Claudia Cappa, Statistics and Monitoring Section, UNICEF , on behalf of the CP MERG TWG on VAC

1. Collecting data on violence against children: review of ethical and methodological issues Findings from the work of CP MERG Technical Working Group on Violence against Children • Claudia Cappa, Statistics and Monitoring Section, UNICEF , on behalf of the CP MERG TWG on VAC ICF International

2. Objective and content • Present results of two papers related to the collection of data on VAC commissioned in 2012 by the Technical Working Group (TWG) on Violence against Children (VAC) of the global Child Protection Monitoring and Evaluation Reference Group (CP MERG) • Discuss current thinking regarding ethical issues and existing empirical support for ethical research practice in collecting data on violence against children • Highlight specific ethical dilemmas and risks associated with the collection of data, and share recommendations within the literature • Provide an overview of data availability on VAC, methods and protocols used to collect data • Discuss some of the methodological challenges related to the collection of data

3. CP MERG Technical Working Group on Violence against Children

4. Background • Part of the CP MERG • Established in April 2011 • 8 members: ILO, Save the Children, Pop Council, ChildFund, Plan International, EU FRA, ICF MACRO, UNICEF • Chaired by UNICEF • More information available at: http://www.cpmerg.org/

5. Rationale • Proliferation of different measurement efforts aimed at filling the existing gaps, primarily using large-scale population-based surveys Absence of commonly agreed operational definitions of VAC and standardized data collection tools • Different standards and practices for protection of respondents and interviewers, and follow-up support to victims Absence of ethical guidelines on data collection on VAC

6. Goal and objectives Goal: assist countries/partners in their efforts to gather reliable, useful, comparable and ethically sensitive data on VAC Objectives: Development of guidelines for the collection of data on VAC • Technical guidelines aimed at maximizing the disclosure of actual violence and at guaranteeing high quality data • Ethical guidelines aimed at minimizing the risk of potential harm to respondents, interviewers and others, resulting from the data gathering process

7. 2012 outputs • Conducted a literature review on research ethics and risks associated with data collection on violence against children • Conducted a mapping exercise and a critical assessment of data collection efforts to identify existing self-report survey tools and methods that are being used or are under development in the area of violence against children

8. Ethical principles, dilemmas and risks in collecting data on violence against children

9. Content • Documentation, including both published and ‘grey’ literature, that is of specific relevance to research ethics in collecting data on VAC • Review of ethical principles and frameworks • Review of ethics documentation: guidelines, codes and standards • Review of published literature on ethical challenges and dilemmas • Review of published literature on risks associated with collecting data on VAC

10. Ethics in research • First acknowledged formally with the development of the Nuremberg code (1947); based on Anglo-American law, focused on respect for personal integrity in experimental research • Subsequent ethical guidelines and codes were developed for medical research, aimed primarily at biomedical clinical studies • First international code of ethics was the Declaration of Helsinki which was written for medical research

11. Main frameworks • Duties Most widely established framework underpinning guidelines and codes Right actions treat people as ends, not means Universal duties Principles of autonomy, beneficence-maleficence, justice • Best outcomes Strategies to reduce harm and costs, and promote benefits Rightness or wrongness depends on the nature of the consequences • Rights Recognition and promotion of children rights as expressed in the CRC (best interest, non-discrimination and right to be heard) • Virtues Base on people’s possessing and acting on good characteristics rather than vices Lack of culture agreement on what constitutes virtues and vices

12. Ethical challenges, dilemmas and risks

13. 1) Impacts on children of participation in research on VAC • Does involvement in child abuse research conflict with ethical principles of beneficence and non-maleficence? • Is it justifiable to include children in abuse research classified as non-therapeutic that has limited, indirect or minor benefits for children? • What are the possible long-term consequences?

14. The benefit of research • Review found limited literature to support the argument that there are positive benefits for children who participate in research on VAC • Available studies on children did not focus specifically on trauma related to violence, but on injuries • From available (literature not related to violence): One benefit of participation may include a positive feeling, even when the topic is serious or the child has had traumatic experiences

15. Risk of discomfort, distress or trauma • Children who have experienced violence: concern is whether involvement in research will cause them discomfort, distress or even re-traumatization, perhaps in the form of memories or flashbacks • Children with no known history of experiencing violence: concern is the potential harm of exposing them unnecessarily to distressing issues that are alien to them

16. Some findings • Minimal research has been done on the effect of questions about violence • Recent US national survey (1,588 participants 10-15 years, Ybarra et al., 2009) Around one quarter (23 per cent) reported being upset by questions, with younger participants far more likely to be upset than older participants. Children who had experienced victimization were just as likely as those who had not been victimized to not be upset by the violence-related questions. • Another US study found (Langinrichensen-Rohling et al., 2006) 30 per cent reported some level of being upset The highest rates were found among younger, middle school children and a truancy sample within a juvenile justice setting. Young people in this study who reported a history of physical or sexual abuse (or suicidal thoughts or drug use) reported feeling upset more often than those without such experiences.

17. Recommendations • Call for further research on the potential risks and benefits to children and young people from participating in research on VAC • In the absence of such empirical evidence, the relatively high number of children reporting upset (between one-quarter and one-third of participants in some studies cited above) suggests the need for caution and for the careful selection of methodologies to ameliorate distress • These could include a debriefing with children; telling children where and how they can get help; the use of computer assisted self- interviewing methods; and a child-centred approach • Some of these suggestions less appropriate to resource-poor countries and in large-scale data collection efforts

18. 2) Challenges related to the provision of information • How much information to provide to children and how much to provide to parents and communities? • What are the possible impacts of disclosing information on survey participation and possible risks?

19. Some principles and findings • Principle of parents acting in the best interest of the child cannot be assumed in research on VAC • Actual consequences on children of disclosure remains unknown and difficult/unethical to investigate • Reviews of different (more or less explicit) consent forms for parents in the US show no impact on participations rates (Runyan, 2000)

20. Recommendations • Further research is needed. This includes research on how parents weigh up the risks and benefits of participation • Different provisions are appropriate in different contexts • Need for researchers to be reflexive in their practice and attentive to the rights and responses of children and young people, and attuned to their expression

21. 3) Children’s consent to participate in research • Extent to which children understand the nature of the research and the implications of their consent • Principle that consent can only be given if the participant has been fully informed is recognized in principle, but found problematic in practice • Children are likely to interpret information in the light of understandings they already have (David et al., 2001) • “Mismatches of understanding can be difficult if not impossible to detect” (Gallagher et al., 2010, p. 478)

22. Some findings • Study by Abramovitch and colleagues (1991): many children thought that there would be negative consequences if they did not comply, and felt under pressure to agree to participate if their parents had given consent. • A US study with children aged 8-12 found that children understood their research rights, but were unconvinced about confidentiality (Hurley and Underwood, 2002). • Kalterand colleagues (1988) : young children often misunderstand confidentiality to mean that they must keep secret from their parents what they say to the interviewer. • Participants in one health study thought the researcher would be unhappy if they withdrew from the study (Ondrusek et al., 1998).

23. Recommendations • Researchers should endeavour to ensure that children and young people fully understand what is involved in their participation • Encourage questions and clarification, and allowing sufficient time for potential participants to reflect on and decide about taking part • Strategies can be employed to by researchers to assess children’s understanding of consent/assent, for example, using quizzes, asking children questions one-to-one or asking them to summarize what they have been told • Not always possible and require close controls over interviewers

24. 4) Confidentiality in relation to child protection • Whether child abuse should be asked about in research at all • Whether child abuse should be asked about in research in countries where there are no services • Whether reporting suspected child abuse is mandated by the principle of beneficence • Whether researchers should be legally mandated to report suspected child abuse

25. Some findings • General consensus of the need for research even in contexts where resources are not available for follow-up • Many arguments in both favour and against all the other dilemmas found in the literature • Large and controversial debate mainly in USA and UK, Canada • Less debate in LAMI countries • Very different practices

26. Concluding considerations • Existing gaps in documentation and research, and areas of potential risk to children • With such gaps in the research it is difficult, at present, to derive any full understanding of these issues • Further research in these areas is critical, especially as research and data collection continues despite the lack of an evidence base, raising the pivotal question of whether this research is in the best interests of the children participating • Need to develop a strong children’s rights-based framework for ethical research practice, which provides clear direction while supporting reflexivity

27. Measuring violence against children: Inventory and assessment of quantitative studies

28. Methods

29. Steps and components • Key informant interviews • Inventory and description of quantitativestudies on VAC 44 studies + leads to additional 21 studies • In-depth assessment of 7 studies (UK, Georgia, India, Moldova, Tanzania, Eastern Caribbean, Chile)

30. Elements covered in the assessment • Commissioning and implementing agencies • Definitions and indicators • Sample designs • Research protocols • Ethical protocols • Field coordination • Quality control and data processing

31. Limitations • Review only includes studies that are publicly available and for which some background documentation was found = not meant to be exhaustive • Data quality not part of the assessment (access to datasets not granted in most cases) • Review of prevalence estimates not part of the assessment (results are largely non comparable) • Assessment of usefulness for programs and impacts of the studies not included

32. Content

33. Basic characteristics • 36studies had a specific focus on VAC (stand alone studies) • 8 studies were general surveys with modules or questions on VAC - 4 national surveys • 4 part of international programs (MICS, DHS, GSHS, HBSC) • 34/44 were meant to be representative at the national level

34. International survey programs

35. International survey programs

36. MICS data on child discipline • Data on child discipline collected since 2005-2006 • Questions addressed to family relatives/mothers or primary caregivers of one randomly selected child aged 2 to 14 years old • The questionnaire asked whether any member of the household had used any of various disciplinary practices with that child during the past month • 8 violent disciplinary practices: 2 psychological (such as shouting and name calling); 6 physical (such as shaking, spanking and hitting with an implement) • 3 non-violent disciplinary practices (such as taking away privileges and explaining why something is wrong) • Assesses mother/primary caregivers’ attitude toward physical punishment

37. Global School-based Student Health Surveys: Methodology and questionnaire • Developed by the WHO and CDC • School-based surveys of children aged 13-15 • Not conducted at regular intervals but implemented upon request from countries • Standard GSHS contain three VAC-related questions: • one about physical violence (involvement in physical fights) • two on bullying (being bullied and bullying others). • In its expanded version, the GSHS questionnaire also includes questions on: • dating violence • physical attacks • sexual abuse • carrying of weapons • perception of safety and • physical violence by teachers

38. Health Behavior in School-aged Children Study • HBSC initiated in 1983 in 3 countries and soon after became a World Health Organization collaborative study • Now 43 member countries in Europe and North America and a network of more than 350 researchers • Conducted at regular intervals (last round 2009-2010) • School-based surveys of children (average sample size of 1,550 for each age group - 11, 13 and 15 year olds) • The standard HBSC contain three VAC-related questions: • one about physical violence (involvement in physical fights) • and two on bullying (being bullied and bullying others)

39. DHS indicators on violence Data first collected in 1990, standardized in 1998-1999 Collects data on women aged 15-49 through an optional domestic violence module • Percentage of women aged 15-49 who have ever experienced different forms of violence, by current age • Percentage of women aged 15-49 who have ever experienced physical violence since age 15 and who experienced any physical violence in the past 12 months (age group 15-19 available) • Percentage of women aged 15-49 who have ever experience physical violence during pregnancy

40. DHS indicators on violence (con’t) • Percentage of women aged 15-49 who have experienced sexual violence by age at first experience of sexual violence • Percentage of women aged 15-49 whose first experience of sexual intercourse was forced, by age of first forced sexual intercourse • Percentage of women aged 15-49 who have ever (including in childhood) experienced sexual violenceand who experienced any sexual violence in the past 12 months (age group 15-19 available)

41. DHS indicators on violence (con’t) Spousal violence • Percentage of ever-married women age 15-49 years by whether they have experienced physical, sexual or emotional violence committed by their current or most recent husband/partner, ever and any in the past 12 months • Further info available on frequency of violence experienced in past 12 months and help-seeking behaviour (disaggregated by age groups)

42. Overview of country studies

43. Years and frequency of implementation • Among the 40 national studies : 12 conducted in 2008 alone 9 conducted after 2008, the latest in 2011 19 studies conducted before, the earliest in 2002-2003 • 36 of the 40 national studies were conducted just once

44. Coverage by region Number of national studies by region Note: This table does not included countries that collected data on VAC through MICS, DHS, GSBS or HBSC.

45. Coverage by country Number of national studies by country and region Note: This table does not included countries that collected data on VAC through MICS, DHS, GSBS or HBSC.

46. Commissioning and implementation • Of the 40 national studies identified, most were commissioned by government agencies (19), followed by NGOs (10), international organizations (11) and academic institutions • Most of the studies conducted before 2006 were undertaken by research institutions or NGOs. During and after 2006, 31 studies were conducted with governments’ participations • Little information on the identity of the organization or individuals implementing the survey. When information is available, most studies conducted by a (team of) consultants • Few studies used the same teams of consultants

47. Some information on the study design • Most studies were household surveys, few school based • Full questionnaire available for only 15 of the studies • In 16 studies self-administered questionnaire, 11 interviews, rest unknown • Respondents: children from age 5 (mostly adolescents) and adults (as victims and as perpetrators)

48. Definitions and indicators • Vast majority of the surveys identified in this review used their own definitions (15) • In a few cases, definition used reflected national legal framework (3) • Frequent references to the CRC (24) • Some references to the WHO definitions of violence and abuse (5) • Rationale for selection the target population or definitions not given in most cases (17)

49. Questionnaire design • Majority of surveys developed/used own tools • 12 studies relied on modified versions of the CTS or ICAST • Limited information on how the tools were developed and selected • Cognitive testing= no information/not done • Field testing of the questionnaire prior to survey implementation = no information/not done • Pilot testing in 27 cases

50. Types of violence covered