8: Case Review

There are a number of benefits associated with case review that flow directly to the MDT members. During case review:

• Additional forms of elder abuse may be uncovered. For example, in discussing a financial exploitation case, an MDT member mentioned that the caregiver/daughter leaves her bedridden mother for days at a time. Another MDT member observed, “Isn’t that neglect?”

• MDT members learn from each other. For example, a police officer can bring medical documents and photographs to a meeting and get immediate feedback from a nurse or physician regarding the level of suspicion and concern.

• Work is divided among the members, preventing duplication of effort.

• The MDT develops innovative and effective care plans for victims by drawing on the wisdom of multiple agency representatives and enhances feelings of competency.

• MDT members become well acquainted with one another, which increases the likelihood that MDT members will contact one another between meetings when needed.

• Information from multiple disciplines can assist in a more comprehensive and holistic view of the client and the client’s needs. For example, APS caseworkers are guided by the principle of self-determination and have different expertise than health care professionals. Therefore, APS may be persuaded by an articulate and impassioned plea by a client who wishes to remain in a questionable situation. A physician, however, may have assessed the client’s cognitive capacity, which will influence the team’s evaluation of the situation.

• Information sharing is not only a teaching strategy, but also a way for team members to understand any problems the victim may be facing. For example, a victim may say something to one professional, who can then convey that conversation to the team during case review.

The Toolkit item: Discussion of Case Review Logistics, presents a description of a number of issues related to meeting logistics that the MDT may want to discuss. And always bring food. Consistent across MDTs is the finding that providing food increases attendance and likely good will. Food can be as simple as cookies and coffee, but providing some nutritional incentive is highly recommended.

There are many ways to structure a case review meeting. However, typical steps in the case review meeting (described in greater detail in Table 2) include:

Meeting launch

Consider beginning the meeting with a presentation of the agenda and a brief reminder of the purpose of case review, any announcements, and short informal exercise to get members talking socially.

Case presentation

A member of the MDT presents a case. Information provided may include the type of abuse, the dynamics involved, victim characteristics, abuser characteristics, the victim’s wishes, any services the victim may have accessed in the past, and identification of the presenting problem (what aspect of the case is the presenter struggling with). Some MDTs require information submitted in advance (to enable the preparation of PowerPoint slides) while others do not. Typically, each case will require 30 minutes of presentation, discussion, and recommendations so be sure to allow sufficient time to review the cases on the agenda in the allotted meeting time.

In addition to reviewing new cases, some MDTs review old cases to provide an opportunity for status updates and to allow for discussion.

Discussion of the case

Next, the case is opened up for discussion among the MDT members. Any MDT member may ask questions, request more information, or brainstorm about potential solutions. For example, if there are capacity or mental health issues that warrant emergency removal orders, it may be beneficial to discuss these options with the group to determine if there are less restrictive means of advancing safety.

The team should discuss the case from a variety of perspectives. Reaching a consensus on the underlying cause of the problem will facilitate a unified solution. Framing the problem has tremendous implications for which interventions are selected, with important consequences for the victims.

Is the goal safety? Then nursing home placement may be the preferred outcomes. Is victim’s self-determination paramount? Then providing supports for the victim to remain in their own home is the preferred outcome.

A team member stated, “She doesn’t want to change.” Another team member amended the statement saying, “Maybe she doesn’t want to change, or maybe she doesn’t know how.”

Potential recommendation identified

Based on the discussion, a set of recommendations might be adopted that include a record review, new ideas regarding services in the community, suggestions for the next step an individual should take, or a house call. Any further discussion of the risks and benefits occurs at this point. Any dissenting opinions should be formally recorded. MDT members are given assignments that are recorded to ensure follow through.

Summary and recommendation adopted

The MDT Coordinator will write a formal summary of the recommendations adopted by the MDT. The MDT may want to develop a case review data collection form (or some other method of tracking meeting data). Assignments for follow-up are made this point. The meeting minutes are written and distributed as soon as possible to all MDT members. Consider including in the minutes:

• A description of the condition of the client
• Other needed services/testing and who is responsible
• Diagnosis and prognosis (if applicable)
• A statement regarding the client’s capacity to consent
• Recommendations for services
• Goals, time frames, and follow-up plans

After a thorough discussion, a plan of action should be developed and adopted by the MDT, with MDT members carrying out the recommendations. The information captured in the plan of action will assist the team in measuring the success of each case. Accountability is important for the MDT members and survival of the MDT; therefore, assignments should be made explicit during the meeting. Consider recapping assignments and expectations just before the MDT adjourns.

Follow-up

The MDT Coordinator (or whomever the MDT chooses for this role) has responsibility for following up with MDT members who were given particular assignments to enhance accountability. In addition to distributing meeting notes which contains a summary of assignments, some MDTs use email reminders to ensure MDT members are aware of their commitments. The MDT Coordinator should then hold team members accountable at the following meeting.

Report back to MDT

Finally, during the next case review meeting the original presenter reports back to the MDT as to whether the recommendations and insights of the MDT were helpful. This feedback not only validates the MDT members’ advice, but also builds trust among the MDT members.