Validating the modified mini screen (MMS) as a mental health referral screen for public assistance recipients in New York State

This study validated and developed guidelines for the Modified Mini Screen (MMS) to screen people receiving welfare benefits in New York State (NYS) for Mental Health (MH) conditions. Driven in part by lifetime limits on federal benefits, the proportion of people with MH conditions receiving welfare has increased but their MH service use is low. The welfare system may provide a point of access to MH services for underserved populations. A computer-assisted protocol delivered the MMS, demographic, and health-related questions (MOS-SF-12) to a representative sample of 490 welfare recipients. Telephone SCIDs identified a MH condition. Bivariate and ROC analyses were conducted to describe the sample, evaluate group differences, and validate the screen. Researchers found that 52% of participants met criteria for a non-substance-related lifetime MH condition. 36% met current criteria but 44% were not engaged in treatment. Participants with a MH condition reported more health problems, more disability days and lower levels of functioning than those without a MH condition. The MMS was reliable internally (Cronbach's alpha=.92) and over time (rho=.71). Accuracy was greatest when 7-9 items were endorsed (.81-.96, sensitivity; .69-.77, specificity). Therefore, the MMS is an accurate and reliable tool for guiding welfare system's MH referral practices. Screening and increased referrals may have a significant impact on local resources including behavioral health and primary care agencies. Implementation guidelines will take into account policy objectives, the impact on clients, treatment resources and local social service departments. Computer-assisted technology promotes access for people with varied literacy and elicits honest responses.