7: Professional Development
Training is a critical component of any MDT. All three types of training, professional development, MDT, and cross training, are important to the success of the MDT. Avoid the “one-and-done” approach, but rather, offer or arrange periodic and ongoing training opportunities for the MDT.
Professional Development Across Three Types of Training
One-time training is not optimal for any profession and can negatively impact case outcomes and team effectiveness. Build into the MDT protocols periodic and ongoing training, both formal and informal, particularly as new members arrive and protocols and policy change, and the political landscape shifts. There are three types of training reviewed in this chapter:
- Professional Training
- MDT Training
- Cross Training
Over time, belonging to a group changes the ways its members view the world (Levi, 214).
Professional Training and Training in Elder Abuse
All MDT members should maintain their professions’ standards of training (e.g., continuing education training). In addition, given the varying levels of familiarity with elder abuse, all MDT members should attend elder abuse training, regardless of their level of expertise, to ensure all MDT members have the same exposure to information.
In addition, the MDT Coordinator will want to identify weaknesses in the MDT’s knowledge base and arrange for training (e.g., financial exploitation; power of attorney) where weaknesses exist. Your MDT may want to offer paying for training for MDT members whose training budgets are inadequate.
MDT Training
Not everyone instinctively knows how to collaborate and be a member of an MDT. Therefore, your MDT will benefit from MDT training. MDT training can overcome the tension between different organizational cultures and also produce morale and cohesion among team members.
If professional training is unavailable in your community, consider attending MDT training offered in other disciplines or group exercises designed to strengthen relationships. For example, consider using active learning styles such as role playing and small group discussions as some MDT members find lectures boring.
…simply putting people together in groups, representing many disciplines, does not necessarily guarantee the development of a shared understanding. …The extra ingredient that turns a group of professionals from different disciplines into an effective working team…[is] the creation of a new way of working…[which] can only emerge and develop through intense interactions (Ratcheva, 2009).
Cross Training
An important component that must be built into your MDT is cross training. As it stands, most systems are unfamiliar with other system’s mandates and jargon and the contribution each system makes to the team. Cross training provides an opportunity to ensure that all members of the MDT know each other, trust each other, and share a common vision for the MDT. These are critically important qualities. If an MDT member knows he needs help with some aspect of a case, but does not know whom on the MDT to contact, the MDT is not functioning effectively for that team member.
In addition to formal cross training (or where formal training is unavailable), informal cross training can be beneficial as well. Examples might include:
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Encourage MDT members to visit another organization
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Listen in on elder abuse intake calls
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Invite MDT members to in-service trainings
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Ask a member to make a brief educational presentation to the team on matters in which they have expertise that would be of benefit to the MDT, either in a structured manner, such as once a month, or on an ad hoc basis.
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Create your own training. Toolkit item: Issues to Discuss for Cross Training, provides an extensive list of topics for cross training purposes that the MDT may choose to discuss. Look for commonalities as well as differences across these topics. Consider these issues in the context of the case example below.
An older domestic violence victim lives in senior housing but her three sons live with the couple and sleep on the floor. She could lose her house if the housing authority learns they live there. The MDT wondered whether these sons were protective – whether her husband doesn’t beat her when the boys are home – or whether they are also abusing her. The APS caseworker is unsure. The team agreed not to notify the authorities until it was learned what role the sons play. In the meantime, a mental health provider is still seeing her to ensure the older woman has contact with someone outside her family, but is not telling the victim that she is a mental health provider. The victim either has an eating disorder or does not eat when she feels anxious.
- Consider mapping out how a typical case flows through various systems using a flow chart and where each MDT member fits in the flow chart (see below). The flow chart should begin with the referral protocol so everyone knows their role and the procedures to follow from the beginning of the case through to completion.
Santa Clara County Flow Chart
The image above depicts the Santa Clara County FAST Flow Chart.
Referrals can come from the District Attorney, the public (for example friends, relatives, neighbors, or mandated reporters), or from the Public Administrator/Guardian/Conservator.
These referrals flow into Adult Protective Services, also known as APS (phone number 1-800-414-2002).
APS receives reports of suspected abuse, screens for eligibility, and conducts a risk assessment.
Then APS refers these cases to one of two places: The Financial Abuse Specialist Team Rapid Response (also known as FAST) or to a 10 Day APS response category.
FAST Meetings are held bi-monthly.
If the case is referred to FAST, the following immediate interventions are available:
- 911 / Medical Provider Contact
- Call for Law Enforcement Assistance
- FAST Investigation
- Use Probate Code 2901 to Freeze Assets
- Referral for Probate Conservatorship
If the case is referred to the 10 Day APS response category, the following interventions are available:
- Referrals for Services
- Advocacy
- Family Support
- APS Case Management
- Public Guardian investigation/ Evaluation
- Conservatorship
These additional resources are available to both groups of referrals:
- Private Attorney
- Community Legal Services
- District Attorney
- County Counsel
Houston Sample Flow Chart
The chart above shows how a case flows from Adult Protective Services (APS) to the Texas Elder Abuse and Mistreatment Institute, also known as TEAM Institute or TEAM.
APS refers to TEAM intakes triage. From here, the case can flow in one of two directions:
- Capacity assessment only, in which case the psychiatry team in engaged, the case is referred for IDT, and then a court document is produced, or
- Medical assessment with or without a capability assessment, in which case it flows to the geriatrics team, IDT, and assessment report with or without court document, TEAM submits reports to APS, and APS and TEAM complete billing.
Have each MDT member outline the following pieces of information and then compare across members. Look for similarities and differences and discuss how these differences might be handled.
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Applicable law – laws that guide their practice
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Applicable policies – policies that guide their practice
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Culture – reward structure, agency philosophy
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Hierarchy – power structure, decision making authority
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Roles – dispel or confirm assumptions about each other’s agency
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Responsibilities – duties required as part of one’s job
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Anticipated barriers to the MDT – confidentiality issues, turf issues
From Cross Training to Protocols
Now that differences have been identified and discussed, the MDT will need to decide how to address these differences and memorialize them in protocols so they are no longer barriers.
