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Using the MAYSI-2
  What About False Positives?
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 in doing so, it might also identify many youths who score 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 place all of these youth on suicide watch or refer them 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.  Simply asking a follow-up question about whether she feels that way now, or whether she said “yes” to the item because she felt that way 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.

The MAYSI-2 manual includes a set of “Second Screening” forms for each of the MAYSI-2 scales.   These provide questions that staff can ask to follow up on youths’ MAYSI-2 responses in the manner described in the above example.
Another scale on which Second Screening is often important is Thought Disturbance.  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.
Can the MAYSI-2 be Used Outside of the Juvenile Justice System?
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 hesitate to recommend the MAYSI-2 for those settings.

, 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 Mental Health Screening and Assessment in Juvenile Justice (2005) edited by Grisso, Vincent, and Seagrave.