Form CJ-15 JFCP – Facility Operations Module

Juvenile Facility Census Program (JFCP)

JFCP – Facility Operations Module

OMB: 1121-0381

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U.S. DEPARTMENT OF COMMERCE U.S. CENSUS BUREAU
ACTING AS A COLLECTING AGENT FOR U.S. DEPARTMENT OF JUSTICE OFFICE OF JUVENILE JUSTICE AND DELINQUENCY PREVENTION

2025 Juvenile Facility Census Program:
Facility Operations Module

This questionnaire asks about services, staff, and persons
assigned beds in this facility on Wednesday, March 25, 2026.
Instructions:
1. A juvenile residential facility is a place
where young persons who have committed
offenses may be housed overnight as
direct result of those offenses. A facility
has living/sleeping units, such as wings,
floors, dorms, barracks, or cottages on one
campus or in one building.
2. Any buildings with living/sleeping units that
are not on the same campus should be
considered separate facilities and should
submit a separate questionnaire. Please
request additional questionnaires using the
contact information below.

You may find it helpful to use this form to gather
the requested information. We ask that you submit
your response online BY APRIL 30, 2026:

https://respond.census.gov/jfcp
If you cannot submit your information online,
please mail or fax your information to the following:
U.S. Census Bureau
PO Box 5000
Jeffersonville, IN 47199-5000
GOVS/JFCP
Fax: 1–888–262–3974

If you have any questions, contact the U.S. Census Bureau: 1–800–352–7229 | erd.jfcp@census.gov
FACILITY NAME

PERSON COMPLETING THIS QUESTIONNAIRE
Name

E-mail address

Title
Street Address or P.O. Box
Apt, Suite, or Unit (Optional)

Telephone
State

City

FORM

CJ-15 (05-09-2025)

ZIP Code

Area code

Number

Extension

OMB No. 1121-0381: Approval Expires 12-31-2027

MAILING ADDRESS OF FACILITY
Street Address or P.O. Box

Apt, Suite, or Unit (Optional)
City

State

ZIP Code

State

ZIP Code

PHYSICAL ADDRESS OF FACILITY
Physical address is the same as the mailing address
Street Address (DO NOT provide P.O. Box)
Apt, Suite, or Unit (Optional)
City

Section 1 – GENERAL FACILITY INFORMATION
1a. Is this facility part of a larger agency?
01
Yes
02
No ➔ Go to Note A

NOTE
B

Questions 4 and 5 ask who OPERATES this
facility (either directly or under contract).

1b. What is the name of this agency?

NOTE Questions 2 and 3 ask who OWNS this facility. Later
you will be asked who OPERATES this facility.
A
2a. Who OWNS this facility?
Mark (X) only one.
01
a private non-profit agency
02
a for profit agency
03
a government agency ➔ Go to Question 3

4a. Who OPERATES this facility?
Mark (X) only one.
01
a private non-profit agency
02
a for profit agency
03
a government agency ➔ Go to Question 5

4b. What is the name of the private non-proﬁt
or for-proﬁt agency that OPERATES this
facility?

➔

2b. What is the name of the private non-proﬁt
or for-proﬁt agency that OWNS this facility?

➔
3.

Go to
NOTE B

What is the level of the government agency
that OWNS this facility?
Mark (X) all that apply.
01
A Native American Tribal Government
02
Federal
03
State
04
County
05
Municipal (includes Washington, DC)
06
Other – Specify

Page 2

Go to
Question 6

What is the level of the government agency
that OPERATES this facility?
Mark (X) all that apply.
01
A Native American Tribal Government
02
Federal
03
State
04
County
05
Municipal (includes Washington, DC)
06
Other – Specify

FORM CJ-15 (05-09-2025)

Section 1 – GENERAL FACILITY INFORMATION – Continued
6. What type of residential facility is the one
listed on the front cover?
Mark (X) all that apply.
01

Detention Center: A short-term facility that
provides temporary care in a physically restricting
environment for young persons in custody pending
court disposition and, often, for young persons 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 young persons committed for
short periods of time as part of their disposition
(e.g., weekend detention).
Long-term Secure Facility: A specialized type
of facility that provides strict confinement and
long-term treatment generally for post-adjudication
committed young persons placed for delinquency or
status offenses. Includes training schools, juvenile
correctional facilities, youth development centers.
Reception or Diagnostic Center: A short-term
facility that screens young persons committed by the
courts and assigns them to appropriate correctional
facilities.
Group Home or Halfway house: These facilities
are 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.
Residential Treatment Center: A facility that
focuses on providing some type of individually
planned treatment program for young persons
(substance use, sex offender, 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.

Ranch or Wilderness Camp: A long-term facility
focused on providing structured outdoor programs,
such as farming, forestry, wildlife conservation, and
environmental education. These facilities are
generally non-secure and typically located in a remote
area.

Runaway and Homeless Shelter: 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: This includes emergency
non-secure shelters where young persons are
housed short-term until another placement can be
found.
Other: This includes independent living programs
and anything that cannot be classified above.
Specify

7a. What was the TOTAL NUMBER OF
STANDARD BEDS in this facility on the
night of Wednesday, March 25, 2026?
Do NOT include staff beds.
● A single bed is one standard bed
● A double bunk bed is two standard beds
Total number of standard beds

7b. On the night of Wednesday, March 26,
2026, were there ANY OCCUPIED
MAKESHIFT BEDS in this facility?
Makeshift beds are:
●
●
●
●
●
●

Roll-out mats
Fold-out cots
Roll-away beds
Pull-out mattresses
Sofas
Any other beds that are put away or
moved during non-sleeping hours

Yes

➔

Go to Question 8

7c. How many makeshift beds were occupied
that night?
Occupied makeshift beds

INSTRUCTIONS
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 Wednesday, March 25, 2026.
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 this facility population into two age
groups:
1. those persons under age 21; and
2. those persons age 21 and older.
You will then be asked to classify each person
UNDER THE AGE OF 21 into just one of the
two following categories:
1. 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.
2. those here for reasons other than offenses.

FORM CJ-15 (05-09-2025)

Page 3

Section 1 – GENERAL FACILITY INFORMATION – Continued
8. According to your records, at the end of the day on March 25, 2026, how many persons had
assigned beds in this facility in the following categories?
Include persons who were temporarily away but had assigned beds on the reference date. Do not include staff.
Write "0" if there are No persons in a category.

Number of Persons

Category
a. Total persons assigned beds

Skip Instructions
If "0" go to Question 9a

(sum of b + c)

Age Group
b. Persons age 21 or older
c. Persons under age 21

If "0" go to Question 9b

Include persons under 21 being tried as adults in criminal court.

(sum of d + e)

Reason for Admission

d. Persons under age 21 charged with or
court-adjudicated for an offense
An offense is any behavior that is illegal in your state for an underage person alone or both underage persons and
adults. This includes a CRIMINAL OR DELINQUENCY OFFENSE, a STATUS OFFENSE (e.g., running away, truancy,
curfew violation IF ILLEGAL in your state), or an offense being ADJUDICATED IN JUVENILE OR CRIMINAL COURT,
including a probation or parole violation. It includes CHINS (Children in Need of Services) and PINS (Persons in Need
of Services) here BECAUSE of an offense.
e. Persons under age 21 assigned beds for reasons
other than an offense
Include persons here for NON-OFFENSE reasons (e.g., neglect, abuse, dependency, mental health, or substance use
problems, or other non-offense reasons); who have committed one or more offenses in the past but are here on the
census date for reasons OTHER THAN THESE OFFENSES; here for behaviors such as running away, truancy,
incorrigibility, or curfew violations if such behaviors are NOT ILLEGAL in your state; or voluntarily admitted. Include
CHINS (Children in Need of Services) and PINS (Persons in Need of Services) not held for an offense.

If "0" go to Question 9c

Go to Section 2

9a. Specify why there were "0" persons reported in 8a.
Mark (x) only one and THEN STOP and submit this form.
01

Facility permanently closed

Facility temporarily closed

Other - Specify:

Date of Closure:

_ _ /_ _ /_ _ _ _

9b. Specify why there were "0" persons reported in 8c.
Mark (x) only one and THEN STOP and submit this form.
01

Adult only facility

No persons under age 21 were placed in this facility

Other - Specify:

9c. Specify why there were "0" persons reported in 8d.
Mark (x) only one and THEN STOP and submit this form.
01

No persons under age 21 were placed in this facility for an offense.

This facility is no longer under contract to hold persons under age 21 for offense reasons.

Other – Specify:

Page 4

FORM CJ-15 (05-09-2025)

Section 2 – FACILITY CHARACTERISTICS
1a. Are ANY young persons in this facility
locked into their sleeping rooms by staff
at ANY time to confine them?
01

Yes

➔

3c. When are outside doors to buildings with
living/sleeping units in this facility locked?
Mark (X) all that apply.

Go to Question 2

01
02

1b. (If yes) In what situations are young
persons locked in their sleeping rooms?

03
04

Mark (X) all that apply.
01
02
03
04
05
06
07

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 – Specify

4a. Is treatment provided INSIDE this
facility?
Inside refers to any location on the facility grounds.
01
02

1c. (If part of a set schedule) When are young
persons in this facility locked into their
sleeping rooms?

02
03
04

Yes
No ➔ Go to Question 5

4b. What kind of treatment is provided INSIDE
this facility?
Mark (X) all that apply.
01

Mark (X) all that apply.
01

All of the time
During the day for 2 hours or less
During the day for more than 2 hours
At night
Other – Specify

All of the time
During the day for 2 hours or less
During the day for more than 2 hours
At night

03
04
05
06

2. Does this facility have any of the following
features utilized by staff to secure or
conﬁne young persons within speciﬁc
areas?

07
08
09

Mental health treatment
Substance use treatment
Sex offender treatment
Treatment for arsonists
Treatment specifically for violent offenders
Behavioral modification or therapy
Trauma treatment
Anger management
Other – Specify

Mark (X) all that apply.
01
02
03
04
05
06

Locked doors for secure day rooms
Locked internal security doors (e.g., wing,
floor, corridor)
Locked outside doors
Fences or walls without razor wire
Fences or walls with razor wire
Other – Specify

Which of the following training
requirements are front-line supervision
staff and direct care staff required to take
before working with young persons?
Mark (X) all that apply.
01
02

None of the above

3a. Are outside doors to any buildings with
living/sleeping units in this facility ever
locked?
01

Yes

➔

Go to Question 4a

Mark (X) all that apply.
02

04
05
06

3b. Why are outside doors to buildings with
living/sleeping units in this facility locked?

07
08
09
10

Behavioral health interventions and resources
Conflict de-escalation training and
communication with young persons
Cross-sex supervision
Defensive tactics and restraint techniques
Gang identification, prevention, and management
Managing young persons with mental health
problems
Professional conduct and ethics
Staff boundaries
Trauma-informed care
Other – Specify

To keep intruders out
To keep young persons inside this facility

FORM CJ-15 (05-09-2025)

Page 5

Section 2 – FACILITY CHARACTERISTICS – Continued
6a. Does this facility provide any of the following activities or services for the young persons in
this facility through either the facility’s own staff or by bringing in external providers?
Mark (X) all that apply.
Provided by the
facility’s staff
(1)

Provided by bringing
in external providers
(2)

This facility does
not provide this
(3)

a. Artistic opportunities (e.g., music, painting, drama)

b. Formal mentoring program

c. Recreation (e.g., team sports, playing games)

d. Reentry planning

e. Religious/Spiritual/Faith-based

f. Wellness (e.g., yoga, meditation)

g. Workforce development or vocational training

6b. Are there any other activities or services not listed above that are provided for young
persons in this facility? Please list any other activities or services provided.

7. Which of the following best describes the
physical layout of this facility?
Mark (X) only one.
This facility is 01
02
03
04

a part of one building
all of one building
more than one building at a single site or on
one campus
Other – Specify

9a. Are there any other juvenile residential
facilities located within the same building
or on the same campus as the facility
being reported on here?
01

Yes

➔

Go to Section 3

9b. How many OTHER juvenile residential
facilities are located within the same
building or on the same campus as the
facility being reported on here?
Juvenile residential facilities

8. Are there any other buildings with
living/sleeping units that are associated
with this facility that are not next to this
facility building or on the same campus?
01
02

Yes
No

9c. Does the facility being reported on here
share any of the following with the other
facilities located in the same building or
on the same campus?
Mark (X) all that apply.
01
02

INSTRUCTIONS
Please use the contact information on Page
1 to request additional questionnaires for
each building with living/sleeping units
associated with this facility that is not at the
site of this facility building or campus.

03
04

05
06
07
08
09
10
11

Page 6

The same agency affiliation
The same mailing address
The same on-site administrators
One or more staff directly caring for the young
persons
One or more security staff
The same school rooms
The same infirmary
The same food services
The same dining room
The same laundry services
None of the above services are shared
FORM CJ-15 (05-09-2025)

Section 3 – MENTAL HEALTH SERVICES
1a. For each of the following behavioral/mental health providers, please indicate if young
persons have access to these providers as paid facility employees, contract staff, or are
available as needed in the community.
Mark (X) all that apply.
Available as
paid facility
employees
(1)

Available as
contract staff
(2)

Available as
needed in the
community
(3)

Not available
(4)

a. Psychiatrists (MDs or DOs)

b. Licensed clinical psychologists (PhDs)

c. Licensed clinical social worker or licensed mental
health clinicians (e.g., persons with a master’s
degree in social work)

1b. Do young persons have access to any other behavioral/mental health providers not listed
above?
Please list any other behavioral/mental health providers.

2a. After arrival in this facility, are ANY young
persons asked questions or administered
a form which asks questions to determine
risk for suicide?
01

Yes

➔

INSTRUCTIONS
Mental health professionals are limited in
this census to:
● psychiatrists
● psychologists with at least a Master’s
degree in PSYCHOLOGY
● social workers with at least a Master’s in
SOCIAL WORK (MSW, LCSW)

Go to Question 7

2b. What best describes the process through
which young persons are asked questions
or administered a form which asks
questions to determine risk of suicide?

Counselors in this census are:
● persons with a Master’s degree in a field
other than psychology or social work
● persons whose highest degree is a
Bachelor’s in any field

Mark (X) all that apply.
01

04
05
06
07

One or more questions about suicide
incorporated into the medical history or
intake process
A form or questions designed by this facility
to assess suicide risk
A form or questions designed by a county or
state juvenile justice system to assess suicide
risk
MAYSI – Full Form
MAYSI – Suicide/depression module
C-SSRS
Other – Specify

3. Who asks questions or administers a form
which asks questions to determine risk of
suicide?
Mark (X) all that apply.
01

03
04

FORM CJ-15 (05-09-2025)

Counselors/intake workers who have NOT been
trained by mental health professionals
Counselors/intake workers who have been
trained by mental health professionals
A mental health professional
Some other person – Specify

Page 7

Section 3 – MENTAL HEALTH SERVICES – Continued
4. When are young persons FIRST asked
questions or administered a form which
asks questions to determine risk of
suicide?
Mark (X) all that apply.
01
02
03
04

Within less than 24 hours after arrival
Between 24 hours and less than 7 days
after arrival
Seven or more days after arrival
Other – Specify

5. Which young persons are asked questions
or administered a form which asks
questions to determine risk of suicide?
Mark (X) all that apply.
01

ALL young persons are asked questions or
administered a form which asks questions to
determine suicide risk ➔ Go to Question 6

Young persons who come directly from
home, rather than from another facility
Young persons who display or communicate
suicide risk
Young persons known to have prior suicide
attempts
Young persons for whom no mental health
care record is available
Other young persons not listed above –
Specify

03
04
05
06

6. Are ANY young persons re-asked questions or
re-administered a form to evaluate suicide risk?
Mark (X) all that apply.
01
02

Yes, as necessary on a case-by-case basis
Yes, systematically, based on length of stay,
facility events, or negative life events (for
example, after each court appearance, every
time the young person re-enters the facility,
after a death in the family)
Other – Specify

7. Does this facility assign different levels of
risk to young persons based on their
perceived risk of suicide?
01
02

The following questions ask about preventative
taken once a young person is identified
NOTE measures
to be at risk for suicide. Please include all levels of
E
suicide risk used by this facility, if any, when
answering these questions.

8a. Are young persons who are determined to
be at risk for suicide ever placed in a
sleeping room or observation room that is
locked or under staff security?
01
02

Page 8

No, they are not re-asked questions or readministered a form to determine suicide risk

Yes
No ➔ Go to Question 9

8b. Which of the following best describes
what happens in the sleeping room or
observation room that is locked or under
staff security?
Mark (X) all that apply.
01
02
03
04
05
06

Camera observation
15-minute staff checks
5-minute staff checks
Line of site supervision (direct or through glass)
Staff assigned to doorway or in sleeping room/
One-on-one supervision/Arms length supervision
Other – Specify

9. Are any of the following preventative
measures taken when a young person is
determined to be at risk for suicide?
Mark (X) all that apply.

One-on-one supervision/Arms length supervision
Line-of-sight supervision
Special clothing to identify young persons as at
risk for suicide
Special clothing designed to prevent suicide
attempts
Restraints used to prevent suicide attempts
Removal of personal items that may be used to
attempt suicide
Removal from the general population

Other – Specify

No preventative measures are taken when a
young person is determined to be at risk for
suicide

01
02
03
04
05
06

Yes
No

FORM CJ-15 (05-09-2025)

Section 3 – MENTAL HEALTH SERVICES – Continued
Questions 10 through 14 ask about mental health
provided at a location either INSIDE or
NOTE services
OUTSIDE this facility. INSIDE refers to any
F
location on the facility grounds. OUTSIDE refers to
any location in the community or off facility grounds.

10. Do young persons assigned beds receive
mental health services other than a suicide
evaluation either INSIDE or OUTSIDE this
facility?
Mental health services include:
● evaluations and appraisals conducted by
mental health professionals to diagnose or
to identify mental health needs
● ongoing mental health therapy
● ongoing counseling
Yes, provided both INSIDE and OUTSIDE this facility
01
Yes, provided INSIDE this facility
02
Yes, provided OUTSIDE this facility
03
No, this facility does not provide mental health
04
services ➔ Go to Question 14a

11a. Is ongoing COUNSELING for mental health
problems provided INSIDE or OUTSIDE this
facility by a COUNSELOR?
Counselors are limited to:
● persons with a Master’s degree in a field
other than psychology or social work
● persons whose highest degree is a
Bachelor’s in any field
01
02
03
04

Yes, INSIDE and OUTSIDE this facility
Yes, INSIDE this facility
Yes, OUTSIDE this facility
No, ongoing counseling is not
provided ➔ Go to Question 12a

11b. Which forms of ongoing COUNSELING for
mental health problems are provided by a
COUNSELOR?
Mark (X) all that apply.
01
02
03
04

Individual counseling
Group counseling
Family counseling
Other – Specify

12a. Are ANY young persons evaluated or
appraised by a MENTAL HEALTH
PROFESSIONAL at a location INSIDE or
OUTSIDE this facility?
Evaluations and appraisals are conducted by
mental health professionals to diagnose or to
identify mental health needs.
Mental health professionals are limited to:
● psychiatrists
● psychologists with at least a Master’s
degree in PSYCHOLOGY
● social workers with at least a Master’s
degree in SOCIAL WORK (MSW, LCSW)
01
02
03
04

12b. When are young persons evaluated or
appraised by a MENTAL HEALTH
PROFESSIONAL?
Mark (X) all that apply.
01
02
03
04

Within less than 24 hours
Between 24 hours and less than 7 days after
arrival
Seven or more days after arrival
Other – Specify

12c. Which young persons are evaluated or
appraised by a MENTAL HEALTH
PROFESSIONAL?
Mark (X) all that apply.
01

ALL young persons are evaluated or appraised
by a MENTAL HEALTH PROFESSIONAL

➔

02
03
04
05
06
07

FORM CJ-15 (05-09-2025)

Yes, INSIDE and OUTSIDE this facility
Yes, INSIDE this facility
Yes, OUTSIDE this facility
No ➔ Go to Question 13a

Go to Question 13a

Young persons who come directly from home,
rather than from another facility
Young persons who are ordered by the court to
get an evaluation
Young persons whom staff identify as needing
an evaluation
Young persons known to have mental health
problems
Young persons for whom no mental health
record is available
Other young persons not listed above –
Specify

Page 9

Section 3 – MENTAL HEALTH SERVICES – Continued
13a. Is ongoing THERAPY for mental health
problems provided to young persons by a
MENTAL HEALTH PROFESSIONAL INSIDE
or OUTSIDE this facility?
Mental health professionals are limited to:
● psychiatrists
● psychologists with at least a Master’s
degree in PSYCHOLOGY
● social workers with at least a Master’s
degree in SOCIAL WORK (MSW, LCSW)
01
02
03
04

Yes, INSIDE and OUTSIDE this facility
Yes, INSIDE this facility
Yes, OUTSIDE this facility
No, ongoing THERAPY is not
provided ➔ Go to Question 14a

13b. Which forms of ongoing THERAPY for
mental health problems are provided by
MENTAL HEALTH PROFESSIONALS?
Mark (X) all that apply.
01
02
03
04

Individual therapy
Group therapy
Family therapy
Other – Specify

14a. Are there one or more special
living/sleeping unit(s) in this facility
reserved just for young persons with
mental health problems that are separate
from other living/sleeping units?
01
02

Yes
No ➔

Go to Section 4 on page 11

14b. What are the differences between special
living/sleeping units reserved just for young
persons with mental health problems and
the other living/sleeping units?
Mark (X) all that apply.

average length of stay
physical security and/or monitoring of young
persons
number of staff per young persons
type of treatment program
characteristics of young persons
specialized criteria for staff selection
specialized curriculum of treatment for the
residents of these units
Other – Specify

No differences between units

01
02

03
04
05
06
07

Page 10

FORM CJ-15 (05-09-2025)

Section 4 – EDUCATIONAL SERVICES
1. After arrival in this facility, are ANY young
persons evaluated to determine their
educational grade levels and their
educational needs at a location either
INSIDE or OUTSIDE this facility?
01
Yes
02
No ➔ Go to Note G

5a. Do ANY young persons assigned beds here
attend school or receive teacher
instruction at a location either INSIDE or
OUTSIDE this facility?
Mark (X) only one.
01
02

2. After arrival in this facility, when are
young persons evaluated to determine
their educational grade level?

03
04

Mark (X) all that apply.
01
02
03
04

Within less than 24 hours after arrival
Between 24 hours and less than 7 days after
arrival
Seven or more days after arrival
Other – Specify

3. Which of the following methods are used to
evaluate young persons to determine their
educational grade levels and their
educational needs?
Mark (X) all that apply.
01
02
03
04
05
06

Review of previous academic records
Interview with an education specialist
Administration of one or more written or
computerized tests
Interview with an intake or admissions
counselor
Interview with guidance counselor
Other – Specify

4. Which young persons are evaluated to
determine their educational grade levels
and their educational needs?
Mark (X) all that apply.
01

ALL young persons are
evaluated ➔ Go to Note G

Young persons who come directly from home,
rather than from another facility
Young persons whom the staff identify as
needing an assessment
Young persons for whom no educational record
is available
Young persons with known educational problems
Other young persons not listed
above – Specify

03
04
05
06

5b. Which young persons attend school or
receive teacher instruction?
Mark (X) all that apply.
01

All young persons are required to
attend school or receive teacher
instruction ➔ Go to Question 6

Those young persons who have not completed
high school or their GED
Those young persons with special needs for
remedial education
Those young persons who have been in the
facility long enough to receive educational
services
Those young persons who are required by the
state to attend school because of their age
Those young persons assigned beds in special
living/sleeping units – Specify unit type

03
04

05
06

Mark (X) all that apply.
01
02
03
04
05
06
07

NOTE
G

FORM CJ-15 (05-09-2025)

Other young persons not listed
above – Specify

6. Which of the following educational services
are provided to young persons assigned
beds here at a location either INSIDE or
OUTSIDE this facility?

Questions 5 through 6 ask about educational services
provided either INSIDE and/or OUTSIDE this facility.
INSIDE this facility refers to any location on the facility
grounds. OUTSIDE this facility refers to any location in
the community or off facility grounds.

Yes, provided both INSIDE and OUTSIDE
this facility
Yes, provided INSIDE this facility
Yes, provided OUTSIDE this facility
No, educational services are not provided
to young persons while assigned beds
here ➔ Go to Section 5 on page 12

Elementary-level education
Middle school-level education
High school-level education
Special education
GED preparation
GED testing
post-high school education or post-high school
correspondence courses
Vocational/technical education
Life skills training
Other – Specify

Page 11

Section 5 – SUBSTANCE USE SERVICES
1a. After arrival in this facility, are ANY young
persons evaluated to determine whether
they have substance use problems?

Mark (X) all that apply.

Substance use problems include problems with
drugs and/or alcohol.
01
02

2. When are young persons FIRST evaluated
to determine whether they have substance
use problems?
Within less than 24 hours after arrival
Between 24 hours and less than 7 days after
arrival
Seven or more days after arrival
Other – Specify

Yes
No ➔ Go to Question 4a

02
03

1b. Which of the following methods are used
to evaluate persons after arrival in this
facility to determine whether they have
substance use problems?
Mark (X) all that apply.
01
02
03
04

Visual observation
Standardized self-report instruments, such as
the SASSI, JASI, ACDI, ASI
Self-report check list inventory which asks about
substance use
A staff-administered series of questions which
asks about substance use
Other – Specify

3. After arrival in this facility, which young
persons are evaluated for substance use
problems?
Mark (X) all that apply.

➔

ALL young persons

Young persons charged with or adjudicated for
a drug or alcohol-related offense
Young persons identified by the court or a
probation officer as potentially having
substance use problems

Go to Question 4a

Young persons identified by facility staff as
potentially having substance use problems
Other young persons not listed
above – Specify

4a. Are ANY young persons required to provide urine FOR DRUG ANALYSIS after arrival IN
THIS FACILITY?
01
02

Yes
No ➔ Go to NOTE H

4b. Which statements below describe the circumstances under which young persons are
required to provide urine INSIDE this facility FOR DRUG ANALYSIS?
Mark (X) all that apply.

PERSONS
PROVIDING URINE
SAMPLE

After initial
arrival in this
facility
(1)

CIRCUMSTANCES OF TESTING
Each time
young persons
At randomly When drug use At the request
reenter the
scheduled
facility during
is suspected or of the court or
times
their stay
drug is present probation officer
(5)
(3)
(2)
(4)

a. Young persons who are suspected of recent
drug or alcohol use

b. Young persons with substance use problems

c. ALL young persons assigned beds here

Page 12

FORM CJ-15 (05-09-2025)

Section 5 – SUBSTANCE USE SERVICES – Continued
Questions 5 through 9 ask about substance use services provided

NOTE at a location either INSIDE or OUTSIDE this facility. INSIDE
refers to any location within facility grounds. OUTSIDE refers to
H
any location in the community or off facility grounds.

INSTRUCTIONS
Substance use services include:
● developing a substance use treatment plan assigning a
● case manager to oversee substance use treatment
● assigning young persons to special living units just for those
with substance use problems

● ongoing substance use therapy or counseling
● substance use education
Substance use treatment professionals are limited in
this census to:
● CERTIFIED substance use or addictions counselors
● psychiatrists
● psychologists with a Master’s or higher in PSYCHOLOGY
● social workers with a Master’s or higher in SOCIAL WORK
(MSW, LCSW)

Counselors who are NOT substance use treatment
professionals are limited to:
● persons with a Master’s degree in a field other than
psychology or social work

● persons whose highest degree is a Bachelor’s in any field
5. Do ANY young persons assigned beds here
receive substance use services INSIDE or
OUTSIDE this facility other than urinalysis
or a substance use screening?
Yes, both INSIDE and OUTSIDE this facility
01
Yes, INSIDE this facility
02
03
Yes, OUTSIDE this facility
04
No, this facility does not provide substance
use services ➔ Go to Section 6
6. Which of the following SUBSTANCE USE
services are provided INSIDE or OUTSIDE
this facility?
Mark (X) all that apply.
Substance use education
01
Assignment of a case manager to oversee
02
substance use treatment
03
Development of a treatment plan to
specifically address substance use problems
Special living units in which all young persons
04
have substance use offenses and/or problems
None
of these services are offered
05
7. Which of the following self-led, self-help
groups are provided INSIDE or OUTSIDE
this facility?
Mark (X) all that apply.
01
Alcoholics Anonymous or other related groups
02
Narcotics Anonymous or other related groups
03
Other – Specify

8a. Is ongoing COUNSELING for substance use
problems provided to young persons
INSIDE or OUTSIDE this facility by a
COUNSELOR who is NOT a substance use
treatment professional?
Counselors who are NOT substance use treatment
professionals are:
● persons with a Master’s degree in a field
other than psychology or social work
● persons whose highest degree is a
Bachelor’s in any field
01
02
03
04

8b. Which forms of ongoing COUNSELING for
substance use problems are provided
INSIDE or OUTSIDE this facility to young
persons by a COUNSELOR who is NOT a
substance use treatment professional?
Mark (X) all that apply.
01
02
03
04

Individual counseling
Group counseling
Family counseling
None of these are provided

ongoing
THERAPY
for
substance
use
problems
9a. Is
provided to young persons INSIDE or OUTSIDE this
facility by a SUBSTANCE USE TREATMENT
PROFESSIONAL?
01
02
03
04

Yes, both INSIDE and OUTSIDE this facility
Yes, INSIDE this facility
Yes, OUTSIDE this facility
No, ongoing THERAPY for substance use
problems is not provided ➔ Go to Section 6

9b. Which forms of ongoing THERAPY for
substance use problems are provided
INSIDE or OUTSIDE this facility to young
persons by a SUBSTANCE USE
TREATMENT PROFESSIONAL?
Mark (X) all that apply.
01
02
03
04

Yes, provided both INSIDE and OUTSIDE this
facility
Yes, provided INSIDE this facility
Yes, provided OUTSIDE this facility
No, this facility does not provide
COUNSELING for substance use
problems ➔ Go to Question 9a

Individual therapy
Group therapy
Family therapy
None of these are provided

No self-led, self-help groups are provided

FORM CJ-15 (05-09-2025)

Page 13

Section 6 – MEDICAL SERVICES

INSTRUCTIONS
Questions 1 through 7 ask about the availability of medical services at locations either INSIDE and/or
OUTSIDE this facility.
INSIDE this facility refers to any location on the facility grounds.
OUTSIDE this facility refers to any location in the community or off facility grounds.

1. For each of the following medical providers, please indicate if this facility has access to
these providers as paid facility employees, contract staff, available as needed in the
community, or if the medical providers are not available.
Mark (X) all that apply.
Available as paid Available as paid
facility employee
contract staff
(1)
(2)

Available as
needed in the
community
(3)

Not available
(4)

a. Physicians (MDs or DOs)

b. Nurse practitioners (NPs) or physician
assistants (PAs)

c. Registered nurses (RNs)

d. Licensed practical nurses (LPNs) or licensed
vocational nurses (LVNs)

e. Certified nursing assistants, nursing assistants,
medication technicians or medication aides

f. Licensed social workers or persons with a
bachelor’s or master’s degree in social work

2. Do ANY young persons assigned beds here receive the following examinations by a
qualiﬁed provider, including a physician or ophthalmologist (MD or DO), nurse practitioner
(NP), physician assistant (PA), optometrist (OD), or audiologist (AuD), either INSIDE or
OUTSIDE of this facility?
Mark (X) only one in each row.

Yes, provided
INSIDE and
OUTSIDE this
facility
(1)

Yes, provided
only INSIDE
this facility
(2)

Yes, provided
only OUTSIDE
this facility
(3)

No, not provided
(4)

a. Physical Examination

b. Dental Examination

c. Vision Examination

d. Hearing Examination

Page 14

FORM CJ-15 (05-09-2025)

Section 6 – MEDICAL SERVICES – Continued
3. When a medical provider orders
vaccinations for ANY young persons
assigned beds here, can the young persons
receive the vaccinations at a location
either INSIDE or OUTSIDE of this facility?
Yes, provided INSIDE and OUTSIDE this facility
Yes, provided INSIDE this facility
Yes, provided OUTSIDE this facility
No, vaccinations are not provided

01
02
03
04

4. Do medical providers INSIDE or OUTSIDE
this facility prescribe psychotropic
medication for young persons?
01
02
03
04

Yes, prescribed INSIDE and OUTSIDE this facility
Yes, prescribed INSIDE this facility
Yes, prescribed OUTSIDE this facility
No, psychotropic medications are not prescribed

7a. Were ANY young persons assigned beds in
this facility known by facility staff to be
pregnant between March 1, 2025 and
February 28, 2026?
01
Yes
02
No ➔ Go to Section 7 on page 16
7b. How many young persons assigned beds
in this facility were pregnant between
March 1, 2025 and February 28, 2026?
Number of pregnant young persons

7c. Did ANY young persons assigned beds in
this facility who were pregnant between
March 1, 2025 and February 28, 2026
receive prenatal care from a physician (MD
or DO), nurse practitioner (NP), or physician
assistant (PA) at a location either INSIDE
or OUTSIDE of this facility?
01

5. Do medical providers INSIDE or OUTSIDE
this facility monitor psychotropic
medication for young persons?
01
02
03
04

Yes, monitored INSIDE and OUTSIDE this facility
Yes, monitored INSIDE this facility
Yes, monitored OUTSIDE this facility
No, psychotropic medications are not monitored

02
03
04

Yes, provided INSIDE and OUTSIDE this
facility
Yes, provided INSIDE this facility
Yes, provided OUTSIDE this facility
No, prenatal care was not provided

6. Do ANY female young persons assigned
beds here receive a gynecological
examination by a physician (MD or DO),
nurse practitioner (NP), or physician
assistant (PA) at a location either INSIDE
or OUTSIDE of this facility?
A gynecological examination involves the medical
provider gathering a medical history regarding
reproductive health and sexual behavior and
conducting a pelvic and breast exam.

Yes, provided INSIDE and OUTSIDE this facility
Yes, provided INSIDE this facility

Yes, provided OUTSIDE this facility

No, gynecological examinations are not provided
No, this facility does not house female young persons

FORM CJ-15 (05-09-2025)

Page 15

Section 7 – THE PRIOR MONTH

INSTRUCTIONS
The following items ask you to answer
questions about different events that may
have occurred at this facility over a 28-day
period.

2b. For what reason(s) were the young persons
transported to a hospital emergency room
DURING THIS 28 DAY PERIOD in February?
Mark (X) all that apply.
01
02

The 28-day REFERENCE PERIOD for this
section covers the time between the
beginning of the day on February 1, 2026
and the end of the day on February 28,
2026.

During the month of February 2026, were
there ANY UNAUTHORIZED DEPARTURES
of any young persons who were assigned
beds at this facility?

06
07
08

An "unauthorized departure" includes any incident in
which a young person leaves without staff permission
or approval for more than 10 minutes from:

● The physical security perimeter of the
facility
● The mandatory supervision of a staff
member when there is no physical security
● The mandatory supervision of
transportation staff
● Any other approved area
01
02

Yes
No

2a. During the month of February 2026, were
ANY young persons assigned beds at this
facility transported to a hospital
emergency room by facility staff,
transportation staff, or by an ambulance?
01
02

Sports-related injury
Work or chore-related injury
An injury that resulted from interpersonal
conflict between one or more young
persons, not including a sports-related injury
An injury that resulted from interpersonal
conflict between a young person and a
non-resident (including staff, visitors, or
persons from the community)
Illness
Pregnancy complications
Labor and delivery
Suicide attempt
A non-emergency injury or illness that
occurred when no physical health professional
was available at the facility or on call
A non-emergency injury or illness that
occurred when no doctor’s appointment could
be obtained in the community
Other – Specify

During the month of February 2026, were
ANY of the young persons assigned beds
here restrained by facility staff with a
mechanical restraint?
Mechanical restraints include handcuffs, leg cuffs,
waist bands, leather straps, restraining chairs, strait
jackets, or other mechanical devices
If the facility staff ONLY used mechanical restraints
during transportation to and from this facility answer NO.

Yes
No ➔ Go to Question 3

01
02

Yes
No

During the month of February 2026 were
ANY of the young persons assigned beds
here locked for more than four hours alone
in an isolation, seclusion, or sleeping room
to regain control of their unruly behavior?
Answer NO if:
● Young persons were locked in their
sleeping rooms as part of the facility routine
OR
● Young persons were locked in their rooms
ONLY for purposes of quarantine, suicide
watch, facility wide lockdown, or
self-requested seclusion
01
02

Page 16

Yes
No
FORM CJ-15 (05-09-2025)

Section 8 – THE PAST YEAR
INSTRUCTIONS
Questions 1 through 3 ask about deaths of young persons at locations either INSIDE and/or OUTSIDE
this facility during the period between March 1, 2025 and February 28, 2026.
INSIDE this facility refers to any location on the facility grounds.
OUTSIDE this facility refers to any location in the community or off facility grounds.

1. During the YEAR between March 1, 2025 and February 28, 2026, did ANY young persons die
while assigned a bed at this facility at a location either INSIDE or OUTSIDE of this facility?
01

Yes

➔

Go to Note I

2. How many young persons died while assigned beds at this facility during the year between
March 1, 2025 and February 28, 2026?
Person(s)

3. What was the cause of death, location of death, age, sex, race, date of admission to the facility,
and date of death for each young person who died while assigned a bed at this facility?

a. Cause of death
1 – Illness/natural causes
2 – Injury suffered prior to
placement here
3 – Suicide
4 – Homicide or manslaughter
by another resident
5 – Homicide or manslaughter
by non-resident(s)
6 – Accidental death
7 – Other – Specify in box ➔
b. Location of death
1 – Inside this facility
2 – Outside this facility

Young person 1

Young person 2

Young person 3

(1)

(2)

(3)

Code

c. Age at death (in years)
d. Sex
1 – Male
2 – Female
e. Race
1 – White, not Hispanic origin
2 – Black or African American,
not of Hispanic origin
3 – Hispanic or Latino
4 – American Indian/
Alaskan Native
5 – Asian
6 – Native Hawaiian or other
Pacific Islander
7 – Middle Eastern or North
African
8 – Other – Specify in box ➔
f. Date of admission to
facility (mm/dd/yyyy)
g. Date of death
(mm/dd/yyyy)

FORM CJ-15 (05-09-2025)

Page 17

COMMENTS
Thank you for completing this questionnaire. If you would like to give us any comments on this
form, please write them on this page or attach another sheet.

NOTE
I

Please make a copy of this questionnaire for your records so that if we need to contact you about
a response, you will be able to refer to your copy.
If you are unable to submit online, please mail the completed form to –
U.S. Census Bureau
P.O. Box 5000
Jeffersonville, IN 47199–5000
ERD/JFCP
or FAX toll free to: 1–888–262–3974.

Comments

DEFINITIONS OF TERMS
Court-adjudicated: Refers to a youth who has been
determined by a court to have committed the delinquent act
or status offense for which they were charged.
Facility: A place that has living/sleeping units such as
wings, floors, dorms, barracks, or cottages on one campus
or in one building.
Gynecological Exam: Involves the medical provider
gathering a medical history regarding reproductive health
and sexual behavior and conducting a pelvic and breast
exam.

Services “Inside” a Facility: A service provided at any
location on the facility grounds.
Services “Outside” a Facility: A service provided at
any location in the community or off facility grounds.
Status Offense: An offense that is illegal in a state for
underage persons but not for adults. Examples include
running away, truancy, incorrigibility, curfew violation, and
underage liquor violations.

Makeshift Beds: Alternative beds including roll-out mats,
fold-out cots, roll-away beds, pull-out mattresses, sofas, and
any other beds that are put away or moved during nonsleeping hours.

Substance Use Services: Include substance use
evaluations, developing a substance use treatment plan,
assigning a case manager to oversee substance use
treatment, assigning young persons to special living units for
those with substance use problems, ongoing substance use
therapy or counseling, and substance use education.

Medical Providers: Individuals who are authorized to
practice by the state and are performing within the scope of
their practice as defined by state law, such as physicians
(MDs or DOs), registered nurses (RNs), nurse practitioners
(NPs), etc.

Substance Use Treatment Professionals:
Individuals that are certified substance use or addiction
counselors, psychiatrists, or psychologists, with at least a
master’s degree in psychology, as well as social workers
with at least a Master’s degree in social work (MSW, LCSW).

Mental Health Professionals: Individuals that are
Psychiatrists or Psychologists with at least a master’s
degree in psychology, and Social Workers with at least a
Master’s in social work (MSW, LCSW).

Therapy: Treatment of physical, mental, or behavioral
disorders or disease.

Mental Health Services: Includes evaluations and
appraisals conducted by mental health professionals to
diagnose or to identify mental health needs, as well as
ongoing mental health therapy and ongoing counseling.
Residential Facility: A facility that houses persons
overnight.

Page 18

Treatment: Intervention designed to manage illness,
injury, disease or disorders.
Unauthorized Departures: Incidents in which a young
person leaves without staff permission or approval for more
than 10 minutes from the following: the physical security
perimeter of the facility, the mandatory supervision of a staff
member when there is no physical security; the mandatory
supervision of transportation staff, or any other approved
area.

FORM CJ-15 (05-09-2025)

File Type	application/pdf
File Title	CJ-15 - 2026 Juvenile Residential Facility Census
Author	United States Census Bureau
File Modified	2025-09-16
File Created	2025-05-15