National Survey of Youth in Custody Facility Questionnai

FORM APPROVED
OMB No.: 1121-XXXX
EXPIRATION DATE: XX/XX/20XX

National Survey of Youth in Custody
Facility Questionnaire
Facility name:

NSYC researchers are scheduled to visit your facility on .
This questionnaire asks about staffing and youth in this facility as of
, the Wednesday before the NSYC visit.

Person Completing this Questionnaire
Name

Email Address

Title
Facility Name

Telephone
Area code Number

Extension

Facility Address – Number/street/PO Box number

Fax Number
City

State

ZIP Code

Area code Number

Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a
currently valid OMB control number. Public reporting burden for this collection is estimated to average 60 minutes per
response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information. Send comments regarding this burden
estimate or any aspect of this collection of information, including suggestions for reducing this burden, to the Director,
Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531; and to the Office of Management and
Budget, OMB No. 1121-XXXX, Washington, DC 20503.

If you have any questions, please contact the National Survey of Youth in Custody Help
Desk at XXX-XXX-XXXX or [email protected].

FACILITY STATISTICS
1.

Please use your most recent payroll records to provide the number and gender of staff members
working at this facility as of Wednesday, . Include full and part-time payroll and non-payroll staff.
Examples of non-payroll staff: staff provided by outside agencies such as teachers provided by schools,
and staff paid under contractual agreements/grants.
For each category, please provide the number of staff members working at this facility as of Wednesday,
.
Include each staff person in only one category. If a staff member serves in more than one capacity, categorize
the person based on his or her primary role.
TOTAL

2.

SEX
Male

Female

TOTAL STAFF

______

______

______

a. Frontline supervision staff, direct care staff, and
correctional officers

______

______

______

b. Program staff (e.g., instructors, teachers, librarians,
education assistants, and other program staff)

______

______

______

Compared to 12 months ago, has the current number of paid staff at this facility increased, decreased, or
stayed the same? Include ONLY full and part-time payroll staff.
Increased
Decreased
Stayed the same

3.

How many paid staff have been hired and how many paid staff have left this facility in the past 12
months?
TOTAL

4.

a. Paid staff who have been hired

______

b. Paid staff who have left

______

As of Wednesday, , how many vacant or unfilled positions existed within this facility?
_____________
Vacant positions (include partial FTEs)
NOTE: If there were no vacant or unfilled positions, please enter ‘0’ in the space above and skip to Item 5.

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4a. Indicate how many vacant or unfilled positions exist currently for each category. Include full and parttime payroll and non-payroll staff. (Include partial FTEs.)
TOTAL

a. Frontline supervision staff, direct care staff, and correctional officers

______

b. Program staff (e.g., instructors, teachers, librarians, education assistants, and other
program staff)

______

Please consider only frontline supervision staff, direct care staff, and correctional officers when answering the
next seven questions.

5.

Please use your most recent payroll records to provide counts of frontline supervision staff, direct care
staff, and correctional officers at this facility as of Wednesday, .
If exact counts are not available, please provide estimates and check this box .
TOTAL

a. White, not of Hispanic origin

______

b. Black or African American, not of Hispanic origin

______

c. Hispanic or Latino

______

d. American Indian or Alaska Native, not of Hispanic origin

______

e. Asian, not of Hispanic origin

______

f. Native Hawaiian or Other Pacific Islander, not of Hispanic origin

______

g. Two or more races, not of Hispanic origin

______

h. Additional categories in your information system
Other (Please specify):
_____________________________________________________

______

i. Not known

______

TOTAL (Sum of items 5a to 5i)

______

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6.

Please use your most recent payroll records to provide counts of frontline supervision staff, direct care
staff, and correctional officers by age working at this facility as of Wednesday, .
If exact counts are not available, please provide estimates and check this box .
TOTAL

7.

a. 29 or younger

______

b. 30-39

______

c. 40-49

______

d. 50 or older

______

Please use your most recent payroll records to provide counts of frontline supervision staff, direct care
staff, and correctional officers by length of service working at this facility as of Wednesday, .
If exact counts are not available, please provide estimates and check this box .
TOTAL

a. Less than 1 year

______

b. 1-2 years

______

c. 3-4 years

______

d. 5-9 years

______

e. 10 or more years

______

f. Unknown

______

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PERSONNEL SCREENING
Personnel screening involves procedures that go beyond asking someone to self-disclose information. Examples of
screening include checking police records and records of other public agencies.
Please consider only frontline supervision staff, direct care staff, and correctional officers when answering the
following questions:
8.

When screening potential new hires for frontline supervision staff, direct care staff, and correctional
officer positions, does this facility utilize the following sources?
Yes

No

a. Criminal record/history check
b. Test for current drug use
c. Child abuse/sex offender registry check
d. Domestic violence/civil protective order check
STAFF TRAINING
The next questions ask about staff training programs.
Examples of training programs include supervised on-the-job instruction, classroom training, distance learning, selfdirected learning, workshops, lectures, group discussions, demonstrations, role-play, and other methods of group and
individual interaction.
Please consider only frontline supervision staff, direct care staff, and correctional officers when answering
the following questions:
9.

What topics are covered during required training programs for new hires and refresher training for
current frontline supervision staff, direct care staff, and correctional officers?
Mark all that apply. Please consider training for new hires and current employees separately.

Employee Training Topics

New hires

Refresher training
for current
employees

Not
currently
offered

a. Cross-gender supervision
b. LGBT responsiveness
c. Managing mentally disordered youth
d. Staff boundaries
e. Conflict de-escalation training and communication with
youth
f. Gang management, identification, and prevention

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10. What is the required number of training hours on PREA-related topics that new frontline supervision
staff, direct care staff, and correctional officers must complete either pre-service and/or during their first
year of employment?
______________
Hours

None [IF “NONE” IS SELECTED, SKIP TO ITEM 12]

11. What is the required timeframe for new frontline supervision staff, direct care staff, and correctional
officers to complete all PREA-related trainings?
Pre-service (prior to starting position)
Within first 24 hours of starting position
After first 24 hours but within first week (7 days) of starting position
After first week but within first month (30 days) of starting position
After first month but within first six months (180 days) of starting position
After first six months but within first year (365 days) of starting position
Other (Please specify): __________________________________________________________
__________________________________________________________
__________________________________________________________

FACILITY CHARACTERISTICS
This section asks about youth in the facility. When providing responses, please include youth who:


Have been adjudicated for an offense in juvenile court. Adjudication is the court process that
determines if the juvenile committed the act for which he or she is charged. The term "adjudicated" is
analogous to "convicted" and indicates that the court concluded the juvenile committed the act.



Have been convicted for an offense in adult court.

12. How many adjudicated/convicted youth were held in this facility on Wednesday, ?
______________
Adjudicated/convicted youth

13. During the past 12 months, how many adjudicated/convicted youth were admitted to this facility?
______________
Admitted youth (include all youth admitted to this facility including those transferred from another facility)

14. During the past 12 months, how many adjudicated/convicted youth were released from this facility?
______________
Released youth (include all youth released from this facility including those transferred to another facility)

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15. As of Wednesday, , how many youth were assigned beds in this facility? Include standard and
makeshift beds. Makeshift beds are roll-out mats, fold-out cots, roll-away beds, pull-out mattresses,
sofas, or any other beds that are put away or moved during non-sleeping hours.
TOTAL ASSIGNED BEDS

______

a.

Standard beds

______

b.

Makeshift beds

______

16. On Wednesday, , how many beds were not assigned?
Not assigned
a.

Standard beds

______

b.

Makeshift beds

______

17. Does this facility currently house any transgender youth?
Yes  How many? ______
No

18. During the past 12 months, has this facility housed youth with any of the following limitations?
Yes

No

a. Limited English proficiency
b. Deaf or hard of hearing
c. Blind or limited vision
d. Learning disabilities (e.g., dyslexia, language processing disorder)
e. Intellectual/developmental disabilities
f. Other physical, mental, or medical disabilities that cause
impairment to youth functioning

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GRIEVANCE PROCESS
19. Which of these ways can a youth use to report a complaint against a staff member in this facility?
Yes

No

a. Make a report or talk to a different staff member or administrator
b. Report by phone or hotline
c. Talk to someone outside the facility
d. Talk to someone who visits from outside the facility
e. Report some other way

SPECIAL HOUSING
20. During the past 12 months, did this facility isolate youth in a separate room or area without sight and
sound contact from other youth or staff for more than 20 hours (excluding protective or medical
isolation)?
Yes
No [IF “NO” IS SELECTED, SKIP TO ITEM 23]

21. On Wednesday, how many youth did this facility isolate in a separate room or area without sight
and sound contact from other youth or staff for more than 20 hours (excluding protective or medical
isolation)?
______________
Youth

None

22. On Wednesday, how many youth did this facility isolate in a separate room or area without sight
and sound contact from other youth or staff for more than 20 hours for discipline or misconduct?

______________
Youth

None

23. Does this facility have a written policy requiring approval from the superintendent before youth can be
isolated for any reason (excluding protective and medical)?
Yes
No

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24. Does your facility have a written policy stating the maximum amount of time youth can be isolated for any
reason (excluding protective and medical)?
Yes
No [IF “NO” IS SELECTED, SKIP TO ITEM 25]

24a. What is the maximum amount of time youth can be isolated for any reason (excluding protective and
medical)?
______________ hours

25. In the last 30 days, were any youth placed in “time out” in a room or area other than their own room or
housing unit? By “time out” we mean confinement lasting less than one hour at either a youth’s request
or a staff member’s direction.
Yes
No

26. On Wednesday, how many youth did this facility place in “time out” in a room or area other than
their own room or housing unit?

______________
Youth

None

27. In the last 30 days, were any youth placed in “time out” in their own room or housing unit as punishment
or for an administrative reason (such as waiting to be transferred to another unit or facility)?
Yes
No [IF “NO” IS SELECTED, SKIP TO ITEM 29]

28. On Wednesday, how many youth did this facility place in “time out” in their own room or housing
unit as punishment or for an administrative reason (such as waiting to be transferred to another unit or
facility)?
______________
Youth

None

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YOUTH EDUCATION ON PREA
29. How are youth typically given information that sexual activity is not allowed in this facility?
Yes

No

a. Facility staff
b. Posters/signs
c. Brochure/flier/pamphlet
d. Handbook with facility rules
e. Video
f. Other (Please specify): _____________________________________
_____________________________________

GENERAL COMMENTS
30. Please provide any additional suggestions, explanations, or comments.
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

Thank you very much!

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