Are there Measurement Inconsistencies by Race
on the Massachusetts Youth Screening
Instrument-version 2 that Cause a Disparity in
which Juvenile Offenders Receive Mental
Health Services?
Henrika McCoy, MSW, MJ, PhD
Boston College
Academy Health Annual Meeting
June 28, 2009
1
Background and Significance
•
600,000 juveniles with mental health disorders enter the
justice system every year.1
•
Courts are more likely to refer African American youth to
corrections facilities and Caucasian youth to psychiatric
hospitals. 2
•
For African American youth, mental health disorders are often
mis-diagnosed or not diagnosed.3,4
•
If their symptoms present with an aggressive tenor they may be
perceived as violent and not in need of mental health services.5
•
“Young Blacks in particular are more likely to kill themselves
after a confrontation or perceived victimization by institutional
authorities such as the police [or] the criminal justice system.”6
2
Research Aims & Hypothesis
•
Aim 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.
•
Aim 2: Explore the potential differences in the juvenile’s
interpretation about the purpose of the MAYSI-2’s
administration for African American versus Caucasian juvenile
offenders, and if so what are those differences.
•
Aim 3: Explore whether African American and Caucasian
juvenile offenders interpret the MAYSI-2 items differently, and
if so what are those differences.
•
Central hypothesis: a juvenile offender’s race may impact
their MAYSI-2 scores when mediated by their experiences with
discrimination, reading level, mental health service use history,
social desirability and cognitive processing.
3
Methodology and Research Design
•
Quantitative
•
African American (n=70) and Caucasian (n=20) males ages 12-17
• 90 Structured Interviews - 45 to 60 minutes
• SAS – Bivariate & Multivariate Analyses
• Mplus - Path Analysis
•
Qualitative
•
African American (n=8) and Caucasian (n=8) males ages 12-16
• 16 Semi-Structured Cognitive Interviews - 2 hour maximum
• Responses elicited via cognitive interviewing were separated by
question, grouped by race and themes identified.
• Quotes that illuminated those themes were selected.
4
Participants
1.
Parents and juveniles were approached and informed about
the study during regular visitation times by the PI or an RA.
2.
Administered the MAYSI-2 by their respective facility
3.
Between the ages of 12 and 17
4.
Male juvenile offenders detained at two Midwestern juvenile
detention facilities between March 9, 2008 and June 5, 2008
5.
Self-identified as African American, Caucasian or Bi-racial
(Caucasian and African American, Caucasian or African
American and another racial group)
5
Sample Demographics
• The mean age was 15
• Of those still in school the mean grade of enrollment was
8.9, SD=1.3
• Of those no longer enrolled the mean grade for leaving was
8.75, SD=0.99
• At or above the 5th grade level:
• Overall sample - 12.5%
• African Americans - 8.6%
• Caucasians - 20%
6
Results of Aim 1
•
Race impacted MAYSI-2 scores on all six domains.
•
Discrimination was a mediator in all six of the models. The
relationship between being African American and discrimination was
always positive.
•
Lifetime mental health service was a mediator between African
American and the MAYSI-2 in two models; in both models the
relationship was negative.
•
The relationship between social desirability and African American was
always positive. Social desirability also acted as a mediator in two of
the models – it had a negative relationship with Angry/Irritable and
Somatic Complaints.
•
There was a negative relationship between being African American
and reading level. Reading level was a mediator in the Suicide Ideation
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model – the relationship was positive.
Results of Aims 2 & 3
1.
African American and Caucasian youth interpreted
the dimension of time differently
2.
African American and Caucasian juveniles
interpreted symptoms differently
3.
There were instances where African American and
Caucasian youth misunderstood the question being
posed and therefore they may have provided
inaccurate answers.
4.
There was some suspicion of the MAYSI-2 by both
African American and Caucasian youth resulting in
minimized responses or in some case the
withholding of information.
8
Implications
•
The experiences of this population must be considered because they
may impact symptom presentation.
•
During MAYSI-2 administration, providing a specific time frame or
landmarks and alternative words or definitions could also potentially
increase reliability.
•
MAYSI-2 administrators should be made aware of possible suspicion by
youth, provided strategies for administration, and advised about what
to share with a juvenile about the MAYSI-2’s purpose.
•
Practitioners must increase their awareness about how symptoms may
differ from expectations and staff must increase their knowledge of
mental health needs.
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Conclusion
•
There are measurement issues related to race that
result in different MAYSI-2 scores and impact how
juveniles interpret the MAYSI-2 items and
administration process.
•
These issues can lead to racial disparities in referrals
for services and must be considered when
administering the MAYSI-2 and interpreting scores.
10
Funding
Fahs-Beck Fund for Research and
Experimentation
11
Thank You!
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References
1Teplin,
L. A. (2001). Assessing alcohol, drug, and mental disorders in juvenile
detainees. Washington, DC: US. Department of Justice, Office of Justice
Programs, Office of Juvenile Justice and Delinquency Prevention.
2Adebimpe, V. R. (1984). American Blacks and psychiatry. Transcultural
Psychiatric Research Review, 21, 83-111.
3Fabrega, H. Jr., Ulrich, R., & Mezzich J. E. (1993). Do Caucasian and Black
adolescents differ at psychiatric intake?. Journal of the American Academy of
Child and Adolescent Psychiatry, 32(2), 407-413.
4Hubner, J. & Wolfson, J. (2000). Handle with care: Serving the mental health
needs of young offenders. Washington, DC: Coalition for Juvenile Justice.
5Corbit, K. (2005). Inadequate and inappropriate mental health treatment and
minority overrepresentation in the juvenile justice system. Hastings Race and
Poverty Law Journal, 3, 75-93.
6Poussaint, A. F. & Alexander, A. (2000). “He didn’t seem depressed”: Faces behind
the numbers. In Lay my burden down: Unraveling suicide and the mental
health crisis of African Americans (p. 22), Boston: Beacon Press.
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