MAYSI-2 Scales and Their Use
This document describes (a) what each of the 7 MAYSI-2 scales measures, (b) the way that MAYSI-2 defines “high” scores on each scale, and (c) how high scores on various scales are used to create a “decision rule” that should trigger a staff response to the youth’s behavioral health needs. This document provides only a brief description of these features of the MAYSI-2, which are described in greater detail in the MAYSI-2 Manual.
Labels and Meanings of the MAYSI-2 Scales
The MAYSI-2 has 6 clinical scales and one additional scale. Each scale represents some important set of behaviors, thoughts, feelings or symptoms associated with various behavioral health problems of adolescents.
The 6 clinical scales are:
- 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. (In the study with which the MAYSI-2 was developed and validated, a scale associated with thought disturbance proved satisfactory for use with boys, but did not prove satisfactory for use with girls. Its meaning when administered to girls, therefore, is questionable).
The additional seventh scale is Traumatic Experiences (TE): While this scale does not assess a clinical condition, like PTSD, it identifies youths who may have had greater exposure to potentially traumatizing events compared to other youths, not whether they were traumatized.
Note: None of the 52 MAYSI-2 items asks for information about specific substances used or length and frequency of use. In addition, no items ask questions that might constitute admissions to specific offenses for which the youth could be adjudicated. Research also has found no specific relation between MAYSI-2 scores and general recidivism or specific offenses.
MAYSI-2 Scale Cut-Off Scores
Each scale has cut-off scores, offering a research-validated indicator that the youth with scores above these cut-offs is scoring "high" compared to other youth in juvenile justice settings nationally.
The scales use two types of cut-off scores:
- Caution Cut-off Score
- The youth’s score is high enough to be “clinically significant.” That is, the youth has scored at a level that is comparable to scores on more comprehensive tools for assessing youth psychopathology that identify youth in need of clinical attention.
- Warning Cut-off Score
- This cut-off score is higher on each scale than the Caution cut-off score. It indicates that the youth has scored higher than 90% of youth seen in juvenile justice programs.
MAYSI-2 Decision Rules
Programs use the cut-off scores on one or more scales to create their own "decision rule" as a matter of program policy. A decision rule determines when a youth’s MAYSI-2 results require a staff response (e.g., immediate attention by a mental health professional) because of high behavioral health needs.
In determining its own decision rule, a program uses some combination of scores above cut-off on the MAYSI-2 scales to identify whether staff will take certain specific actions in response to a youth’s MAYSI-2 results.
Here is an example of a decision rule used in juvenile detention centers in several states:
A request will be made for a mental health professional to examine the youth within 24 hours if the youth’s MAYSI-2 scores are:
- Over the WARNING cut-off on any TWO of the six clinical scales (TE excluded) OR
- Over the CAUTION cut-off on Suicide Ideation (in addition, implement suicide precautions)
The MAYSI-2 Manual provides further guidance for programs to develop decision rules that meet the program’s own objectives and resources for responding to youths’ behavioral health needs.