SSV-5 Survey of Sexual Victimization State Juvenile Systems Su

OMB No. 1121-0292: Approval Expires 06/30/2017
U.S. DEPARTMENT OF JUSTICE

SSV-5

FORM
(4-20-2016)

BUREAU OF JUSTICE STATISTICS

SURVEY OF SEXUAL VICTIMIZATION, 2015
State Juvenile Systems
Summary Form

AND ACTING AS COLLECTION AGENT

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

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 State-operated juvenile residential placement facilities
used to house juveniles and youthful offenders, regardless of
age or reason for placement.
• INCLUDE State-operated juvenile residential facilities
such as: 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 privately operated facilities and
facilities operated or administered by local
governments. (These facilities will be
contacted directly for data on sexual
victimization.)
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 not held in facilities
operated by your State juvenile system.

Reporting instructions:
•
•

Please complete the entire SSV-5 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 question is
"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:
• If you need assistance, please call Greta Clark at the
U.S. Census Bureau toll-free at 1–800–253–2078 or
email govs.ssv@census.gov
• 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 60 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.

2. On December 31, 2015, how many persons
held in the facilities reported in Item 1 were —

DEFINITIONS
JUVENILES and YOUTHFUL OFFENDERS
• Any person under the jurisdiction of your State’s juvenile
system or youthful offender authority, regardless of age
or reason for placement.

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

FACILITIES

b. Females

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

INCLUDE all State-operated facilities used to house juveniles
or youthful offenders charged with or court-adjudicated for:
c. TOTAL (Sum of Items 2a and 2b)

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

• Count persons held in the facilities reported in Item 1
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).

3. On December 31, 2015, how many persons
held in the facilities reported in Item 1 were —

EXCLUDE State-operated facilities used ONLY to house
juveniles for:
• Non-criminal purposes (neglect, abuse, abandonment, or
dependency);

a. Age 17 or younger . . . . . . . .

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 . . . . . . . . . .
d. TOTAL (Sum of Items 3a through
3c should equal Item 2c) . . . . . .

Section I – GENERAL INFORMATION

• Count all persons held in the facilities reported in Item 1
regardless of age or reason for placement. Include
persons who were temporarily away but had assigned
beds on December 31, 2015.

1. On December 31, 2015, how many facilities
operated by your State held juveniles or
youthful offenders CHARGED WITH or
COURT-ADJUDICATED FOR AN OFFENSE?

Number of facilities

...

4. Between January 1, 2015, and December 31, 2015,
how many persons were admitted to or discharged
from the facilities reported in Item 1?

• Count all juvenile residential facilities where young
persons who have committed offenses may be
housed overnight.

a. TOTAL number admitted

• Count each facility with a separate physical location
only once. Do not count separate living/sleeping units,
wings, floors, dorms, barracks, or cottages within a
single facility.

..

b. TOTAL number discharged .
• Include all persons admitted into your State-operated
juvenile residential facilities by a formal legal document,
by the authority of the courts, or by some other official
agency.
• Include all persons discharged from your
State-operated juvenile residential facilities 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 operated by your State, or temporary
release including work/school release, medical
appointments, other treatment facilities, or court
appearances.

FORM SSV-5 (4-20-2016)

Page 2

Section II – YOUTH–ON–YOUTH SEXUAL VICTIMIZATION 5. Does your State juvenile system record

allegations of youth-on-youth NONCONSENSUAL
SEXUAL ACTS?

DEFINITIONS

01

The survey utilizes the definition of “sexual abuse” 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 three categories of
youth-on-youth sexual victimization. These categories are:

Yes ➔ a. Do you record all reported
occurrences, or only
substantiated ones?
01
02

All
Substantiated only

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

AND
• Sexual contact between the penis and the vulva or the
penis and the anus including penetration, however slight;
OR

02
02

No

Both attempted and completed
Completed only

➔ Please provide the definition used by your
State juvenile system for youth-on-youth
NONCONSENSUAL SEXUAL ACTS in the
space below. Use that definition to complete
Items 6 and 7.

• 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.
ABUSIVE SEXUAL CONTACT

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

Sexual contact of any person without his or her consent,
or of a person who is unable to consent or refuse;
AND
• Intentional touching, either directly or through the
clothing, of the genitalia, anus, groin, breast, inner thigh,
or buttocks of any person.

Number reported

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.

None

• If an allegation involved multiple victimizations, count
only once.
• Exclude any allegations that were reported as
consensual.

• EXCLUDE incidents in which the contact was incidental
to a physical altercation.
SEXUAL HARASSMENT

......

7. Of the allegations reported in Item 6, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)
None

a. Substantiated . . . . . . .

• 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
occured.
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
7a through 7d) . . . . . . . .

None

• The total should equal the number reported in
Item 6.
FORM SSV-5 (4-20-2016)

Page 3

8. Does your State juvenile system record
allegations of youth-on-youth ABUSIVE SEXUAL
CONTACT? (See definitions on page 3.)

11. Does your State juvenile system record
allegations of youth-on-youth SEXUAL
HARASSMENT? (See definitions on page 2.)
01

01

02

Yes

No

Yes

from allegations of
NONCONSENSUAL SEXUAL ACTS?
01

Yes

02

No

➔ Do you record all reported allegations
or only substantiated ones?

➔ Can these be counted separately

➔ Skip to Item 11.
02

➔ Please provide an explanation in the space

No

01

All

02

Substantiated only

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

below and then skip to Item 11.

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

12. Between January 1, 2015, and
December 31, 2015, how many allegations of
youth-on-youth SEXUAL HARASSMENT
were reported?
Number reported . . . . . .
None
• If an allegation involved multiple victims or youth
perpetrators, count only once.

Number reported . . . . . .
None
• If an allegation involved multiple victimizations, count
only once.
• Exclude any allegations that were reported as
consensual.
10. Of the allegations reported in Item 9, how
many were — (Please contact the agency or
office responsible for investigating allegations of
sexual victimization in order to fully complete this
form.)

• Exclude any allegations that were reported as
consensual.
13. Of the allegations reported in Item 12, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)

.......

None

a. Substantiated . . . . . . .

None

b. Unsubstantiated . . . . .

None

b. Unsubstantiated . . . . .

None

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

None

c. Unfounded

.........

None

d. Investigation ongoing . .

None

d. Investigation ongoing .

None

e. TOTAL (Sum of Items
10a through 10d) . . . . . . .

None

e. TOTAL (Sum of Items
13a through 13d) . . . . . . .

None

a. Substantiated

• The total should equal the number reported in
Item 9.

FORM SSV-5 (4-20-2016)

• The total should equal the number reported in
Item 12.

Page 4

Section III – STAFF-ON-YOUTH SEXUAL ABUSE

14. Does your State juvenile system record
allegations of STAFF SEXUAL MISCONDUCT?
01

DEFINITIONS
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

Yes

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 17.

STAFF SEXUAL MISCONDUCT
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, friend 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;

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

OR
• Completed, attempted, threatened, or requested sexual
acts;
OR
• Occurrences of indecent exposure, invasion of privacy,
or staff voyeurism for reasons unrelated to official duties
or for sexual gratification.

None

• If an allegation involved multiple victimizations, count
only once.
16. Of the allegations reported in Item 15, how
many were — (Please contact the agency or
office responsible for investigating allegations of
sexual victimization in order to fully complete this
form.)

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;

a. Substantiated . . . . . . .

None

b. Unsubstantiated . . . . .

None

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

None

d. Investigation ongoing .

None

e. TOTAL (Sum of Items
16a through 16d) . . . . . . .

None

OR

• Repeated profane or obscene language or gestures.

• The total should equal the number reported in
Item 15.

FORM SSV-5 (4-20-2016)

Page 5

17. Does your State juvenile system record
allegations of STAFF SEXUAL HARASSMENT?
(See definitions on page 5.)
01

02

Yes

No

Section IV – PRIVATE AND LOCAL ALLEGATIONS

20. Did any of the allegations reported in Items 6, 9,
12, 15, or 18 occur in a privately operated
facility?

➔ Can these allegations be counted
separately from allegations of
STAFF SEXUAL MISCONDUCT?
01

Yes

02

No

➔ Skip to Item 20.

01

Yes

02

No

21. Did any of the allegations reported in Items 6, 9,
12, 15, or 18 occur in a facility operated or
administered by local governments?

➔ Please provide an explanation in the space
below and then skip to Item 20.

01

Yes

02

No

Section V – TOTAL SUBSTANTIATED
INCIDENTS OF SEXUAL VICTIMIZATION
22. What is the total number of substantiated
incidents reported in Items 7a, 10a, 13a,
16a, and 19a?

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

Number reported . . . . . .

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

None

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

• If an allegation involved multiple victims or staff, count
only once.
19. Of the allegations reported in Item 18, 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 19a
through 19d) . . . . . . . . . .

None

None

NOTES

• The total should equal the number reported in
Item 18.

FORM SSV-5 (4-20-2016)

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