Amiya Bhatia, Amber Peterman and Alessandra Guedes
Think Piece (Part 2)
Global stakeholders have raised concerns about the implications of COVID-19 for violence against children (VAC). An increased risk of violence could result from a variety of compounding structural, interpersonal and individual-level risk factors, including the increased economic strain placed on families, stay-at-home orders, school closures and other COVID-19 response measures. Over 165 governments have urged the UN to “Protect our Children” and the leaders of 22 organizations have called for the need to integrate measures to protect children from violence in COVID-19 response plans. To guide action on preventing and responding to violence, eight UN agencies outlined a child rights and multi-sectoral framework agenda for action. Initial and preliminary evidence on COVID-19 and VAC suggests that the pandemic could affect not only the risks of violence, but also help-seeking behavior and access to violence-related services.
Researchers are well positioned to contribute to informing response plans and policy dialogues on VAC, drawing both on past evidence, as well as studying COVID-19 dynamics as they unfold in real-time. However, COVID-19 magnifies existing challenges and poses new ones in relation to both initiating and continuing research on VAC. To monitor and support the COVID-19 response, many organizations and researchers are considering whether, and how, to collect new data – including on VAC – within mobile or internet surveys. In addition, researchers conducting ongoing or routine surveys are making decisions about whether to postpone data collection or shift to remote implementation.
For researchers, there is general guidance on: (1) mobile data collection efforts during COVID-19; (2) whether to conduct a mobile phone and SMS based ‘rapid’ survey; and, (3) key data protection considerations. However, there are limited resources on if and how data on VAC can be ethically and safely collected as well as accurately measured and interpreted during COVID-19. Existing guidelines for VAC data collection underscore the importance of rights-based approaches central to the Convention of the Rights of the Child. Ethical guidance also requires researchers to ensure voluntariness and to obtain fully informed consent guided by the evolving capacities of a child, minimize the risk of harm, and ensure just and equitable distribution of burdens and benefits. Finally, data collection efforts must take into account caregiver/parental consent and mandatory reporting laws, and should include safety protocols combined with strong links to local services, and sampling designs that promote inclusion and protect both the online and offline privacy of children and the confidentiality of their data.
COVID-19 magnifies existing challenges and poses new ones in relation to both initiating and continuing research on VAC.
The complexity of data collection on VAC is in part due to the diverse forms of violence children are exposed to, ranging from physical, emotional and sexual violence, to bullying, gang violence, trafficking, neglect, exploitation, and adolescent intimate partner violence. VAC also occurs across multiple settings at the hands of different perpetrators – including at home, in school, in public spaces, or online. In the last two decades, the global child protection community has transformed global data on VAC. Today, there are several approaches for collecting data on VAC, including surveying children or caregivers directly with standardized questionnaires, utilizing qualitative, ethnographic and participatory methods to interview children and communities about VAC or collecting and analyzing administrative, call or surveillance data from support services. The collection and use of these data to inform programming as well as to enable monitoring and accountability has been central to ensuring VAC is not ‘hidden in plain sight’.
In this second (of 2) “conversations with experts”, we unpack what COVID-19 means for data collection efforts on VAC. The first piece in this series focused on violence against women (VAW), and asked 10 experts working in diverse settings to reflect on ethical and methodological issues – as well as priority research questions. Recognizing that there are a number of crucial differences between VAW and VAC research, in this Think Piece we frame and explore these issues from a VAC perspective. We asked experts to reflect on which forms of VAC data collection were possible during COVID-19, the limits and benefits of remote data collection with children and adults, and the priority research gaps. We talked to six experts including: Dr. Andres Villaveces [AV], Dr. Bina D’Costa[BDC], Dr. Claudia Cappa [CC], Dr. Gabrielle Berman [GB], Dr. Greta Massetti[GM] and Dr. Karen Devries [KD] (learn more about the experts below). The responses below draw on personal expertise and experiences, do not represent the official standpoints of their organizations and are not meant to replace official guidance from affiliated organizations.
Is it necessary – or possible – to collect remote data on VAC directly from children during COVID-19 given the risks and ethical challenges?
We received an unequivocal message from experts: A desire for more data during COVID-19 should not compromise the safety of children. “As researchers, first and foremost we need to protect our participants” [Karen Devries]. More specifically, experts warned against interviewing children directly about violence using remote methods while COVID-19 lockdown measures were in place. In this context, experts cautioned that “if a perpetrator is in the household, the child may not be able to or willing to spend time over the phone. It is a moral decision to not conduct interviews during this time” [Claudia Cappa].
Other experts echoed the additional challenges COVID-19 posed to ensuring privacy and safety when face-to-face data collection was no longer possible: “parents/guardians may be reluctant to permit child participants to [respond to an] interview in privacy. With in-person interviews, the interviewers can confirm that they are in a private setting or end the interview if privacy is not granted. With remote data collection, data collectors cannot guarantee or confirm privacy” [Andreas Villaveces/Greta Massetti]. The ability to ensure privacy and confidentiality was especially uncertain when considering qualitative data collection which requires conversations with children to explore their experiences. These concerns were mirrored by VAW experts – but are likely to be even more acute for child participants, especially given the role caregivers often play in consent procedures for VAC data collection.
In situations where children disclose violence, several experts explained that safety plans, mandatory reporting, and referrals become almost impossible to implement in the context of COVID-19 measures. For example: *“we use detailed algorithms to determine what disclosures from children should be reported to whom, and within what time frame. We develop and agree on these with local services providers (child protection, health services, police and other relevant stakeholders) at the start of each study” *[KD]. Remote data collection, particularly during lockdown conditions, makes it harder to organize response options, to ensure that functional referral paths are open, and to refer children to available services within short time periods. In addition, access to many services may be compromised due to COVID-19 conditions. Safety plans are essential – not optional – elements of VAC data collection crucial for promoting children’s safety and wellbeing during and following data collection: “I would stress that in order to proceed with data collection, it needs to be still possible to mount a response for emergency situations that will be encountered. These might include someone needing PEP [post-exposure prophylaxis for HIV exposure after rape], or having to be transported to a health center because of physical injury or severe neglect” [KD]. Experts warned that no data collection should take place in the absence of safety protocols, highlighting that we should “think carefully before embarking on such projects [where] do no harm is key” [Bina D’Costa].
There was a strong consensus that researchers should not conduct remote VAC data collection with children while lockdown measures are in place
Given these concerns, experts recommended researchers and organizations should “avoid direct lines of questioning of contemporary or recent experiences of VAC, unless data collection is part of service provision, undertaken by a person with relevant qualifications and experience, and support services are available" [Gabrielle Berman]. These recommendations are in line with recent UNICEF guidance on data collection with children during the COVID-19 pandemic that highlighted the following concerns: a risk of (re)traumatization for children experiencing violence, difficulties in ensuring an appropriate duty of care given the possibility of limited access to services, privacy or confidentiality violations, data obtained being misused for political surveillance or social shaming. The possibility of State surveillance of mobile and internet devices was also raised by experts who described the additional risks of conducting remote data collection in these contexts: “Many of these surveys are carried out in [contexts] where State surveillance is an everyday occurrence for vulnerable communities. Phone calls are tapped, internet searches are strictly regulated. In a culture of fear and the context of structural violence, how honest and candid people can be during surveys ... In this sense, a guarantee of confidentiality is not enough. In certain contexts, nothing is confidential” [BDC].
Experts acknowledged that the combination of the additional logistical and ethical challenges posed by COVID-19 paired with the challenges of remote survey methodologies mean that we are in ‘uncharted territory’ for directly surveying children about their experiences of violence.
Do these same issues apply to collecting remote data on VAC by interviewing caregivers or other adults during COVID-19?
Several experts mentioned the possibility of asking adults about their use of VAC during COVID-19 where safety allowed (e.g. collecting quantitative data from caregivers on violent discipline). While administering remote surveys to adults on VAC was not seen as straightforward and would require both standard safety and referral protocols as well as numerous other considerations, experts suggested that under the right conditions, it may be possible. However, they underscored that these opportunities should be carefully scrutinized, similar to when collecting data on VAW, and should only include questions on VAC which are actionable and do not trigger mandatory reporting (which is difficult to coordinate remotely – a topic we return to later).
Given the recommendation to not collect remote VAC data from children during COVID-19 lockdowns, what are the priority research gaps in relation to COVID-19 and VAC?
Experts highlighted key knowledge gaps on the effects of COVID-19 on VAC, while acknowledging that many of these knowledge gaps could not be filled immediately due to concerns with conducting real-time data collection. For example, experts agreed that stakeholders were interested in “understanding the population-level effects of COVID-19 on children, especially VAC” [AV/GM]. However, they also emphasized that in assessing “changes (increases/decreases) in violence as a result of COVID-19 dynamics, there are additional challenges to fully assess and interpret these changes, especially in the absence of baseline data” [AV/GM]. Similar cautions were raised by VAW experts – who stressed that simply collecting prevalence measures, by themselves, would give little understanding of whether changes in the levels of violence could be attributed to COVID-19. This is due in part to underlying levels of VAC, existing trends and changes in reporting/disclosure of violence.
Experts suggested “the overriding research question during COVID-19 is to understand the potential impact of various COVID-related response measures taken by governments on violence, who is more vulnerable, and how the effects of some of these response measures might be mitigated" [KD]. They emphasized that context-specific research is needed which 1) acknowledges how response measures vary across countries, and within countries, and 2) considers how exposure to both structural and interpersonal violence and social inequalities prior to COVID-19 could affect changes in the risk of VAC: “COVID-19 has shown us many faces of global inequality and socio-economic patterns of structural/everyday violence” [BDC]. Experts also noted that COVID-19 mitigation measures may not always lead to net adverse effects on VAC: “for some children and families, staying at home may mean they are less likely to be victimized in school, or they may be experiencing improvements in protective factors, such as family closeness and improved communication. Understanding these factors is also important to gain a complete and nuanced picture of the ways children are being impacted within the contexts of their families, households, and communities” [AV/GM].
Experts emphasized that research exploring VAC mitigation and response measures could directly help governments craft response strategies – including those over the medium and longer-term as the compounding effects of COVID-19, such as loss of income and school closures, are felt over the coming years. This research will not only help inform responses during the current COVID-19 crisis, but will help preparedness for future pandemics and public health emergencies: “other public health crises will happen, if not of the same scope. After the crisis was over during the Ebola period, there was not sufficient research to really understand what happened during Ebola. My recommendation would be to, instead of diving straight into VAC data collection, use this time to learn as much as we can from other methodologies to help be prepared for next time." [CC] Experts suggested part of this work could be explicitly developing ethical and methodological guidance for research on VAC during future pandemics and public health emergencies.
In the absence of being able to collect VAC data directly from children, what other data sources and proxy measures should we analyze?
In the absence of data collection on VAC, experts agreed that other existing data could be helpful to guide programming and policy responses. For example, doing VAC service-level assessments to understand “how services have been shut down or re-organized – documenting interesting initiatives in the response efforts” [CC] could help us ensure survivors’ access to needed services. Child helpline data, administrative or surveillance data from “emergency department admissions for injuries among minors, as well as numbers and severity of cases reported to child protection” [GM/AV] were also mentioned as potential data sources. Case data from case management systems, case reports, and other service provision could also help inform efforts to prevent and respond to violence, and do not require directly interviewing children about VAC using remote data collection. However, careful consideration should be given to data privacy, data protection, and to anonymizing case records when using case data. Experts suggested that researchers could also support the analysis and interpretation of program data collected by the UN or NGOs by partnering and collaborating with these organizations. Finally, “big data”, including social media were also mentioned as potential sources to monitor search trends related to VAC. Experts emphasized the importance of understanding – and being explicit about – which children are included and excluded in these data. For example, service data excludes children unable to reach social workers or hospitals, and social media data excludes children without access to technology.
*Our conversations with experts revealed important tensions and challenges in understanding VAC during COVID-19. *
While discussing these alternate data sources, experts also highlighted challenges in the use and interpretation of administrative data to study VAC. For example, in the U.S. “preliminary data suggests that in some states and jurisdictions the number of cases reported for child abuse has gone down following school closures and stay-at-home orders were put in place, but the number of severe cases has increased. Data also suggests that the number of cases of child sexual exploitation reported to the National Center for Missing and Exploited Children has increased significantly" [GM/AV]. Experts cautioned that, in addition to not representing the magnitude of violence at population-level, administrative data may suffer from differences in collection procedures, reporting laws and, in some settings, may simply not be available or of sufficient quality. They also noted that COVID-19 may also change service availability as well as propensity to report VAC – making it difficult to interpret findings. For example: “are the increases in cases reported to National Center for Missing and Exploited Children due to greater numbers of children being exploited, or more people taking the time to report images, or more people spending time online? In the absence of additional data we will be unable to fully assess alternative explanations for these changes” [AV/GM]. Because only a small fraction of survivors of violence ever seek services, administrative data represents the “tip of the iceberg” where the number of cases is concerned.
On the subject of collecting proxy measures for VAC, some experts suggested these could be collected at the individual or household level via vignettes, questions about feelings of fear, or opinions about community-level changes in violence. Another suggestion was to ask about “feelings of safety rather than violence and where they [children] feel most safe (framing in the positive, rather than negative)" [GB]. Other options are to ask about caregivers “whether they are more frustrated with partners/children … changes in relationships with child/ partner (more time spent, greater stress and tension etc..)” [GB]. These types of proxies would need careful attention to the response options and to ensure that in case of spontaneous disclosure of VAC, appropriate referral options were available. Nonetheless, given the context of COVID-19 and the general concerns about safety and security, experts emphasized that: “making [questions] more vague does not make them safer or reliable from a data quality perspective” [CC].
Experts expressed caution that proxy measures should be selected, defined, and used carefully, with checks for completeness and validity, and a clear understanding of their meaning and limitations. For example, some mentioned that proxies “do not generally correlate well with our gold-standard measures of self-reported prevalence and therefore will provide only limited information about levels of violence within households” [KD]. Therefore, proxy measures were considered valuable in “providing some preliminary information about emerging issues and areas of concern” [GM/AA] and perhaps in informing future research but should not be interpreted as providing an accurate description of the incidence of VAC during the pandemic. Similar to other VAC measures, proxy measures should not be collected without careful consideration of interpretation and use.
Beyond COVID-19, are there other methodological or logistical concerns regarding remote VAC data collection with children?
Most experts expressed concerns about the reliability and validity of remote methods to collect data of VAC even without the additional challenges posed by COVID-19, reinforcing challenges of privacy, confidentiality, safety and informed consent. Experts discussed how remote data collection could also affect the participation of both children and interviewers, particularly in the context of building rapport and creating a safe environment. This is highly important because experiences of VAC “are also deeply personal traumatic memories. I am not sure how much of these could be ethically asked about and communicated through a phone call. It requires physical support and a sense of empathy that must be communicated between the interviewer and interviewee” [BDC].
More generally, there is little guidance on whether remote data collection on VAC is possible. While there are some examples of phone-based research on children’s experiences of sexual abuse and assault in the U.S., most research examines the potential uses of digital technologies to address violence, deliver interventions, report violence and link children to services, explores how caregivers and children perceive data collection with digital technologies, or investigates how children experience violence online. There are emerging, but limited, examples for researchers to learn from and draw on.
Experts articulated concerns about the implications of remote methods on the quality, bias, and representativeness of VAC data. First, they pointed out that: *“VAC measures are extremely sensitive in terms of disclosure and the mode of administration … so, we might be jumping into experimenting by using methodologies that have not necessarily been properly validated for VAC. Now is not the time to experiment, especially given the potential risks” *[CC]. Experts agreed that little was known about the effects of remote data collection on disclosure rates and cautioned that researchers should be “aware of possible biases and think about the direction of effects of these biases on our prevalence or effect estimates” [KD]. In line with this, experts also raised questions about whether it was possible to maintain representativeness or unbiased samples within remote data collection: “Research has shown that response rates are consistently higher among in-person surveys than phone surveys. This research is typically from adult samples rather than child samples. For child participants, phone and internet panel surveys pose unique challenges in terms of reaching participants directly. In LMICs and geographic areas with low internet penetration rates, it is difficult to reach participants of any age, particularly minors, who are less likely to have internet access and cellular phones than adults.” [AV/GM]
Finally, experts mentioned that remote data collection made it challenging to include children in the design of research, and to employ diverse and participatory methodologies with children including photovoice, safety mapping, theatre, games, or youth-led research. Due to children’s evolving capacities, the trauma of violence, and the uncertainty of COVID-19, children – particularly younger children – may be less likely to respond to direct questions from adults who are not trusted or known. These factors will complicate and compromise remote data collection.
After COVID-19 measures ease, and face-to-face data collection becomes possible, what factors should researchers consider when deciding whether and how to collect VAC measures?
Experts reminded us of the responsibilities associated with deciding to collect VAC data as COVID-19 measures ease: “It is critical to learn about local community’s understandings of VAC and local pathways to child protection risks before embarking on data collection. Such learning also allows us to build trust and provide crucial entry point for conversations, particularly difficult conversations to take place after” [BDC]. They also emphasized that the protocols for face-to-face surveys should apply – in line with global guidance - to efforts to collect data on VAC when lockdown measures ease. Although the aim of this Think Piece is not to address face-to-face VAC data collection, broadly, experts emphasized three main recommendations regarding: 1) the design of questions; 2) training and support of data collectors; and 3) safety protocol, including mandatory reporting.
Regarding the design and ordering of questions, experts highlighted the importance of using standard questions for any data collected – so that we are building on existing evidence about how best to collect such data and producing measures that are comparable across settings and data sources. In surveys that ask about individual’s direct experience of VAC, experts had the following recommendations about question wording: “1) A clear statement of the time frame covered (since the beginning of physical distancing; since school was canceled; since you have been staying home; etc.); 2) A behavioral description of the VAC exposures of interest. Behaviorally-worded questions avoid subjective interpretations and facilitate disclosure; 3) Information about the perpetrator or context to help clarify and define the exposure” [AV/GM]. Because VAC typologies are diverse and children experience them in different settings – simply asking about VAC without details could lead to a reduce the ability to properly use findings for policy action.
Second, both the selection and training of interviewers were seen as essential in collecting high quality data in face-to-face surveys. For example training procedures for the Violence Against Children and Youth Surveys led by CDC *“include the importance of careful recruitment of interviewers who are competent, empathetic, trustworthy, and non-judgmental. In addition, the value of intensive training on the topics relevant to the survey content, the importance of practice sessions in advance of data collection, and many other key aspects” *[AV/GM]. In addition, support to interviewers throughout the process of data collection, including regular check-ins and debriefs to mentally process violence disclosures is a critical part of supporting staff.
Finally, surveys should ensure participant safety and adhere to mandatory reporting laws. This includes ensuring linkages to services are available, a detailed response plan is established and approved by local (and international) ethics board, with clear and consistent criteria for offering referrals (as well as a monitoring plan to ensure referrals are followed-up). Mandatory reporting laws are a long-standing challenge – especially in the context of addressing duty of care when there are very limited services. Experts emphasized that laws (and exemptions) vary by setting, and that in some contexts “mandatory reporting of some cases may be the most ethically-sound approach. It is important to balance the need to take the participants’ wishes and agency into account with the desire to protect children and vulnerable participants” [AV/GM]. In large-scale data collection like the VAC survey, the approach aims to let the child or young person, whenever possible, be the one to decide whether violence should be reported to the relevant authorities – while respecting local requirements. However, when that is not possible, it is essential to have clear language in consent and assent procedures to alert participants that “information they share may trigger a report or referral. This applies to both adult participants (such as caregivers or adults reporting retrospectively) as well as child participants” [AV/GM]. Other experts reinforced this reminder that mandatory reporting applies even when interviewing caregivers and cautioned that “where mandatory reporting is required and the risks of reporting are likely to be too high, specific information pertaining to the experience of violence should simply not be [collected]” [GB]. Experts referred to a range of existing guidance (UNICEF, INSPIRE) on how researchers can conduct ethical research on VAC with children and young people.
Concluding thoughts
The importance of integrating efforts to prevent and respond to VAC within COVID-19 remains urgent. Our conversations with experts revealed important tensions and challenges in understanding VAC during COVID-19. There was a strong consensus that researchers should not conduct remote VAC data collection with children while lockdown measures are in place. In addition, experts agreed that as long as access to local services for referrals was restricted and the privacy and safety of respondents could not be ensured, collecting VAC data directly from children via phone or internet could put children at risk. These lessons are also relevant for funders and organizations weighing whether to support remote data collection on VAC during COVID-19.
Beyond the immediate ethical and safety concerns, experts also highlighted the challenges and limits of remote data collection on VAC post-COVID-19. Given the limited number of examples of remote VAC data collection, particularly in LMICs, these methodologies were seen as untested and unreliable. While potential for remotely interviewing adolescents about VAC in high-income settings exists based on the evolving capabilities approach – experts agreed that COVID-19 was not the time for researchers to experiment with these methodologies.
The contributions researchers could make on the study of VAC during COVID-19 could therefore include: 1) mapping, data collection and analysis at service and systems level (including administrative data); 2) analyzing existing VAC data – with an acknowledgement of data limitations – to understand and potential links between COVID-19 and VAC, or to simulate changes in VAC.
When the COVID-19 measures that hamper researchers’ abilities to implement safe and ethical research procedures ease, experts still cautioned that data collection on VAC with children and adults should be carefully considered, be actionable, rights-based, and conducted in consultation with (and feeding into) survivor services: “at the outset we must have very clear ideas about how [data collected will] benefit communities … such projects are about care and responsibility towards children, the women, their families, and communities” [BDC]. As researchers committed to strengthening the evidence about VAC, including during COVID-19, we must be guided by our commitments to the safety and wellbeing of children and young people.
Contributors
Thank you to Dr. Susan Jack and Dr. Shanaaz Mathews for reviewing this Think Piece. Thank you to all our experts (listed in alphabetical order]. Disclaimer: These opinions are personal statements from experts and do not reflect the official standpoints of the organizations they work for.
- Dr. Andres Villaveces is a physician and epidemiologist with over 25 years of experience working on violence prevention globally. He is a senior scientist in the Division of Violence Prevention at the CDC. He has worked in academic, private, government and multilateral organizations and has experience working in The Americas, Africa, Asia, and Europe.
- Dr. Bina D’Costais a Professor in the Department of International Relations, Coral Bell School of Asia-Pacific Affairs at the Australian National University. She is an expert on refugees, stateless communities and international displaced persons and conducts research in emergency responses focusing on VAW and VAC, war and peacebuilding. She also served as the senior migration and displacement specialist at UNICEF-Innocenti between 2016-1018 and led its research responses in three global emergencies.
- Dr. Claudia Cappa is a Senior Adviser for Statistics in the Data and Analytics Section, at the UNICEF headquarters. She is the focal point for data collection, data analysis and methodological work on Early Childhood Development, Child Disability and Child Protection from Violence, Exploitation and Abuse.
- Dr. Gabrielle Berman is the Senior Advisor, Ethics in Evidence Generation at UNICEF. She is responsible for providing advisory and technical support to ensure the highest ethical standards within UNICEF’s research, evaluation and data collection and analysis programs globally. Her role includes the development of relevant guidance and resources and advocating for ethical practices for evidence generation involving children in different contexts, for different cohorts and utilizing existing, new and emerging technologies.
- Dr. Greta Massetti is a senior scientist in the Division of Violence Prevention at the CDC, where she leads the division’s efforts to address the global burden of violence against children and youth. Dr. Massetti serves as the lead for the global Violence Against Children and Youth Surveys to determine the magnitude and nature of violence against children and young people in multiple countries. Dr. Massetti works with global partners to increase the availability of scientific data on the topics of violence against children, gender-based violence, and related health consequences, and to support governments in designing and implementing program and policy strategies to end violence against children and gender-based violence.
- Dr. Karen Devries is Professor of Social Epidemiology at LSHTM, where she runs the Child Protection Research Group and is a member of the Gender, Violence and Health Centre. Her main areas of research are around the prevention of VAC and VAW, child protection and epidemiological methods. Her current work is mainly in partnership with colleagues in Uganda, Cote d’Ivoire, Tanzania and Zimbabwe, and she has extensive experience collecting sensitive data on children and adolescents.
Thank you to our experts! Also check out Part 1 focusing on violence against women.
Authors: Amiya Bhatia is a Research Fellow in Social Epidemiology and Child Protection at the London School of Hygiene and Tropical Medicine, Amber Peterman is a Research Associate Professor at UNC and consultant to UNICEF Innocenti, Alessandra Guedes is the Gender & Development Research Manager at UNICEF Innocenti.