CEV were

subdivided into non-mutually exclusive categories based

on their capacity to provide initial identification/referral/

screening, initial treatment, or ongoing treatment. Systems

with the potential to identify/refer/screen were subdivided

into incident-based, symptoms-based, or both, depending

on their point of contact with children and/or their care-

givers. Incident-based systems included first responders

(e.g., law enforcement, fire/emergency management ser-

vices, hospital emergency rooms). Symptom-based systems

included non-emergency mental and physical health care

organizations, community and faith-based organizations,

child care providers and organizations, and early childhood

Am J Community Psychol (2007) 39:365–379 369

123

education providers (e.g., Head Start). Systems with the

potential to handle incident- and symptoms-based identi-

fication included child welfare, the court system, hospital

emergency rooms, and domestic violence service provid-

ers. Systems with the potential to provide initial treatment

such as crisis intervention included child welfare, domestic

violence service providers, substance abuse treatment

providers, and child care/early education providers. Sys-

tems with the potential to provide ongoing treatment in-

cluded family support service providers and mental health

service providers.

Engagement and preliminary planning activities domi-

nate the second step. The project director stated that the

project pitched the incubation metaphor to system repre-

sentatives by communicating with them that, ‘‘Our systems

are all connected in some way with children, and every

individual in these systems can help make life better for

children. There is a way for you to personally maximize the

chances that one child, child X, will have a better life, and

that is by helping us create a CEV incubator in your sys-

tem.’’ To engage change agents and promote planning, we

used a series of group activities to allow partners to suggest

actions that they could take. A matrix was distributed that

had each IAB member’s name as a row and each commit-

ment step and incubation action as a column. IAB members

were asked to list what they thought they could do (rea-

sonably and within a three-month time frame) as individuals

or as change agents to further their organization’s com-

mitment to CEV or implementation of incubation actions.

Some IAB members, for example, indicated that they could

review their organization’s intake procedures to identify

places where CEV screening might be feasible, or schedule

train-the-trainer sessions on CEV for educators in their

organizations. Following this exercise, the team developed

a chart of commitments and continued to distribute this list

and update it as partners met their commitments throughout

the program year. Where possible, project staff also worked

with change agents to conduct feasibility studies, identify

points of entry (CEV inclusion) in standard practice, clarify

the decision-making hierarchy, devise an initial approach to

gain institutional support, and suggest an incubation time-

line and action items.

The third step formalizes the process and cements the

system’s commitment to become a CEV incubator.

Working with and through the system representative, pro-

ject staff gain formal commitment to the change process

from the target organization or system, usually in the form

of a Memorandum of Understanding that clarifies a time-

line for a launch date and initial change activities, clarifies

accountability expectations (who does what when), stipu-

lates funding to be provided, if any, and identifies public

awareness and education activities that should be con-

ducted to support the launch. We sought commitment at the

executive level, but became more flexible in cases where it

was clear that incubation could occur at lower levels.

Step Four finds the incubation team developing a plan

for implementing change. The plan itself is not a prescribed

template. Here we were looking for the partners to simply

commit to a process and an outcome. Usually, incubator

actions began to be implemented in this step.

As the last commitment step in the incubation approach,

the project works with all incubation sites to monitor and

evaluate the effectiveness of the incubation change effort.

Again, efforts are made to integrate evaluation into the

organizations’ standard operating procedures, and time,

money, and other resource commitments are taken into

consideration when developing a monitoring and evalua-

tion plan for each participating organization.

Incubation actions

Incubation actions can occur at any commitment step, but

usually occur during Steps 4 and 5. There are seven incu-

bation actions, the first two of which are needs assess-

ments: (1) Conduct a pre-incubation assessment to

document current (baseline) policy and/or practice (2)

Review and identify policies that may be enhanced or

changed to better support CEV responsiveness (3) Offer

staff training on CEV (4) Enhance the identification of

exposed or at-risk children (5) Enhance the screening of

exposed or at-risk children (6) Enhance the referral of

exposed or at-risk children, and (7) Enhance the services

delivered to exposed and at-risk children.

Incubation actions 1 and 2

Systems that are unsure of the best way for their systems to

become incubators may elect to work with the project staff

to conduct strategic planning activities, such as a pre-

incubation assessment to document current (baseline) pol-

icy and/or practice, culminating in a written assessment

and recommendations document that can be used for future

decisionmaking. Systems may also choose to conduct a

policy review to identify policies that may be enhanced or

changed to better support CEV responsiveness. Such a

review considers the political environment of the system

and attempts to ascertain where additional advocacy and

external support for the change effort may be required.

Incubation action 3

One of the most basic incubation actions a system can take

is to train their personnel on CEV. System representatives

may receive training in CEV and may also choose to par-

ticipate in the project’s Train-the-Trainer program by

attending a three-to-six hour orientation program to learn

370 Am J Community Psychol (2007) 39:365–379

123

how to train others on CEV responsiveness. Training can be

a one-time event, but the preferred solution is for CEV

training to be incorporated into an organization’s annual

professional development curriculum. Another less-inten-

sive incubation action is for a system to promote CEV

awareness and integrate into their existing internal and

external communications and social marketing materials

messages on CEV. Actions include displaying CEV specific

posters and brochure in close to consumers and other staff.

Incubations actions 4–7

The last four incubation actions are more involved and

constitute a more comprehensive commitment to integrat-

ing CEV responsiveness into policies, procedures, and

practices. Systems can become incubators by enhancing

their ability to (4) identify (5) refer (6) screen and/or (7)

serve children exposed to violence. Prior to 2006, the only

actions that were explicitly funded by the project were

actions 4–7. In some instances, program partners provided

the necessary funding to produce materials and/or deliver

the CEV training. Nevertheless, from the program’s per-

spective, only three service providers in the target com-

munities were funded to identify, refer, screen, and treat

children exposed to violence and their caregivers. These

service providers collected intake information and con-

ducted post-treatment assessments. Apart from these three

funded providers, the project usually attempted to enhance

systemic responsiveness in the least invasive way possible

– the way that requires the least amount of change, dis-

ruption, or funds expenditures from the target system. For

example, the project considered how both internal and

external referrals are currently made in target systems and

worked with change agents to identify the least disruptive

way to integrate identification and referral for CEV into

domestic violence and family support service organiza-

tions. For current child service providers, system change

efforts might focus on the service content, such as building

knowledge of CEV and trauma-sensitive care into existing

clinical protocols and enhancing eligibility for treatment to

include children exposed to violence.

Measures and data analysis

Qualitative interviewing, participant observation, focus

groups, document content analyses, and collection of

quantitative process data were used to evaluate the effec-

tiveness of the incubation approach. Qualitative data were

analyzed using Glaser’s (1992) grounded theory approach,

while quantitative process data (e.g., number of organiza-

tions trained, number of children referred) were summed

across years, organizations, or systems to determine sys-

tem- or project-level outcomes. We evaluated the success

of each commitment step through a series of unstructured

qualitative interviews and focus groups with project staff

and IAB members, who responded to questions about les-

sons learned and facilitators and barriers at each step.

Responses to these questions were compiled and organized

by theme. Only events mentioned by a majority of

respondents and affirmed in focus groups with core project

staff were included as commitment step successes, chal-

lenges, facilitators, or barriers.

To evaluate the success of incubation actions, we used a

mixed-methods approach that included conducting quali-

tative interviews and exercises with project staff and IAB

members, reviewing relevant documents, and collecting

quantitative process data. For example, to get an under-

standing of our progress toward meeting each systems

change goal, project staff collaboratively rated progress on

each goal’s activities using a five-point rating scale, where 1

was ‘‘no progress,’’ 2 was ‘‘a little progress,’’ 3 was ‘‘some

progress,’’ 4 was ‘‘a lot of progress’’ and 5 was ‘‘activity

completed’’. We then averaged the activity ratings by goal

to determine progress on each goal. The results of this

exercise were summarized in a progress report and used to

inform a focus group in which project staff discussed suc-

cesses, challenges, facilitators and barriers for each action.

We measured the success of the first two incubation

actions by reviewing project progress documents devel-

oped by project staff that detailed their efforts, successes,

and challenges in implementing these actions in target

systems. For action 3, we collected quantitative process

and outcome data on training effectiveness, including the

number of people trained and participant increases in CEV

knowledge and skills. For actions 4–7, we collected

quantitative process data from the three contracted service

providers and from other organizations that had committed

to identify and refer children for treatment to the funded

service providers. The funded service providers transmitted

information on the number of referrals received and the

source of each referral to project evaluators each month. At

termination of treatment, service providers completed end-

of-treatment forms detailing the number of caregivers and

children that had received services, the types of services

they had received, and the number of sessions each par-

ticipant attended. From this data we determined the total

numbers of, for example, needs assessments completed,

training sessions conducted, and number of children and

adults referred, screened, and provided with services.

Results and discussion

Table 1 describes outcomes for each commitment step –

the types and number of systems changed, examples of

successes and challenges, and facilitators and barriers. As

Am J Community Psychol (2007) 39:365–379 371

123

Table 1 Commitment outcomes

Commitment

step

Type of system (# of

organizations) changed

Successes Challenges Facilitators and barriers

Identify target

systems

n/a Categorizing systems as

incident-based, symptoms-

based, or both was helpful

in identifying systems and

the organizations within

them. This categorization

scheme also served as a

template from which to

recruit IAB members.

There were so many systems

that touched either children

exposed to violence or their

caregivers that managing

the scope of the

intervention was difficult.

Some systems had

hundreds of organizations

within them, but had to be

targeted because of their

relevance, such as domestic

violence service providers.

The scope of the intervention

was larger than its

capacity, so there were

problems in the beginning

because too many

organizations (over 300 at

one point) were targeted

for intervention. As the

project progressed, the

number of systems targeted

remained the same, but the

number of organizations

within each system that

were targeted for

intervention was decreased

to make the project more

manageable and more in

line with existing capacity.

Engage change

agents in

preliminary

planning

process

Courts (1), domestic violence

(2), early education (2),

family support (2), first

responders (1), funding (3),

government (2), higher

education (1), mental and

physical health (1),

violence prevention (2)

The city’s police department

had an accessible and

invested representative;

through her the project

gained the support and

endorsement of decision-

makers that led to a change

in police protocol for

responding to incidents of

domestic and community

violence.

We attempted to do the same

with the city’s Fire Dept.

The change agent was fully

on board, but we did not

get a wholehearted

endorsement from the

executive office to move

forward. Consequently, we

had to reconsider our

planned timeline for

incubating within this

organization.

Change agents who held

executive-level positions in

target system organizations

were most able to commit

to systems-level

engagement. Other

individual change agents,

while not at the executive

level, often had high

personal commitments to

the project, but were not

always able to secure

organizational commitment

to becoming a CEV

incubator. In some cases,

other members of the

collaborative were able to

encourage CEV

commitments across

systems.

Gain formal

commitment

to the change

process from

the target

system

Clinical practice (2), courts

(1), domestic violence (1),

early education (1), family

support (1), first responders

(1), funding (2), violence

prevention (1)

About half of our IAB

voluntarily and quickly

signed the formal

memorandum of

understanding and

institutionally endorsed

IAB participation and plans

to move the CEV work

forward.

Some of the partners were

unable to get executive

approval of the proposed

actions from their

executive officers, and we

had to settle for conducting

basic training at the

organization, whereas we

would have preferred a

more far reaching

commitment.

Again, we were most likely to

secure organizational

commitment from change

agents with

decisionmaking authority

in their organizations. We

discovered that we needed

to be more flexible in

requiring executive

authorization in cases

where certain actions could

be institutionalized at

lower levels. Monetary

support may have helped

secure institutional-level

commitment by offsetting

the use of limited

resources.

372 Am J Community Psychol (2007) 39:365–379

123

can be seen, having a change agent at the executive level in

an organization within a target system was key in obtaining

commitment at the organizational level. Barriers to com-

mitment included commitment at the change agent level

that did not translate into commitment at the organization

level, capacity constraints within organizations, and the

lack of funding available for needs assessment tasks, and

engagement disruptions due to sweeping organizational

change. Data collection capacity in five systems, including

the city’s police department, the domestic violence hotline,

and the three contracted service providers, was enhanced to

allow collection of previously uncaptured data on the

prevalence of CEV and the characteristics of violent

events, victims and perpetrators.

Table 1 continued

Commitment

step

Type of system (# of

organizations) changed

Successes Challenges Facilitators and barriers

Collaborate with

systems

representatives

to develop and

implement an

action plan

clinical practice (2),

community and faith-based

(1), domestic violence (1),

family support services (1),

first responder (1), funding

(2), violence prevention (1)

We have made it this far with

only a few of the partners

as our second stage was to

gather commitments at the

IAB level. One notable

success is that an ex-

offender reentry service

program has identified two

staff persons to join with

project staff in designing

and conducting incubation

actions 1 and 2.

An early education service

organization offered the

project multiple years of

funding to deliver CEV

training, but organizational

restructuring and staff

changes has interrupted

consistent contact with

organization

representatives. Their

commitment to the issue is

high, however.

The implementation plan

itself does not need to hold

to a prescribed template,

which promotes flexibility.

Nevertheless, this stage can

seem overwhelming, as

change agents are faced

with conducting

comprehensive, unfunded,

and time-consuming

analyses. Thus, we lowered

our expectations at this

step and are now simply

looking for target systems

to commit to a change-

oriented process with a

traceable outcome.

Facilitators include

executive-level

involvement and/or

consent in the process;

barriers include lack of

system capacity,

consistency, or interest.

Develop a

monitoring

and feedback

plan

Domestic violence (1), first

responder (1), family

support services (2),

clinical practice (2)

The police department

changed their policies and

procedures in the target

communities. The police

documented the number of

identifications and referrals

they made and forwarded

this information to project

evaluators on a quarterly

basis along with descriptive

data on victim and offender

age, gender and

relationship, and number

and ages of children

present on each call.

An early education

organization underwent

train-the-trainer sessions,

but we were not able to

establish a reliable protocol

to receive training counts

on a regular basis. For

different reasons, we faced

a similar barrier getting

some of the 1st responder

partners to document

counts for the training they

delivered.

While some of the system

partners received funding

to ensure that they had the

capacity to support the data

exchange functions, others

donated staff time. In the

latter case, CEV actions

may have to yield to allow

the organization to address

its other fiduciary

responsibilities.. In cases

where we had knowledge

that the organizations were

implementing incubation

actions, we did not insist

on monitoring and

feedback commitments.

Another potential barrier is

the absence of evaluation

and technical consultants.

The program will lack the

statistical and interpretive

expertise necessary to

appropriately process and

disseminate the data we

collect.

Am J Community Psychol (2007) 39:365–379 373

123

Regarding incubation actions, as can be seen in Table 2,

7 organizations in 5 target systems implemented incubation

actions 1 or 2 by conducting needs assessments in their

organizations. 56 organizations in 11 target systems re-

ceived training on CEV, and 8 organizations in 7 target

systems received Train-the-Trainer education. Eight orga-

nizations in 7 target systems have identification protocols

in place, and the 3 service providers received 736 referrals

for services from 5 organizations in 4 target systems,

indicating the effectiveness of implemented referral pro-

tocols. The 3 contracted service providers screened 640

children for exposure to violence and provided direct ser-

vices to 483 children and 344 caregivers.

Challenges to implementing incubation actions within

target systems included lack of financial incentives, capacity

constraints of both the project and organizations in target

Table 2 Incubation action outcomes

Incubation action Type of systems (# of

organizations) changed

Successes Challenges Facilitators and barriers

Actions 1 and 2:

Assess current

policy and/or

practice/ identify

policies that might

be changed or

enhanced

Clinical practice (2), family

support (1), first

responders (1), funding

(2), violence prevention

(1)

Seven organizations in five

target systems conducted

needs assessments. The

first and second actions

were most focused around

CEV where we invested

funds (incubators) vs. the

voluntary incubator

commits via the IAB.

Both the substance abuse

and faith incubators have

committed to scan their

providers’ knowledge of

and ability to address

(skills) the interconnected

issues that weigh on CEV.

This gap analysis should

yield a more focused

training and action

agenda.

The project attempted to

engage an ex-offender

organization in formally

assessing relevant policies

but limited staff capacity

made this process

impossible.

The preconditions for these

two, and maybe all, CEV

actions are time, a

committed focus, and

available resources. In the

final phase of the federal

funding, the project

expanded CEV incubation

seed funding to several

systems, which greatly

enhanced our capacity to

change specific systems.

This realizes another

aspect of the project’s

strategic plan. Althought

fleibility is required, the

resulting strategic

planning products (written

report and questions

addressed) are most useful

if standardized across

involved systems and

vetted collaboratively.

The goal is to ensure that

the outcome is far-

reaching and not narrow

in scope.

Action 3: Host CEV

training or train-

the-trainer sessions

child care (10), child welfare

(1), clinical practice (15),

community and faith-

based (11), courts (1),

domestic violence (2),

early education (10),

family support (3), first

responders (1), funding

(1), substance abuse (1)

About 56 organizations in 11

target systems have

received training on CEV;

eight organizations have

received train-the-trainer

education, including Head

Start providers and mental

health consultants.

We have been unable to

collect data on the number

of people trained by non-

project staff. While it is

preferred, few trainers

comply with the request to

submit subsequent data

back to the project office.

Nevertheless, we look for

alternative ways to

reconnect with those

certified via the train-the-

trainer series to gauge

their actions and

outcomes.

Facilitators include

delivering customized

training when possible.

Such training customizes

the content in view of the

existing processes of

target organizations and

the needs of the people

served by the

organization. One barrier

is that the end user

training, which was our

most often-delivered

training, is delivered to

the audience for

knowledge gain only. The

training of organization

teams as part of a systems

change agenda may

require more time and

coordination.

374 Am J Community Psychol (2007) 39:365–379

123

Table 2 continued

Incubation action Type of systems (# of

organizations) changed

Successes Challenges Facilitators and barriers

Action 4: Enhance

capacity to identify

exposed or at-risk

children or their

caregivers

child care (1), clinical

practice (2), domestic

violence (1), early

education (1), family

support (1), first

responders (1),

government (1)

Eight organizations in seven

target systems have

identification protocols in

place.

We do not know whether

and to what extent

individuals who received

training have identified

children exposed to

violence and taken action

to address the situation, as

these identifications fall

outside of formal data

exchange agreements.

Facilitators include making a

personal commitment to

incubate CEV

responsiveness as an

individual, securing a high

level of organizational

commitment to the issue

of exposure, and

providing funding.

Barriers to expanding

capacity to identify, refer,

screen, and serve children

exposed to violence are

the competing demands

that are placed on nearly

all social service agencies.

Adding additional

activities that might be

somewhat outside an

agency’s primary mission,

service delivery approach,

and data collection

process has proven to be a

difficult task.

Action 5: Enhance

capacity to refer

for care exposed or

at-risk children or

their caregivers

Clinical practice (2),

domestic violence (1),

family support services

(1), first responder (1)

The three service providers

received 736 referrals for

services from five

organizations in four

target systems, indicating

the effectiveness of

implemented referral

protocols. Police

responding to incidents of

domestic and community

violence where children

were present would 1)

give the non-offending

caregiver written

information about the

project and CEV, 2) give

the non-offending

caregiver the number of

the city’s domestic

violence hotline and offer

to call the hotline for the

caregiver, and 3) complete

a project referral card.

Most of the referrals (70%)

came from the police or

from within one of the

three service provider

agencies; there is no way

to track to what extent our

training efforts resulted in

participants referring

children or caregivers for

services.

Facilitators included having

a formal referral system in

place and training

organizational

representatives in referral

protocol. Barriers to

referral included the fact

that the project formally

served only children and

caregivers residing within

the target communities,

which probably decreased

the overall number of

referrals. Organizations

may not want to make

referrals if treatment is

available in limited

locales.

Action 6: Enhance

capacity to screen

at-risk children or

their caregivers

Clinical practice (2), Family

support services (1)

The three contracted service

providers screened 640

children for exposure to

violence. Domestic

violence and ex-offender

organizations

implemented screening

procedures for CEV into

their existing services.

We did not succeed in

developing a common

tool that could be shared

across systems to screen

for CEV. Each system

adopted its own system-

specific tools and

processes.

While funding may be

needed to support research

and instrument

development, there are

real barriers that prohibit

the use of common tools.

Am J Community Psychol (2007) 39:365–379 375

123

systems, and lack of data collection protocol for capturing

identifications and referrals from outside key organizations.

Theoretical implications

We evaluated the effectiveness of the project’s five theo-

retical components (Dunphy, 1996) through participant

observation and qualitative interviews with project staff

and IAB members. The incubation metaphor was effective

in that it increased the chances that individuals would make

personal commitments to become incubators themselves.

The incubation metaphor appealed to the nurturing, caring

personalities of people who work in public and social

service systems and care about the mental and physical

health of fragile children. The use of the incubation met-

aphor helped individuals mentally connect the change ef-

fort to something good and positive – an incubator where

vulnerable children could be helped by nurturing system

representatives. The incubation metaphor, which carries

with it the promise of technical support, may have also

helped ease fears about implementing change in the minds

of skeptical or ambivalent change agents.

The change process on this project was understood to

occur primarily through personal and professional rela-

tionships, and data from qualitative interviews with project

staff suggest that relationships were a key factor in getting

the IAB and workteams up and running and securing per-

sonal commitments to the project and to CEV advocacy in

general. The relational approach worked well for recruit-

ment and creating change in individuals, but not as well for

gaining commitment or implementing incubator actions in

target systems unless the change agent was an executive in

his or her organization. Although the project, at times

through staff and others via collaborative members, was

able to gain an audience with the state governor and county

court judges by capitalizing on the existing relational net-

works of IAB members, the project’s inability to intervene

in negotiation processes between motivated change agents

and decisionmakers in their organizations in some places

may have hampered our efforts to convert individual

change into organizational change. The incubation process

often stalled when change agents attempted to create

change in their organizations absent financial or other re-

source commitments from the project. For example, as a

federal initiative, project staff cannot actively lobby elected

officials. Additionally, all lobbying efforts are coordinated

across the host department, which means the project can

not independently approach decision makers. The legisla-

tive agenda for the department is developed and promoted

through a central government affairs office and then

through the city Mayor’s office. Lastly, some incubator

commitments were unable to be sustained because of a lack

of resources to continue even effective efforts.

There is disagreement on the effectiveness of the IAB

and workteam structure. First, the IAB remained the hub to

which all workteams reported. Various workteams experi-

enced some tension when its decisions were not fully

supported by the IAB. Nevertheless, most of the imple-

mentation teams satisfied their charge to develop and

implement aspects of the project that included issues of

information dissemination and review of project materials

such as training curricula and evaluation protocol. A cri-

tique of the IAB could be that the absence of an articulated

decisionmaking process made moving beyond areas of

Table 2 continued

Incubation action Type of systems (# of

organizations) changed

Successes Challenges Facilitators and barriers

Action 7: Enhance

capacity to provide

services to exposed

or at-risk children

or their caregivers

Clinical practice (2), Family

support services (1)

The three contracted social

service agencies have

provided direct services to

483 children and 344

caregivers.

The challenge here is

convincing non-delegate

organizations to offer

additional services

without a guarantee that

those services are

reimbursable.

Facilitators include

providing monetary

support, training,

measurement protocol,

and ongoing evaluation

and technical

consultation. Absent

monetary support,

organizations are unable

to support the provision of

non-reimbursable

services. To fit into

existing service systems,

children must either be

diagnosed with a

psychological disorder

before treatment will

reimbursable or attached

to early education issues.

376 Am J Community Psychol (2007) 39:365–379

123

disagreement difficult. Further, the administrative tasks of

preparing for, facilitating, and documenting IAB and

workteam meetings became one of the main tasks of the

project. But the project did not always realize a return on

its considerable investment of resources into managing

these meetings, when the outcomes of the meeting did not

in general move the project forward in its systems change

goals.

This large, collaborative structure helped establish and

maintain relationships and commitment to the project, but

the collaborative decisionmaking expected within such a

structure bogged the project down; the key decisionmaker

on the project was not one individual but a group of indi-

viduals from different target systems who participated on

the project for very different reasons. Consensus was not

often forthcoming, which sent project staff ‘‘back to the

drawing board’’ on multiple occasions in an attempt to

develop solutions that would satisfy all project members.

As a result, it was not uncommon for some decisions such

as which evaluation instrument to use or how to format a

training evaluation form to stretch out over multiple

months. Another drawback of this approach was that while

in theory the project was a collaborative one, when divisive

issues such as how to sustain the project beyond its initial

funding period arose, decisionmaking was hampered by the

absence of a formal voting process.

Our model of an ideal organization as an organization

implementing one or more incubation actions resulted in a

somewhat skewed view of change, because the majority of

incubation actions took place through training on CEV at

organizations within target systems. As noted, the purpose

of the basic training was to increase knowledge of CEV

and ability to take action to help children exposed to vio-

lence, which are individual rather than organizational

change outcomes. Thus although training was one of the

most successful aspects of the project, it did not necessarily

foster change at the organization and system level, al-

though it did result in a number of individuals becoming

personal incubators. On the other hand, the delivery of

CEV training was viewed as a fundamental starting point to

allow individuals - within organizations - to gain a better

understanding of CEV, which would inform decisions

about organizational behavior.

The intervention theory used on the project of slow,

evolutionary, non-coercive change was embraced by

change agents who often represented systems in which the

wheels of change turned slowly indeed. An evolutionary

theory of change may be the most appropriate theory to

adapt when attempting to change existing systems that are

entrenched in bureaucracy and slow decisionmaking pro-

cesses. The downside to this, however, as evidenced by the

many small changes but few large changes made by the

project, is that the inroads made using this approach may

be too small to make a difference at a systems level, or that

change efforts may lose momentum over the long term.

The goal is to leverage smaller improvements into greater

commitments, which are supported by the collaborative

base.

The role of the change agent as ‘‘tempered radical’’

worked best when the change agent was an executive in a

target system, but also when the change agent had suffi-

cient access to executives with the power and authority to

drive through potentially controversial changes. For

example, a citywide service program to help ex-offenders

reintegrate into society has incorporated CEV training,

screening, and referral into their client assessment and

service planning protocol even though addressing CEV was

not initially seen as one of the primary goals of the system.

Through the efforts of one motivated mid-management

change agent, the system embraced CEV responsiveness as

a vital aspect of its mission.

Facilitators and barriers to the incubation approach

As shown in Tables 1 and 2, several key facilitators and

barriers to using the incubation approach to systems change

emerged. Perhaps the most important facilitator was pro-

viding seed funds to organizations within target systems to

support the implementation of incubation actions. The fact

that CEV is emerging as a new issue means that existing

systems have to be retrofit to accommodate CEV actions.

This requires a substantial commitment of staff time, which

is often scarce. Few of the partner organizations had re-

sources to dedicate to the project, so all donations of time

(and there were many) and funds meant that something else

went undone. Other facilitators included recruiting pow-

erful, executive-level system representatives for leadership

positions in the project collaborative and challenging

individuals to engage in CEV activism. Barriers included

high staff turnover at target systems, systems in chaos, and

systems with autonomously operating subsystems.

The incubation approach appears best-suited to use with

stable systems that have low turnover and well integrated

subsystems. In some cases, project staff spent a great deal

of time and effort working with individual system repre-

sentatives only to have those representatives leave the

target systems without fully orienting their replacements on

the project. The incubation approach’s focus on working

through individual system representatives is vulnerable to

staff turnover and reassignment.

Another identified vulnerability of the approach was that

it did not seem to work well in systems with unintegrated

subsystems. Systems in which subsystems operated as

autonomous units and did not interact with other subsys-

tems was a barrier to incubation in the overall system,

because incubation seeds planted in one subsystem tended

Am J Community Psychol (2007) 39:365–379 377

123

to remain in that subsystem and did not necessarily per-

meate throughout the organization due to the lack of in-

frastructural integration among subsystems. The sub-

systems were approached as separate entities requiring the

requisite level of attention as though they were in fact

independent organizations. Lastly, systems undergoing

reorganizations or executive reshufflings are not suited to

the incubation approach, because their lack of stability

precludes gaining an incubation foothold.

Conclusion

The Incubator Approach’s results thus far show that it may

be a viable approach to embedding change in existing

systems by capitalizing on interpersonal relationships and

leveraging individual change to change systems, although

clearly the approach does have shortcomings, chief among

these being its ability to catalyze individual change into

systems change in the short term. However, the approach is

consistent with community psychology values of collabo-

ration and promotion of wellness, and is thus recommended

as a potentially attractive approach for use by community

psychologists working for change in existing human ser-

vice systems. Evaluation results suggest that capitalizing

on the power of metaphor, creating small pockets of

change in target systems, and maximizing the use of

executive-level ‘‘tempered radicals’’ as change agents

while minimizing the politicization and slow work pro-

cesses that often occur in collaboratives can make for a

successful strategy for creating change in existing

bureaucratic human service systems.

Acknowledgements This project was supported by Grant #

2000JWVXK004 awarded by the Office of Juvenile Justice and

Delinquency Prevention, Office of Justice Programs, US Department

of Justice. Points of view or opinions in this document are those of the

authors and do not necessarily represent the official position or pol-

icies of the US Department of Justice.

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