Identifying What Factors Cause Differences on the Massachusetts Youth Screening Instrument version 2 for African American and Caucasian Male Juvenile Offenders

Background and Purpose: Every year 600,000 juveniles with mental health disorders enter the juvenile justice system, many of whom are African American (Teplin, 2001). The Massachusetts Youth Screening Instrument – version 2 (MAYSI-2) is the mental health screening tool used in juvenile justice systems in 47 states (National Council for Mental Health and Juvenile Justice, 2003); therefore, it is critical that it be free of racial bias. Recent evidence indicates that minority youth interpret MAYSI-2 items differently (Cauffman & MacIntosh, 2006), possibly resulting in a disparity in referrals. This study had three aims: 1) Explore potential mediators of race on MAYSI-2 scores, including a juvenile's experiences with discrimination, mental health service use history, reading level, and social desirability, 2) Explore whether African American and Caucasian juvenile offenders interpret the purpose of the MAYSI-2's administration differently, and if so what those differences are, and 3) Explore whether African American and Caucasian juvenile offenders interpret the MAYSI-2 items differently, and if so what those differences are. Hypothesis: a juvenile offender's race will impact their MAYSI-2 scores when mediated by their experiences with discrimination, reading level, mental health service use history, social desirability, and cognitive processing.

Methods: Seventy African American and 20 Caucasian male juvenile detainees, ages 12 to 17, recruited between March 1, 2008 and May 30, 2008 from two Midwestern detention facilities participated. Aim 1: 90 participants engaged in a structured interview. Via Mplus, path analysis was used to assess mediation. Aims 2 and 3: 16 of the 90 participated in a semi-structured cognitive interview. With a grounded theory approach, interview responses were separated by question, grouped by race, and the relationships examined to identify potential themes.

Results: The effect of race on all six MAYSI-2 domains was mediated by experiences with discrimination, reading level, mental health service use history, and social desirability; race had a direct effect on the Somatic Complaints domain. The qualitative results showed that African American and Caucasian youth interpreted time and symptoms differently, resulting in inaccurate responses.

Conclusions and Implications: Measurement issues, related to race, impact how juveniles interpret the MAYSI-2 items and administration process causing different scores and possibly racial disparities in referrals. The specific experiences of juvenile offenders must be considered when creating and administering mental health screening tools because they may impact responses. Reliability of the MAYSI-2 could be improved by providing specific time frames or landmarks or alternative words or definitions during MAYSI-2 administration. Staff should be made aware of possible youth suspicion and advised about what to share about the MAYSI-2's purpose. Complementing the MAYSI-2 with screening tools, known to identify psychiatric concerns with the general adolescent population, could strengthen the MAYSI-2's results. Practitioners must increase their awareness about how symptom presentation for African American youth may differ from their expectations. Finally, state mandates regarding mental health screening must be informed by what is known from research and practice.