Diagnostic performance and optimal cut-off scores of the Massachusetts youth screening instrument-second version in a sample of Swiss youths in welfare and juvenile justice institutions.

BACKGROUND: There is a growing consensus about the importance of mental health screening of youths in welfare and juvenile justice institutions. The Massachusetts Youth Screening Instrument-second version (MAYSI-2) was specifically designed, normed and validated to assist juvenile justice facilities in the United States of America (USA), in identifying youths with potential emotional or behavioral problems. However, it is not known if the USA norm-based cut-off scores can be used in Switzerland. Therefore, the primary purpose of the current study was to estimate the diagnostic performance and optimal cut-off scores of the MAYSI-2 in a sample of Swiss youths in welfare and juvenile justice institutions. As the sample was drawn from the French-, German- and Italian-speaking parts of Switzerland, the three languages were represented in the total sample of the current study and consequently we could estimate the diagnostic performance and the optimal cut-off scores of the MAYSI-2 for the language regions separately. The other main purpose of the current study was to identify potential gender differences in the diagnostic performance and optimal cut-off scores. METHODS: Participants were 297 boys and 149 girls (mean age = 16.2, SD = 2.5) recruited from 64 youth welfare and juvenile justice institutions (drawn from the French-, German- and Italian-speaking parts of Switzerland). The MAYSI-2 was used to screen for mental health or behavioral problems that could require further evaluation. Psychiatric classification was based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime version (K-SADS-PL). The MAYSI-2 scores were submitted into Receiver-Operating Characteristic (ROC) analyses to estimate the diagnostic performance and optimal 'caution' cut-off scores of the MAYSI-2. RESULTS: The ROC analyses revealed that nearly all homotypic mappings of MAYSI-2 scales onto (cluster of) psychiatric disorders revealed above chance level accuracy. The optimal 'caution' cut-off scores derived from the ROC curve for predicting (cluster of) psychiatric disorders were, for several MAYSI-2 scales, comparable to the USA norm-based 'caution' cut-off scores. For some MAYSI-2 scales, however, higher optimal 'caution' cut-off scores were found. CONCLUSIONS: With adjusted optimal 'caution' cut-off scores, the MAYSI-2 screens potential emotional or behavioral problems well in a sample of Swiss youths in welfare and juvenile justice institutions. However, as for choosing the optimal 'caution' cut off score for the MAYSI-2, both language as well as gender seems to be of importance. The results of this study point to a compelling need to test the diagnostic performance and optimal 'caution' cut-off scores of the MAYSI-2 more elaborately in larger differentiated language samples in Europe.

Mental health problems in young male offenders with and without sex offences: a comparison based on the MAYSI-2.

BACKGROUND: There is a need for better knowledge about the relationship between sexual offending by young people and mental health problems. AIM: This study aimed to compare mental health problems between young people who commit sexual offences and those who do not. METHODS: After completion of the Massachusetts Youth Screening Instrument-Version 2 (MAYSI-2), 334 young people who, according to MAYSI-2 information, had committed a sex offence were compared with 334 young people whose MAYSI-2 data suggested that they had not committed a sex offence. They were matched for age, race/ethnicity, type of facility and adjudication status. We also examined the young sex offenders for within group differences. RESULTS: The young sex offenders were less likely to report anger-irritability or substance misuse than the comparison youths. Within the sex offender group, older juveniles were more likely to report alcohol and drug use problems than younger ones, Caucasians were more likely to report anger and suicidal ideation than their non-Caucasian peers, those detained were more likely to report alcohol and drug use problems and somatic complaints than those on probation, and convicted youths were more likely to report alcohol and drug use problems and anger-irritability than those awaiting trial. CONCLUSIONS: Juvenile sexual offending seems less likely to be committed in the context of an anti-social lifestyle than other offending. Important findings among young sex offenders are their higher levels of mental health problems among those detained and convicted than among those on probation or awaiting trial. Assessment of the mental health of young sex offenders seems to be even more important the further they are into the justice system. Copyright © 2015 John Wiley & Sons, Ltd.

Behavioral Health Care Needs, Detention-Based Care, and Criminal Recidivism at Community Reentry From Juvenile Detention: A Multisite Survival Curve Analysis.

OBJECTIVES: We examined the provision of behavioral health services to youths detained in Indiana between 2008 and 2012 and the impact of services on recidivism. METHOD: We obtained information about behavioral health needs, behavioral health treatment received, and recidivism within 12 months after release for 8363 adolescents (aged 12-18 years; 79.4% male). We conducted survival analyses to determine whether behavioral health services significantly affected time to recidivating. RESULTS: Approximately 19.1% of youths had positive mental health screens, and 25.3% of all youths recidivated within 12 months after release. Of youths with positive screens, 29.2% saw a mental health clinician, 16.1% received behavioral health services during detention, and 30.0% received referrals for postdetention services. Survival analyses showed that being male, Black, and younger, and having higher scores on the substance use or irritability subscales of the screen predicted shorter time to recidivism. Receiving a behavior precaution, behavioral health services in detention, or an assessment in the community also predicted shorter time to recidivating. CONCLUSIONS: Findings support previous research showing that behavioral health problems are related to recidivism and that Black males are disproportionately rearrested after detention.

Feasibility of an Assessment Tool for Children's Competence to Consent to Predictive Genetic Testing: a Pilot Study.

Knowledge on children's capacities to consent to medical treatment is limited. Also, age limits for asking children's consent vary considerably between countries. Decision-making on predictive genetic testing (PGT) is especially complicated, considering the ongoing ethical debate. In order to examine just age limits for alleged competence to consent in children, we evaluated feasibility of a standardized assessment tool, and investigated cutoff ages for children's competence to consent to PGT. We performed a pilot study, including 17 pediatric outpatients between 6 and 18 years at risk for an autosomal dominantly inherited cardiac disease, eligible for predictive genetic testing. The reference standard for competence was established by experts trained in the relevant criteria for competent decision-making. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) served as index test. Data analysis included raw agreement between competence classifications, difference in mean ages between children judged competent and judged incompetent, and estimation of cutoff ages for judgments of competence. Twelve (71 %) children were considered competent by the reference standard, and 16 (94 %) by the MacCAT-T, with an overall agreement of 76 %. The expert judgments disagreed in most cases, while the MacCAT-T judgments agreed in 65 %. Mean age of children judged incompetent was 9.3 years and of children judged competent 12.1 years (p = .035). With 90 % sensitivity, children younger than 10.0 years were judged incompetent, with 90 % specificity children older than 11.8 years were judged competent. Feasibility of the MacCAT-T in children is confirmed. Initial findings on age cutoffs are indicative for children between the age of 12 and 18 to be judged competent for involvement in the informed consent process. Future research on appropriate age-limits for children's alleged competence to consent is needed.

The relation of standardized mental health screening and categorical assessment in detained male adolescents.

Having an effective triage tool is an important step toward a careful use of the restricted time and qualified personnel to perform comprehensive psychiatric assessment in juvenile justice settings. The aims of this study were to examine the construct validity of the Massachusetts Youth Screening Inventory-second version (MAYSI-2), and its likelihood to identify youths who might have a psychiatric disorder. Data from up to 781 male adolescents (mean age = 16.73 years) were gathered as part of the standardized mental health screening and assessment in two all-male Youth Detention Centers in the Netherlands. Categorical assessments were based on two structured diagnostic interviews. Sensitivity, specificity, positive and negative predictive values, and the area under the curve were calculated to evaluate the likelihood of the MAYSI-2 to identify youths with a psychiatric disorder. Youths with a disorder scored significantly higher on the corresponding MAYSI-2 subscale than youths without a disorder. In the total sample, 70 % of the youths with a disorder met the Caution cut-off criteria on at least one MAYSI-2 scale, while youths without a psychiatric disorder were very unlikely to meet cut-off criteria for multiple MAYSI-2 scales. Overall, the sensitivity was slightly better when analyses were repeated in groups of youths from various ethnic origins. The findings supported the construct validity of the Dutch MAYSI-2 and suggested that the MAYSI-2 is a valid mental health screening tool that may serve relatively well as a triage tool. Its effectiveness, however, may differ between ethnic groups.

Ten year research update (2001-2010): evaluations for competence to stand trial (adjudicative competence).

This article reviews and evaluates publications during 2001-2010 with relevance for assessments of competence to stand trial, referred to in this article as adjudicative competence. The review focuses specifically on articles that provide new concepts or data supported by research or case analyses. The studies are reviewed under the following headings: (i) systemic issues, (ii) conceptual guidelines for AC evaluations, (iii) AC assessment methods, (iv) empirical correlates of AC judgments and psycholegal abilities, (v) quality of AC evaluations and reports, (vi) interpretive issues, (vii) special populations (defendants who are elderly, defendants with intellectual disabilities), (viii) AC evaluations of juveniles, and (ix) treatment of incompetent defendants. Suggestions are offered for further research to advance the quality of clinical evaluations of adjudicative competence.

Mental Health Problems in Girls Who Committed Sexual Offenses: Similarities and Differences Compared to Girls With Non-sex Offenses and Boys With Sex Offenses.

Female juvenile offenders have only recently shifted into the focus of research. Moreover, a specific subgroup, female juveniles who sexually offended (JSO) are greatly overlooked. Therefore, there is a dearth of knowledge regarding the characteristics of female JSOs. The aim of the current study was to explore mental health problems (MHP) of female JSOs in more detail. Moreover, we compared their mental health with female juveniles who committed non-sexual offenses (JNSOs) and male JSOs. The sample comprised 33 female JSOs (Mean age 14.5, SD 1.8), 33 age-matched female JNSOs, and 33 age-matched male JSOs. We used the Massachusetts Youth Screening Instrument-version 2 to examine MHP. Although both internalizing and externalizing MHP were not uncommon in female JSOs, they reported fewer problems than female JNSOs. No differences were found between female and male JSOs. With regard to their mental health profile, female JSOs resemble male JSOs more than female JNSOs. These results should be taken into account in the assessment and treatment of this group. However, more research is needed.

Police-induced confessions, risk factors, and recommendations: looking ahead.

Reviewing the literature on police-induced confessions, we identified suspect characteristics and interrogation tactics that influence confessions and their effects on juries. We concluded with a call for the mandatory electronic recording of interrogations and a consideration of other possible reforms. The preceding commentaries make important substantive points that can lead us forward-on the effects of videotaping of interrogations on case dispositions; on the study of non-custodial methods, such as the controversial Mr. Big technique; and on an analysis of why confessions, once withdrawn, elicit such intractable responses compared to statements given by child and adult victims. Toward these ends, we hope that this issue provides a platform for future research aimed at improving the diagnostic value of confession evidence.

Police-induced confessions: risk factors and recommendations.

Recent DNA exonerations have shed light on the problem that people sometimes confess to crimes they did not commit. Drawing on police practices, laws concerning the admissibility of confession evidence, core principles of psychology, and forensic studies involving multiple methodologies, this White Paper summarizes what is known about police-induced confessions. In this review, we identify suspect characteristics (e.g., adolescence; intellectual disability; mental illness; and certain personality traits), interrogation tactics (e.g., excessive interrogation time; presentations of false evidence; and minimization), and the phenomenology of innocence (e.g., the tendency to waive Miranda rights) that influence confessions as well as their effects on judges and juries. This article concludes with a strong recommendation for the mandatory electronic recording of interrogations and considers other possibilities for the reform of interrogation practices and the protection of vulnerable suspect populations.

The use of the MacCAT-CA with adolescents: an item response theory investigation of age-related measurement bias.

Despite the application of the MacCAT-CA to juveniles, questions been raised regarding the appropriateness of this tool for adolescents. The current study tested for age-related measurement bias using data from the MacArthur Juvenile Adjudicative Competence Study (n = 1393). Five of the MacCAT-CA items showed age-related measurement bias (i.e., DIF) for adolescents aged 11-15, and three items showed DIF for adolescents aged 16-17. Several items (e.g., understanding of juries) were more difficult for adolescents than adults matched at the same latent level of capacity, suggesting that these items might underestimate adolescents' legal capacities. Contrary to expectations, there was little evidence of age-related measurement bias on the Appreciation scale. The use of the MacCAT-CA in research and clinical settings is discussed.

The relation between mental health problems and future violence among detained male juveniles.

BACKGROUND: Detention personnel may assume that mental health problems heighten the likelihood of future violence in detained youth. This study explored whether brief mental health screening tools are of value for alerting staff to a detained youth's potential for future violent offending. METHOD: Boys (n = 1259; Mean age = 16.65) completed the Massachusetts Youth Screening Instrument-Second Version (MAYSI-2) and the Strengths and Difficulties Questionnaire (SDQ) as part of a clinical protocol. Official records were collected to index past and future violent offending. RESULTS: A few significant positive and negative relationships between MAYSI-2 and SDQ scale scores and future violent offending were revealed, after controlling for age, past violent offending, and follow-up time. These relations were almost entirely dissimilar across the ethnic groups, even to the extent of finding opposite relations for boys in different ethnic groups. CONCLUSIONS: The small number of relations and their small effect sizes suggest little likelihood that screening for mental health problems in boys who are detained in the Netherlands offers any potential for identifying youth at risk for committing future violent crimes. The current findings also suggest that ethnic differences in the relation between mental health problems and future criminality must be considered in future studies.

The Classification of Violence Risk.

(Reprinted with permission from Behav. Sci. Law 24: 721-730, 2006).

Sex and race differences in mental health symptoms in juvenile justice: the MAYSI-2 national meta-analysis.

OBJECTIVE: Studies have suggested a high prevalence of mental health symptoms among youths in the juvenile justice system, with the highest prevalence among girls and whites compared to boys and other races. This multisite, archival study examined whether sex and race differences, when they exist, were consistent across U.S. juvenile justice programs. METHOD: Data included scores on the Massachusetts Youth Screening Instrument-Version 2 (MAYSI-2) for 70,423 youths from 283 juvenile justice probation, detention, or corrections programs. A meta-analytic technique investigated the consistency of effect sizes for sex and race/ethnic differences across sites in self-reported mental health problems; RESULTS: Across sites, girls on average were 1.8 (95% confidence interval 0.98-1.10) to 2.4 (95% confidence interval 2.38-2.48) times as likely as boys to have clinical elevations on all applicable MAYSI-2 scales except the Alcohol/Drug Use scale. On the Alcohol/Drug Use scale, a sex effect existed but only among youngeryouths. Whites were more likely to have clinical elevations than blacks or Hispanics; but surprisingly disparities varied across mental health categories and varied considerably across sites. CONCLUSION: At the aggregate level, 72% of girls and 63% of boys had a clinical elevation on at least one MAYSI-2 scale. Our meta-analytic technique indicated that the sex differences across sites were even larger than these numbers imply. Conversely and counter to existing evidence, race-related differences were generally small or nonexistent. Whites were more likely to have alcohol and drug problems and suicide ideation, but not more likely to have symptoms of depression, anxiety, or thought disturbance than blacks or Hispanics.

Assessment of mental capacity to consent to treatment in anorexia nervosa: A comparison of clinical judgment and MacCAT-T and consequences for clinical practice.

Informed consent requires adequate mental capacity to consent to treatment. Mental capacity (MC) to consent to treatment refers to the ability to make medical decisions. MC is assessed in a general psychiatric interview, but this clinical assessment is known to overestimate mental capacity in patients and the inter rater reliability is low. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) has emerged as the gold standard to assess mental capacity to consent to treatment. The MacCAT-T is a semi-structured interview designed to aid clinicians in this assessment and has shown good inter rater reliability in patients with schizophrenia and other mental disorders, but has hardly been studied in patients with anorexia nervosa. Patients with anorexia nervosa (AN) regularly avoid treatment, even when severely ill and discussion includes assessing MC to consent to treatment. The aim of this study is to compare clinical judgment and the MacCAT-T in evaluating MC in patients with AN which in turn may influence use of the MacCAT-T in daily practice. In a sample of 70 consecutively referred severely ill patients with AN with a mean BMI of 15.5 kg/m2 and a mean duration of illness of 8.6 years, clinical assessment of MC by experienced psychiatrists and the outcome of the MacCAT-T interview were compared. Agreement (κ-value) was calculated. Agreement between clinical assessment and outcome of the MacCAT-T was questionable (κ 0.23). Unlike in other psychiatric populations, clinicians judged a high proportion of patients with AN as having diminished MC. The MacCAT-T can be useful in assessing MC in AN when used in addition to clinical judgment to aid clinicians in complex cases. Why clinicians judge a relatively high proportion of patients with AN as having diminished MC, in contrast to lower proportions in other psychiatric disorders, is an area in need of further research.

Juvenile Justice Anger Management (JJAM) Treatment for Girls: Results of a randomized controlled trial.

This study examined the efficacy of the Juvenile Justice Anger Management (JJAM) Treatment for Girls, an anger management and aggression reduction treatment designed to meet the unique needs of adolescent girls in residential juvenile justice facilities. This randomized controlled trial of JJAM compared changes in levels of anger and aggression among girls who participated in the JJAM treatment with those of girls who participated in treatment as usual (TAU) at the facilities. This study also investigated the theoretical model underlying the JJAM treatment, which proposed that reductions in hostile attribution biases, development of emotion regulation skills, and improvement in social problem solving would serve as mechanisms of action in JJAM. Participants were 70 female youth who ranged in age from 14 to 20 years (M = 17.45, SD = 1.24) and were placed at 1 of 3 participating juvenile justice facilities; 57 youth completed the study and were included in analyses. Results revealed greater reductions in anger, reactive physical aggression, and reactive relational aggression among girls in the JJAM treatment condition when compared to girls in the TAU control condition. The proposed theoretical model was partially supported via significant mediation findings; changes in hostile attribution bias were identified as a significant mechanism of action in the JJAM treatment. Results suggest that JJAM is a promising treatment to effectively reduce anger and reactive aggression among adolescent girls in juvenile justice placements. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Progress and perils in the juvenile justice and mental health movement.

The juvenile justice system in the United States is experiencing a social movement aimed at responding to the mental and emotional problems of delinquent youths. Ironically, this movement arose in the wake of a decade of reform in juvenile justice that had set aside the system's 100-year tradition of rehabilitation for delinquents in the interests of their punishment and a primary emphasis on public safety. This article describes the recent juvenile justice and mental health movement, discusses the circumstances that motivated it, and provides examples of its progress. Now that the movement has taken hold, however, its future is threatened by several unintended consequences of the motives and strategies of those who succeeded in promoting the movement. Those potential perils are described with an eye to reducing their impact, thereby sustaining the movement and its potentially positive effects.

Aggression toward forensic evaluators: a statewide survey.

There is an increasing body of literature regarding violence toward mental health professionals in clinical settings, but little is known about the frequency of assaults on forensic evaluators. Forensic evaluators play a very different role in the evaluee's life than do treating clinicians. This study examined the incidence of aggressive behavior specifically directed toward forensic clinicians. Psychologists and psychiatrists (n = 190) in Massachusetts were surveyed regarding their experience of verbal threats, harassment/intimidation (H/I), and physical assault. Respondents were asked about the most distressing incident (MDI) in their forensic practices. This study found no more risk of aggressive behavior in the forensic context than the nonforensic context and concluded that forensic clinicians' concerns about their safety may be somewhat misplaced. In the 76 reported MDIs, physical injury was minimal, yet emotional distress was pronounced. Training programs and work settings should validate the legitimacy of these reactions, and help clinicians to cope with their emotional reactions.

Childhood traumatic experiences and mental health problems in sexually offending and non-sexually offending juveniles.

OBJECTIVE: To examine the relationship between a history of childhood abuse and mental health problems in juveniles who sexually offended (JSOs) over and above general offending behavior. METHODS: A sample of 44 JSOs incarcerated in two juvenile detention centers in the Netherlands between May 2008 and March 2014 were examined for childhood abuse history (Childhood Trauma Questionnaire-Short Form) and mental health problems (Massachusetts Youth Screening Instrument-Version 2). Furthermore, the connection between childhood abuse and mental health problems in JSOs was compared to a sample of 44 propensity score matched juveniles who offended non-sexually (non-JSOs). RESULTS: In JSOs, sexual abuse was related to anger problems, suicidal ideation, and thought disturbance. These associations were significantly stronger in JSOs than in non-JSOs. CONCLUSIONS: Our results suggest that the relationship between childhood abuse and both internalizing and externalizing mental health problems is of more salience for understanding sexual offending than non-sexual offending, and should, therefore, be an important focus in the assessment and treatment of JSOs.

An actuarial model of violence risk assessment for persons with mental disorders.

OBJECTIVES: An actuarial model was developed in the MacArthur Violence Risk Assessment Study to predict violence in the community among patients who have recently been discharged from psychiatric facilities. This model, called the multiple iterative classification tree (ICT) model, showed considerable accuracy in predicting violence in the construction sample. The purpose of the study reported here was to determine the validity of the multiple ICT model in distinguishing between patients with high and low risk of violence in the community when applied to a new sample of individuals. METHODS: Software incorporating the multiple ICT model was administered with independent samples of acutely hospitalized civil patients. Patients who were classified as having a high or a low risk of violence were followed in the community for 20 weeks after discharge. Violence included any battery with physical injury, use of a weapon, threats made with a weapon in hand, and sexual assault. RESULTS: Expected rates of violence in the low- and high-risk groups were 1 percent and 64 percent, respectively. Observed rates of violence in the low- and high-risk groups were 9 percent and 35 percent, respectively, when a strict definition of violence was used, and 9 percent and 49 percent, respectively, when a slightly more inclusive definition of violence was used. These findings may reflect the "shrinkage" expected in moving from construction to validation samples. CONCLUSIONS: The multiple ICT model may be helpful to clinicians who are faced with making decisions about discharge planning for acutely hospitalized civil patients.