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Description of the MAYSI-2

Purpose

The MAYSI-2 is a youth self-report behavioral health screening tool. It is designed for use with every youth within a few hours after their entry into juvenile detention or corrections facilities, or at initial interviews in juvenile diversion or probation offices. MAYSI-2 scores identify the extent to which youth are reporting thoughts, behaviors or feelings that may be symptoms or signs of significant mental health problems. Its purpose is to identify youth who may be experiencing mental health symptoms requiring immediate attention (e.g., suicide precautions) or who may need further, more complete assessment by a mental health professional. As a screening tool, the MAYSI-2 does not “diagnose” mental disorders. The MAYSI-2 has been normed and researched for youth in juvenile justice settings and programs, and thus it is not recommended for use by non-juvenile-justice schools, medical services, or community mental health services.

Summary of Overall Process

If using online Web MAYSI-2, the staff administering the MAYSI-2 enters basic demographic and case identification data into the case file. Then the youth is offered instructions for answering 52 MAYSI-2 items, concerning whether they have been true (yes, no) for the youth within the past few months. Web MAYSI-2 then automatically uses the responses to create scores on seven MAYSI-2 scales and provides a report. 

Using paper-and-pencil administration, youths answer the 52 items on the MAYSI-2 Questionnaire, circling yes/no on each item. The staff creates scores on the seven MAYSI-2 scales by transferring the yes/no responses using a Scoring Form and then records the scores on a Scoring Summary showing scores on each of the seven MAYSI-2 scales. 

As described below, scores on the MAYSI-2 scales identify which youths are “critical cases” requiring a response determined by the agency’s policies.

MAYSI-2 Questionnaire Items

Youths answer 52 items regarding whether various thoughts, behaviors or feelings have been true for them in the past few months. Examples: “Have you had a lot of trouble falling asleep or staying asleep?” “Have you felt angry a lot?” The youth answers by circling yes/no (paper) or with a mouse on a computer screen (Web MAYSI-2). For youths with reading problems, MAYSI-2 items may be read to them while they circle yes/no; with Web MAYSI-2, an audio feature automatically reads each item to the youth aloud.

MAYSI-2 Scales

Answers to MAYSI-2 items contribute to six clinical scales and one additional “Traumatic Experiences” scale.  (Various scales have 5, 6, 8, or 9 items.) Youths’ yes/no responses are transferred via a Scoring Form to produce scores on each of the seven scales. Those are recorded on a Summary Form.  (A few MAYSI-2 items do not contribute to any scale but were included for research purposes.) 

The following are the six clinical scales and their meanings:

Alcohol/Drug Use (AD)
Identifies youths who may be using alcohol or drugs to a significant degree, and who are therefore at risk of substance dependence and/or abuse.
Angry-Irritable (AI)
Assesses explicit feelings of preoccupying anger, a general tendency toward irritability, frustration, impulsive reactions, and tension related to anger.
Depressed-Anxious (DA)
Elicits symptoms of mixed depressed mood and anxiety.
Somatic Complaints (SC)
Assesses presence of various bodily aches and pains that may affect the youth, especially those often associated with anxiety.
Suicide Ideation (SI)
Specifically identifies thoughts and intentions about self-harm and depressive symptoms that may present an increased risk for suicide.
Thought Disturbance (TD)
Boys only
Assesses the possibility of serious mental disorder involving distortion of reality. (Original development of the MAYSI-2 identified a Thought Disturbance scale demonstrating validity for boys but not girls. A TD score may be calculated for girls, but its meaning is uncertain.)

The additional seventh scale is Traumatic Experiences (TE). While this scale is not known to assess a clinical condition, like PTSD, it identifies youths who may have had greater exposure than other youths to potentially traumatizing events but not necessarily whether they were traumatized.

Cut-Off Scores

The Summary Form shows whether a youth’s scores on each of the clinical scales is below or above certain cut-off scores that define whether they are high enough to be of concern. There are two cut-off scores on each clinical scale: Caution and Warning.  

This creates three zones on each clinical scale in which a youth’s score may fall:

  • Scores below the Caution cut-off are “low” (indicated by scores in a “green” zone)
  • Scores above the Caution cut-off but below the Warning cut-off are considered “clinically significant:” that is, high enough to be of concern (indicated by scores in a “yellow” zone)
  • Scores above the Warning cut-off are very high, among the top 10% of youth in juvenile justice settings (indicated by scores in a “red” zone)

“Critical Case” Decision Rules

Scores in the various cut-off zones determine whether the youth is a “critical case,” meaning that some action needs to be taken.  The decision rule defining a critical case is determined as a matter of policy by the juvenile justice agency using the tool. [The MAYSI-2 Manual or the MAYSI-2 Helpdesk can provide guidance in forming that policy.]  Here are examples of two typical combinations of scores defining a critical case:

Definition A

  • In the Warning zone on at least two clinical scales, OR
  • In the Caution or Warning zone on Suicide Ideation.

Definition B

  • In the Warning Zone on at least one clinical scale OR
  • In the Caution zone on at least two scales, OR
  • In the Caution or Warning zone on Suicide Ideation

Research has indicated that Definition A will identify about 18-22% of youth entering the facility as a “critical case.” Definition B will identify about 30-35% of youth as a critical case.   

All screening tools produce some false positives (wrongly identified as having high mental health needs) and false negatives (having high mental health needs but wrongly identified as not having them).  These will vary depending on the decision rule that is used.  For example, using Definition A above, almost all youth meeting the definition will truly have high mental health needs,  but some youth with high needs will be “missed.” Using Definition B, fewer will be “missed,” but only some of the youth meeting the definition actually will have high mental health needs.

Action Responses to Critical Cases

Agencies vary in their policies about what to require by way of staff action responses to critical cases. 

Here is an example of a staff response policy:

“A MAYSI-2 critical case will require (a) timely referral (e.g., within 24 hours) for assessment by a mental health professional; (b) in case of elevated Suicide Ideation, immediate action according to the facility’s suicide precautions protocol; and (c) notification of detention staff supervisor regarding a newly admitted youth’s critical case status.”

MAYSI-2 Second Screening

An optional but recommended staff response is to employ MAYSI-2 Second Screening for critical cases. Second Screening involves the staff member asking the youth three or four questions for each scale that has contributed to the youth being identified as a critical case. The MAYSI-2 Manual (or Web MAYSI-2) provides these Second Screening questions for each of the clinical scales. This allows staff to determine whether the youth’s high score is truly urgent or may be less urgent than the youth’s answers to the MAYSI-2 items suggested. 

When Second Screening is used by an agency, a critical case usually is defined according to Definition B as described above in [add anchor link]“Critical Case Decision Rules.”

The MAYSI-2 Manual and the MAYSI-2 Helpdesk provide further guidance for agencies to develop decision rules that meet their agency’s own objectives and resources for responding to youths’ behavioral health needs.