1. Yes

2. No → Go to Q6

1. Yes → Go to Q5

2. No

3. Not clear → Go to Q6

4. Not slated

6. Has offender accepted responsibility for his criminal behaviour, according to case management officer?

1. Yes, all offenders

2. Yes, some offenders

3. No

4. Unclear

5. Not stated

Demographic Information

7. At most recent admission, offender identified himself as belonging to which ethno cultural group? (REFER TO CODE BOOK).

Specify _______________________

8. At most recent admission, offender identified himself as belonging to which religious group? (REFER TO CODE BOOK).

Specify _______________________

9. Country of birth (REFER TO CODE BOOK).

Specify _______________________

If not born in Canada date of immigration

10. Preferred language of services

1. English

2. French

3. Understands neither English nor French

4. Not stated

Education and Employment History

11. Highest level of education completed: (SEE CODE BOOK)

Specify _______________________

12. Disability: (CIRCLE AS MANY AS APPLY)

1. No specific impairment mentioned

2. Physical impairment

3. Psychiatric impairment

4. Mentally challenged

5. Learning disability → Q.12a

12a. if there is indication of a learning disability, specify; (CIRCLE AS MANY AS APPLY)

1. Reading skills

2. Writing expression skills

3. Spelling skills

4. Numeracy skills

5. Language skills

6. Visual spatial processing skills

7. Attention skills

8. Memory skills

9. Not stated

Other ________________________

13. Does the offender have a certificate or diploma for a trade profession?

1. Yes → Q.13a

2. No → Q.14

3. Not stated → Q.15

1. None

2. Yes, some of the certificate/diploma

3. Yes, all of the certificate/diploma

4. Not stated

14. Usual occupation (occupation prior to incarceration) (CONSULAT CODE BOOK FOR DEFENITION);

1. General labour

2. Skilled labour

3. Clerical or office work

4. Sales or service

5. Administration, managerial, professional

6. Fishing Trapping

7. Unemployed - never worked

8. Unemployed - student most of life

Other. Specify__________________

15. Offender's employment stability in the two years prior to most recent admission; (REFER TO CODE BOOK)

1. Stable

2. Somewhat stable → Q.15a

3. Unstable → Q.15a

4. Not applicable (e.g. incarcerated for the majority of that time)

5. Unemployed most of time

6. Not applicable, in school

7. Not enough information

15a. if circled 2 or 3 (somewhat stable or instable), specify usual reason for leaving the job.

1. Usually quit - become unemployed

2. Usually quit - served to another job

3. Usually dismissed

4. Usually laid off

5. Quit and dismissed an equal number of times

6. Not stated

Other. Specify__________________

16. Specify the family with which the offender has spent the greatest number of years during childhood and adolescence (up to 16 years). (If equal number of years, record family with whom the offender had closest emotional ties)

1. Family of origin (which one or both biological parent)→ Q.17

2. Extended family

3. Adoptive family

4. Foster family → Q.16a

5. Institution

6. Not stated → Q.21

Other. Specify__________________

16a. if ANSWER TO Q.16 IS 2, 3 OR 5, why was offender not relsed by family of origin? (CIRCLE ALL THAT APPLY)

1. Parents died

2. Child abused in family of origin

3. Chid severely neglected by family of origin

4. Child abandoned by family of origin

5. Child has behaviour problems which parents can't control

6. Parents asked other than family member to raise child

7. Not stated

Other. Specify__________________

17. Does the offender currently have contact with family noted in Q. 16?

1. Yes

2. No

3. Not applicable (parents died)

4. Not stated

18. Specify in Matrix A frequency of contact the offender had with the "parent" from all applicable units, note whether offender was abused, and the age of the offender at time of abuse, using the following codes.

FREQUENCY OF CONTACT

Continuous(for all, or almost all the time)
Continuous(for a partial of the time)
Infrequent(at least once every three months)
Very infrequent(less than once every three months)
Sporadic and irregular
No, or almost no contact
Not applicable
Not stated
Other: Specify ________________

No indication of abuse
Some indication of unspecified abuse
Physical abuse
Sexual abuse
Psychological abuse
Neglect, and physical not sexual abuse
Not stated
Other: Specify _____________
                         ( Do not code)

Parent

BIOLOGICAL PARENTS

EXTENDED FAMILY MEMBER, GUARDLAN

ADOPTED PARENTS

GUARDLAN

STEP PARENTS

POSTER PARENTS

INSTITUTIONAL AUTHORITY FIGURE

19. Specify in Matrix B frequency of contact the offender may have had between the age of 6 and 11 with "parents" from all applicable family units, and note whether abuse occurred, using the codes given in Q.18

Parent

BIOLOGICAL PARENTS

EXTENDED FAMILY MEMBER, GUARDLAN

ADOPTED PARENTS

GUARDLAN

STEP PARENTS

POSTER PARENTS

INSTITUTIONAL AUTHORITY FIGURE

20. Specify in Matrix C frequency of contact the offender may have had between the age of 12 and 16 with "parents" from all applicable family units noted above, and note whether abuse occurred, using the codes given in Q.18

Parent

BIOLOGICAL PARENTS

EXTENDED FAMILY MEMBER, GUARDLAN

ADOPTED PARENTS

GUARDLAN

STEP PARENTS

POSTER PARENTS

INSTITUTIONAL AUTHORITY FIGURE

1. Yes → go to Q 22

2. No → go to Q 22

3. Not stated → go to Q 22

21a. Note in MATRIX D the level of contact of offender with (at least one) sibling when offender was between the age of 0 and 5 and 11, and 12 and 16, using the following codes:

1. Continuous (all or almost all the time)

2. Continuous (for a portion of the time)

3. Infrequent (at least once every three months)

4. Very infrequent (less than once every three months)

5. Sporadic and irregular

6. No, or almost no contact

7. Some indication of continuous contact

8. Not applicable

9. Not stated

Other: Specify ___________________

MATRIX D Contact with Siblings

Age of offender

22. Is there any indication that OFFENDER WAS ABUSED BY A STELING OR A MEMBER OF THE EXTENDED FAMILY other than those mentioned in Q. 18, Q19 and Q. 20, up until the age of 16? If no, skip to Q.23, if yes use MATRIX E to indicate perpetrator, gender of perpetrator, frequency of contact of offender with perpetrator at time of abuse, type of abuse, and age of offender when abuse took place, using the following codes.

1. Sibling, step or ball sibling

2. Grandparent

3. Aunt, Uncle

4. Cousin

5. Brother or Sister-In-law

6. Unclear

7. Not stated

Other Specify ___________________
 ( Do not code)

Gender

1. Male

2. Female

Contact

1. Continuous (all or almost all the time)

2. Continuous (for a portion of the time)

3. Infrequent (at least once every three months)

4. Very infrequent (less than once every three months)

5. Sporadic and irregular

6. No, or almost no contact

7. Not applicable

8. Not stated

Other: Specify ___________________

Type of abuse

1. Physical abuse

2. Sexual abuse

3. Psychological/emotional abuse

4. Neglect/depravation

5. Financial exploration

6. Not stated

1. Between 0 and 5 years

2. Between 6 and 11 years

3. Between 12 and 16 years

4. Between 0 and 11

5. Between 6 and 16

6. Between 0 and 16

7. Not stated

8. Not clear

MATRIX E: Offender as victim of abuse by family member

Perpetrator

23. Has the offender been a victim of abuse at any time after age 16?

1. Yes →go to Q. 23a

2. No → go to Q. 24

3. Not stated → go to Q. 24

23a. If YES please specify: ____________________

24. Has offender been a WITNESS to any abuse during his childhood or adolescence between 0 and 16?

1. Yes → go to Q. 25

2. No → go to section 3

3. Not stated → go to section 3

25. If yes, who was the perpetrator? Who was the victim? What was the nature of the abuse? How old was the offender when abuse was witnessed? Use the following codes to complete Matrix F for each applicable perpetrator in left column.

1. Biological father

2. Father figure

3. Biological mother

4. Mother figure

5. Sibling, step sibling

6. Member of extended family

7. Non-related authority figure

8. Stranger male

9. Stranger female

Other Specify ___________________
 ( Do not code)

VICTIM INFORMATION

1. Adult male

2. Adult female

3. Child male

4. Child female

5. Adult male and female

6. Child male and female

7. Adult and child male

8. Adult and child female

9. Any three (1 to 4)

10. All four

11. Not stated

12. Not clear

Other Specify ___________________
 ( Do not code)

NATURE OF ABUSE

1. Physical abuse

2. Sexual abuse

3. Psychological/emotional abuse

4. Neglect/depravation

5. Financial exploration

6. Not stated

Other Specify ___________________
 ( Do not code)

Age of offender

1. Between 0 and 5

2. Between 6 and 11

3. Between 12 and 16

4. Between 0 and 11

5. Between 6 and 16

6. Between 0 and 16

7. Not stated

MATRIX F: Offender as Witness of Abuse

Perpetrator

Section 3: Intimate Relationships

26. Official relationship status of offender at time of admission for current term. (See profile sheet)

1. Single

2. Married

3. Common law

4. Separated

5. Divorced

6. Widowed

7.Not Sated

Other. Specify ___________________

27. Has the offender's relationship status changed since admission for current term?

1. Yes → go to Q.27a

2. No → go to Q.28

27a. If YES, what is offender's current relationship status: (See progress reports)

1. Single

2. Married

3. Common law

4. Separated

5. Divorced

6. Widowed

7. Not Sated

Other. Specify ___________________

28. History of offender's relationships.

1. None, no dating go to section 4

2. Dating relationships only

3. 1-2 marriages (including common-law and live-in relationships)

4. 3-4 marriages (including common-law and live-in relationships)

5. 5 or more marriages or common-law relationships

6. Not stated

29. Is the offender maintaining a relationship with a female (none blood relative) during the current term?

1. Yes

2. No

3. Not stated

30. Is there an indication that a partner's spouse (including girlfriend) has been abusive to the offender?

1. Yes → go to 30a

2. No → go to section 4

3. Not stated → go to section 4

30a. if YES, complete Matrix G with the following codes:

Partner

1. Present partner

2. Past partner

Type of abuse
(code as many as three)

1. Physical abuse

2. Psychological/emotional abuse

3. Neglect/depravation

4. Financial exploration

5. Not stated

Other. Specify ___________________

MATRIX G: Abusive Partner

Partner

Section 4: children / Dependants

31. Did offender have children, step children and foster children at time of incarceration for major admitting offence?

1. Yes

2. No →go to section 5

3. Not stated → go to section 5

32. Indicated in Matrix H the total number of children, step children and foster children by age group at time of incarceration for current term and indicate the number of children living with offender at that time. Use code "99" if age and number of children is not stated.

MATRIX H: Number of children

Age group

0-6 years

33. Frequency of contact with children not living with offender at time of incarceration at current term: (contact by phone, email, visit, etc.)

1. Frequent at least 1 contact every three months

2. Infrequent less than contact every three months

3. Not or almost no contact

4. Not stated

Section 5: History of Violence

I: Physical Assaults/Abuse