The Consequences of Mental Health Screening in Juvenile Pretrial Detention
Principal Investigator
Dr. Thomas Grisso, Ph.D.
National Youth Screening Assistance Project
University of Massachusetts Medical School
Summary
Rationale
Juvenile pretrial detention centers nationwide admit thousands of youth each day. Recent research indicates that well over one-half of youth entering detention centers meet criteria for one or more mental disorders. Not all of those youth need immediate treatment. But detention centers must respond to emergency mental health conditions of youth (e.g., serious depression to avoid suicide) in order to meet their requirements as temporary custodians. Knowing about youths' mental health problems also may allow the juvenile justice system to divert some youth to mental health services in the community.
Recently federal and state agencies have urged detention centers to use systematic, valid ways to identify youth with serious mental health problems when they enter detention. In the 1990s we developed for that purpose a tool called the Massachusetts Youth Screening Instrument-Second Version, or MAYSI-2. Requiring only about 15 minutes, it is administered to every youth within a few hours after admission to detention centers. Youths' responses to its 52 items produce scores on seven symptom scales. Patterns of scores allow staff to identify youth who might need further assessment and special care (e.g., suicide precautions). With support from the MacArthur Foundation since 2000, we have provided technical assistance to juvenile detention centers willing to adopt the MAYSI-2. The instrument is now used in juvenile detention centers in almost all states, and statewide in about one-half of the states.
Purpose for the Research
Ample research has supported the value of the MAYSI-2 in identifying youth with mental health problems. But little is known about its actual impact on juvenile detention center practices. Does it lead to increased referrals of youth for more detailed assessment and mental health services? In addition, observations by detention centers themselves have suggested that the use of mental health screening might increase detention staff's ways of perceiving and relating to youth. It might also help them manage youth in ways that increase the safety of detention centers.
To investigate the potential value of mental health screening, the present study will examine its effects in three detention centers in each of three states: Louisiana, Illinois and Indiana. The sites vary in size, and none had used a mental health screening tool prior to the study. The study does not merely examine the value of the tool. It seeks to learn the effects of a "mental health screening program"--that is, the impact on the detention center itself when it undergoes the process of learning about, implementing, and using mental health screening.
Study Methodology
Each detention center will undergo a ten-month study period. It begins with staff education and measurement of staff attitudes toward youths' mental health problems. This is followed by several months during which baseline information about "detention events" is obtained. These detention events include daily recordings of the frequency of youths' problem behaviors in detention, such as youth-on-youth assaults, suicide gestures, and need for special programming. They also include a record of staff's referrals of youth for mental health services.
Then detention administrators are assisted in putting MAYSI-2 mental health screening in place mid-way in the study period. Finally, detention events, staff attitudes, and mental health referrals continue to be measured for the second half of the study period, in order to determine changes potentially related to implementing mental health screening (e.g., greater sensitivity in staff's attitudes, reduced youth misbehavior, and increased mental health referrals).
Work with the detention centers will occur in 2008 and 2009. We anticipate reporting our results in 2010.
What are the benefits to participating?
If positive changes are found, the results will be useful in promoting mental health screening in juvenile detention centers as a way to increase the likelihood that youth will obtain necessary mental health services. Results are also likely to offer strategies for the process of implementing mental health screening so that it maximizes its value.