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.

 

Clericís first initial ____

Clericís 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): __________________________

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

Yes No

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

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

  1. 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): __________________________________________

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

Mother

Peer/acquaintance

Father

Person in a position of authority (e.g., babysitter, coach)

Sibling

Priest

Other family member

Deacon

Teacher

Other (please specify):______________________

  1. 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)

 

 

  1. 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) ___________________________________

  1. 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)_______________________

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

Yes No

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

Yes No

  1. Please describe the problem to the extent possible__________________________________

__________________________________________________________________________

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

Yes No

  1. What is the approximate date the problem was recognized? ____________
  2. 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 _____________

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

Parishes ________ Congregations ________

  1. 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

  1. 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________

 

  1. 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 CLERICíS ALLEGED VICTIM(S) FROM YOUR DIOCESE

  1. How many victims made allegations of sexual abuse against this cleric in your diocese? ________
  2. 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

  1. If yes, please indicate how many other alleged victims there are who have not officially made a complaint against this cleric. _____________________
  2. 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 INSTITUTIONíS RESPONSE TO THE SEXUAL ABUSE ALLEGATIONS AGAINST THIS PARTICULAR CLERIC

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

Cleric reprimanded, returned him to duties

Cleric referred for spiritual retreat
Cleric referred for evaluation Cleric referred for treatment

Cleric given administrative leave

Cleric given medical leave

Cleric resigned or retired

Cleric sought laicization

Cleric reinstated

Cleric removed from clerical state

Cleric suspended from ministry

Other (specify)________________

No action taken

 

  1. If the cleric was reinstated, was it:

Within the diocese, same parish

Within the diocese, different parish

Different diocese

Restricted ministry

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

Year__________ Action___________________

Year__________ Action___________________

Year__________ Action___________________

  1. 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):____________________

 

  1. 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)_________________________

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

Yes No No information in file

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

Yes No No information in file

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

REMEMBER Ė 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

  1. 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 __________________

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

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

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

1 - 6 22 - 35 81 Ė 110 400 and up

7 - 14 36 - 57 111 - 176

15 -21 58 - 80 176 - 399

  1. 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 __________

  1. How many clerics with allegations have been completely exonerated? _______________
  2. Based on your reviews of the records, please indicate the total number of victims who have made allegations against clerics in your religious order. ____________________
  3. 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. ___________________
  4. 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 clericís 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

  1. 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 _______________________

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

Month __ __ Day __ __ Year __ __ __ __

  1. Who initially made the allegation?

The victim

The victimís parent(s) or guardian(s)

A teacher

A police officer

A cleric

A lay person in the Church

Other (specify)____________________

A doctor

 

Victimís attorney

  1. How was the allegation initially made?

Called the parish

Called the diocese

Sent a signed letter to the parish

Sent a signed letter to the diocese

Sent an anonymous letter to parish

Sent an anonymous letter to diocese

Went to the parish

Went to the diocese

Told trusted priest/deacon who brought complaint to diocese or order

Called the Provincial or Major Superior of the order or congregation

Information obtained through the media

Other (specify): _____________________

Sent signed letter to the Provincial or Major Superior of the order or congregation

 

Sent anonymous letter to the Provincial or Major Superior of the order or congregation

  1. Is there a record of the victim or victimís family following up on the allegation?

No Yes (specify method of follow up):_______________________________

  1. If the victim/victimís family did follow up, how many times? __________________
  2. How many times was the victim allegedly abused?

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

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

Yes No Information not in the file

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

Before Concurrent with After

 

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

Mass

Choir

Boys club/youth recreation

Sunday school teacher

Teacher in preschool, kindergarten, or elementary school (up to grade 6)

At an altar service

In the rectory

Teacher in middle school (grades 7-8)

Work in a hospital

Teacher in high school (grades 9-12)

Seminary faculty

Orphanage

In jail/prison/youth offender residence

Home of victim

Home of cleric

At a vocational inquiry

Seminary administrator

At a social function w/ victimís family

Other (specify)________________

While assigned to the victimís parish (e.g., as an extern priest)

  1. What was the clericís 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)________________

 

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

Yes No Information not in the file

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

In the church

In church day activities (e.g., picnics)

Spent time with the family in his residence

He spent time with the family in their residence

Vacations

Other (specify):________________________

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

Verbal (sexual talk)

Photos taken of victim while victim was disrobed

Victim disrobed

Masturbation in front of victim

Cleric disrobed

Mutual masturbation

Sexual touching over clothes of victim

Manual (finger) penetration (of vagina or anus)

Sexual touching over clothes of the cleric

Penetration with foreign object (e.g., sexual aid)

Sexual touching under clothes of victim (no penetration)

Oral/genital contact where offender performed fellatio/cunnilingus

Sexual touching under clothes of cleric (no penetration)

Oral/genital contact where victim performed fellatio/cunnilingus

Victim shown pornographic videos

Victim shown pornographic magazines/photos

Penile penetration (of anus or vagina)

Other _________________________

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

Yes No Information not in the file

  1. If yes, what type of threat?

Physical threat, with weapon

Physical threat, no weapon

Verbal threat (of harm to the victim)

Verbal threat (that harm will come to the cleric)

Threatened family of victim

Spiritual manipulation

Threatened public exposure of victimís behavior to family or others

Other (specify):_______________________

  1. 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

Clericís office

In school

In the hospital

In a hotel room

In a car

Retreat house

Vacation house

Other (specify):__________________

 

  1. When did the abuse reportedly occur?

During a retreat

During a social event

During a church service

During reconciliation

During travel

During a sporting event (e.g., swimming)

During counseling session

During other type of travel

Other (specify):_________________

 

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

Yes No Information not in the file

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

Yes No Information not in the file

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

Given money

Allowed to stay up late

Allowed to do special church activities (e.g., solo in the choir) Given alcohol or drugs

Allowed to drive a car

Taken to sporting matches or other recreational activities

Access to pornography, videos

Allowed to stay overnight with the cleric

Other (specify) ___________

Sports-related enticement (e.g., put in starting position of a team)

  1. 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

 

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

Yes No Information not in the file

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

Yes No Information not in the file

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

Yes No Information not in the file

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

Yes No Information not in the file

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

Allegation substantiated

Allegation unsubstantiated

Cleric admitted abuse

Allegation found to be false

Other (specify) ________________

 

35. What action was taken regarding the cleric?

No action taken

Transferred cleric to another parish w/in the diocese

Cleric suspended w/ treatment ordered

Transferred the cleric to another diocese

Cleric resigned or retired

Cleric was reinstated

Cleric received treatment but continued in ministry

Dismissed from clerical state

Other (specify)________________________

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

Yes No Information not in the file

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

Yes No Information not in the file

  1. Was there a police investigation?

Yes No Information not in the file

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

Yes No Information not in the file

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

Yes No Information not in the file

  1. If yes, for what offense? _____________________________________
  2. 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) _________________

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

Yes No Information not in the file

  1. 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.

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

the allegation of abuse?

Yes No Pending Information not in the file

  1. What was the approximate total compensation or payment made to date to this victim from all sources? $ _________
  2. How much of this was covered by, or derived from, insurance? $_______________
  3. What was the approximate payment to date for treatment for this victim? $ ____________
  4. How much of this was covered by or derived from insurance? $______________
  5. What was the approximate payment to date for treatment for this cleric? $_____________
  6. How much of this was covered by or derived from insurance $______________
  7. What was the approximate total payment to date made by the diocese to attorneys to represent the diocese related to this victimís allegations? $______________