There are two“when” questions about the use of the MAYSI-2 in pretrial detention centers. When should it be given in relation to the point in time when youths are admitted? When should that routine be over-ruled?

First, the recommended time for giving the MAYSI-2 in detention is within a few hours after youths have been admitted. Typically the best time is 2 to 4 hours after admission. Why is that? While observing detention centers nationwide, we've learned that the first hour typically is occupied with a variety of identification and health screening questions, safety issues, detention pod assignments, description of the rules, and so forth. Putting a youth in front of the MAYSI-2 in this relatively intense and sometimes chaotic event probably is not the best time for thoughtful answers to questions about one’s feelings and behaviors. A good time for the MAYSI-2 is right at the end of that process—perhaps when a youth has been assigned to a pod, has seen where he or she will be tonight, and is able to take a deep breath. Waiting much beyond 2 to 4 hours, however, runs risks of a youth having an important emergency mental health need that goes undetected until the youth actually acts out that need.

Second, are there exceptions to that rule? Of course there may be, and detention centers should include such exceptions in their policies. For example, if a youth is in a rage or is so confused that he or she can hardly sit down and take pencil (or computer keyboard) in hand, staying to the routine of “within 2-4 hours” should be set aside. Staff is already quite aware of the youth’s current mental state, a MAYSI-2 under conditions of rage would probably have no valid meaning, and delaying the MAYSI-2 until a few hours after the youth stabilizes might be of much greater value, even if that is 24-48 hours after admission.

Similarly, detention policy should address whether youths who are merely being transported from one detention center to another need to be administered the MAYSI-2 on the second admission. One might think that it would do little harm. But there there is some evidence that youths can get the MAYSI-2 too often—that is, their answers change when they receive it over and over in a short period of time. Moreover, usually the previous placement will know of the youth’s special mental health needs and can inform the receiving placement about them—e.g., putting them on alert regarding past suicide risk status which many detention centers would want to reinstate upon a youth’s movement to any new setting.

A common concern of many programs that use brief screening instruments is what test developers call “false positives.” An instrument’s cut-off score on a good suicide screening scale might identify most of the youths who are really at risk, but the tool may also identify many youths whose scores are above the cut-off, yet are not seriously suicidal. This is a problem because when youths are over the cut-off score on a MAYSI-2 scale, such as Suicide Ideation, many juvenile facilities refer all these individuals for costly clinical evaluations. We’ve often been asked by MAYSI-2 users whether there is a way to reduce “false positives,” thereby reducing the number and additional cost of those unnecessary clinical referrals. There is. You can instruct staff members who give the MAYSI-2 to ask two or three follow-up questions whenever a youth scores above the Caution or Warning cut-off on a scale. (Some programs do this just for two or three scales they are most concerned about—for example, Suicide Ideation, Depressed-Anxious, and/or Thought Disturbance.) Typically this is done immediately after scoring the MAYSI-2, and before deciding what response to make in terms of referral or further evaluation. For example, imagine that a youth answers “yes” to two or three of the Suicide Ideation items, putting her over the Warning cut-off. Sometimes this happens because the youth was feeling that way sometime in the past few weeks (as suggested by the MAYSI-2 instructions), rather than right now. A second screening question asking the youth whether she feels that way now or at some time in the past helps staff to make a judgment about whether the threat at the moment is serious. One should not ignore the youth’s report that she felt that way in the past and not now. But knowing this helps one to decide whether or not a suicide watch, for example, is needed at the moment. Similarly, when you ask some youths about their high scores on Thought Disturbance items about “seeing things others don’t see,” sometimes second screening reveals that they meant “when I am high”. This may indicate a problem—drug use—but suggests a lower likelihood that they are referring to hallucinations related to thought disturbance.

A note of caution—there is nothing magical about these second screening questions. They will not guarantee that youths are or are not at risk. They simply give staff members a bit more information with which to judge whether there is a need for immediate, emergency intervention.

Second Screening forms are contained in the 2006 MAYSI-2 manual and within MAYSIWARE.

We are often asked whether the MAYSI-2 is appropriate for use with youths in programs and facilities that are not part of the juvenile justice system—for example, child mental health clinics, community substance use programs, or public school counseling services. There are several reasons that we do not recommend the MAYSI-2 for those settings. First, the MAYSI-2 was normed on youths in juvenile justice facilities, so that we do not know whether the “cut-off scores” on the MAYSI-2 would have the same meaning with different groups of youths in other settings. Second, the value of MAYSI-2 screening in clinical settings is usually less than in juvenile justice settings. The MAYSI-2 was designed for use especially by non-clinicians to decide which youths to refer for assessment of possible mental health problems.  In contrast, we presume that when youths enter clinical settings, there is less need for a tool that determines whether they have mental health problems.  Typically they do (or they would not have gotten there).   Moreover, unlike many juvenile justice settings, clinical settings have clinicians at the front door who assess every youth, so that there is little need in clinical settings for a screening tool to determine whether a youth needs to be assessed. 

Finally, there are far better instruments than the MAYSI-2 for the more focused screening sometimes required in clinical settings (e.g., specifically for substance abuse or for trauma). Although some of these focused screens are used in juvenile justice settings, usually they have been developed with child clinical populations specifically for use in community clinical settings. For a review of many of these tools, see Screening & Assessing Mental Health And Substance Use Disorders Among Youth In The Juvenile Justice System: A Resource Guide for Practitioners by Grisso and Underwood. It was published by the Office of Juvenile Justice and Delinquency Prevention.