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APPENDIX A - Youth Information Form

(A separate form needs to be completed for EACH youth in your facility)

Instructions: Please fully complete one data collection form for EACH youth in your facility on Snapshot Day. Please print your answers in the spaces provided or check the appropriate box.

Institutional Information

1. Name of facility

2. Province (Please use a two letter abbreviation)

Demographic Information

3. Age (indicate age on Snapshot Day)

4. Gender

Male
Female

5. Languages spoken (Please check ALL that apply)

French
English
Aboriginal
Other (specify) _____________________

Legal Information

6. Legal Status of Youth (Please check ALL that apply)

Remand
Serving an OPEN sentence
Serving a SECURE sentence
Other (specify) ______________________

7. If serving a custodial sentence : Most Serious Offence (Please consult the Seriousness Index attached as Appendix A to determine the youth's most serious offence and enter the three digit numerical code)

8. If on remand : Most Serious Charge (Please consult the Seriousness Index attached as Appendix A to determine the youth's most serious charge and enter the three digit numerical code)

9. Date of Admission (Please indicate the date of the youth's FIRST admission to custody for the specific MSO or MSC indicated above)

10. Legislation (Please indicate if the youth is serving YOA or YCJA sentence)

11. AGGREGATE Custody Sentence (Please record the total number of days for the aggregate YOA sentence OR the total number of days of the CUSTODIAL PORTION for the aggregate YCJA sentence )

12. Has an application been approved to maintain the youth in custody beyond the ordered number of days?

Yes
No

13. If yes, how many additional days has the youth served?

If yes, how many additional days remain?

Aboriginal Status Information

13. Aboriginal Status

Non-Aboriginal
Aboriginal

Information on Aboriginal Youth Only

14. Aboriginal Identity

First Nations
Metis
Inuit
Innu
Inuvialuit
Unknown
Other (specify) ______________________

15. Aboriginal Status

Status Indian
Non-status Indian

16. Living Arrangements (Please indicate status prior to admission to custody)

Dual-parent
Lone-parent
Extended family
Foster parents
Group home
Transient/living on the streets
Other (specify) ______________________

17. Child Welfare Status (Please indicate status prior to admission to custody)

Ward of the State
Active Child Welfare File - NOT a Ward of the State
No child welfare involvement

18. Social Assistance (Please indicate if the youth resided in a family that received social assistance as the primary source of income)

Yes
No

19. First Conviction (Please indicate the age of the youth at their first conviction)

20. Education (Please indicate the highest grade COMPLETED in school)

21. Diagnosis of Foetal Alcohol Syndrome/Foetal Alcohol Effects

Confirmed diagnosis (obtained from medical records)
Suspected (obtained from custodial file)
Suspected (obtained from self-report)
No information available

Confirmed problem
Suspected
No information available

23. Suicide (PRIOR to current CUSTODY admission)

Previous attempts
Previous suicidal thoughts
No information available

24. Suicide (WITHIN CUSTODY during current sentence)

Attempts
Suicidal thoughts
No information available

25. Self-Harm (WITHIN CUSTODY during current sentence)

Yes (self-cutting/slashing/burning, etc.)
No
No information available

Geographical Information

26. In which city, town or reserve did the youth spend the longest period of time during the two years preceding his or her current admission? (Please exclude time spent in custody)

26.1 Location of residence

26.2 Province (Please use a two letter abbreviation)

27. In which city, town or reserve did the youth commit or allegedly commit the offence that led to the current admission? If the youth has more than one charge or conviction, please specify the location where the most serious charge or conviction took place

27.1 Location of offence

27.2 Province (Please use a two letter abbreviation)

28. In which city, town or reserve does the youth plan to locate upon release?

28.1 Location of release

28.2 Province (Please use a two letter abbreviation)

If you have any questions when completing this form please contact:

Jeff Latimer
Senior Research Officer
Research and Statistics Division
Department of Justice Canada
(613) 957-9589
jlatimer@justice.gc.ca

Serious Index

The following Index is used by the Canadian Centre for Justice Statistics in order to calculate the Most Serious Charge/Offence. The seriousness of an offence is ranked according to offence type and the potential impact on the person. Offences are ordered from most to least serious.

Please select the most serious charge (MSC) or offence (MSO) for each youth, for the current custody or remand admission. If there is only one offence, then that offence is the MSC/MSO. If there is more than one offence, then the MSC/MSO is determined by the following offence severity scale. For instance, if a youth committed "break and enter" and "theft under," the MSO would be the break and enter. You would then enter numerical code 031 as the youth's most serious charge/offence. The number of offences does not matter. For example, if a youth was convicted for multiple "theft under" offences but only one "break and enter", the MSO remains "break and enter".

Offences Against the Person

001 - Murder, First degree
002 - Murder, Second degree
003 - Manslaughter
004 - Criminal Negligence Causing Death
005 - Other related offences causing death
006 - Attempted Murder
007 - Conspire to Commit Murder
008 - Aggravated sexual assault
009 - Kidnapping
010 - Hostage Taking
011 - Robbery
012 - Extortion
013 - Other Violent Violations
014 - Sexual Assault with a Weapon
015 - Aggravated Assault - Level 3
016 - Discharge Firearm with intent
017 - Sexual Assault
018 - Assault with weapon or causing bodily harm - level 2
019 - Unlawfully causing bodily harm
020 - Criminal negligence causing bodily harm
021 - Abduction under 14
022 - Abduction contravening a custody order
023 - Abduction - no custody order
024 - Infanticide
025 - Assault - level 1
026 - Assault against peace-public officer
027 - Abduction under 16
028 - Other sexual crimes
029 - Other assaults
030 - Criminal harassment

Break and Enter

031 - Break and Enter

Controlled Drug and Substance Act

032 - Trafficking - Heroin
033 - Trafficking - Cocaine
034 - Trafficking - Other N.C.A
035 - Trafficking - Cannabis
036 - Importation - Heroin
037 - Importation - Cocaine
038 - Importation - Other N.C.A.
039 - Importation - Cannabis
040 - Trafficking - Controlled drugs
041 - Trafficking - Restricted Drugs
042 - Possession - Heroin
043 - Possession - Cocaine
044 - Possession - Other N.C.A.
045 - Possession - Cannabis
046 - Cultivation - Cannabis
047 - Possession Restricted Drugs

Other Criminal Code Offences

048 - Offensive Weapons - Explosives

Criminal Code Traffic Violations

049 - Dangerous Operation Causing Death
050 - Impaired Operation/Related Violations Causing Death

Offences Against Property

051 - Arson

Other Criminal Code Offences

052 - Counterfeiting Currency
053 - Firearms and Other Offensive Weapons (Part III C.C.)
054 - Offences Related to Currency (Part XII C.C.)

Criminal Code Traffic Violations

055 - Dangerous Operation Causing Bodily Harm
056 - Impaired Operation/Related Violations Causing bodily Harm

Offences Against Property

057 - Theft over
058 - Fraud
059 - Possession of Stolen Goods
060 - Mischief - Property Damage

Other Criminal Code Offences

061 - Offence Against Public Order (Part II C.C.)
062 - Prostitution - Procuring
063 - Offences Against the Rights of Property (Part IX C.C.)

Other Criminal Code Offences

064 - Offensive Weapons - Prohibited
065 - Offensive Weapons - Restricted
066 - Offensive Weapons - Firearms Transfer/Serial Numbers
067 - Offensive Weapons - Other
068 - Offences Against the Administration of Law and Justice (Part IV C.C.)
069 - Fraudulent Transactions Relating to Contracts and Trade (Part X C.C.)
070 - Wilful and forbidden Acts in Respect of Certain Property (Part XI C.C.)
071 - Attempts, Conspiracies, Accessories (Part XII C.C.)

Criminal Code Traffic Violations

072 - Dangerous Operation of Motor Vehicle, Vessel or Aircraft
073 - Impaired Operation of Motor Vehicle, Vessel or Aircraft over 80 MG
074 - Failure to Provide a Breath Sample
075 - Failure to Provide a Blood Sample
076 - Other Criminal Code

Other Federal Statute Violations

077 - Canada Shipping Act
078 - Income Tax Act
079 - Customs Act
080 - Competition Act
081 - Immigration Act
082 - Bankruptcy Act

Other Criminal Code Offences

083 - Prostitution - Bawdy House
084 - Gaming and Betting - Other Gaming and Betting
085 - Bail Violations
086 - Escape Custody
087 - Public Morals
088 - Obstruct Public Peace Officer
089 - Prisoner Unlawfully at large
090 - Fail to appear
091 - Sexual Offences, Public Morals and Disorderly conduct (Part V C.C.)
092 - Invasion of Privacy (Part VI C.C.)
093 - Offences against the person and reputation (Part VIII C.C.)

Criminal Code Traffic Violations

094 - Failure to stop or remain
095 - Driving while prohibited

Other Federal Statute Violations

096 - Excise Act
097 - Young Offenders Act

Other Criminal Code Offences

098 - Prostitution - Other Prostitution
099 - Gaming and Betting - Betting House
100 - Gaming and Betting - Gaming house
101 - Disturb the Peace
102 - Indecent Acts
103 - Trespass at Night
104 - Breach of Probation
105 - Threatening/Harassing Phone Calls
106 - Disorderly Houses, Gaming and Betting (Part VII C.C.)
107 - All other Criminal Code (includes Part XII.2 C.C.)

Other Federal Statutes

108 - Other Federal Statutes

Provincial Statute Violations

109 - Other provincial statute violations
110 - Securities Act
111 - Liquor Act
112 - Highway Traffic Act (or equivalent)
113 - Fail to Stop or Remain
114 - Dangerous Driving without due care and attention
115 - Driving while disqualified or license suspended

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