SSV-6 Survey of Sexual Victimization Locally or Privately Owne

OMB No. 1121-0292: Approval Expires 6/30/2017
U.S. DEPARTMENT OF JUSTICE

SSV-6

FORM
(4-21-2016)

SURVEY OF SEXUAL VICTIMIZATION, 2015
Locally or Privately-Operated Juvenile Facilities

BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT

U.S. DEPT. OF COMMERCE
Economics and Statistics Administration

Summary Form

U.S. CENSUS BUREAU

DATA SUPPLIED BY

TELEPHONE
E-MAIL
ADDRESS

City

Number and street or P.O. Box/Route Number
Area code

Number

FAX
NUMBER

State

▼

OFFICIAL
ADDRESS

Title

▼▼▼

Name

Area Code

ZIP Code
Number

(Please correct any error in name, mailing address, and ZIP Code)

What facilities are included in this data collection?
All juvenile residential placement facilities operated or
administered by a local government and all privately owned or
operated facilities that are used to house juveniles and
youthful offenders, regardless of age or reason for placement.
• INCLUDE locally-operated juvenile residential facilities;
privately owned or operated juvenile residential facilities;
detention centers, training schools, long-term secure
facilities; reception or diagnostic centers; group homes or
halfway houses; boot camps; ranches; forestry camps,
wilderness or marine programs, or farms; runaway or
homeless shelters; and residential treatment centers for
juveniles.
• EXCLUDE State operated juvenile residential
facilities. (These facilities will be contacted
directly for data on sexual victimization.)

Reporting instructions:
•
•
•

Please complete the entire SSV-6 Form.
If the answer to a question is "not available" or "unknown,"
write "DK" (do not know) in the space provided.
If the answer to a question is "not applicable," write "NA"
in the space provided.

•

Section I: when exact numeric answers are not available,
provide estimates and mark ( X ) the box beside each
figure.

•

Sections II, III, and V: if the answer to a questions "none"
or "zero," write "0" or mark the box ( X ) provided.

Substantiated incidents of sexual violence:
• Please complete an Incident Form (Juvenile, SSV-IJ)
for each substantiated incident of sexual victimization.
Returning forms:

What persons and incidents are included in this
data collection?
Juveniles and youthful offenders, regardless of age or
reason for placement, under your custody between
January 1, 2015, and December 31, 2015.
• INCLUDE incidents involving juveniles or youthful
offenders under the authority, custody, or care of your
confinement or community-based facilities or staff.
• EXCLUDE incidents involving juveniles or
youthful offenders held in facilities operated
by your State juvenile system.

• If you need assistance, please call Greta Clark at the
U.S. Census Bureau toll–free at 1–888–369–3613,
option 2, or e-mail [email protected]
• Please return your completed summary and
substantiated incident forms by
September 15, 2016.
• You may complete these forms online (see
enclosed instructions). Or if you prefer, you
may return these forms by mail or fax.
• MAIL TO: U.S. Census Bureau, P.O. Box 5000,
Jeffersonville, IN 47199-5000
• FAX (TOLL FREE): 1–888–262–3974

Burden Statement
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. The burden of this collection is estimated to average 30 minutes per response, including reviewing instructions, searching
existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden estimate or
any aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street,
NW, Washington, DC 20531. Do not send your completed form to this address.

DEFINITIONS

3. On December 31, 2015, how many persons
held in this facility were —

JUVENILES and YOUTHFUL OFFENDERS
• Any person under the custody or care of a juvenile
residential facility owned or operated by a local
government or private agency.

a. Males . . . . . . . . . . . . . . . . . .

FACILITIES

b. Females

INCLUDE all juvenile residential placement facilities operated
or administered by a local government and all privately owned
or operated facilities that are used to house juveniles and
youthful offenders charged with or court-adjudicated for:

c. TOTAL(Sum of Items 3a and 3b) .

• Any offense that is illegal for both adults and juveniles;

...............

• Count persons held in the facility regardless of age or
reason for placement. Include persons who were
temporarily away but had assigned beds on
December 31, 2015.

OR
• An offense that is ILLEGAL in your State for juveniles,
but not for adults (running away, truancy, incorrigibility,
curfew violations, and liquor violations).

4. On December 31, 2015, how many persons
held in this facility were —

EXCLUDE all State-operated facilities and locally or
privately-operated facilities used ONLY to house juveniles for:
a. Age 17 or younger . . . . . . . .

• Non-criminal behavior (neglect, abuse, abandonment, or
dependency);
OR

b. Age 18 to 20

• Being Persons in Need of Services (PINS) or Children in
Need of Services (CHINS) who have assigned beds for
reasons other than offenses.

c. Age 21 or older . . . . . . . . . .

Section I – GENERAL INFORMATION

d. TOTAL (Sum of Items 4a through
4c should equal Item 3c) . . . . . .

1. Is this facility owned by a —
01

Private agency

02

Native American Tribal Government

03

State

04

County

05

Local or municipal government

06

Other – Specify

............

• Count all persons held in the facility regardless of age
or reason for placement. Include persons who were
temporarily away but had assigned beds on
December 31, 2015.
5. Between January 1, 2015, and
December 31, 2015, how many persons were
admitted to or discharged from this facility?

a. TOTAL number admitted

2. Is this facility operated by a —
01

Private agency

02

Native American Tribal Government

03

State

04

County

05

Local or municipal government

06

Other – Specify

..

b. TOTAL number discharged .
• Include all persons admitted to this facility by a formal
legal document, by the authority of the courts, or by
some other official agency.
• Include all persons discharged from this facility after a
period of confinement including sentence completion,
pretrial releases, transfers to adult jurisdictions or to
other States, and deaths.
• Exclude admissions and discharges resulting from
returns from escape, administrative transfers to other
juvenile facilities, or temporary release including
work/school release, medical appointments, other
treatment facilities, or court appearances.

FORM SSV-6 (4-21-2016)

Page 2

Section II – YOUTH-ON-YOUTH SEXUAL VICTIMIZATION 6. Does your facility record allegations of
youth-on-youth NONCONSENSUAL SEXUAL
ACTS?
DEFINITIONS
01
Yes ➔ a. Do you record all reported
The survey utilizes the definition of “sexual abuse” as
occurrences, or only
provided by 28 C.F.R. §115.6 in the National Standards to
substantiated ones?
Prevent, Detect, and Respond to Prison Rape (under the
Prison Rape Elimination Act of 2003). For purposes of SSV,
01
All
sexual abuse is disaggregated into three categories of
Substantiated only
02
youth-on-youth sexual victimization. These categories are:
b. Do you record attempted
NONCONSENSUAL SEXUAL ACTS
or only completed ones?

NONCONSENSUAL SEXUAL ACTS
Sexual contact of any person without his or her consent,
or of a person who is unable to consent or refuse;

01
02

AND
• Contact between the penis and the vulva or the penis
and the anus including penetration, however slight;

02

No

Both attempted and completed
Completed only

➔ Please provide the definition used by your
facility for youth-on-youth NONCONSENSUAL
SEXUAL ACTS in the space below. Use that
definition to complete Items 7 and 8.

OR
• Contact between the mouth and the penis, vulva, or
anus;
OR
• Penetration of the anal or genital opening of another
person, however slight, by a hand, finger, object, or
other instrument.

7. Between January 1, 2015 and December 31, 2015,
how many allegations of youth-on-youth
NONCONSENSUAL SEXUAL ACTS were reported?

ABUSIVE SEXUAL CONTACT
Sexual contact of any person without his or her consent,
or of a person who is unable to consent or refuse;

Number reported . . . . . .

AND

• If an allegation involved multiple victimizations, count only
once.

• Intentional touching, either directly or through the
clothing, of the genitalia, anus, groin, breast, inner thigh,
or buttocks of any person.
• EXCLUDE incidents in which the contact was incidental
to a physical altercation.
SEXUAL HARASSMENT

None

• Exclude any allegations that were reported as consensual.
8. Of the allegations reported in Item 7, how many
were — (Please contact the agency or office responsible
for investigating allegations of sexual victimization in order
to fully complete this form.)

Repeated and unwelcome sexual advances, requests for
sexual favors, or verbal comments, gestures, or actions
of a derogatory or offensive sexual nature by one youth
directed toward another.

a. Substantiated

None

......

• The event was investigated and determined to have
occurred, based on a preponderance of the evidence
(28 C.F.R. §115.72).
b. Unsubstantiated

None

....

• The investigation concluded that evidence was insufficient
to determine whether or not the event occurred.
None

c. Unfounded . . . . . . . . .

• The investigation determined that the event did NOT occur.
d. Investigation ongoing

.

None

• Evidence is still being gathered, processed or evaluated,
and a final determination has not yet been made.
e. TOTAL (Sum of Items
8a through 8d) . . . . . . . .

None

• The total should equal the number reported in Item 7.
FORM SSV-6 (4-21-2016)

Page 3

9. Does your facility record allegations of
youth-on-youth ABUSIVE SEXUAL CONTACT?
(See definitions on page 3.)
01

02

Yes

No

12. Does your facility record allegations of
youth-on-youth SEXUAL HARASSMENT?
(See definitions on page 3.)

➔ Can these be counted separately

01

from allegations of
NONCONSENSUAL SEXUAL ACTS?
01

Yes

02

No

Yes

➔ Do you record all reported

allegations or only substantiated
ones?

➔ Skip to Item 12.

➔ Please provide an explanation in the space

02

below and then skip to Item 12.

All

02

Substantiated only

➔ Please provide an explanation in the space
below and then skip to Section III.

10. Between January 1, 2015, and
December 31, 2015, how many allegations of
youth-on-youth ABUSIVE SEXUAL CONTACT
were reported?
Number reported . . . . . .

No

01

13. Between January 1, 2015, and
December 31, 2015, how many allegations of
youth-on-youth SEXUAL HARASSMENT were
reported?
Number reported . . . . . .

None

None

• If an allegation involved multiple victimizations, count
only once.

• If an allegation involved multiple victims or youth
perpetrators, count only once.

• Exclude any allegations that were reported as consensual.

• Exclude any allegations that were reported as consensual.

11. Of the allegations reported in Item 10, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)

14. Of the allegations reported in Item 13, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)

a. Substantiated . . . . . . .

None

a. Substantiated . . . . . . .

None

b. Unsubstantiated . . . . .

None

b. Unsubstantiated

....

None

c. Unfounded

None

c. Unfounded

.........

None

d. Investigation ongoing . .

None

d. Investigation ongoing

e. TOTAL (Sum of Items
11a through 11d) . . . . . . .

None

e. TOTAL (Sum of Items
14a through 14d) . . . . . . .

.........

• The total should equal the number reported in Item 10.

FORM SSV-6 (4-21-2016)

.

None

None

• The total should equal the number reported in Item 13.

Page 4

Section III – STAFF-ON-YOUTH SEXUAL ABUSE

15. Does your facility record allegations of STAFF
SEXUAL MISCONDUCT?

DEFINITIONS
Yes

01

The survey utilizes the definition of “sexual abuse” by a staff
member, contractor or volunteer as provided by 28 C.F.R.
§115.6 in the National Standards to Prevent, Detect, and
Respond to Prison Rape (under the Prison Rape Elimination
Act of 2003). For purposes of SSV, sexual abuse is
disaggregated into two categories of staff-on-youth sexual
abuse. These categories are:

02

STAFF SEXUAL MISCONDUCT

No

➔ Do you record all reported

occurrences, or only substantiated
ones?
01

All

02

Substantiated only

➔ Please provide an explanation in the space
below and then skip to Item 18.

Any behavior or act of a sexual nature directed toward a youth by
an employee, volunteer, contractor, official visitor or other agency
representative (exclude family, friends or other visitors).
Sexual relationships of a romantic nature between staff and
youths are included in this definition. Consensual or
nonconsensual sexual acts include–
• Intentional touching, either directly or through the clothing,
of the genitalia, anus, groin, breast, inner thigh, or buttocks
that is unrelated to official duties or with the intent to abuse,
arouse, or gratify sexual desire;
OR
• Completed, attempted, threatened, or requested sexual acts;
OR

16. Between January 1, 2015, and
December 31, 2015, how many allegations of
STAFF SEXUAL MISCONDUCT were reported?

• Occurrences of indecent exposure, invasion of privacy,
or staff voyeurism for reasons unrelated to official duties
or for sexual gratification.

Number reported . . . . . .

• If an allegation involved multiple victimizations, count only
once.

STAFF SEXUAL HARASSMENT
Repeated verbal statements, comments or gestures of a sexual
nature to a youth by an employee, volunteer, contractor, official
visitor, or other agency representative (exclude family, friends,
or other visitors). Include–
• Demeaning references to gender; or sexually suggestive
or derogatory comments about body or clothing;

None

17. Of the allegations reported in Item 16, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)

a. Substantiated

OR

......

None

• Repeated profane or obscene language or gestures.
....

None

c. Unfounded . . . . . . . . .

None

d. Investigation ongoing

None

e. TOTAL (Sum of Items
17a through 17d) . . . . . .

None

b. Unsubstantiated

• The total should equal the number reported in Item 16.

FORM SSV-6 (4-21-2016)

Page 5

Section IV – TOTAL SUBSTANTIATED
INCIDENTS OF SEXUAL VICTIMIZATION

18. Does your facility record allegations of STAFF
SEXUAL HARASSMENT ? (See definitions on page 5.)
Yes

01

No

02

➔ Can these allegations be counted

21. What is the total number of substantiated
incidents reported in Items 8a, 11a, 14a,
17a, and 20a.

separately from allegations of
STAFF SEXUAL MISCONDUCT?
01

Yes

02

No

➔ Skip to Item 21

Total substantiated
incidents . . . . . . . . . . . . .

None

➔ Please provide an explanation in the space
below and then skip to Item 21.

➔ Please complete aa Substantiated Incident Form
(Juvenile, SSV-IJ) for each substantiated
incident of sexual victimization.

NOTES

19. Between January 1, 2015, and
December 31, 2015, how many allegations of
STAFF SEXUAL HARASSMENT were reported?

Number reported . . . . . .

None

• If an allegation involved multiple victims or staff, count
only once.
20. Of the allegations reported in Item 19, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)

a. Substantiated . . . . . . .

None

b. Unsubstantiated . . . . .

None

c. Unfounded . . . . . . . . . .

None

d. Investigation ongoing .

None

e. TOTAL (Sum of Items 20a
through 20d) . . . . . . . . . .

None

•

The total should equal the number reported in Item 19.

FORM SSV-6 (4-21-2016)

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