The Massachusetts Youth Screening Instrument (MAYSI) was developed in the 1990s by Thomas Grisso and Richard Barnum at the University of Massachusetts Medical School with grants from the William T. Grant Foundation and the MacArthur Foundation. It was designed to be used within the juvenile justice system to identify youths experiencing thoughts, feelings, or behaviors that may need immediate attention regarding possible suicide risk or emergent mental health needs. Since being made available in 2000, the second version, MAYSI-2, has been adopted by over 1,500 juvenile justice facilities in 48 U.S. states to screen youths’ mental health needs when entering those facilities. This article focuses on the development of, research behind, and use of the MAYSI-2 within the juvenile justice system.
Basic Description
The MAYSI-2 was designed to assist juvenile justice agencies in identifying youth who have mental health and emotional needs. It is not intended to provide psychiatric diagnoses. It is intended for use at a youth’s entry or transitional placement points within the juvenile justice system. The MAYSI-2 was designed to be a brief, self-report screening tool that consists of 52 questions written at a fifth-grade reading level. Youths circle yes or no concerning whether each item has been true for them within the past few months or ever in your whole life. There are six primary clinical scales: Alcohol/Drug Use, Angry-Irritable, Depressed-Anxious, Somatic Complaints, Suicide Ideation, and Thought Disturbances (boys only). A seventh nonclinical scale, Traumatic Experiences, provides information about potential recent trauma.
The MAYSI-2 can be administered in two ways: (1) youths read the items themselves or have juvenile justice staff read them the questions on the paper-and-pencil version or (2) youths use the computerized version of the MAYSI-2, known as MAYSIWARE (or an equivalent provided by a commercial online assessment service), whereby they are read the items via the computerized voice program while responding to the questions using the keyboard or mouse. MAYSIWARE is available in both English and Spanish, and the paper-andpencil format is available in English, Spanish, and 15 other languages.
Youths’ yes answers are summed for each scale either by use of a scoring key if the paper-and-pencil version is administered or automatically if MAYSIWARE is used. The scores are then recorded on the Scoring Summary Form. Youths’ answers contribute to seven scales for boys and six scales for girls, each scale having 5–9 items. The six clinical scales were developed with two levels of cutoff scores, which are used to define what is meant by a high score on any scale: Caution and Warning. Scores above the Caution cutoff indicate that the youth scored at a clinical level of significance, meaning the youth may be in need of some clinical, nonurgent, attention. Scores above the Warning cutoff indicate that a youth has scored in the top 10% of youth in the normative sample on a given scale, meaning the youth scored exceptionally high in comparison to other youths in the juvenile justice system and is potentially in need of an immediate emergency response. Normative sample refers to the sample of test takers representative of the population for whom the test is intended. The MAYSI-2’s normative sample is youths involved in the juvenile justice system (probation intake, detention, and corrections).
Development of the MAYSI-2
Initial item development for the six MAYSI clinical scales involved a review of the symptoms of the more prevalent mental disorders, emotional disturbances, and behavioral problems among adolescents. The wording of the 52 items was guided by consultation with national experts and in consultation with youths in the Massachusetts Department of Youth Services to determine any difficulties in understanding the words or phrases comprising each item. The following chronology shows the initial development, testing, and subsequent revision of the original MAYSI:
1994–1996: Initial drafting and pilot testing of the MAYSI.
1996–1998: Scales identified, initial norms and cutoffs developed, and initial validation.
1998–2000: Additional analyses of the Massachusetts data lead to the second version of the screening tool (called the MAYSI-2) and a new manual.
2000–2002: The MAYSI-2 released to juvenile justice agencies and, with funding from the MacArthur Foundation, the National Youth Screening & Assessment Program developed to provide technical assistance to those agencies using the MAYSI-2.
2002–2005: National norms developed using data collected from over 70,000 juvenile justice agencies (intake probation, detention, and corrections) and MAYSIWARE developed. Evaluation of the impact of mental health screening in juvenile justice settings conducted with funding from the William T. Grant Foundation. In addition, how the MAYSI-2 was being implemented nationally and its effect on youths’ mental health services in juvenile justice settings evaluated with funding from the MacArthur Foundation.
2005–2011: Technical assistance for MacArthur Foundation’s Models for Change Initiative provided.
2011–2015: Technical assistance to jurisdictions and states that are using or plan to use MAYSI-2/ MAYSIWARE provided.
Research Evidence
In 1994, after a review of symptoms associated with prevalent mental disorders, emotional disturbances, and behavioral problems among adolescents, 52 questions were selected to create a MAYSI questionnaire prototype. During the next few years, efforts began to identify the scales, develop norms and cutoff scores, and determine psychometric properties. Which of the original 52 items would be included was determined through a process of examining a series of analyses including item total correlations, α coefficients, and factor analyses. Factor analyses performed on a Massachusetts sample led to decisions about the final scales and their items. Additional analyses were subsequently performed on another sample of youth from California, confirming the Massachusetts results. Finally, the performance of youths taking both the MAYSI-2 and other validated scales of child psychopathology were used to determine the cutoff scores on the six clinical MAYSI-2 scales.
In 2005, a study was conducted with a national sample of youths in juvenile justice facilities in 19 states. This research allowed MAYSI-2 users to compare youths to national norms rather than the Massachusetts norms on which the original cutoff scores were based and examined the degree of consistency across age, gender, and race-related differences in the proportions of youths with elevated MAYSI-2 scales.
To measure the internal consistency of the MAYSI-2, researchers used Cronbach’s α coefficients, which ranged from .61 to .86 for items within scales, indicating acceptable internal consistency. Few differences were seen in α coefficients between race and gender. The MAYSI-2 has also been shown to be reliable (using intraclass correlation coefficients) based on comparisons of individual youth scores across a 1- to 2-week period of time, ranging from .53 to .89 across various scales. Analyses aimed at addressing MAYSI-2’s validity showed that the MAYSI-2 scales correlated in the expected direction, with scales measuring parallel symptom constructs on other mental health assessment instruments.
Since made available in 2000, numerous studies and reviews have examined the reliability, internal consistency, utility, and structure of the MAYSI-2. A detailed review of the existing research in addition to up-to-date quarterly reviews of MAYSI-2 research can be found on the website of the National Youth Screening and Assessment Partners. The reviews present research only when the MAYSI-2 was used in the settings for which it was intended, on the target populations for which it was developed, and administered in the manner recommended by the authors.
Use of MAYSI-2 in Juvenile Justice Facilitates
The MAYSI-2 is the most widely used mental health screening tool in juvenile justice facilities, and it is recommended by a number of U.S. government juvenile justice and mental health agencies. Its values and limits are identified by over 60 published studies in scientific journals.
With a little more than one half of young people entering juvenile justice facilities meeting criteria for one or more mental disorders, the MAYSI-2 provides a quick way to identify mental health and substance use symptoms that may threaten the welfare of youth. For example, the MAYSI-2 can help determine if an immediate (acute) emergency response is needed to suicide risks or to youths who may need immediate attention due to an acute condition that may deteriorate rapidly (e.g., substance abuse withdrawal). The MAYSI-2 can also help alert staff to the potential need for longer range rehabilitation plans by identifying youths whose chronic and persistent mental health problems may need care on a continuous basis. In addition, it can aid in identifying conditions (e.g., depression) that may increase the risk of aggression, which could put staff and other youth at risk.
MAYSI-2 scores are used to determine whether a youth is screened out (i.e., needs no further follow-up or assessment) or screened in (i.e., requires a staff follow-up response and/or further mental health assessment). Screened in means the youth’s scores are above the Caution or Warning cutoffs on any of the six MAYSI clinical scales. The clinical scales and cutoffs that define screened in are determined as a matter of policy by an agency’s administrators and, therefore, may be different between jurisdictions across the United States.
The types of follow-up responses when a youth is screened in include having staff ask second screening questions, which are available for each of the six clinical scales comprising the MAYSI-2. The second screening questions allow staff to rule out false positives and determine a course of action (e.g., obtain an emergency clinical assessment for the youth, schedule a nonemergency comprehensive assessment for the youth, refer the youth to a mental health diversion option).
As with all screening tools, the MAYSI-2 does not provide psychiatric diagnoses, and the cutoff scores do not identify every youth who might have a mental disorder nor do they assure that all youths screened in actually have a mental disorder. Also it does not provide the type of information needed to make long-range treatment plans. In addition, some scores above the cutoff are temporary moods, while others are due to longer term conditions. Therefore, this type of intake screening should be used only for intake management and should not be used for longer term planning (e.g., case dispositions). Lastly, the MAYSI-2 does not protect against self-report bias, so youths may sometimes conceal symptoms, and they may sometimes exaggerate them.
Research suggests that there are no differences in MAYSI-2 scores for paper-and-pencil administration versus computer administration (via MAYSIWARE), although youths tend to prefer the computer to paper-and-pencil, and when youths need to have the items read to them (e.g., because of reading problems), they tend to report more freely to the computer administration (whereby the items are read to the youth via computerized voice program) than to a staff member reading the items to them.
Screening for mental health needs using the MAYSI-2 with youth in juvenile justice settings has become standard practice nationwide—at probation intake, detention centers, or juvenile corrections programs. Identifying young people’s needs—substance use, trauma-related problems, and suicide ideation—is important at first contact. It is the first step for identifying those who need immediate attention and further assessment for mental health needs.
Special initiatives are being developed to study and improve mental health screening in juvenile justice facilities in other countries. Researchers in 17 countries covering Asia, Australia, Europe, the Soviet Union, and the Americas have translated the MAYSI-2 into various languages in order to conduct further research on the cross-national and cross-cultural effectiveness of implementing juvenile justice mental health screening, using the MAYSI-2.
References:
- Grisso, T., & Barnum, R. (2006). Massachusetts Youth Screening Instrument—Version 2: User’s guide and technical report. Sarasota, FL: Professional Resource Press.
- Grisso, T., Fusco, S., Paiva-Salisbury, M., Perrault, R., Williams, V., & Barnum, R. (2012). The Massachusetts Youth Screening Instrument-Version 2 (MAYSI-2): Comprehensive research review. Worcester: University of Massachusetts Medical School.
- Grisso, T., & Quinlan, J. C. (2005). Massachusetts Youth Screening Instrument (2nd version). In T. Grisso, G. Vincent, & D. Seagrave (Eds.), Mental health screening and assessment in juvenile justice (pp. 99–111). New York, NY: Guilford Press.
- National Center for Mental Health and Juvenile Justice. (2008). Mental health screening within juvenile justice: The next frontier. Delmar, NY: Author.
Websites
- National Youth Screening and Assessment Partners. Retrieved from https://www.nysap.us/