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How does the size of the MDT affect the group dynamic? The logistical effort required to sustain the effort? The potential for collective success?
Deciding group size requires the evaluation of competing tensions within MDTs. Some challenges are more logistical than substantive. Here are some points to consider, bearing in mind there is not “one right way” to set up a multi-disciplinary team.
OPT FOR BROADER EXPERTISE: Adding more people in varying roles contributes to the collective knowledge of the MDT. Having those different perspectives ready to tap can be a strong asset when problem-solving, especially in emergencies. However, as the group size increases, so might the challenges related to managing the MDT.
Consideration: Take care to clarify any overlap in professional disciplines so that members can contribute without treading on others’ territory or authority.
GROUP MANAGEMENT: Managing a large group necessitates institutionalized logistical support that is set up to be transferred as leaders transition over time. Organizing the work of a twenty-member MDT simply requires more focused effort than that of a five person MDT. The leadership roles in the larger MDT will likely also require more definition and structure. No matter the size of the MDT, storing its work history in a place accessible to all members, such as an on-line platform, will better enable transfer of responsibilities and enable a shared understanding of the MDT's history.
Consideration: Larger MDTs require more formalized expectations of leadership and management. Clarify roles and responsibilities regularly. Ensure broad access to the institutional memory of the MDT.
SUSTAINED ENGAGEMENT: As groups get larger, some members may feel less valuable or interested and choose to disengage, whether by not contributing to group discussions or otherwise not participating to their full capacity. MDT leaders will need to be intentional in reminding their diverse members why each person’s perspective matters.
Consideration: Design meeting agendas to include small group discussions or exercises that seek the input of everyone present. Do not allow those who are introverted, less interested, or distracted to passively opt out of participation. Similarly, facilitate discussions so that no one person or group dominates.
So…How many people should we include on the MDT?
There is no right answer for how many people you should have on your MDT. In the beginning, it can be advantageous to have a smaller MDT of 4 to 6 members so that you can focus on building your working relationships, then expand later as needed. A smaller dedicated team can help build the necessary foundation for the collaborative work and grow the effort over the long haul.
The following are some suggested core team members:
- Adult Protective Services
- Aging services network personnel
- Geriatricians/physicians
- Law enforcement
- Prosecutors
- Victim-witness advocates/victim service providers
- Clerks of Court
How does having a hybrid MDT affect these competing interests in group development?
A hybrid MDT would involve a small subset of professionals who use confidentiality agreements or client releases to enable case reviews. In addition, larger groups of community members would be invited to systemic reviews and general educational sessions with guest speakers. Those larger, open sessions can involve more diverse professional perspectives (such as bankers or animal control professionals) who might not be needed in all case reviews. These broader sessions can serve to educate more community professionals and key volunteers about critical local issues affecting the community’s vulnerable adults. Some attendees of the systemic review sessions might become useful recruits for the case review group.
To operate this hybrid structure, an MDT might consider one of two options: (1) Schedule separate meeting times for systematic reviews and case reviews, perhaps alternating forms from month to month. (2) Schedule a large group discussion about the system at the beginning of a meeting, take a break, and then have the smaller group reconvene with a case review. Being transparent about the different functions and limitations of the two groups will be important to build trust in the MDT.
Conclusion
Regardless of team size, it is important to set up consistent rules of engagement to ensure meetings are efficient and members are productive together, satisfied with the investment of their time in the MDT. Once facilitative leaders and the core group are established, the meetings should be held consistently. Establishing clear roles and expectations for all members of the team might take some time, but that is critical to establish a work culture that will generate mutual respect for the roles that the members play in the community.
Margaret Henderson and Rebekah Appleton relied on resources contained within the following to co-author this post:
- “Developing an Elder Abuse Case Review Multidisciplinary Team in Your Community” from the department of justice MDT toolkit. Drawing from primarily from chapter 3: https://www.justice.gov/elderjustice/mdt-toolkit
- “A Practitioner’s Perspective of Multidisciplinary Teams: Analysis of Potential Barriers and Key Factors for Success,” Psychological Thought, 2016, Vol. 9(1), 15–23. Retrieved from https://psyct.psychopen.eu/article/view/145/html#d2e259