MDT Guide and Toolkit

2: Meeting the Needs of Your Community

Chapter 2: Summary

Conducting a needs assessment will provide your community with the evidence it needs to demonstrate to stakeholders that a need exists for an MDT. Other important decisions your community will need to make concern the organizational structure of the MDT, the organization with which the MDT is affiliated, and the primary purpose of the MDT. There are no right or wrong decisions but rather will depend on the needs of and resources within your community. They are important decisions, however, as all other decisions will flow from these three initial decisions. For more about foundational activities, see our Toolkit item: Other Activities to Build the Foundation for an MDT.

Needs Assessment, Organizational Structure, Affiliation, and Purpose

In laying the foundation for developing an MDT, many communities initially undertake a needs assessment. In addition, your community will want to consider the organizational structure of the MDT, the MDTs affiliation, and the purpose of the MDT. Many other decisions will flow from these three initial decisions.

Visit Existing MDT Models

Throughout this process, take field trips to visit other communities that utilize MDTs. It may be easier to find a nearby Child Advocacy Center that can model the MDT approach, as they are far more prevalent than elder abuse MDTs. Most Directors are willing to share their knowledge and experience with others. An added benefit is that Child Advocacy Centers vary in size and scope and you may find one that has comparable demographics to your own community. If you are unable to physically visit an MDT, most Directors would be willing to talk with you on the phone.

Needs Assessment

Your community likely will be required to provide evidence to community stakeholders that there exists a need for forming an MDT. A needs assessment can provide that evidence.

A needs assessment is the systematic effort to gather information from various sources that will identify the needs of victims in your community and the resources that are available to them. It will help your community pinpoint reasons for gaps in your community’s ability to respond to elder abuse victims and identify new and future performance needs.

It may be desirable to illustrate the current response to elder abuse in comparison with how you envision the MDT responding to these cases. An agency self-assessment may facilitate these exercises as well. Other foundational activities can be found in the Toolkit item: Other Activities to Build the Foundation for an MDT.

You may want to assess:

Resources available in your community to support the MDT
Barriers that will need to be addressed
Existing MDTs (and coordinate with existing MDTs to eliminate redundancy; one community found a “…confusing array of elder abuse teams…”)
Special populations that are in need of services

Organizational Structure

The organizational structure may depend on which agency initiated the idea of forming an MDT. There are many ways in which MDTs have been started:

Mandated by statute
Organized by individuals or groups that have recognized a need for an MDT
Initiated by local or state policymakers

This guide tends to focus on community-level case review MDTs. However, there are many ways in which MDTs may be structured. Discuss the strengths and weaknesses of these various options for your community:

State level (e.g., task force, coalition)
Local level (e.g., case review, systems change)
- Organization-specific
  - Different disciplines within an institution such as a hospital
- Community/consortium
  - Different agencies and service systems that work collaboratively
    - Agency-based joint investigations
    - Cadre of members that coordinate investigation and services
    - Elder Justice Forensic Centers

MDT Affiliation

MDTs may be affiliated in a variety of ways. Your community can discuss the ways in which MDTs are typically affiliated with a:

Medical facility (teams exist in Minnesota, New York, California, and Texas)
Governmental agency (e.g., adult protective services)
Non-profit, such as Area Agencies on Aging
Federally Qualified Healthcare Center

The Purpose of the MDT

MDTs form for a variety of purposes. The purposes listed below are not necessarily mutually exclusive. After reading the various descriptions, your community can discuss ways in which these purposes best meet the needs of your community.

Case Review (service delivery and investigation/prosecution enhancement)

Some MDTs are developed to enhance both the investigation and prosecution of open elder abuse cases while responding to victim needs. Many of these MDTs focus on:

Ensuring the safety of the victim and his/her property.
Supporting the victim by creating an individualized care plan in a timely manner from a variety of disciplines for each victim.
Collecting comprehensive and accurate information from various team members, for example, by evaluating the victim, collecting the evidence required for a case, and accessing the varied expertise needed to prosecute elder abuse.

Systems Change (or Community Action Teams)

Some MDTs are developed to review closed cases in an effort to improve system responses (e.g., investigation, prosecution, service provision) and make recommendations for system improvements. There are also coordinated community response teams as described by the National Clearinghouse on Abuse in Later Life (NCALL).

Case Consultation Teams

Some MDTs are developed to provide expert consultation to service providers and thereby focus on resolving complex open cases and enhance victim safety (e.g., medical case management teams). The investigation of these cases is de-emphasized given that most cases will not be prosecuted. Nonetheless, these complex cases can benefit from the varied perspectives and expertise of MDT members. The MDT acts as resource for the MDT members rather than provide direct services or investigation (although some MDTs also provide direct services). Service referrals might include physical and social assessments, psychiatric screening, and mental health referrals. In some cases, the team can write a letter with recommendations, identifying the pros and cons of each recommendation.