Cleric Survey:

CONFIDENTIAL

 

Please complete the following information. To ensure confidentiality, this information will be encrypted for data analysis and this page will be destroyed.

 

Cleric’s first initial ____

Cleric’s last initial ____

Date of Birth __ __/__ __/__ __

 

 

 

 

 

 

 

 

Reminder: Do not write in the names of any clerics or victims anywhere on this survey. If you have any questions and you call the John Jay college research team hotline at (212) 237-8539, please do not say your name, the name of your diocese, or the name of any alleged victims or abusers.

 

 

 

 

 

Please fill out this form to the best of your knowledge for every cleric against whom there are or have been allegations of sexual abuse between 1950 and 2002. Do not fill this out for clerics against whom the only allegations were known to be false. For the purpose of clarity and flow, the term "diocese" is used to refer to all diocesan, eparchial and religious orders, societies and communities. If a question is not appropriate for your order, please write N/A.

FIRST, WE ARE GOING TO ASK YOU TO PROVIDE SOME BASIC INFORMATION ABOUT THIS PARTICULAR CLERIC.

1. Year of birth: __ __ __ __
2. At the time of the alleged offense(s), was this cleric a(n): (check as many answers if necessary if the allegations against this cleric extended over a period of time)

Diocesan Priest Eparchian Priest

Extern Priest Religious Priest

Transitional Deacon Permanent Deacon

Eparch Bishop

Cardinal Other (specify): __________________________

3. If ordained, year of ordination: __ __ __ __
4. What seminary/seminaries did the cleric attend? ____________________________
5. Was cleric married at time of alleged offense(s)?

Yes No

6. Does the cleric have a history of being a victim of abuse?

Yes No known abuse (If No, skip to Question 9)

7. If yes, the type of abuse indicated in the record or known to the diocese is best described as (check all that apply)

Physical abuse Emotional Abuse

Sexual Abuse Verbal Abuse

Physical & Sexual Abuse Neglect

Other (specify): __________________________________________

8. This abuse was allegedly committed by: (check all that apply)

9. Are there indications in the record that the cleric had problems with alcohol or substance abuse?

Yes, Alcohol Yes, Drugs Yes, Alcohol & Drugs No (If no, skip to question 13)

 

 

10. If you answered "Yes" to Question 9, then please indicate what action(s) was taken to address the alcohol or drug abuse problem? (check all that apply)

Referral for Evaluation Spiritual Counseling Provided

Referral for Treatment Intervention

Spiritual Counseling Recommended No action taken

Other action taken (describe) ___________________________________

11. If treatment was provided, where did it occur? (if none, skip to question 13)

inpatient substance /alcohol abuse treatment within the diocese

inpatient substance/alcohol abuse treatment outside diocese

outpatient within diocese (specify type of program) _________________________

outpatient outside of diocese (specify type of program)_______________________

12. During treatment for alcohol/drug abuse, did the cleric admit to sexual abuse(s) of a minor(s)?

Yes No

13. Are there other specific medical or psychological problems that raised concerns about this cleric’s fitness for ministry? (if no, skip to question 18)

Yes No

14. Please describe the problem to the extent possible__________________________________

__________________________________________________________________________

15. Was the problem recognized before any allegation of abuse?

Yes No

16. What is the approximate date the problem was recognized? ____________
17. If the cleric has multiple medical or psychological problems, please specify the year each was recognized (if more than three, please continue question 16 on the back.)

Year ________ problem ______________________

Year ________ problem ______________________

Year ________ problem ______________________

Check here if continued on back _____________

18. How many dioceses has this cleric served in? __________
19. How many times has this cleric transferred within your diocese?

Parishes ________ Congregations ________

20. Does this cleric have allegations of sexual abuse against him at any of these other dioceses in which he served?

Yes No No information in file

21. If yes, how many victims made allegations of abuse against this cleric in each diocese, parish and congregation in which he served?

Dioceses ________ Parishes ________ Congregations________

 

22. Is it known from the files, or by other means, that this cleric had behavioral/boundary problems other than allegations of sexual abuse of minors (e.g., letters of complaint from parishioners)?

Yes (specify) _____________________________________________________

No

NOW WE ARE GOING TO ASK ABOUT THIS CLERIC’S ALLEGED VICTIM(S) FROM YOUR DIOCESE

23. How many victims made allegations of sexual abuse against this cleric in your diocese? ________
24. Is there any indication that the cleric has abused more victims than there are official allegations made (e.g., victims who made a complaint claim that there are other victims who do not want to come forward)?

Yes No

25. If yes, please indicate how many other alleged victims there are who have not officially made a complaint against this cleric. _____________________
26. How many allegations of abuse of minors does the cleric have in each of the following age ranges and genders at your diocese? (give your best approximation of the age range based on information in the file)

# of victims under 8 years of age ________ # male _______ # female ________

# of victims 8 - 10 years of age ________ # male _______ # female ________

# of victims 11-14 years of age ________ # male _______ # female ________

# of victims 15 - 17 years of age ________ # male _______ # female ________

THE FOLLOWING QUESTIONS HAVE TO DO WITH THE INSTITUTION’S RESPONSE TO THE SEXUAL ABUSE ALLEGATIONS AGAINST THIS PARTICULAR CLERIC

27. What did the diocese do in response to the allegation(s) of sexual abuse against this cleric? (check all that apply)

28. If the cleric was reinstated, was it:

Within the diocese, same parish

Within the diocese, different parish

Different diocese

Restricted ministry

29. What year(s) did the diocese take action against the cleric?

Year__________ Action___________________

Year__________ Action___________________

Year__________ Action___________________

30. If the cleric participated in any type of treatment to address the sexual abuse allegations, what kind of treatment was it? (check all that apply) If no treatment, skip to question 35.

Specialized sex offender treatment program specifically for clergy	Specialized sex offender treatment program for all sex offenders, not just for clergy
General treatment program not specifically for sex offenders	One-on-one counseling w/ psychiatrist, psychologist, or other mental health expert
Psychotherapist	Relapse prevention treatment program
Evaluation by mental health professional or expert, but no indication of treatment	Spiritual counseling or direction provided by the church
Other (specify):____________________

31. If the cleric participated in treatment, at which facility?

Behavioral Medicine Institute of Atlanta, GA	Servants of the Paraclete, Jemez Springs, NM
Issac Ray Center, Chicago, Il	Servants of the Paraclete, Albuquerque Villa, NM
Johns Hopkins Medical Institutions, Baltimore, MD	St. Louis Consultation Service, St. Louis, MO
Progressive Clinical Services, Cincinnati, OH	Institute of Living, Hartford, CT
St. Luke Institute, Suitland, MD	Menninger Clinic, Topeka, KS
Servants of the Paraclete, St. Louis, MO	New Life Center, Middleburg, VA
Shalom Center, Inc., Splendora, TX	Villa St. John Vianney, Downingtown, PA
Southdown, Aurora, Ontario, CN	Other (specify)_________________________

32. How many times did the cleric participate in a sex offender treatment program? ________
33. Did the cleric complete a treatment program?

Yes No No information in file

34. If cleric received treatment, did he re-offend after he finished treatment?

Yes No No information in file

35. Provide additional information known or from the record that would assist in understanding the behavior of this cleric.

REMEMBER – do not provide any names or other identifying information

 

Order Profile:

CONFIDENTIAL

Form #1: Religious Order Profile

Please answer these nine questions to the best of your knowledge. It should include information between 1950-2002.

1. Is this institution a(n): (Please check one)

Diocese Eparchy Religious Order

2. List the approximate number of active and retired clerics in the religious order from 1950 (or since the establishment of the religious order) to 2002:

a. priests in religious order: incardinated ______ extern _______

b. fathers in religious order: incardinated ______ extern _______

c. "Others" in diocese __________________

3. What is the approximate membership of the religious order at this time?

1 - 10 31 - 40 111 – 150 541 and up
11 - 20 41 - 75 151 - 305
21 - 30 76 - 110 306 - 540

4. What is the approximate number of priests and fathers who are now members (part of?) the religious order?

1 - 6 22 - 35 81 – 110 400 and up

7 - 14 36 - 57 111 - 176

15 -21 58 - 80 176 - 399

5. Based on your review of the records, indicate how many clerics have had allegations made against them while in your diocese.

Number of incardinated __________ number of extern __________

6. How many clerics with allegations have been completely exonerated? _______________
7. Based on your reviews of the records, please indicate the total number of victims who have made allegations against clerics in your religious order. ____________________
8. Based on your reviews of the records, please indicate the total amount of money paid out by your diocese to alleged victims of sexual abuse between 1950 and 2002. ___________________
9. For how many of the victims in Question #8 have:

__________ all of their allegations been shown to be known false

(# of victims)

__________ all of their allegations been withdrawn

(# of victims)

 

Victim Survey:

CONFIDENTIAL

Prepare a separate profile for each victim who issued an allegation against this particular cleric. If a cleric had multiple allegations, prepare a separate victim profile for each victim who initiated an allegation. Please answer each of these questions to the best of your knowledge and indicate when an answer is approximate rather than specific. If a question is not appropriate for your order, please write N/A. Remember to write the matching cleric’s number in the upper right hand corner.

WE ARE NOW GOING TO ASK YOU TO PROVIDE SOME BASIC INFORMATION ABOUT EACH VICTIM WHO BROUGHT AN ALLEGATION AGAINST THIS PARTICULAR CLERIC.

1. Gender of victim (check one)

Male Female

2. When did the alleged abuse occur? (Be as specific about the date or range of dates as possible)

Month __ __ Day __ __ Year __ __ __ __ OR range of dates _______________________

3. When was this abuse reported? (Be as specific as possible)

Month __ __ Day __ __ Year __ __ __ __

4. Who initially made the allegation?

5. How was the allegation initially made?

6. Is there a record of the victim or victim’s family following up on the allegation?

No Yes (specify method of follow up):_______________________________

7. If the victim/victim’s family did follow up, how many times? __________________
8. How many times was the victim allegedly abused?

Once More than once (number __________) numerous (unknown number)

9. Did the victim allege abuse by more than one cleric? (If no, skip to question 12)

Yes No Information not in the file

10. If yes, how many clerics allegedly abused this victim? _________
11. Did the abuse by the other cleric(s) occur before, concurrent with or after this cleric? (check all that apply)

Before Concurrent with After

 

12. Age (in years) when alleged abuse began (or occurred, if only happened once). ___________ years
13. Age (in years) when abuse ended (if occurred more than once). ____________ years
14. Age (in years) when victim first told someone about the abuse. ______________ years
15. Number of months/years the victim waited to report the abuse. _____________
16. Where did the victim first meet the cleric?

17. What was the cleric’s primary duty when he met the victim? (check all that apply)

Pastor	Associate pastor
Resident priest	Seminary faculty
Boys club/youth recreation	Catechism teacher
Teacher in preschool, kindergarten, or elementary school (up to grade 6)	Choir Chaplain
Teacher in middle school (grades 7-8)	Worked in a hospital
Teacher in high school (grades 9-12)	Saying Mass
Seminary administrator	Bishop, Vicar, Chancellor, Cardinal
Guidance counselor	Coach
Other (specify)________________

18. Did the cleric socialize with the family of the alleged victim(s)?

Yes No Information not in the file

19. If yes, in what way? (check all that apply)

20. Type of behavior alleged by this victim (check all that apply):

21. Was the victim threatened by the cleric in any way?

Yes No Information not in the file

22. If yes, what type of threat?

23. Where was the abuse reported to have occurred?

(check all that apply)

In the church	In the parish residence
In the home of the victim	Cleric’s office
In school	In the hospital
In a hotel room	In a car
Retreat house	Vacation house
Other (specify):__________________

24. When did the abuse reportedly occur?

25. Did the victim receive any gifts from the cleric?

Yes No Information not in the file

26. If yes, what type of gift(s)? __________________________________________
27. Were there any other enticements given to this victim?

Yes No Information not in the file

28. If yes, what were the enticements? (check all that apply)

29. Who did the victim live with when allegedly abused (check all that apply)

Mother only	Father only
Both parents	Brother(s)
Sister(s)	Other guardian
Grandparents	Boarding school
Foster parents	Orphanage
With the cleric	Other (specify)____________
In the rectory or church-related residence

30. Were any of victim's siblings also abused by any cleric?

Yes No Information not in the file

31. At the time of the alleged abuse, was the victim under the influence of alcohol or drugs?

Yes No Information not in the file

32. At the time of the alleged abuse, was the cleric under the influence of alcohol or drugs?

Yes No Information not in the file

33. Was there a diocesan investigation? (If no, skip to Question 37)

Yes No Information not in the file

34. If there was a diocesan investigation, what was the result? (check all that apply)

35. What action was taken regarding the cleric?

36. Was the victim or their family ever contacted regarding the results of the investigation?

Yes No Information not in the file

37. Did the victim report the incident to the police or district attorney?

Yes No Information not in the file

38. Was there a police investigation?

Yes No Information not in the file

39. Was the cleric charged with a criminal offense? (If no, skip to Question 45)

Yes No Information not in the file

40. If yes, what charge was brought?________________________________________
41. Did the charges result in a conviction?

Yes No Information not in the file

42. If yes, for what offense? _____________________________________
43. If there was a conviction, what was the sentence? (check all that apply)

Fine	Jail
Probation	Prison
House arrest	Electronic monitoring
Community service	Other (specify) _________________

44. If there was a conviction, what was the length of the sentence imposed? __________________
45. Was there any civil action taken against the cleric or the diocese for damages?

Yes No Information not in the file

46. Was there any other form of legal action taken with respect to this cleric and this victim?

Yes(specify)___________________ No Information not in the file

NOW WE ARE GOING TO ASK ABOUT FINANCIAL INFORMATION IN REGARD TO THIS VICTIM. YOU MAY NEED ASSISTANCE FROM THE acting budget/financial officer or accountant within the diocese TO ANSWER THESE QUESTIONS.

47. Was the victim given any type of compensation to settle

the allegation of abuse?

Yes No Pending Information not in the file

48. What was the approximate total compensation or payment made to date to this victim from all sources? $ _________
49. How much of this was covered by, or derived from, insurance? $_______________
50. What was the approximate payment to date for treatment for this victim? $ ____________
51. How much of this was covered by or derived from insurance? $______________
52. What was the approximate payment to date for treatment for this cleric? $_____________
53. How much of this was covered by or derived from insurance $______________
54. What was the approximate total payment to date made by the diocese to attorneys to represent the diocese related to this victim’s allegations? $______________