VACS Adaptation Expert Consultation Report

Final Report for the
Violence Against Children Survey (VACS) For Domestic Use:
Expert Meeting
Atlanta, GA
July 18, 2017
Meeting Location
CDC Foundation
600 Peachtree Street NE
Suite 1000
Atlanta, GA 30308

Submitted by:
Valerie B. Coles Cone, PhD
University of Georgia
vcoles@uga.edu
404-314-3514

Violence Against Children Survey (VACS) For Domestic Use

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PROJECT INTRODUCTION
The Violence Against Children Surveys (VACS) systematically measure physical, emotional, and
sexual violence against girls and boys, and identify risk and protective factors and health
consequences, as well as use of services and barriers to seeking help. Children who experience
violence are at greater risk for common and destructive yet preventable consequences,
including HIV, chronic diseases, crime and drug abuse, as well as serious mental health
problems. Findings from VACS provide data that may help countries ensure that limited
resources to develop, launch, and evaluate violence prevention programs and child protection
systems are used most effectively. An expert meeting was held mid-July 2017 to discuss the
feasibility of adapting the VACS for the United States.

Tuesday
June 18, 2017
Start
Time
8:30 AM

End
Time
8:52 AM

Session

Presenter(s)

Welcome/Objectives of the Project

Rachna Chandora (CDC
Foundation)

Rachna Chandora (CDC Foundation) opened the meeting by welcoming everyone, reviewing the
function and impact of CDC Foundation, and detailing the purpose of the meeting. This meeting
was the first step in determining the feasibility of the development of the Violence Against
Children Survey (VACS) for the United States.
List of Attendees
• Dr. Desmond Runyan (Kempe Center at the University of Colorado, Boulder)
• Dr. Dorothy Espelage (University of Florida)
• Dr. Leah Gilbert (CDC National Center for Injury Prevention and Control)
• Dr. Steven Ondersma (Wayne State University)
• Dr. Anjani Chandra (CDC National Center for Health Statistics)
• Dr. Jason Hsia (CDC National Center for Chronic Disease Prevention and Health Promotion)
• Dr. Greta Massetti (CDC National Center for Injury Prevention and Control)
• Dr. Daniela Ligiero (Together for Girls)
• Dr. Linda Dahlberg (CDC National Center for Injury Prevention and Control)
• Ms. Rachna Chandora (CDC Foundation)
• Dr. Katherine Yount (Emory University)
• Dr. Deborah Gorman-Smith (Chicago Center for Youth Violence Prevention at the University
of Chicago)
• Dr. Heather Turner (Crimes Against Children Research Center, University of New Hampshire)
• Dr. Lynn Langton (Bureau of Justice Statistics, Department of Justice)
• Ms. Elizabeth Belser-Vega (CDC National Center for Injury Prevention and Control)

Valerie B. Coles Cone

July 18, 2017

Atlanta, Georgia

Violence Against Children Survey (VACS) For Domestic Use

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Dr. Kathleen Basile (CDC National Center for Injury Prevention and Control)
Start
Time
8:52 AM

End
Time
8:54 AM

Session

Presenter(s)

Overview of Meeting Agenda and
Objectives

Daniela Ligiero (Together for
Girls)

Daniela Ligiero (Together for Girls) welcomed everyone and thanked them for being a part of
the meeting and development of the VACS for the US. Ligiero provided an overview of the
meeting agenda and the meeting objectives. Ligiero explained the meeting’s agenda was
divided into topical sessions so that focused in-depth conversations could occur on each
selected topic: methodology and adaptation, ethical considerations, and pilot feasibility study.
Ligiero also emphasized that the purpose of the meeting was to gather opinions and
recommendations but not to achieve consensus amongst all meeting attendees.
Start Time
8:54 AM

End Time
8:59 AM

Session
Introduction from CDC and
Parameters for a Domestic VACS

Presenter(s)
Greta Massetti (CDC)

Greta Massetti (CDC) stated the three main areas of discussion for the day would be (a)
methodology and adaptation, (b) ethical considerations, and (c) pilot feasibility study. Massetti
noted the Together for Girls Partnership has been an effective partnership internationally and is
achieving the broad goal of identifying/addressing cases of violence against children.
Parameters for a domestic application of the VACS were also reviewed. Massetti stated a U.S.
VACS would provide valuable data to fill critical gaps in policy and programming to address
violence against children. The current planned focus for a domestic VACS is on sub-national
data (i.e., at the state or municipality level). Additionally, there is a goal to maintain maximum
comparability. This goal would be achieved, in part, by (a) focusing on 13-24-year-olds, (b)
keeping the methodology in-person and household-based versus telephone, institutionalizedbased, or school-based, and (c) maintaining a core questionnaire with some modifications
tailored for specific locations.
Start Time
9:00 AM

End Time Session
10:25 AM Methodology and Adaptation: Brief
Overview of VACS Methodology,
Sampling

Presenter(s)
Leah Gilbert (CDC); Group
Discussion Facilitated by
Daniela Ligiero (Together for
Girls)

Leah Gilbert (CDC) began this session with a review of the current methodology and adaptation
of the Domestic VACS. The Domestic VACS is proposed to be a national household survey that
takes place in a three-stage cluster sample survey design. The first stage involves randomly
selecting x clusters from a national sampling frame. The goal is to utilize a sampling frame from
another household survey such as the Demographic and Health Surveys (DHS). The second

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July 18, 2017

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stage involves randomly selecting x number of households per cluster to visit for eligibility
screening. The third stage involves randomly selecting one respondent from eligible household
members. Eligible participants must be 13-24 years old and may be male or female. Surveys will
be carried out by in-country institutions. The current goal is to gender match interviewees and
interviewers, as is done internationally with the VACS (apart from Swazi). Like the international
application of the VACS, the domestic application will solicit a retrospective report of violence.
It was also noted that there will be extensive efforts in place to protect child respondents.
Gilbert’s presentation was followed by a discussion/question-and-answer session facilitated by
Daniela Ligiero (Together for Girls). Discussion focused on the purpose and utility of adapting
the VACS domestically, the extent to which special populations (e.g., military, incarcerated)
should be included, how to include those living away from home (e.g., college students) who
would not be included based on the current sample survey design, incentives, the best
administration method (e.g., in-person, interview-interviewer, self-administered, web-based),
and issues of standardization versus customization of the VACS. One overall takeaway from the
discussion/question-and-answer session was that administering the VACS via an ACASI was
recommended by several meeting participants.
Start Time
10:35 AM

End Time Session
11:50 AM Ethical Considerations: Brief
Overview of VACS Strategies for
Ethics and Respondent Protections

Presenter(s)
Leah Gilbert (CDC); Group
Discussion Facilitated by
Daniela Ligiero (Together for
Girls)

Leah Gilbert (CDC) began this session with a review of ethical considerations applicable for the
Domestic VACS. These considerations included CDC IRB and local review of VACS Protocol,
including children as respondents, lengthy training for field staff, split sample design,
community involvement, the number of respondents per household, questionnaire design,
services for respondents, and the consent process. Following this review, Daniela Ligiero
(Together for Girls) facilitated a discussion session of these and other ethical considerations
that should be considered for the domestic application of the VACS.
The discussion largely related to issues of anonymity and confidentiality, consent procedures,
disclosure of reportable violence, mandatory reporting, survey administration methods, risk
assessments, and response processes. The utility of gender matching interviewers and
interviewees was discussed. Several attendees noted that gender matching may not have as
much utility domestically as it may internationally. Several meeting attendees shared the
opinion that asking participants to report any potential reportable violence information in an
ACASI would be a way to collect sensitive information and ensure data quality while
maintaining respondent privacy, confidentiality, and safety. Potential applications of mandatory
reporting were discussed. Some attendees expressed concern that poor data would be
collected and breaches of respondent confidentiality could occur if the respondents knew any
disclosures of violence would trigger mandatory reporting. Discussions focused on the ways
data are collected. Since Personally Identifiable Information (PII) is not collected through VACS,
Valerie B. Coles Cone

July 18, 2017

Atlanta, Georgia

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use of ACASI would mean the only way to access information reported by respondents would
be to breach confidentiality and disclose information not provided to an individual.
Start
End
Time
Time
12:28 PM 1:37 PM

Session

Presenter(s)

Questionnaire Adaptation

Group Discussion Facilitated
by Daniela Ligiero (Together
for Girls)

This session focused on which sections/items need to be added and/or expanded to the VACS and which
need to be eliminated. Leah Gilbert (CDC) began the session by reviewing the current items/topics
included in the international version of the VACS. Questionnaire addition ideas included general

demographic questions (e.g., race/ethnicity and sexual orientation), parental SES, parental
substance use and mental health conditions, respondent health and mental health conditions,
respondent resiliency, perceptions of police, respondent self-harm history (e.g., cutting),
implicit associations that examine attitudes about violence, and assessment of whether a
respondent was threatened with violence or the recipient of violence. Additionally, several
meeting attendees recommended that the bullying section be expanded. It was also noted that
not all of these recommendations can or should be added due to both focus and space
limitations. Items recommended for omission were (a) remittances and (b) perpetration items.
Several meeting attendees agreed that while perpetration is an interesting topic, the VACS
cannot and should not attempt to do everything.
Start
Time
1:50 PM

End
Time
2:36 PM

Session

Presenter(s)

Pilot Feasibility Study: Primary
Research Question to be Addressed in
a Pilot Study

Group Discussion Facilitated
by Daniela Ligiero (Together
for Girls)

Daniela Ligiero (Together for Girls) facilitated this session focused on soliciting suggestions for
what should be considered during the development of a pilot feasibility study. Ligiero began the
session by identifying two discussion targets: (1) Geographic reach of the pilot (e.g., state/city;
urban/rural) and (2) Primary research question to be addressed in a pilot study. During this
session, there was no one recommendation that dominated the conversation. Instead, this was
a listening session where any ideas were voiced and, at times, some feedback and additional
comments followed. The discussion session included the following suggestion topics: sampling
and power, the purpose and intended outcome(s) of the pilot study, leveraging existing
measures to either pull items from for expansion or to use for validity assessment of the
Domestic VACS (e.g., Behavioral Risk Factor Surveillance System (BRFSS); Juvenile Victimization
Questionnaire (JVQ)), examining the application of gender matching the interviewee and
interviewer, incorporating qualitative data, utilizing repeated measures, planned missingness,
consent procedures, the appropriate length of the questionnaire, using cuing strategies for
facilitating recall of past events, and comparing urban areas versus rural areas. As expressed in
earlier sessions, several meeting attendees expressed concern that while there are many
Valerie B. Coles Cone

July 18, 2017

Atlanta, Georgia

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directions the pilot study could go in, it would be best not to attempt to utilize all (or even
most) of the suggestions. At the conclusion of the session, Ligiero requested each participant to
identify the top one (or two) suggestions discussed in the session that should be considered for
the pilot study. These suggestions (in addition to ones collected in previous sessions) were then
utilized to further focus conversation and recommendations in the following session.
Start
Time
2:38 PM

End Time

Session

Presenter(s)

2:58 PM

Top Idea Activity

Group Discussion Facilitated
by Daniela Ligiero (Together
for Girls)

After each discussion session (i.e., Methodology and Adaptation; Ethical Considerations;
Questionnaire Adaptation; and Pilot Feasibility Study) each meeting attendee identified one or
two key ideas s/he believed the CDC should consider implementing for the Domestic VACS. For
this session, Daniela Ligiero (Together for Girls) instructed each participant to indicate her/his
top three ideas amongst all the participant feedback per discussion session.
The top three suggestions for the Methodology and Adaptation session were (1) utilize ACASI,
(2) use incentives, and (3) retain the ability to have comparable data across jurisdictions (and
possibly over time) by establishing consistent procedures, methodology, and questionnaire, as
has been done with the global VACS.
The top three suggestions for Ethical Considerations session were (1) utilize an ACASI, (2) create
protocol around anonymity and retain the ability for the respondent to seek help if s/he wants,
and (3) investigate whether gender matching has the same utility domestically as it does
internationally.
The top three suggestions for the Questionnaire Adaptation session were (1) modify the items
related to bullying, socioeconomic status, contraception, and transactional sex; (2) measure
resiliency and child mental health; and (3) measure parent substance abuse and mental
disorders.
The top three suggestions for the Pilot Feasibility Study session were (1) test different strategies
for response rates, (2) adapt and evaluate procedure, incentives, and response rates, and (3)
conduct a feasibility assessment in rural areas.
Start
Time
2:58 PM

End Time

Session

Presenter(s)

3:53 PM

Summary and Revisiting Outstanding
Questions

Discussion Facilitated by
Daniela Ligiero (Together for
Girls)

Valerie B. Coles Cone

July 18, 2017

Atlanta, Georgia

Violence Against Children Survey (VACS) For Domestic Use

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The purpose of this session was to summarize the meeting, gather overall reactions, and solicit
any lingering suggestions not yet discussed. The session began with a discussion of whether to
administer the entire survey via ACASI or whether it would be more advantageous to
administer some questions via ACASI and some face-to-face with an interviewer. Opinions were
mixed on which method would be best. The conversation then turned to whether the ACASI
questions should (a) be accompanied by an audio recording and (b) if so, then whether there
should be an “opt out” button for more competent readers. Also related to the ACASI, several
meeting attendees suggested the inclusion of either a privacy screen or a “privacy button” built
into the ACASI to protect respondent responses.
Other discussion revolved around response protocols, what information should be included in
the questionnaires (e.g., parental health and risk information), and to whom risk information
should be asked (i.e., the child or the parent). Many meeting attendees recommended that (a)
there should be a response protocol in place for respondents to accept if they wish and (b) each
respondent, regardless of responses, should receive a resource list (as is currently done with
the VACS internationally). When discussing parental health and risk information, several
meeting attendees noted that although only the parents may have accurate answers to these
questions, asking for this information may deter parents from consenting for their children to
participate. Some alternative approaches were discussed.
It was also reemphasized that two elements the pilot study needs to examine are (a) the
duration of the survey and (b) incentives (e.g., How much? Children only? Children and
parents?). It was noted during the conclusion of the session that a domestic advisory
committee of key stakeholders will be formed to replicate what has been done with the VACS
internationally.
Start Time
3:53 AM

End Time
3:58 PM

Session
Closing Remarks and Adjourn

Presenter(s)
CDC Foundation

Following a few concluding suggestions (e.g., considering education aspirations and examining
respondents’ family structures), Greta Massetti (CDC) closed the meeting by thanking everyone
for all of their work.
Name
Centers for Disease Control and Prevention
Violence Against Children Survey

Valerie B. Coles Cone

Abbreviation
CDC
VACS

July 18, 2017

Atlanta, Georgia