Multidisciplinary Teams

Recognizing the diverse expertise within Adult Protection MDTs, the formation of specialized subcommittees can enhance the team’s response to specific challenges in the community. Here are some potential subcommittees to consider:

Hoarding Intervention

A subcommittee focused on hoarding might address the intricate challenges associated with hoarding behavior, which poses significant health and safety risks to individuals and the community.

Mental Health

A mental health subcommittee may develop specialized responses to the mental health needs of adults requiring protection. It might also attempt to streamline access to services for these vulnerable adults.

Fatality Review

A subcommittee that reviews fatalities might perform in-depth analyses of adult fatalities to identify patterns, systemic issues, and intervention opportunities.

Adult Abuse Prevention

An adult abuse prevention subcommittee is likely to concentrate on developing community prevention programs, such as planning adult abuse awareness events.

Financial Exploitation

A subcommittee focused on financial exploitation may tackle issues like scams, theft, and the misuse of an adult’s finances.

When selecting subcommittees, assessing the unique needs of your community is important.  Engaging with members of the MDT, outside stakeholders, and the broader community will aid in identifying the types of subcommittees that would be most beneficial.

MDTs can choose to build exercises into their agendas that facilitate continuous learning about each other’s organizations and roles.

One option is to select one of the following prompts and have everyone respond to it.  (Question 4 can generate interest, in particular.)

Another approach is to focus on a single organization and ask them to address every prompt.  In the latter case, try to avoid an overload of data.  Keep the information concise in the beginning and allow the group’s questions to direct the discussion.

This list of prompts uses Adult Protective Services (APS) as the example:

1. Call APS when ___________________.
2. The key people from APS for you to contact are ____________________.
3. To enable our best success, what APS needs from you is ____________________.
4. A resource, asset, or service APS can provide but you might not know about is _______________.
5. What can APS clarify for you about our agency?

Taking time to learn about the intricacies and challenges of each other’s work fosters respect and trust.  Seeing the details and difficulties in someone’s work can show where working together could give better results than working alone.  Working together in this way can lead to reduced frustrations, new ideas, and better results for vulnerable adults.

Strong adult protection multidisciplinary teams (MDTs) are important to effectively addressing and responding to adult abuse, neglect, and exploitation. These teams bring together professionals from various disciplines to collaborate, share information, and coordinate interventions. Here are some attributes that contribute to the strength of such teams:

Clear Mission and Goals

Establish a clear mission statement and set of goals for the MDT. Clearly define the purpose and objectives of the team’s work, ensuring that all members are aligned and motivated to achieve the same outcomes.

Leadership and Governance

Establish clear leadership roles within the team and provide strong governance structures. Effective leadership ensures that the team operates cohesively and remains focused on its mission.  Strong MDTs take the time to develop MOUs with participating agencies to clarify how the team members will work together.

Regular Training and Education

Continuous training and professional development are essential to keep team members up-to-date with the latest knowledge, best practices, and legal frameworks related to adult protection.

Regular Meetings and Communication

Hold regular team meetings to discuss cases, share information, and make decisions. Effective communication fosters a sense of shared purpose and ensures that everyone is informed and engaged.

Shared Decision-Making

The team should promote a culture of collaboration and shared decision-making. All members’ input should be valued, and decisions should be made collectively based on a holistic understanding of the situation.

Engagement with Community Partners

Strong MDTs actively engage with community organizations, advocacy groups, and other relevant stakeholders. Collaborating with these partners enhances the team’s ability to provide comprehensive support and connect vulnerable adults with additional resources.

Accountability and Oversight

Clear accountability mechanisms and oversight structures ensure that the team operates ethically and within legal guidelines. Regular reviews and audits help maintain the team’s integrity and effectiveness.

Cultural Competence

Foster cultural sensitivity and competence among team members. Develop an understanding of different cultural backgrounds to communicate effectively and tailor interventions appropriately.

Evaluation and Quality Improvement

Regularly evaluate the team’s performance, outcomes, and processes. Identify areas for improvement and implement changes to enhance efficiency and effectiveness.

Public Awareness and Education

Raise public awareness about adult protection issues and promote education within the community. Empower individuals to recognize signs of abuse and know how to report concerns.

By implementing these strategies, an adult protection multidisciplinary team can strengthen its work, improve outcomes for vulnerable adults, and contribute to creating a safer and more supportive community.

Some of the best work of an MDT can be accomplished informally—just by meeting together, building relationships, creating lines of communication, and sharing basic information about each other’s work.

However, one function that warrants a more formalized or systematic approach relates to accountability: who is going to do what, when, how, and under what circumstances. Three steps can be followed to ensure accountability within your MDT:

Step 1

Remove any role ambiguity. Talk with your team about the expected outcomes of the role and strive for agreement about why and how a task needs to be carried out. Summarize why the expectations placed on any individual will be important to the success of the team.

Step 2

Be specific about the expectations for the work. Clear explanations of the tasks are less likely to be misinterpreted. Documenting the expectations in minutes of MDT meetings provides the team with a useful reference for the future.

Step 3

Say the words. One strategy is to wrap up every meeting by summarizing the next steps people are expected to take. That also provides an opportunity to design backup plans of support or designate points of expected collaboration. Similarly, begin the next meeting by asking for updates on progress. If the MDT creates permanent roles, formalize the expectations in writing. Clarifying the expectations of the position creates ownership and can be referenced in times of confusion. It also helps prevent the duplication of responsibilities, thereby increasing productivity. Finally, provide consistent, constructive feedback and recognition for tasks to help motivate team members.

Everyone benefits by understanding each other’s roles, as well as the expectations for accountability placed on them.

Inviting complementary perspectives into your MDT is a necessary practice. No one (or two) of you can strengthen your systems of identification, intervention, and response by yourselves. A natural by-product of involving these varied perspectives is that different ideas will emerge about the best way forward. Try to resist labeling this dynamic as a problem, and reframe it as a gift, even if it is a potentially challenging one.

Here are some practices that enable respectful discussions about the different perspectives that MDT members hold:

Inquire

When approaching conflict, it is important to find the sources of the different perspectives. Ask “why?”—perhaps more than once—to identify the underlying reasons for the opinion any MDT member holds. Separate the positions (e.g., “We have to implement Plan X for this case.”) from the underlying interests (e.g., “My office doesn’t have the resources to implement Plan Y well, even if that is a preferable strategy.”)

Assess Systemic Impact

Consider how the reasons for MDT members’ opinions apply to the whole system and whether they can be traced back to an optional personal preference, rather than to policy, resources, or external influences. Employ your inner detective and your best active listening skills to fully open the dialogue and explore the ripple effects of any limitations, options, or decisions.

Refer to your Mission Statement

A complex situation can tempt a group to take off on compelling tangents. Reference your mission statement to refocus your team perspective and reset your objectivity.

Negotiate

Invite team members to identify the elements of solutions that would provide the most benefit for everyone. It is possible to design solutions that support and maintain the team’s purpose and result in a “win-win.” Solutions should be a team effort and not based on one viewpoint.

Reframe

Working through conflict is an opportunity for growth as you deepen your operation as an MDT. Take a moment to consider the specific tools and practices that helped your team work through the challenge. Whatever you did well this time, remember to do it again next time.

The following is a list of tasks that MDTs will benefit by performing, along with suggestions for those responsible for the work.

Before the Meeting

1. The Coordinator takes the lead in keeping the member list, sending out meeting notices, arranging the meeting space, and having any information or resources ready for the discussion.
2. The Chair and the Coordinator set and share the meeting agenda with MDT members.
3. If the MDT is engaging in case review, the Coordinator identifies cases and prepares them for review by the MDT members are who are legally permitted to receive that information.

During the Meeting

1. The Chair calls the meeting to order, presides over the meeting, and enforces any agreed-upon rules of engagement during the meeting discussions.
2. The Secretary takes attendance and notes during the meeting.
3. In a case review MDT, the Coordinator might also be responsible for presenting case information for discussion.
4. While the Facilitator might be the Coordinator or the leader who called the meeting, it is hard for anyone to both facilitate AND participate in the content of discussions.  Using an external facilitator might be advisable at times.
5. The Chair might end the meeting by leading the members in an informal self-evaluation to assess whether members’ expectations for the meeting were met, the extent to which the team’s values were upheld during the meeting, and how the MDT wants to improve its work in the next meeting.

After the Meeting

1. The Coordinator shares the minutes, saves the agenda and minutes to the MDT archives, and engages members to take any actions specified by case discussions.
2. Individual MDT members follow-up on any action items discussed during the MDT meeting.
3. The Coordinator maintains a roster of the members of the MDT and uses that to help identify gaps in professional representation.
4. If new recruits join the MDT, then the Coordinator or another designated volunteer orients them to the MDT’s work and structure prior to the first meeting.

MDT membership will change and evolve over time. MDT members will need to periodically discuss assigning these roles and responsibilities to different individuals as transitions happen.

All members of your MDT are busy people with many demands on their time.   Let’s assume you are missing the participation of one key stakeholder, and that absence is contributing to a lack of collective success in working on behalf of the vulnerable adults in your community.

That absentee stakeholder might have a range of reasons for non-attendance, such as:

• The time/place is inconvenient.
• The meeting date conflicts with another obligation.
• The meeting content is not a priority.
• The interpersonal dynamics on the MDT are frustrating somehow.
• The work of the MDT is perceived as not beneficial.
• The meeting notices are easy to ignore.

One strategy is to contact the absentee stakeholder directly to inquire why they do not attend and explain why they are a necessary part of the team.  Group emails are easy to ignore.  Instead, make a personal appeal to attend and provide examples of why they are needed.  “When we discussed X, we didn’t know what your office would need or could provide to intervene.”  Ask what prohibits their participation and consider whether adjustments to scheduling or the meeting process would increase their participation.

Another strategy is to design one meeting around that stakeholder’s function; give them the spotlight.  Using the district attorney as an example of the absentee stakeholder, explain the MDT members need to better understand the prosecutorial priorities of that office or the nuances of evidence collection and presentation the DA wants to see before taking on a case.  “What can we do better to enable your success as a prosecutor?”

If your MDT conducts case reviews, you might explain that you are all trying to assess what went well in a recent case, and what needs to be strengthened in the future.

Giving the absentee stakeholder the chance to explain the processes, authority, and limitations of that office can potentially open the door to better understanding and mutually beneficial interactions.

We all appreciate convenience and useful meeting content, and most of us respond affirmatively to food, good humor, and personal invitations, even when our schedules are full.

Greater understanding of each other’s responsibilities, authority, and limitations builds over time.  Building a culture of genuine curiosity, rather than blaming, helps MDT members ask questions about what each of you can and cannot do.  The important strategy is to be able to build better mutual understanding of your work, without targeting any frustration at each other, so that you can engage in successful problem-solving.  Chances are that none of your MDT members have all the power, resources, or authority they might like to exercise on behalf of your community.

Here is one exercise, with three examples of questions that could be asked.  They can be used as an opening exercise in your meetings and as a framework for sharing information with new members of the group or with the public.

Consider using a single question as an icebreaker at the beginning of a meeting.  Responses should be specific and concise rather than all encompassing.

Q1:  To enable our best work, one thing [my department or organization] needs from you is ___________.
Q2:  A common misunderstanding about the allowable scope of my work is _____.
Q3:  A resource, asset, or service [my department or organization] can provide but you might not know about is __________.

In the debrief, allow follow-up questions, then discuss any common themes that were mentioned in response to the first question.  There may be things that you all need from each other, such as complete and accurate background data or timely responses.

The creation of an MDT can emerge from any stakeholder in the county.  It could be that DSS or other key stakeholders would be willing to participate but do not have the capacity to logistically support the MDT meetings.  It could be they don’t see the potential benefit of having an MDT.

The stakeholders who ARE interested could initiate the meetings and encourage participation from all key stakeholders.  The first meeting could include an exercise to surface the various reasons why having an MDT might benefit your community.  An initial meeting that includes an exploratory discussion can inform stakeholders who inaccurately assume “everything is fine” or who are unaware of the potential benefits of having an MDT.

Reluctant members might need personal encouragement to attend.  You could consider coaching them about the benefit that their participation would offer others in the system of care.  It might be appropriate to ask them to train others about what their role is or what they need from others to succeed in their responsibilities.

The reality is that few of us want to attend meetings we don’t find useful or rewarding somehow, and we all must budget how we spend our time.  An initial strategy is to ask people what practices would make the meeting worthwhile.  It could be your meetings are spent in ways that don’t meet the interests of a few (or many) of the group members.

One way to do this is to take time in a meeting to ask everyone to fill in the blank: “For me to feel these meetings are a good use of my time and beneficial to our community, we should ____________.”

One example of competing interests for MDT meetings lies in specific vs. general information sharing. Perhaps programmatic updates should be shared in an online format rather than verbally in a meeting.  Some MDT members might only be motivated to contribute to problem-solving or other focused discussions that have a direct connection to systemic improvements.

If someone in a particular role is disengaged from the MDT, one strategy is to talk directly with that person to learn what topics would be worth the investment of their time.  You might consider asking them to attend a meeting in which they share what their office needs to succeed in their role.

One advantage of a hybrid model of MDT operation is that interests in both general and case-specific discussions can be met in alternate meetings.

If MDT members are unable to share identifiable, confidential information about specific cases with each other, one alternative option is for members to present “de-identified” cases to each other, in which all identifying characteristics and information about the vulnerable adult have been removed and key details about the case have been changed to protect the adult’s anonymity. This option may help an MDT member to get advice and strategies from other MDT members on how to handle challenging issues in a specific case, without having to disclose any confidential information about the vulnerable adult they are serving.

Practically speaking, MDT members may find it challenging to truly “de-identify” a case presentation in a way that abides by applicable confidentiality laws while still allowing for meaningful case review discussions.

For example:

Other MDT members in the room may be working with the same vulnerable adult and may be able to identify the individual based on some of the facts presented.

If a case has received public attention, other MDT members may be able to identify the individual described through pieces of information they have learned in news reports or through community chatter.

If the MDT member presenting the case changes key details of the case in an effort to protect the vulnerable adult’s identity, those key details may be relevant to providing advice on how to handle the case. In other words, if an individual’s case is truly de-identified and anonymized when it is presented, MDT members may provide less helpful or relevant recommendations about the case, because they do not know full or accurate information about the case.

If an MDT wants to try a de-identified case review approach, each MDT member that is subject to any confidentiality laws should discuss best practices and legal requirements for de-identification of case information with their agency or organization’s legal counsel.

For example, any member whose organization is subject to HIPAA must follow a specific method described in the law for de-identification of protected health information (see 45 CFR § 164.514(b)).