Don Bosco Hall PREA Policy
|DBH Residential Prison Rape
Elimination Act Policy
|Class: PREA-Federal law
||Number: PREA RTX JJR
(X) Reviewed/Revised: 06 01 16
PREVENTION OF CLIENT SEXUAL ASSAULT/RAPE
There is a zero tolerance of sexual assault/rape of clients in juvenile justice facilities. DBH Personnel will follow all rules and expectations designed to prevent sexual assault and must cooperate with law
enforcement, prosecutors, and the courts in the investigation and possible prosecution of anyone involved in the sexual assault/rape of a client.
To implement the Prison Rape Elimination Act (PREA) and prevent sexual assault/rape of clients in
residential care; to prevent incidents of sexual abuse and sexual harassment; and to take prompt,
effective, and compassionate action if allegations of sexual abuse or harassment are made.
Resident-an-resident sexually abusive penetration: Any sexual penetration by a resident of another
resident. The sexual acts included are: contact between the penis and the vagina or the anus; contact
between the mouth and the penis, vagina, or anus; or, penetration of the anal or genital opening of
another person by a hand, finger, or other object.
Resident-an-resident sexually abusive contact: Non-penetrative touching (either directly or through the
clothing) of the genitalia, anus, groin, breast, inner thigh, or buttocks without penetration by a resident
of another resident, with or without the latter's consent, or of a resident who is coerced into sexual
contact by threats of violence, or of a resident who is unable to refuse.
Resident-an-resident sexual harassment: Repeated and unwelcome sexual advances, requests for
sexual favors, verbal comments, or gestures or actions of a derogatory or offensive sexual nature by one
resident directed toward another.
Staff-an-resident sexually abusive contact: Includes non-penetrative touching (either directly or
through the clothing) of the genitalia, anus, groin, breast, inner thigh, or buttocks by a staff member or a
resident that is unrelated to official duties.
Staff-an-resident sexually abusive penetration: Sexual penetration by a staff member of a resident,
including contact between the penis and vagina or anus; contact between the mouth and the penis,
vagina, or anus; or, penetration of the anal or genital opening of another person by a hand, finger, or
Staff-on-resident indecent exposure: The display by a staff member of his or her uncovered genitalia,
buttocks, or breast in the presence of a resident.
Staff-on-resident voyeurism: An invasion of a resident's privacy by staff for reasons unrelated to official
duties or when otherwise not necessary for safety and security reasons.
Staff-on-resident sexual harassment: Repeated verbal comments or gestures of a sexual nature to a
resident by a staff member. Such statements include demeaning references to gender, sexually
suggestive or derogatory comments about body or clothing, or profane or obscene language or gestures.
Staff sexual misconduct: Includes any behavior or act of a sexual nature directed toward a juvenile or
youthful offender by an employee, volunteer, contractor, official visitor, or other agency representative.
Sexual relationships of a romantic nature between staff and youth are included in this definition.
Sexual Exploitation: Includes allowing, permitting, or encouraging a child to engage in prostitution, or
allowing, permitting, encouraging, or engaging in the photographing, filming, or depicting of a child
engaged in a listed sexual act as defined in MCL 7s0.14sc
Age of legal consent in Michigan: While no statute specifically establishes an age at which a minor may
legally consent to sexual activity, there can be criminal penalties for consensual sexual activity with a
minor under 16 years of age. See MCL § 7s0.s20b. There also can be criminal penalties for consensual
sexual activity with a minor under 18 years old when certain circumstances exist. For example, it is
considered "third degree criminal sexual conduct" for a teacher or school administrator to sexually
penetrate a student under 18 years old, irrespective of consent. MCL § 750.520d.
First Responder: Includes any/all agency personnel to whom an incident or report of alleged sexual
abuse, or any other form of abuse/neglect of youth is reported. This includes staffs own observation or
suspicion, direct report (verbal or written) from youth or third parties of abuse or neglect in accordance
with Mandated Reporting laws and agency policies.
RESPONSIBLE STAFF Facility Director, Program Manager/Supervisors and Clinical Staff
STANDARD OPERATING PROCEDURE
A. Providing Sexual Assault/Rape Prevention Information to Client
1. The facility client orientation process includes policy and procedures relating to prevention and
detection of and response to reports of sexual assault/rape. Client orientation relative to PREA must be
completed no longer than 10 days from the date of the client's intake into the facility. An annual
refresher is also provided. This part of the orientation to the Don Bosco Hall residential program is about preventing sexual abuse and rape. As required by the prison rape elimination act (PREA) Don Bosco Hall residential will not tolerate sexual abuse or attempted sexual abuse of it’s residents. The information provided includes but is not limited to:
- The agency's zero-tolerance policy.
- Self-protection including avoiding risk situations related to sexual assault prevention/intervention.
- Reporting procedures; how to report rape or sexual activity.
- Treatment and counseling, how to obtain counseling services and/or medical assistance if victimized.
- Protection against retaliation.
- Risks and potential consequences for engaging in any type of sexual activity while at the facility.
Clients will not be disciplined for making an allegation of sexual abuse or sexual harassment if the investigation determines that the abuse did not occur, so long as the allegation was based upon a reasonable belief that the abuse occurred and the allegation was made in good faith.
2. The information must be provided verbally and in written form, and the information is in a language
and format that the client can understand.
3. The use of resident interpreters is prohibited except in limited circumstances when delay in
translation could compromise resident safety or the performance of first responder duties.
4. Each client must sign a written acknowledgement form for the sexual assault/rape prevention
portion of the orientation.
5. The signed acknowledgement form is filed in the client's case record.
B. Client Assessment and Placement
1. The client's behavior history is reviewed prior to intake during screening processes, and as part of
orientation/treatment planning to determine the client's potential risk of sexual vulnerability based on
the following risk factors:
- Physical stature
- Developmental disability
- Mental illness
- Sex offender status (per offense history)
- First-time offender status
- Past history of victimization
**AII residents that disclose any prior sexual victimization during a screening must be offered a follow-
up meeting with a medical or mental health practitioner within 14 days. All residents that disclose
during screening that they previously perpetrated sexual abuse are offered a follow-up meeting with a
mental health practitioner. These referrals must be documented.
2. The client's behavior history is reviewed prior to intake during screening processes, and as part of
orientation/treatment planning to determine if the client is prone to victimize other client, especially in
regard to sexual behavior, based on the following risk factors:
- History of sexually aggressive behavior
- History of violence as related to a sexual offense
- Anti-social attitudes indicative of sexually aggressive behavior
3. The agency must use all information obtained to make housing, bed, program, education, and work
assignments for clients with the goal of keeping clients safe and free from sexual abuse.
4. Lesbian, gay, bisexual, transgender, or intersex (LGBTI) clients may not be housed solely on the basis
of such identification or status. In addition, the agency must:
- Decide on a case-by-case basis whether to place a transgender or intersex client in a facility for
male( as DBH is gender specific) clients. Placement decisions are based on whether the
placement would ensure the client's health and safety, and whether the placement would
present management or security problems.
- DBH reviews placement and programming assignments at least quarterly with service plan
updates, and daily (based on incidents reported, administrative walk through, 24/7 line of site
supervision, recipient rights processes and daily unit log review) to assess any threats to safety
experienced by the client.
- Allow transgender and intersex clients the opportunity to shower separately from other
5. Staff must not search or physically examine a transgender or intersex resident for the sole purpose of
determining a youth's genital status. If a youth's genital status is unknown, it may be determined during
conversations with the youth, by reviewing medical records, or, if necessary, by learning that
information as part of a broader medical examination conducted in private by a medical practitioner.
6. A youth may be isolated from other youth as a preventive and protective measure, but only as a last
resort when other less restrictive measures are inadequate to keep the youth safe from other youths,
and then only until an alternate means of keeping all youths safe can be arranged. During any periods of
protective isolation, OBH staff may not deny a youth otherwise under control, access to daily large-
muscle exercise and legally-required educational programming or special education service.
7. Assessment activities will be documented via the interview data form, the short term
goals/agreement and client assignment protocols.
C. Staff Training on Offender Sexual Assault/Rape Prevention and Reporting
1. All facility personnel, contractors, and volunteers must complete training for sexual assault/rape
prevention, detection, incident response, and reporting. All facility staff, contractors, and volunteers
must complete annual refresher training. At the conclusion of each training session, staff, contractors,
and volunteers must sign that they attended and understood the training. This signature sheet will be
kept in each staff personnel file as part of the permanent HR record.
2. All facility staff must read this policy and any related local facility written policy or procedure articles
prior to assuming duties with client, when the policy or procedure changes, and on at least an annual
basis. Staff must sign a written acknowledgment that they read and understood the policies and
procedures. This signature sheet will be kept in each staff personnel file as part of the permanent HR
3. When staff is oriented and trained, all will receive training to work at a facility, housing a different
population (not gender as DBH is Male specific) in the event that they later transfer to a different
4. DBH residential programs will ensure that direct care staff is trained in how to conduct a pat down
search. Cross gender pat searches are not applicable.
5. Searches of transgender and intersex residents must be conducted in a professional and in respectful
manner, and in the least intrusive manner possible, consistent with security needs.
6. All full and part time medical and mental health care practitioners who work regularly with DBH
residents must receive specialized training on: Detecting signs of sexual abuse, preserving physical
evidence, effective response, and reporting. Training will be documented in personnel records.
D. Staff Supervision Relative to PREA Standards
1. Staff must recognize that sexual assault/rape can occur in virtually any area in a residential facility. Requirements for staff line of sight supervision of clients and for (minimally) client-to-staff ratios
of 1:5 during waking hours and 1:8 during sleeping hours apply at all times, which is DBH specific staffing
2. All staff of the opposite gender must announce their presence when entering a resident housing unit.
Staff of the opposite gender shall announce their presence when entering any areas where residents are
likely to be showering, performing bodily functions, or changing clothes.
3. Staff must always be aware of warning signs that may indicate that a client has been sexually
assaulted or is in fear of being sexually assaulted. Warning signs include but are not limited to: isolation,
depression, lashing out at others, refusing to shower, suicidal thoughts or actions, seeking protective
custody, and refusing to leave isolation.
4. Staff must be aware of sexually aggressive behavior. Characteristics or warning signs may include a
prior history of committing sex offenses, use of strong arm tactics (extortion), associating or pairing up
with a client that meets the profile of a potential victim, exhibiting voyeuristic and/or exhibitionistic
behavior, and a demonstrated inability to control anger.
5. Supervisors will conduct unannounced rounds to ensure and verify compliance with PREA standards
and protocols, and to support safety and reporting. Unannounced rounds will occur across all shifts.
Staff is prohibited from warning other staff when unannounced supervisory rounds are occurring.
6. Retaliation against clients or staff who reported is not tolerated. All staff are mandated reporters and
any staff neglect or violation of responsibilities that may have contributed to the incident or retaliation
must be reported.
E. Client Response to Sexual Assault/Rape
Clients must be supported and encouraged to report sexual assault/rape, or attempted sexual
assault/rape, staff neglect and/or violation of responsibility that contributed to the abuse and protected
from retaliation. A client that believes that they were the victim of a sexual assault/rape or attempted
sexual assault/rape, or believes another client was the victim of sexual assault/rape or attempted sexual assault/rape, must report this information to a staff member. Clients may also write down their report
and use Residential facility Health and Recipient Rights boxes on each unit and/or the client grievance
system to submit reports. Clients also have access to an outside reporting option; including the BCAL
Mandated Reporting hotline. This designated hotline for outside client reporting at Don Bosco Hail,'
Department of Health and Human Services Protective Services toll-free number, 1-855-444-3911
1. If a client requests to report outside of the facility, the staff will ensure the following occur:
- First Responder staff will contact the on-duty Supervisor and Clinical Director to remove the client requesting access to the telephone from the living unit and will facilitate the call in an unimpeded manner in a private and safe location.
- Staff will take the youth to a place where the youth can access a telephone to make the call. A Staff (Supervisor or Clinical Staff) will dial the CPS number. The Staff may leave the room to provide confidentiality for the youth but will maintain line of sight supervision of the youth at all times.
- Following completion of the call, the Staff will notify the facility Director or designee in that persons absence and report that a youth made a call to CPS.
*Note: Calls to the hotline are confidential however it could occur that a youth also volunteers
information to staff about sexual abuse. If at any time a youth discloses information about sexual abuse
to any DBH personnel then staff must respond in accordance with the procedures listed under "Staff
Response to Sexual Abuse/Rape".
2. Following a client's allegation that a staff member has committed sexual abuse against the resident, DBH subsequently informs the client (unless the agency has determined that the allegation is unfounded) whenever:
- The staff member is no longer posted within the resident's unit;
- The staff member is no longer employed at the facility;
- DBH learns that the staff member has been indicted on a charge related to sexual abuse within the facility; or
- DBH learns that the staff member has been convicted on a charge related to sexual abuse within the facility.
3. Following a resident's allegation that he has been sexually abused by another resident in an agency
facility, the agency subsequently informs the alleged victim whenever:
- DBH learns that the alleged abuser has been indicted on a charge related to sexual abuse within
the facility; or
- DBH learns that the alleged abuser has been convicted on a charge related to sexual abuse
within the facility.
4. Client Grievances related to sexual abuse allegations:
- A grievance alleging sexual abuse can be filed at any time regardless of when the incident allegedly occurred.
- Third party grievances alleging sexual abuse are accepted.
- A grievance alleging sexual abuse or sexual harassment does not have to be submitted to the person that is the subject of the allegation.
- There is no requirement that youth use an informal process for resolving grievances alleging sexual abuse or sexual harassment.
- Emergency grievances alleging sexual abuse and/or the imminent threat of sexual abuse must be responded to immediately.
F. Staff/First Responder: Response to Sexual Assault/Rape
1. Staff/First Responder receiving a report of a sexual assault/rape or attempted sexual assault/rape, or
staff neglect and/or violation of responsibility that contributes to the abuse, or staff that become aware
of sexual activity between clients or between a client and staff, contractor, visitor, or volunteer must
immediately report this event to their supervisor. The Program Supervisor will immediately separate
the alleged victim and abuser. The Supervisor (Clinical Staff) must immediately relay the report to the
Facility Director. That administrator is responsible for notifying BCAL (Licensing).
2. The staff member receiving the report of actual or suspected sexual abuse or rape must complete and
submit an Incident Report before the end of their work shift and must complete a DHS-3200, Report of
Actual or Suspected Child Abuse or Neglect, immediately and/or 72 hours of becoming aware of the
3. If it is believed or determined that a sexual assault/rape occurred and that the alleged sexual assault/rape occurred within the last 96 hours, the Facility Director or designee must make immediate arrangements to transport the client to DMC Children's Hospital emergency room for a rape kit and the area where the incident occurred must be secured for evidence collection. First responder staff will act to preserve and protect any crime scene until appropriate steps can be taken to collect any evidence. This may include requesting that the alleged victim or abuser not take any actions that could destroy evidence; including as appropriate, washing, brushing teeth changing clothing, urinating, defecating, drinking or eating. If it is believed or determined that a sexual assault/rape occurred more than 96 hours previous, the hospital will be contacted for further instructions.
4. Following emergency response and completion of the rape kit (if applicable) a client believed or
determined to have been the victim of a sexual assault/rape must also be examined by medical staff for
possible injuries, regardless of when the alleged sexual assault occurred.
5. Alleged victims and alleged perpetrators of sexual assault will be encouraged to complete an HIV test.
In the case of a substantiated incident of sexual assault, the perpetrator must be requested to complete
an HIV test. If the perpetrator will not voluntarily take an HIV test, the Facility Director, Program
Supervisor or Clinical Director must seek a court order compelling the test. Resident victims of sexual
abuse will be offered timely information about and timely access to emergency contraception and
sexually transmitted infections prophylaxis, in accordance with professionally accepted standards of
care, where medically appropriate.
6. The victim of sexual assault/rape or attempted sexual assault/rape will be provided mental health
assistance and counseling as determined necessary and appropriate. All services, including medical
forensic exams and counseling are provided at no charge to the client.
7. The Facility Director, Program Supervisor or Clinical Director ensures that incidents of sexual
abuse/rape, findings from investigations, and other pertinent information is reported to the client's
Court of jurisdiction, the client's worker, the client's parent or legal guardian, and to BCAL.
8. At the conclusion of an investigation of any youth allegation of sexual abuse or sexual harassment the
youth must be informed, verbally or in writing, as to whether the allegation has been determined to be
substantiated, unsubstantiated, or unfounded.
9. Records of allegations involving an employee must be kept for as long as the employee is employed
or the youth is in residence, plus five years.
10. If a report is received of sexual abuse from another facility, the facility Director must report Director-
to-Director to the other facility within 72 hours. (All other applicable reporting requirements still apply.)
11. The facility PREA Compliance Manager/Program Manager will monitor reporting staff and client(s) to prevent retaliation for a minimum of 90 days after a sexual abuse report is made. If further monitoring
is appropriate, the timeframe will continue and be reassessed every 30 days thereafter. This will be
documented in the client's case record.
Retaliation against clients or staff who reported is not tolerated. DBH prohibits any staff neglect or
violation of responsibilities that may have contributed to the incident or retaliation. Clients reporting
must be fully protected from retaliation, including retaliation from staff if staff is suspected of sexually
inappropriate or abusive behaviors.
G. Alternate Housing Placement of Victims and Perpetrators
The Facility Director and Clinical Director will take immediate steps to protect the alleged victim from
further potential sexual assault or rape (if still at the facility) by separating the alleged victim from the
alleged perpetrator(s) including arranging for separate housing, dining, and/or other elements of daily
routine to the extent necessary to ensure protection. The same steps will be taken immediately to
protect a youth if it becomes known that a youth is in imminent danger of sexual abuse.
H. investigation Protocols
Each incident of alleged or reported sexual abuse or sexual assault/rape must be investigated to the
fullest extent possible. Evidence collected must be maintained under strict control. Based on the results
of the investigation, facility personnel and prosecuting authorities will meet to determine if prosecution
is appropriate. Staff that conduct investigations into allegations of sexual abuse must receive specialized
investigation training. DBH imposes a standard of a preponderance of the evidence or a lower standard
of proof for determining whether allegations of sexual abuse or sexual harassment are substantiated.
Apart from reporting to the designated supervisors or officials, staff must not discuss the details of
sexual abuse reports with anyone other than to the extent necessary to make treatment, investigation
and other security and management decisions.
1. Suspected or alleged c1ient-on-c1ient rape, sexual assault, or forced sexual activity with or without sexual penetration:
- The victim and alleged perpetrator must be separated, kept isolated from each other, and prevented from communicating.
- The Facility Director, Clinical Director or designee must be contacted immediately. The Facility Director, Clinical Director or designee will make necessary required notifications.
- If the assault is alleged to have occurred within the past 96 hours, the victim must be transported to DMC Children's Hospital Emergency Room for a forensic examination. If the assault is alleged to have occurred more than 96 hours earlier, the hospital is contacted for instructions.
- The police must be contacted to take victim statements and open an investigation.
- The area(s) where the suspected assault took place is sealed off until investigators can gather evidence. Note: Staff or medical personnel can enter the area if it is necessary to ensure client safety, for example if a victim needs medical attention or first aid before being transported, but efforts must be made to not disturb the area as little as possible.
- Any clothing or articles belonging to the victim are left in place and not handled or disturbed until investigators have gathered evidence. The victim must not be allowed to shower or change clothing before being transported to the hospital.
- Staff must submit an Incident Report before the end of their shift.
2. Suspected or alleged staff-on-client sexual activity of any type:
- The Facility Director is immediately notified. The Facility Director, Clinical Director will make all required notifications, including notification to the police to open an investigation and notification to the suspected employee restricting work activities.
- Pending notification from the Director, Clinical Director, the suspected employee will not be in direct contact with facility clients.
- If there has been suspected or alleged sexual penetration of any type the victim is transported for a forensic examination and evidence is protected using the same procedures as listed in items c through g in Section 1 noted above.
3. Any other intentional client-on-client sexual touching (non-penetrative touching, either directly or through the clothing, of the genitalia, anus, groin, breast, inner thigh, or buttocks without penetration by a client of another client, with or without the latter's consent) and/or alleged or suspected client-on- client sexually abusive contact:
- If reported by client, observed, or suspected, duty staff must alert the shift supervisor. The shift supervisor must ensure that duty staff document information in an Incident Report and must ensure that client safety is restored or maintained.
- The Facility Director, Clinical Director must be notified. The Facility Director, Clinical Director determines if police will be contacted for further investigation.
- The Facility Director, Clinical Director makes required notifications.
I. Exhaustion of Administrative Remedies
1. DBH must issue a final decision (initial decision and appeal decision if appealed) on the merits of a grievance alleging sexual abuse or harassment within 90 calendar days of the initial filing of the grievance.
2. DBH may claim an extension of time to respond of up to 70 calendar days if the normal time period for a response is insufficient to make a decision. DBH must notify the client and the client's parent/guardian in writing of any such extension.
3. Third parties, including fellow clients, staff, family, attorneys, and outside advocates may assist a client filing grievances related to allegations of sexual abuse and harassment. If a third party, other than the parent or guardian, files a grievance on the client's behalf, DBH must request as a condition of processing that the alleged victim agree to the grievance filed on his behalf and may also require that the alleged victim pursue any subsequent steps in the remedy process. If the alleged victim declines to have the grievance processed on his behalf, the facility must document the client's decision.
J. Independent Audits and Agency Monitoring and Reporting
1. In addition to internal administrative review and analysis, and internal or external Quality Assurance reviews, an independent and qualified auditor must audit the agency at least every three years. Auditors must be able to access and tour the facility, review documents and records, and interview clients and staff.
2. The facility has a designated interim compliance manager that has the time and authority to oversee facility compliance efforts.
3. The agency will distribute information to the public, via our website, on how to report sexual abuse and sexual harassment on behalf of clients, information on its zero tolerance policy for sexual abuse/rape of clients, and sexual abuse data reports.
4. Upper-level facility management will review each incident of sexual abuse for cause, staffing, and physical barriers, and make recommendations for prevention and implementation of remedy(s).
5. All DBH personnel files are maintained for a minimum of seven years following the staff's
termination/resignation of employment from the agency. In compliance with the Prison Rape
Elimination Act (PREA) any and all personnel records are retained for as long as the alleged abuser is employed with the agency, plus an addition minimum 5 years. DBH standard supersedes this timeframe.
6. The facility will implement and document a staffing plan that provides for adequate levels of staffing and, where applicable, video monitoring (exclusive to DePaul Center) to protect clients from sexual abuse. During quarterly CQI processes, the facility Administration and the facility PREA interim compliance manager will review the plan to ensure:
- Generally accepted secure/non-secure residential practices are met.
- Findings of inadequacy are addressed.
- Adequate numbers of Supervisory personnel.
- Physical plant inadequacies, such as "blind spots" on video monitoring systems are addressed to the maximum extent possible.
- Responses are made where there is a prevalence of sexual abuse reporting on a certain shift, in a certain location, with certain personnel, or as pertaining to other factors.
7. The facility will collect accurate, uniform data for every allegation of sexual abuse. At a minimum the data will be sufficient to answer all questions on the annually-required Survey of Sexual Violence. Aggregated data will be incorporated into agency CQI processes and will be:
- Reviewed in order to assess and improve sexual abuse prevention, detection, and response practices.
- Made available to the public via our agency website.
K. References to Policy Related to Prevention of Sexual Abuse/Rape
Other Don Bosco Hall policies support and address the PREA standards in addition to regulating other
activities. They include, but are not limited to:
Policy CR I-Clients Rights
Policy CR 3-Grievance Procedures for Clients and Families
Policy CR 3; ETH 4-Response to Allegations toward Staff / Protection of Reporters
Policy SA 4-Policy for Prohibited Interventions
Policy SA 2-Client Assessments
Policy RTX 9; JJC 6-Health Services / Resources
Policy CS-JJC; RTX; SA-Family Visitation
Policy JJC I4-Conducting Client Searches
Policy ETH 5-Professional Conduct and Ethics
Policy HR 3-Background Checks
Policy RPM 2/ Performance and Quality Improvement
Policy / Staff-to-Client Ratios
Policy / Line of Sight Policy
Policy / Training Requirements
Policy RPM; CR; ETH; CS-Child Protection law / Mandated Reporting
Policy 8SM 1; 8SM 6-lncident Review Procedures
Human Resources Manual (line of Sight, Ethics/Standards, Employee-Client Relationships, Staff Ratios)