CJRP- JRFC Pilot Test

CJRP Questionnaire

Appendix D: CJRP Questionnaire

All changes from the 2019 CJRP instrument are denoted with red font. Variable names and question numbering may be different.

Table of Contents

INTRO PAGES 1

SECTION 0: FACILITY AND CONTACT INFORMATION 2

SECTION 1: GENERAL INFORMATION 4

SECTION 2a: LENGTH OF STAY 20

SECTION 2: PERSON LEVEL DATA 27

END PAGES 32

INTRO PAGES

LOGIN
ASK	All Respondents
Welcome to the 2021 Census of Juveniles in Residential Placement (CJRP) Pilot Study. Your participation in this census pilot study will help improve the ongoing CJRP data collection. The CRJP provides comprehensive and reliable statistical data on the residential placement of juvenile offenders; facilitates the needs of juvenile justice agencies and social service organizations that address the many problems faced by today’s youth; and gathers the most complete and accurate information regarding issues of juvenile detention, correction, and placement. Thank you for your participation in this endeavor. Please enter the password provided in the mailing packet sent to your facility. <i>Please note that the password case sensitive. </i>

INTRO
ASK	All Respondents
<b>Important Instructions</b> Complete this questionnaire only for <b>[FACILITY_NAME]</b>. We are not requesting forms for any additional facilities in this current round of data collection. Sessions will expire (requiring you to log back in) after 30 minutes of inactivity. A juvenile residential facility is a place where young persons who have committed offenses may be housed overnight. A facility has living/sleeping units, such as wings, floors, dorms, barracks, or cottages on one campus or in one building. Any buildings with living/sleeping units that are not on the same campus should be considered separate facilities and should not be included in this questionnaire.

SECTION 0: FACILITY AND CONTACT INFORMATION

S0_NAME_CONFIRM
ASK	All Respondents
<b>Facility and Contact Information</b> We have the following name listed for this facility. <b>[FACILITY_NAME]</b> Is this the correct name for this facility? Yes No

S0_NAME_UPDATE
ASK	If S0_NAME_CONFIRM = 2
What is the correct name of this facility?

S0_MAILADDR_CONFIRM
ASK	All Respondents
We have the following mailing address listed for this facility. <b>[FACILITY_MAILADDR]</b> Is this the correct mailing address for this facility? Yes No

S0_MAILADDR_UPDATE
ASK	If S0_MAILADDR_CONFIRM = 2
What is the correct mailing address for your facility?

S0_PHYSADDR_CONFIRM
ASK	All Respondents
We have the following physical address listed for this facility. <b>[FACILITY_PHYSADDR]</b> Is this the correct physical address for this facility? Yes No

S0_PHYSADDR_UPDATE
ASK	If S0_PHYSADDR_CONFIRM = 2
What is the correct physical address for your facility?

SECTION 1: GENERAL INFORMATION

S1_AGENCY
ASK	All Respondents
1a. Is this facility part of a larger agency? Yes No

S1_AGENCY_NAME
ASK	If S1_AGENCY = 1
1b. What is the name of this agency?

S1_OWN
ASK	All Respondents
<b>NOTE:</b> Questions 2 and 3 ask who OWNS this facility. Later you will be asked who OPERATES this facility. 2a. Is this facility OWNED by one or more of the following? <i>Select all that apply.</i> A private non-profit agency A for profit agency A government agency

S1_OWN_NAME
ASK	If S1_OWN = 1, 2 or missing
2b. What is the name of the private non-profit or for-profit agency that OWNS this facility?

S1_OWN_GOVTLEVEL
ASK	If S1_OWN = 3 or missing
3. What is the level of the government agency that OWNS this facility? <i> Select all that apply</i> A Native American Tribal Government Federal State County Municipal (includes Washington, DC) Other – Please specify:

S1_OPERATE
ASK	All Respondents
<b>NOTE:</b> Questions 4 and 5 ask who OPERATES this facility. 4a. Is this facility OPERATED by one or more of the following? <i>Select all that apply.</i> A private non-profit agency A for profit agency A government agency

S1_OPERATE_NAME
ASK	If S1_OPERATE = 1, 2 or missing
4b. What is the name of the private non-profit or for-profit agency that OPERATES this facility?

S1_OPERATE_GOVTLEVEL
ASK	If S1_OPERATE = 3 or missing
5. What is the level of the government agency that OPERATES this facility (either directly or under a contract with)? <i>Select all that apply.</i> A Native American Tribal Government Federal State County Municipal (includes Washington, DC) Other – Please specify:

S1_CLASSIFY_A
ASK	If FORM = A
6. What type of residential facility is the one listed on the front cover? <i> Select all that apply </i> <b>Detention center:</b> A short-term facility that provides temporary care in a physically restricting environment for juveniles in custody pending court disposition and, often, for juveniles who are adjudicated delinquent and awaiting disposition or placement elsewhere, or are awaiting transfer to another jurisdiction. In some jurisdictions, detention centers may also hold juveniles committed for short periods of time as part of their disposition (e.g., weekend detention). <b>Long-term secure facility: </b> A specialized type of facility that provides strict confinement and long-term treatment generally for post-adjudication committed juvenile offenders. Includes training schools, juvenile correctional facilities, youth development centers. <b>Reception or diagnostic center: </b> A short-term facility that screens juvenile offenders committed by the courts and assigns them to appropriate correctional facilities. <b>Group home/Halfway house: </b> A long-term facility that is generally non-secure and typically intended for post-adjudication commitments in which young persons are allowed extensive contact with the community, such as attending school or holding a job. <b>Residential treatment center: </b> A facility that focuses on providing some type of individually planned treatment program for youth (substance abuse, sex offender, behavioral/mental health, etc.) in conjunction with residential care. Such facilities generally require specific licensing by the state that may require that treatment provided is Medicaid-reimbursable. <b>Ranch, forestry camp, wilderness or marine program or farm: </b> These are long-term generally non-secure residential facilities often located in a relatively remote area. The juveniles participate in a structured program that emphasizes outdoor work, including conservation and related activities. <b>Runaway and homeless shelter: </b> A short-term facility that provides temporary care in a physically unrestricted environment. It can also provide longer-term care under a juvenile court disposition order. <b>Other type of shelter: </b> This includes emergency non-secure shelters where juveniles are housed short-term until another placement can be found. <b>Other: </b> This includes independent living programs and anything that cannot be classified above. – Please specify:

S1_CLASSIFY_B
ASK	If FORM = B
6. What type of residential facility is the one listed on the front cover? <i> Select all that apply </i> A short-term facility that provides temporary care in a physically restricting environment for juveniles in custody pending court disposition and, often, for juveniles who are adjudicated delinquent and awaiting disposition or placement elsewhere, or are awaiting transfer to another jurisdiction. In some jurisdictions, detention centers may also hold juveniles committed for short periods of time as part of their disposition (e.g., weekend detention). A specialized type of facility that provides strict confinement and long-term treatment generally for post-adjudication committed juvenile offenders. Includes training schools, juvenile correctional facilities, youth development centers. A short-term facility that screens juvenile offenders committed by the courts and assigns them to appropriate correctional facilities. A long-term facility that is generally non-secure and typically intended for post-adjudication commitments in which young persons are allowed extensive contact with the community, such as attending school or holding a job. A facility that focuses on providing some type of individually planned treatment program for youth (substance abuse, sex offender, behavioral/mental health, etc.) in conjunction with residential care. Such facilities generally require specific licensing by the state that may require that treatment provided is Medicaid-reimbursable. These are long-term generally non-secure residential facilities often located in a relatively remote area. The juveniles participate in a structured program that emphasizes outdoor work, including conservation and related activities. A short-term facility that provides temporary care in a physically unrestricted environment. It can also provide longer-term care under a juvenile court disposition order. Other type of shelter including emergency non-secure shelters where juveniles are housed short-term until another placement can be found. Other including independent living programs and anything that cannot be classified above. – Please specify:

S1_CLASSIFY_SCREENPROG
ASK	All Respondents
Does this facility screen young persons to assign them to the appropriate program within this facility? Yes No

S1_CLASSIFY_SCREENLIV
ASK	All Respondents
Does this facility screen young persons to assign them to the appropriate living arrangement within this facility? Yes No

S1_CLASSIFY_SCREENOTH
ASK	All Respondents
Does this facility screen young persons to assign them to another facility? Yes No

S1_CLASSIFY_SCREENCOMM
ASK	All Respondents
Does this facility screen young persons to assign them to a community-based program? Yes No

S1_CLASSIFY_POP
ASK	All Respondents
Which of the following types of young persons does your facility house? <i>Select all that apply.</i> Young persons awaiting adjudication Young persons awaiting disposition Young persons post disposition awaiting placement Young persons post disposition in placement Young persons awaiting transfer to another facility within this jurisdiction Young persons awaiting transfer to another jurisdiction None of the above

S1_CLASSIFY_CONTACT
ASK	All Respondents
Are any young persons in this facility allowed contact with the community, such as attending school or vocational training, or working outside this facility? Yes No

S1_CLASSIFY_TREATPROG
ASK	All Respondents
Does this facility provide an individually planned treatment program for youth in conjunction with residential care? Yes No

S1_CLASSIFY_OUTDOOR
ASK	All Respondents
Does this facility provide a structured program for youth emphasizing outdoor experiences, such as through outdoor work or conservation training? Yes No

S1_CLASSIFY_JOBTRAIN
ASK	All Respondents
Does this facility provide a vocational training program, workforce development services, or job training? Yes No

S1_INSTRUCT
ASK	All Respondents
<b> IMPORTANT INSTRUCTIONS </b> The following items ask you to use your records to provide counts of persons who had assigned beds in this facility at the end of the day on <b>[REF_DATE]</b>. This date has been chosen carefully to give a standardized count of persons in facilities like yours across the country. You will be asked to classify your facility population into two age groups: those persons under age 21; and those persons age 21 and older. You will then be asked to classify each person UNDER THE AGE OF 21 into one of the two following categories: those here because they have been charged with or court-adjudicated for an offense. An offense is any behavior that is illegal in your state for underage persons alone or for both underage persons and adults. those here for reasons other than offenses. Please classify each person under age 21 into just one of these categories. Detailed descriptions of the above categories are provided in the questions themselves and on the Offense Codes on Pages 19 and 20 of the CJRP form. You may also view the descriptions <link>here</link>. Please use your records to answer the following questions.

S1_COUNT
ASK	All Respondents
According to your records, at the end of the day on <b>[REF_DATE]</b>, how many persons had assigned beds in this facility in each of the following categories? <i>Include persons who were temporarily away (such as such as those released for medical care at a hospital), but had assigned beds on [REF_DATE_SHORT]. Please write “0” if there are NO persons in a category.</i> Under the age of 21 _______ 21 or older _______ Total _______

S1_DEFINE
ASK	If S1_COUNT (a) > 0 or missing
<b>NOTE</b>: For all remaining questions, “young persons” refers to “young persons under the age of 21 who have assigned beds” unless otherwise specified in the question.

S1_COUNTCATS

ASK

If S1_COUNT (a) > 0 or missing

At the end of the day on <b>[REF_DATE]</b>, how many young persons did this facility have for each of the following categories?

<i>Include persons who were temporarily away (such as such as those released for medical care at a hospital), but had assigned beds on [REF_DATE_SHORT]. Please write “0” if there are NO persons in a category.</i>

Young persons charged with or court adjudicated for an offense. <i>An offense is any behavior that is illegal in your state for underage persons alone or for both underage person and adults. See the Offense Codes <link>here</link> for reference.</i> INCLUDE: ANY offense that is illegal for both adults and underage persons. ANY offense that is ILLEGAL IN YOUR STATE for underage persons but not for adults. Examples are running away, truancy, incorrigibility, curfew violation, and underage liquor violations. Count persons with these behaviors here ONLY IF THE BEHAVIORS ARE ILLEGAL IN YOUR STATE. This includes those CHINS (Children in Need of Services) and PINS (Persons in Need of Services) who are here BECAUSE of an offense. ANY offense being adjudicated in juvenile or criminal court, including a probation or parole violation. EXCLUDE: Young persons who have committed one or more offenses in the past BUT are here FOR REASONS OTHER THAN OFFENSES. Young persons here BECAUSE OF REASONS OTHER THAN OFFESES, such as neglect, abuse, dependency, abandonment, behavioral/mental health problems, substance abuse problems, etc. Young persons who have run away, been truant or incorrigible, or violated curfew, if these behaviors are NOT considered illegal in your state. Young persons who are PINS (Persons in Need of Services) or CHINS (Children in Need of Services) who are here because of REASONS OTHER THAN OFFENSES.
Young persons assigned beds for other reasons INCLUDE: Young persons here for NON-OFFENSE REASONS such as neglect, abuse, dependency, abandonment, behavioral/mental health problems, substance abuse problems, or another NON-OFFENSE reason. Young persons who have committed one or more offenses in the past BUT are here FOR REASONS OTHER THAN OFFENSES. Young persons who have run away, been truant or incorrigible, or violated curfew, if these behaviors are NOT considered illegal in your state. Young persons here due to voluntary or non-offense related admissions. EXCLUDE: Young persons here BECAUSE THEY WERE CHARGED WITH OR COURT-ADJUDICATED FOR AN OFFENSE.
Total

S1_ONSITE_TREAT
ASK	If S1_COUNT (a) > 0 or missing
<b>INSIDE</b> refers to any location on the facility grounds. <b>OUTSIDE</b> refers to any location in the community or off facility grounds. 12a. Does this facility provide ON-SITE RESIDENTIAL TREATMENT INSIDE this facility? Yes No

S1_ONSITE_TREAT_TYPE
ASK	If S1_COUNT (a) > 0 or missing
12b. What kind of treatment is provided INSIDE this facility? <i> Select all that apply </i> Mental health treatment Behavioral modification or therapy Substance abuse treatment Sex offender treatment Treatment for arsonists Treatment specifically for violent offenders Trauma treatment Anger management Other – Please specify:

S1_LOCKSITS
ASK	If S1_LOCKED = 1 or missing
In what situations are young persons locked in their sleeping rooms? <i>Select all that apply.</i> When they are out of control When they are suicidal For medical reasons other than suicide During shift changes Whenever they are in their sleeping rooms As part of a set schedule Other – Please specify:

S1_LOCKSCHED_A
ASK	If S1_LOCKSITS = 5 or missing and FORM = A
When are young persons locked in their sleeping rooms? <i>Select all that apply.</i> All of the time During the day for 2 hours or less During the day for more than 2 hours At night

S1_LOCKSCHED_B
ASK	If S1_LOCKSITS = 5 or missing and FORM = B
When are young persons locked in their sleeping rooms? <i>Select all that apply.</i> Rarely Sometimes Often Always

S1_LOCKFEATS
ASK	If S1_COUNT (a) > 0 or missing
17. Does this facility have any of the following features intended to confine young persons within specific areas? <i>Select all that apply.</i> Doors for secure day rooms that are locked by staff to confine young persons within specific areas or rooms Wing, floor, corridor, or other internal security doors that are locked by staff to confine young persons within specific areas Outside doors that are locked by staff to confine young persons within specific buildings External gates in fences or walls WITHOUT razor wire that are locked by staff to confine young persons External gates in fences or walls WITH razor wire that are locked to confine young persons Other – Please specify: The facility has none of the above features.

S1_OUTDOORLOCKED
ASK	If S1_COUNT (a) > 0 or missing
18a. Are outside doors to any buildings with living/sleeping units in this facility ever locked? Yes No

S1_OUTDOORLOCKED_REAS
ASK	If S1_OUTDOORLOCKED = 1 or missing
21b. Why Are outside doors to buildings with living/sleeping units in this facility locked to keep young persons inside this facility? Yes No

S1_OUTDOORLOCKED_WHEN
ASK	If S1_OUTDOORLOCKED = 1 or missing
18c. WHEN are outside doors to buildings with living/sleeping units in this facility locked? <i>Select all that apply.</i> All of the time Rarely, no set schedule During the day for 2 hours or less During the day for more than 2 hours At night Other – Please specify:

S1_DEATHS
ASK	If S1_COUNT (a) > 0 or missing
<b>INSIDE</b> refers to any location on the facility grounds. <b>OUTSIDE</b> refers to any location in the community or off facility grounds. 19. During the YEAR between <b>[YEAR_REF_START]</b> and <b>[YEAR_REF_END]</b>, did ANY young persons die while assigned a bed at this facility at a location either INSIDE or OUTSIDE of this facility? Yes No

S1_DEATHS_COUNT
ASK	If S1_DEATHS = 1 or missing
20. How many young persons died while assigned beds at this facility during the year between [YEAR_REF_START] and [YEAR_REF_END]? _____ Person(s)

SECTION 2a: LENGTH OF STAY

S2a_RELEASE14
ASK	If S1_COUNT (a) > 0 or missing
How many young persons were released from this facility in the <b>14 days prior</b> to [REF_DATE], that is between [REF_DATE_14] and [REF_DATE]? <i>Please do not include any young persons who were only temporarily released from your facility, such as those released for medical care at a hospital.</i> _____ Young persons released in the 14 days prior to [REF_DATE]

S2a_RELEASE30
ASK	If S1_COUNT (a) > 0 or missing
How many young persons were released from this facility in the <b>30 days prior</b> to [REF_DATE], that is between [REF_DATE_30] and [REF_DATE]? <i>Please do not include any young persons who were only temporarily released from your facility, such as those released for medical care at a hospital.</i> _____ Young persons released in the 30 days prior to [REF_DATE]

S2a_LOS30
ASK	If S1_COUNT (a) > 0 or missing and FORM = B
What was the average length of stay (in days) for all young persons who were released from this facility in the 30 days prior to [REF_DATE], that is between [REF_DATE_30] and [REF_DATE]? To calculate, sum the total number of days in custody for the youths who were released in the last 30 days. Divide the total number of days by the total number of youths released in the last 30 days to get an average length of stay. Please report up to 2 decimal places. _____ Average length of stay (in days) for all young persons released in the 30 days prior to [REF_DATE]

S2a_LOSINTRO_A
ASK	If S1_COUNT (a) > 0 or missing and FORM = A
In this section you will be asked to record individual-level information on the last 20 young persons released from the facility prior to [REF_DATE]. For the last 20 young persons who were released from your facility, please provide the sex assigned at birth, date of birth, race, three most serious offenses, date of admission, date of release and where this person was released to. <i>Please do not include any young persons who were only temporarily released from your facility, such as those released for medical care at a hospital.</i> <b>Data requested and required format for each person:</b> An identifier (ID number or first name and last initial) Sex assigned at birth (select 1 code from list below) Male Female Date of birth (month/day/year) Race (select 1 code from list below) White, not of Hispanic origin Black or African American, not of Hispanic origin Hispanic or Latino (i.e. Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race) American Indian/Alaska Native, not of Hispanic origin Asian, not of Hispanic origin Native Hawaiian or other Pacific Islander, not of Hispanic origin Two or More Races, not of Hispanic origin (specify) Three most serious offenses resulting in this placement. If the offense(s) was also a probation or parole violation, please check the box to the right of the code you entered. See the Offense Codes <link>here</link> for reference. Date person was admitted to this facility for the most serious offenses listed in #5 (month/day/year) Date person was released from this facility for the most serious offenses listed in #5 (month/day/year) Where person was release to (text box for written response)

S2a_LOSINTRO_B
ASK	If S1_COUNT (a) > 0 or missing and FORM = B
In this section you will be asked to record individual-level information on the last 20 young persons released from the facility prior to [REF_DATE]. For the last 20 young persons who were released from your facility, please provide the sex assigned at birth, date of birth, race, three most serious offenses, date of admission, date of release and where this person was released to. <>Please do not include any young persons who were only temporarily released from your facility, such as those released for medical care at a hospital.</i> <b>Data requested and required format for each person:</b> An identifier (ID number or first name and last initial) Sex assigned at birth (select 1 code from list below) Male Female Date of birth (month/day/year) Race (select 1 code from list below) White, not of Hispanic origin Black or African American, not of Hispanic origin Hispanic or Latino (i.e. Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race) American Indian/Alaska Native, not of Hispanic origin Asian, not of Hispanic origin Native Hawaiian or other Pacific Islander, not of Hispanic origin Two or More Races, not of Hispanic origin (specify) Three most serious offenses resulting in this placement. If the offense(s) was also a probation or parole violation, please check the box to the right of the code you entered. See the Offense Codes <link>here</link> for reference. Date person was admitted to this facility for the most serious offenses listed in #5 (month/day/year) Date person was released from this facility for the most serious offenses listed in #5 (month/day/year) Where person was release to (select 1 code from list below) Released to another facility Released to the supervision of probation or parole Released without supervision of probation or parole Other (specify) Don’t know

S2a_LOSROSTER

ASK

If S1_COUNT (a) > 0 or missing

<b>IMPORTANT INSTRUCTIONS:</b> Please upload your Template file provided on the previous page, <u>OR</u> enter information below for the last 20 young persons released from this facility prior to <b>[REF_DATE]</b>.

Click ‘Finished Adding Persons’ when all persons have been entered.

[button-UPLOAD TEMPLATE] <b>OR</b> [button-ADD A PERSON]

[button-FINISHED ADDING PERSONS]

Count	ID Number/Name	Sex assigned at birth	Date of Birth
1	[row populates after a new person is added]	[row populates after a new person is added]	[row populates after a new person is added]

S2a_LOSROSTER_UPLOAD
ASK	Respondents who choose File Upload
<b>FILE UPLOADS</b> Click the “Browse” button to browse for the file you’d like to upload to our site. Select the file you want to upload. Click the “Upload File” button to start the uploading process. Once your file has been uploaded successfully the file name will appear in the box below. Click ‘Submit’ after you file has been uploaded. <b>Select File to Upload</b> [button-Browse] [button-Upload file] No files have been uploaded [button-Return to Section 2a Instructions] [button-Submit]

S2a_LOSROSTER_ADD_A
ASK	Respondents who choose to Add a Person and FORM = A
Enter an identifier (ID number or first name and last initial). Use an identifier that will allow YOU to reidentify each person in the future. Sex assigned at birth Male Female Date of birth Race White, not of Hispanic origin Black or African American, not of Hispanic origin Hispanic or Latino (i.e. Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race) American Indian/Alaska Native, not of Hispanic origin Asian, not of Hispanic origin Native Hawaiian or other Pacific Islander, not of Hispanic origin Two or More Races, not of Hispanic origin (specify) What were the three most serious offenses for which person was assigned bed on [REF_DATE_SHORT]? Enter the code for the three most serious offenses resulting in this placement. If the offense(s) was also a probation or parole violation, please check the box to the right of the code you entered. See the Offense Codes <link>here</link> for reference. On what date was this person admitted to this facility for the three most serious offenses? If more than one date applies, enter the earliest one for the offenses listed. On what date was this person released from this facility? Where was this person released to? [button-Cancel] [button-Add Person]

S2a_LOSROSTER_ADD_A
ASK	Respondents who choose to Add a Person and FORM = B
Enter an identifier (ID number or first name and last initial). Use an identifier that will allow YOU to reidentify each person in the future. Sex assigned at birth Male Female Date of birth Race White, not of Hispanic origin Black or African American, not of Hispanic origin Hispanic or Latino (i.e. Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race) American Indian/Alaska Native, not of Hispanic origin Asian, not of Hispanic origin Native Hawaiian or other Pacific Islander, not of Hispanic origin Two or More Races, not of Hispanic origin (specify) What were the three most serious offenses for which person was assigned bed on [REF_DATE_SHORT]? Enter the code for the three most serious offenses resulting in this placement. If the offense(s) was also a probation or parole violation, please check the box to the right of the code you entered. See the Offense Codes <link>here</link> for reference. On what date was this person admitted to this facility for the three most serious offenses? If more than one date applies, enter the earliest one for the offenses listed. On what date was this person released from this facility? Where was this person released to? Released to another facility Released to the supervision of probation or parole Released without supervision of probation or parole Other (specify) Don’t know [button-Cancel] [button-Add Person]

S2a_FEAS_ETHNICITY
ASK	If S1_COUNT (a) > 0 or missing
Does your facility document the Hispanic ethnicity of a young person separate from his/her race, such that you would be able to report both the Hispanic ethnicity and the race(s) for each young person in your facility? <i>For example, Hispanic and Black, or Non-Hispanic and Black.</i> Yes No

S2a_FEAS_RACE
ASK	If S1_COUNT (a) > 0 or missing
Does your facility document all races of a young person who identifies as two or more races, such that you would be able to report all races associated with each young person in your facility? Yes No

S2a_FEAS_RACEETH_HOW
ASK	If S1_COUNT (a) > 0 or missing
How is race/ethnicity information determined? <i>Select all that apply</i> Race/ethnicity are self-reported by youth Race/ethnicity is determined by staff Race/ethnicity is obtained from the referral source (e.g., Juvenile court) Other, please specify

S2a_FEAS_GENDERID
ASK	If S1_COUNT (a) > 0 or missing
Does your facility document gender identity of all young persons, such that you would be able to report both the sex assigned at birth and the self-reported gender identity for each young person in your facility? <i>For example, male and transgender male to female.</i> Yes No

SECTION 2: PERSON LEVEL DATA

S2_INTRO
ASK	If S1_COUNTCATS (a) > 0 or missing
In this section you will be asked to record individual-level information on the young persons in the facility on <b>[REF_DATE]</b> specifically because they were charged with or court-adjudicated for an offense. You reported <u>[fill S1_COUNTCATS (a) value]</u> persons that fit this description in Section I, question 10b. For all <u>[fill S1_COUNTCATS(a) value]</u> persons, please provide the 10 pieces of information listed below. You may find it helpful to use this <link>Excel Template</link> to fill information in. Save the Template to a location of your choice before filling it out. On the next screen you may re-upload the Template or instead enter information directly into the webpage. <b>Data requested and required format for each person:</b> An identifier (ID number or first name and last initial) Sex assigned at birth (select 1 code from list below) Male Female Date of birth (month/day/year) Race (select 1 code from list below) White, not of Hispanic origin Black or African American, not of Hispanic origin Hispanic or Latino (i.e. Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race) American Indian/Alaska Native, not of Hispanic origin Asian, not of Hispanic origin Native Hawaiian or other Pacific Islander, not of Hispanic origin Two or More Races, not of Hispanic origin (specify) Who placed this person at this facility (select 1 code from list below) Court, probation agency, or law enforcement agency Corrections or other justice agency not included in option 1 Social services agency School official, parent or guardian, or young person him/herself Other (specify) Level of the agency that placed this person at this facility (select 1 code from list below) Federal A Native American Tribal Government State County Municipal (includes Washington, DC) Other (specify) Three most serious offenses for which person was assigned bed on [REF_DATE_SHORT]. If the offense(s) was also a probation or parole violation, please check the box to the right of the code you entered. See the Offense Codes <link>here</link> for reference. State or territory where person committed the most serious offense listed in #7 Person’s adjudication status on [REF_DATE_SHORT] for the most serious offense listed in #7. “Adjudication” is the court process which determines whether or not the person committed the offense. (select 1 code from list below) Agreement not to adjudicate (diversion) Awaiting adjudication hearing in juvenile court Adjudicated, awaiting disposition by juvenile court Adjudicated and disposed in juvenile court and awaiting placement elsewhere Adjudicated and disposed in juvenile court, in placement here Awaiting transfer hearing to adult criminal court Awaiting hearing or trial in adult criminal court Convicted in adult criminal court Don’t Know Other (specify) Date person was admitted to this facility for the most serious offense listed in #7

S2_ROSTER

ASK

If S1_COUNTCATS (a) > 0 or missing

<b>IMPORTANT INSTRUCTIONS:</b> Please upload your Template file provided on the previous page, <u>OR</u> enter information below for all <u>[fill S1_COUNTCATS (a)value]</u> persons under age 21 that were assigned beds in the facility on <b>[REF_DATE]</b> specifically because they were charged with or court-adjudicated for an offense.

<b> Do NOT list persons assigned beds here for reasons other than offenses. </b>. Click ‘Finished Adding Persons’ when all persons have been entered.

[button-UPLOAD TEMPLATE] <b>OR</b> [button-ADD A PERSON]

[button-FINISHED ADDING PERSONS]

Count	ID Number/Name	Sex assigned at birth	Date of Birth
1	[row populates after a new person is added]	[row populates after a new person is added]	[row populates after a new person is added]

S2_ROSTER_UPLOAD
ASK	Respondents who choose File Upload
<b>FILE UPLOADS</b> Click the “Browse” button to browse for the file you’d like to upload to our site. Select the file you want to upload. Click the “Upload File” button to start the uploading process. Once your file has been uploaded successfully the file name will appear in the box below. Click ‘Submit’ after you file has been uploaded. <b>Select File to Upload</b> [button-Browse] [button-Upload file] No files have been uploaded [button-Return to Section II Instructions] [button-Submit]

S2_ROSTER_ADD
ASK	Respondents who choose to Add a Person
Enter an identifier (ID number or first name and last initial). Use an identifier that will allow YOU to reidentify each person in the future. Sex assigned at birth Male Female Date of birth Race White, not of Hispanic origin Black or African American, not of Hispanic origin Hispanic or Latino (i.e. Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race) American Indian/Alaska Native, not of Hispanic origin Asian, not of Hispanic origin Native Hawaiian or other Pacific Islander, not of Hispanic origin Two or More Races, not of Hispanic origin (specify) Who placed this person at this facility (select 1 code from list below) 1 Court, probation agency, or law enforcement agency 2 Corrections or other justice agency not included in option 1 3 Social services agency 4 School official, parent or guardian, or young person him/herself 5 Other (specify) Is the court, probation, or law enforcement agency, or other agency referred to in question 5 at the federal, tribal, state, county, or municipal level? 1 Federal 2 A Native American Tribal Government 3 State 4 County 5 Municipal (includes Washington, DC) 6 Other (specify) What was the were the three most serious offenses for which person was assigned bed on [REF_DATE_SHORT]? Enter the code for the three most serious offenses resulting in this placement. If the offense(s) was also a probation or parole violation, please check the box to the right of the code you entered. See the Offense Codes <link>here</link> for reference. In which state or territory did this person commit the most serious offense? On [REF_DATE_SHORT], what was this person’s court adjudication status for the most serious offense? “Adjudication” is the court process which determines whether or not the person committed the offense. 1 Agreement not to adjudicate (diversion) 2 Awaiting adjudication hearing in juvenile court 3 Adjudicated, awaiting disposition by juvenile court 4 Adjudicated and disposed in juvenile court and awaiting placement elsewhere 5 Adjudicated and disposed in juvenile court, in placement here 6 Awaiting transfer hearing to adult criminal court 7 Awaiting hearing or trial in adult criminal court 8 Convicted in adult criminal court 99 Don’t Know 10 Other (specify) On what date was this person admitted to this facility for the most serious offense? If more than one date applies, enter the earliest one for the offense listed. [button-Cancel] [button-Add Person]

END PAGES

ELIGIBILITY
ASK	If S1_COUNT (c) = 0 or S1_COUNT (a) =0
Based on your prior answer, what was the reason there was no one (if S1_COUNT (a) =0: under 21) with assigned beds in your facility? Facility Permanently Closed – Specify reason and date of closure Facility Temporarily Closed – Specify reason and reopen date (if known) Adult Only Facility – Specify when facility stopped holding juvenile offenders Other – Specify

BURDEN_ESTIMATE
ASK	All Respondents
Thank you for participating in the 2021 CJRP pilot test. To help inform future CJRP data collection efforts, we would like to understand more about your experience filling out this questionnaire. About how many hours did it take you to complete this questionnaire? <i>Please include any time you spent gathering the necessary information.</i>

COMMENTS
ASK	All Respondents
Please provide any comments you have about the data submitted on this form. Click the ‘Submit Data’ button below to finalize your survey. Once data has been submitted you will be locked out of the survey an unable to make any changes. [button-Previous] [button-<b>Submit Data</b>]

THANKYOU
ASK	All Respondents
Thank you for electronically submitting the 2021 Census of Juveniles in Residential Placement Pilot Study questionnaire. If you have any questions, please contact 2021 CJRP Pilot Study help desk staff at [phone] or [email].