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Multidisciplinary Teams 1
A National Look at Elder Abuse Multidisciplinary Teams
Pamela B. Teaster, Ph.D.1
Lisa Nerenberg, M.S.W., M.P.H.2
Report for the
National Committee for the Prevention of Elder Abuse
Partner
National Center on Elder Abuse
The authors wish to thank the representatives of the multidisciplinary teams for their
dedication to addressing the problem of elder abuse and their assistance with this project.
1 Vice President, National Committee for the Prevention of Elder Abuse and Assistant
Professor, Ph.D. Program in Gerontology and University of Kentucky School of Public
Health, 306 Health Sciences Building, 900 S. Limestone, University of Kentucky,
Lexington, KY 40536-0200, 859.257.1450 ext: 80196 (telephone), pteaster@uky.edu
2 Consultant, National Committee for the Prevention of Elder Abuse,
lnerenberg@aol.com
Multidisciplinary Teams 2
Abstract
Elder abuse multidisciplinary teams (MDTs) include professionals from diverse
disciplines who work together to review cases of elder abuse and address systemic
problems. MDTs reflect the understanding that clinical and systemic issues often exceed
the boundaries of any single discipline or agency. Using an e-mail survey format, the
authors received information from 31 MDT coordinators across the country representing
fatality review teams, financial abuse specialist teams, medically oriented teams, and
“traditional” teams. The coordinators provided information on the functions their teams
perform, the importance of specific functions, cases reviewed, composition of teams,
policies and procedures, administration, funding, and challenges to effective functioning.
The most frequently performed functions are providing consultation aimed at assisting
workers to resolve difficult abuse cases; identifying service gaps and systems problems;
and updating members about new services, programs and legislation. When asked about
the importance of these functions, responders ranked providing consultation aimed at
assisting workers to resolve difficult abuse cases significantly higher than other functions.
Teams expressed only mild concern for breaches in confidentiality. MDTs stressed the
importance of input by professionals from the legal community for successful team
functioning.
Key Words: multidisciplinary team, elder abuse, interdisciplinary team, financial abuse,
fatality review, coordination
Multidisciplinary Teams 3
A National Look at Elder Abuse Multidisciplinary Teams
Multidisciplinary teams (MDTs), groups of professionals from diverse disciplines
who come together to review abuse cases and address systemic problems, are now a
hallmark of elder abuse prevention programs. Teams first emerged in the early 1980s in
recognition of the fact that clinical and systemic issues that abuse cases frequently pose
exceed the boundaries of any single discipline or agency.
Teams are believed to offer many benefits to professionals, clients, and
communities. In addition to helping individual service providers resolve difficult cases,
the team review process has been credited with enhancing service coordination by
clarifying agencies’ policies, procedures, and roles and by identifying service gaps and
breakdowns in coordination or communication. Teams may also enhance members’
professional skills and knowledge by providing a forum for learning more about the
strategies, resources, and approaches used by multiple disciplines.
The rapid proliferation of MDTs across the United States and Canada in the last
two decades has been accompanied by a growing demand for highly specialized expertise
in such areas as financial abuse, fatality review, and medical issues. Federal, state, and
local governments have increasingly acknowledged the importance and benefits of MDTs
and have responded by providing resources, technical assistance, and statutory authority.
Currently, there is a paucity of research examining elder abuse MDTs. The
research that does exist is localized, focuses on team development, and highlights the
benefits of MDTs (Manitoba-Seniors-Directorate, 1994; Wasylkewycz, 1993; Wolf,
1988). Research does not address the functions and composition of MDTs and is not
national in scope. Although anecdotal evidence suggests that teams offer tangible
benefits to their members and communities, in-depth studies to identify how they
function and demonstrate their impact on the problem of elder mistreatment have not
been conducted. To begin to shed light on the functioning of teams, the National
Committee for the Prevention of Elder Abuse (NCPEA), as partner in the National Center
on Elder Abuse (NCEA), carried out a national survey. Team representatives were asked
to identify key features of teams, explain variations, describe specialized teams, and
identify common obstacles and how they are being addressed. The information presented
Multidisciplinary Teams 4
below provides a picture of the various types of teams that responded to the survey.
Further, it provides a framework for decision-making for groups that are considering
starting teams or enhancing existing teams, and sets the stage for future research on
teams’ impact and effectiveness.
Methods
Because no national list of MDTs was available, the authors requested the help of
NCPEA’s Board of Directors and subscribers to NCEA’s list serve (operated by the
American Bar Association’s Commission on Law and Aging) to identify and suggest
elder abuse teams. The request yielded approximately forty recommendations. The
authors did not provide a specific definition of teams in order to capture a wide variety.
However, they attempted to include teams that represented a diverse mix in terms of size
of membership, focus, geographic location, and length of time in existence. The sample
included “traditional” MDTs as well as specialized teams including financial abuse
specialist teams (FASTs), teams with a medical orientation, and fatality review teams.
After approval by the University of Kentucky’s Institutional Review Board, the
authors sent e-mail letters to representatives or spokespersons of 40 teams. The e-mail
communication explained the project, invited representatives of MDTs to participate, and
advised potential participants of project timelines and processes. Thirty-two (32) team
coordinators indicated their willingness to participate, and the project group sent out 32
surveys to them. Coordinators were given two weeks to complete the surveys and return
them via e-mail, fax, or conventional mail. At the end of that period, members of the
project group made follow-up calls to ensure the highest possible response rate. Of the
original 40 team coordinators contacted, thirty-one returned surveys, for a response rate
of 77.5%.
Data Collection Instrument
The survey instrument (Appendix A) was developed in consultation with
members of NCPEA’s Board of Directors to elicit information on defining features of
teams such as sponsorship, funding sources, formalized policies and agreements, and
membership. Respondents were also asked to identify challenges MDTs encountered as
well as successful resolutions. They were further asked to describe products and
accomplishments. Prior to sending the survey to the entire group, it was pilot tested with
________________________________________________________________________
________________________________________________________________________
Multidisciplinary Teams 5
two team coordinators, whose suggestions were then incorporated into the final survey
that was sent to respondents.
Raw data were entered by a doctoral level graduate student in the Ph.D. Program
in Gerontology at the University of Kentucky and cross-checked for accuracy with the
assistance of another doctoral level gerontology student. The doctoral level assistant
contacted respondents for clarification when questions arose regarding the information
provided on the survey. Data were analyzed by faculty and graduate students at the
University of Kentucky using descriptive statistics.
Results
Functions of Teams
To identify the most frequently performed functions of MDTs, respondents were
given a checklist and asked to indicate those they perform. They were also invited to add
additional functions.
The two most frequently cited functions of teams (Table 1) were providing expert
consultation to service providers and identifying service gaps and systems problems
(93.5% each). Nearly all teams also update new members about services, programs, and
legislation (90.3%). Well over three-fourths of teams perform the following additional
functions: advocating for change; planning and carrying out training events; and planning
and carrying out coordinated investigations or care planning.
Table 1
Functions of the Team
Functions n %
Providing expert consultation to service providers 29 93.5
Identifying service gaps and systems problems 29 93.5
Updating members about new services, programs, legislation 28 90.3
Advocating for change 26 83.9
Planning and carrying out training events 26 83.9
Planning and carrying out coordinated investigations or care planning 25 80.6
Multidisciplinary Teams 6
Respondents were given the opportunity to list additional functions and added the
following: providing training to team members on techniques, developing a coordinated
community response to older victims of domestic violence and elder abuse victims,
encouraging the investigation and prosecution of elder abuse crimes, resolving difficult
health and social problems, cutting through delays that are built into ‘the system,’ and
providing an opportunity for colleagues to offer support and advice on such issues as
setting boundaries with clients and counter-transference.
Importance of Team Functions
In addition to identifying frequently performed functions, respondents were asked
to rate the importance of each function on a one to five scale (with one being of no
importance and five being essential). The highest ranking function was “providing expert
consultation to service providers,” which was rated as “Very Important” or “Essential” by
71% of respondents (Table 2).
Table 2
Teams’ Ranking of Functions as Very Important/Essential
Functions n %
Providing expert consultation to service providers 22 71.0
Updating members about new services, programs, legislation 18 58.1
Identifying service gaps and system problems 17 54.9
Planning and carrying out coordinated investigations or care planning 16 51.6
Planning and carrying out training events 14 45.2
Advocating for change 11 35.5
Approximately half the teams ranked as “Very Important” or “Essential” the
following functions: updating members about new services, programs, and legislation;
identifying service gaps or systems problems; planning and carrying out coordinated
investigations or care planning; and carrying out training events. As was the case with the
earlier question, respondents were invited to list additional functions and to indicate their
importance. Ranked as “Essential” were providing training to team members on
Multidisciplinary Teams 7
techniques, developing a coordinated community response to older victims of domestic
violence and elder abuse victims, and encouraging investigation and prosecution of elder
abuse crimes.
Types of Cases Reviewed
Most MDTs conduct case reviews, but they may handle the review process quite
differently. For example, some teams review all types of elder abuse cases, while others
focus on certain types. Nearly three-fourths (71.0%) review cases involving all types of
abuse and neglect. Seven teams (22.6%) focus on financial abuse cases. Of these, five
described themselves as Financial Abuse Specialist Teams (FASTs), a model developed
in Los Angeles in the early 1990s and since replicated in other communities. Despite the
common name, there are wide variations among the FASTs. For example, one FAST
meets every two weeks, only includes representatives from public agencies, and places an
emphasis on its rapid response to deter abuse and preserve assets. Another FAST has
over 50 members, includes representatives from many private, non-profit agencies, and
meets quarterly.
One team in the sample identified itself as a “fatality review team,” a model that
was originally developed in the fields of child abuse and domestic violence to review
suspicious deaths or “near-deaths.” Five additional teams indicated that they review
fatalities but did not specifically call themselves fatality review teams. Two teams
focused on medical issues in cases involving clients with multiple medical problems or
cognitive decline.
Several teams indicated that they focus on particularly problematic cases, such as
self-neglect cases, cases involving persons with mental illness and mental retardation,
high-risk situations, and cases in which guardianship is being considered. Although
many of the teams address systemic problems and issues, two teams indicated that they
focus exclusively on systemic issues (as opposed to clinical issues related to client care).
Team Attendance
Respondents were asked to indicate how many people regularly attend team
meetings. The question was posed in this way (as opposed to asking for number of
members) because teams that operate informally may welcome all interested
professionals to attend and do not require them to sign membership agreements. Nearly
Multidisciplinary Teams 8
half (45.2%) of the teams have an average attendance of between five and 10 people. Just
over one-quarter (25.8%) routinely have between 10 and 20 participants, nearly a tenth
(9.7%) have between 20 and 30 people attend regularly, and nearly a tenth (9.7%)
routinely draw more than 30 participants. One team typically has fewer than four in
attendance (3.2%). Two teams did not respond to the question (6.5%).
Attendance Requirements. A fourth of MDTs (25.8) require members to attend a
certain number of meetings yearly (e.g., five to ten). Three teams indicated that missing a
certain number of meetings (e.g., three consecutive meetings) is grounds for dismissal.
Typically, team members are encouraged to provide alternative attendees in their absence
if they are unable to attend.
Frequency of Meetings. Nearly three-fourths of MDTs (74.2%) meet monthly
(9.7% meet every two weeks, 9.7 % meet every other month and 3.2% meet quarterly).
One Team (3.2%) meets as needed in addition to its regularly scheduled meetings. To
streamline meetings, some teams have structured agendas, which include such items as
introductions, reviews of confidentiality, guest speakers or educational presentations, and
updates on services or developments in the field.
Categories of Membership
MDTs were asked specific questions about their members. Teams reported that
they recruit individual members, invite agencies to join and to designate representatives,
or both. Individual members participate for their own benefit and represent their own
viewpoints or perspectives, while agency members may serve as liaisons between their
organizations and the team, convey agency policy and perspectives, and commit
resources. Well over half of the teams (64.5%) allow individuals to join regardless of
agency affiliation.
Organization members include private non-profit agencies, public agencies, and
for-profit agencies (including professionals in private practice). Some teams only permit
non-profit agencies and individuals who work for non-profit agencies (61.3%) to join.
Slightly over one-third (35.5%) permit for-profit businesses to participate. Two teams
only include representatives from public agencies.
Certain teams have created special categories of membership. For example, some
have “core member” (e.g., APS, or law enforcement), categories that must be filled at all
Multidisciplinary Teams 9
times, and other categories that are considered desirable but not required. Teams may
extend certain benefits to some members and not others, including the right to present
cases (Table 3). Over half (58.1%) permit any team member to present cases, while
others (29.0%) only allow certain members to do so (one team only permits APS workers
to present cases, and another permits APS, Ombudsmen, law enforcement, and private
attorneys to present). Still others (25.8%) allow any service provider in the community to
present cases, regardless of whether or not they are members.
Table 3
Members Allowed to Present Cases
Case Presenters n %
Any team member can present a case 18 58.1
Certain members can present cases 9 29.0
Any service provider, regardless of membership can present 8 25.8
Note: Multiple responses were given for this question.
Respondents indicated that the responsibilities of members also vary. For
example, some teams require certain members to provide additional consultation or
training between meetings and another uses “technical advisors” who do not routinely
attend meetings but who are called upon for assistance as needed.
Disciplines Represented
Respondents were asked to indicate what professional disciplines are represented
on their teams (Table 4). The most commonly cited were police and sheriffs, which was
listed by 93.5% of respondents. APS workers participate on 83.9% of teams. Disciplines
included on more than half of the teams are: providers of geriatric mental health services,
prosecutors, aging service providers, public guardians, and domestic violence advocates.
Other disciplines represented on fewer than 50% of teams include nurses, physicians,
non-geriatric mental health professionals, and victim-witness advocates. Approximately
a third (32.3%) include representatives from financial institutions, and another third
(32.3%) include clergy. Just over one-quarter (25.8%) include retired professionals.
Multidisciplinary Teams 10
Table 4
Professionals Represented on Teams
Disciplines n %
Police/Sheriff 29 93.5
Adult Protection Services 26 83.9
Geriatric Mental Health Services 25 80.6
Prosecutors 22 71.0
Aging Service Providers/Public Guardians 20 64.5
Domestic Violence Advocates 16 51.6
Nurses 15 48.4
Physicians 13 41.9
Non-Geriatric Mental Health Professionals 13 41.9
Victim-Witness Advocates 13 41.9
Representatives from Financial Institutions 10 32.3
Clergy 10 32.3
Retired Professionals 8 25.8
Respondents were invited to list other disciplines and service categories included
on their teams, and over half (51.6%) did so. These included ethicists, animal care and
control officers, public administrators, probation and parole personnel, code enforcement
personnel, resource specialists, fire fighters, a retired judge, housing managers, housing
advocates, personnel from assisted living facilities, members of public utility boards, in-
home service providers, realtors, representatives from state long-term care licensing and
regulatory agencies, hospital social workers, emergency medical personnel, providers of
services for persons with developmental disabilities, media representatives, homeless
shelter staff, health department personnel, health statistics specialists, health advocates,
and certified public accountants.
Multidisciplinary Teams 11
Level of Team Formality
Respondents were asked several questions about formalized policies and
procedures they employ and written materials they use to document or support policies
and procedures, including meeting summaries, memoranda of understanding, “job
descriptions” for members, orientation materials, policy and procedures manuals, and
membership categories. These are described below (Table 5).
Proceedings of Meetings. Over half (54.8%) of MDTs produce written records of
meetings, which may be in the form of “minutes,” summaries of the proceedings or case
reviews, and recommendations. One team uses genograms to graphically depict the
content of the team review (charts that graphically describe the social and familial
relationships between individuals, a technique primarily used by mental health
professionals to help identify positive and negative influences affecting an individual).
Teams that produce written records of meetings vary in how they use and
disseminate them. Over half (51.6%) disseminate information on case reviews to team
members and others. One MDT disseminates minutes to members but excludes
information on case reviews, while another sends minutes to non-members in addition to
members (including all police departments in the county, the district attorney, the
Sheriff’s Department, state adult protection, the public administrator, and a legal center
for handicapped and older adults) as a way to educate these groups about the issue. A
medical team includes case review summaries in clients’ medical charts. One team that
produces minutes keeps them in a special team book maintained by the program
coordinator, who provides summaries upon request.
Contracts and Memoranda of Understanding. Just over half (51.6%) of MDTs
require members to sign contracts or memoranda of understanding, which typically
include provisions for confidentiality and terms of membership. Over a fourth of teams
(29.0%) require agency supervisors or administrators to sign contracts or memoranda of
understanding, affirming the agencies’ commitment to assign representatives and to
replace representatives who are unable to meet their commitments.
Multidisciplinary Teams 12
Table 5
Level of Team Formality
Method n %
Summarized Proceedings
Contracts/Memoranda of Understanding
Case Review Guidelines
Policy and Procedures Manuals
Job Descriptions
Orientation Manuals
Term Limits
17
16
16
10
9
9
7
54.8
51.6
51.6
32.3
29.0
29.0
22.6
Guidelines for Review of Cases. Just over half (51.6%) of teams use case review
guidelines to provide direction or suggestions to presenters on what information to
include in case presentations and the order in which to present it. Typically included are
the client’s living arrangement, support network, functional status, a description of the
abuse and/or other presenting problems, and a history of attempted interventions or
services.
Policies and Procedures Manuals. Approximately a third (32.3%) of teams
indicated that they have formal policies and procedures manuals. Only one team keeps
the manual on disk rather than having it in hard copy due to the sensitive nature of its
contents.
Job Descriptions. Over a fourth (29.0%) use job descriptions for members, which
may be contained in membership agreements, member handbooks, or elsewhere. The
state of Wisconsin has developed a manual for its counties that includes job descriptions
for representatives from the fields of law enforcement, medicine, law, domestic violence,
financial management and mental health, as well as clergy. In addition to outlining the
specific duties and responsibilities of each representative, Wisconsin’s job descriptions
also contain detailed requirements with respect to education, experience, training,
Multidisciplinary Teams 13
knowledge, skills, and abilities. For example, it is recommended that law enforcement
representatives have associates’ degrees in criminal justice or another social science.
Orientation Materials. Approximately a fourth of teams (29.0%) use orientation
materials, which usually include handbooks that contain general information on elder
abuse, pertinent laws, research articles, policies, mission statements, confidentiality
agreements, by-laws, etc. One team has produced a video that all new members must
view.
Term Limits. Nearly a fourth (22.6%) of the teams have term limits for members,
the most common of which is one year. The majority of teams (77.4%) allow members
to serve more than one term. An annual renewal process may serve as an opportunity to
review members’ participation during the year and determine whether they have met their
obligations to the MDT.
Other Information. Other written materials used by teams include a handbook for
coordinators and written protocols. Some teams solicit input from members through
routine or occasional surveys that ask how useful meetings are to members or by
requesting suggestions for educational presentations. They may further ask members to
provide information about case outcomes (e.g., were prosecutions successful as a result
of team interventions; were assets or property recovered and, if so, what was the amount).
Team members may be asked to indicate how many hours they have contributed during
and between meetings and to estimate their associated pro bono contributions. Some
teams ask members to fill out feedback forms at the end of every meeting.
Administration
MDTs were asked to provide information about administration. Four teams
(12.9%) were coordinated by an Area Agency on Aging, and APS administered 10
(52.6%) teams. Other arrangements included administration by a district attorney’s
office or in collaboration with agencies/organizations such as a university, a local non-
profit, or sheriff’s office. Some operate informally without designated administrators.
Activities associated with team administration that were cited included producing and
sending out agendas, meeting announcements and minutes; arranging for meeting space;
recruiting members and negotiating contracts and memoranda of understanding;
preparing materials such as handbooks and job descriptions; producing and disseminating
Multidisciplinary Teams 14
minutes; selecting cases; serving as a focal point for questions; and, in the case of some
teams, following up on members’ recommendations.
Leadership
Adult Protective Services (APS), the agencies mandated to respond to reports of
abuse, neglect, and exploitation of older adults in most states, play a prominent role in
MDTs. Nearly one-third of teams (32.3 %) are administered by APS programs alone or
in collaboration with other agencies (e.g., one team involves collaboration between APS
and a hospital-based geriatric program). Following APS, Area Agencies on Aging
(AAAs) (12.9%) are the next most likely entity to administer teams. Just over half
(51.6%) of the teams surveyed are administered by other agencies. These include a
county attorney’s office, a private non-profit agency, a state attorney general’s office, a
university, and an “elder abuse provider” agency.
Funding and In-kind Support
MDTs were asked to describe their sources of funding and in-kind support. The
most common source of support to teams is APS programs, which provide support to
38.7% of the teams surveyed. Most APS support is in-kind (92.0%), which includes staff
time (this may be for case workers, supervisors, support and clerical staff), meeting
space, and the printing and mailing of materials. A fourth of APS programs (25.0%)
provide funding, with amounts ranging from $70 to $250.
Area Agencies on Aging (AAA) are the second most common source, providing
support to 32.3% of the teams (again, most support is in-kind). Monetary support from
AAAs includes elder abuse funds authorized under the Older Americans Act. Dollar
amounts ranged from $3,000 to $85,122 annually.
Nearly a half of MDTs (48.4%) receive support from other sources. Monetary
support is provided by a state department of public safety, a state justice assistance
council, the American Association of Retired Persons (AARP) and foundations. Funding
amounts from these sources ranged from $500 to $10,000 yearly. Sources of additional
in-kind support included an attorney general’s office, a college of medicine, a county
hospital district, a state attorney, providers of mental health and medical services, law
enforcement, and a medical examiner’s office.
Multidisciplinary Teams 15
Calculating the costs of operating a team was complicated by the fact that few
teams have dedicated staffing. Staffing tasks are often shared by several individuals, are
likely to fluctuate over time, and may be carried out intermittently and in concert with
other tasks. Comparing costs was further complicated by the fact that teams engage in
such diverse activities as community outreach, professional training, and research, all of
which require very different levels of support. In addition, those that rely on in-kind
support typically do not track costs. Consequently, teams’ responses to questions about
their costs varied widely, with some stating that there were no costs associated with the
team, with one team indicating that it operates on an annual budget of over $85,000.
Other MDTs were unable to respond to the question.
Sources of Technical Assistance
Teams receive guidance and technical assistance from a variety of sources, the
most common of which is state agencies. State units on aging, state APS programs, and
offices of attorneys general provide assistance to approximately one-third (32.3%) of the
teams surveyed. These agencies provide manuals, sample materials, and training.
Examples include the Illinois Department of Aging, which creates resource materials,
brochures, posters, and videos. Other sources of technical assistance include national
organizations (9.7%), such as NCPEA, which operates a program of local affiliates, and a
statewide coalition of teams.
Challenges
MDTs have encountered numerous challenges. Respondents were asked to
provide information about these challenges and to describe the initiatives they have taken
to address them (Table 6).
Multidisciplinary Teams 16
Table 6
Challenges That Teams Face
Challenges n %
Lack of Participation by Certain Disciplines
Maintaining an Adequate Number of Cases
Failure of Certain Groups to Present Cases
Confidentiality
Animosity Among Members
Failure to Agreed Upon Follow-Through
Members’ Feeling Times Is Not Well Spent
15
7
5
4
3
3
2
48.4
22.6
16.1
12.9
9.7
9.7
6.7
Lack of Participation By Certain Disciplines. Half (48.4%) of the teams indicated
that they experienced difficulty gaining or maintaining participation by certain
disciplines. Foremost among these was law enforcement (42.9%). Other
underrepresented disciplines include medical professionals, clergy, prosecutors,
attorneys, representatives from financial institutions, providers of services to young
disabled adults, pharmacists, state long-term care licensing and regulatory agencies,
county attorney's offices, and mental health workers.
Maintaining an Adequate Number of Cases. Nearly a fourth of teams (22.6%)
indicated that they have trouble finding enough cases to present. One reason cited was
that APS staff members are too busy to prepare case summaries. In addition, many
communities now have more than one team, which creates “competition” for cases.
Teams have attempted to increase the number and diversity of cases by sending out e-
mail reminders about meetings and, in communities with more than one team, clarifying
the types of cases reviewed by each.
Confidentiality. Although the researchers had anticipated that breaches in
confidentiality would be a major concern of teams, only four respondents (12.9%)
indicated that this was a challenge for them. Respondents were also asked to indicate if
they had, in fact, experienced breaches. Only one team reported experiencing a “close
Multidisciplinary Teams 17
call.” This relatively moderate level of concern may reflect teams’ satisfaction with
measures they have taken to preserve confidentiality.
Measures that MDTs have taken to ensure confidentiality included confidentiality
agreements, which are employed by well over half (64.5%) of the teams and the use of
pseudonyms or initials when discussing cases (48.4%). Over a third of teams (35.5%)
operate in states that have special laws that permit the sharing of information and/or
immunity laws, which protect information disclosed at meetings from being used as
evidence in civil actions or disciplinary proceedings. Other methods for ensuring
confidentiality included written reminders about confidentiality (with applicable state
code sections) on monthly meeting agendas, outlining confidentiality provisions in a
memorandum of understanding members sign when they join the team, and not
disseminating case summaries. One respondent observed that as teams gain experience
and members get to know each other, concerns about confidentiality have decreased.
Other Challenges. Other challenges cited included the failure of certain groups to
present cases (16.1%), animosity among members (9.7%), failure of members to follow
through on actions to which they have agreed (9.7%), and members not feeling their time
is well spent (6.7%). Additional challenges cited by single respondents included: agency
representatives delegated to attend meetings do not have the authority needed to make
systems changes, and those with the authority do not attend, lack of funding and support,
and failure to achieve “buy-in” from members whose participation is not voluntary (e.g.,
they are mandated to participate).
Tangible Products
In addition to case reviews, teams engage in many other activities, the most
common being those related to training (58.1%). Training materials produced by teams
include booklets, packets, manuals, PowerPoint presentations, and a curriculum and
workbook. Groups targeted for training include bank employees, clergy, gatekeepers, the
public, law enforcement, medical students and practitioners, and mandated reporters.
Training events include conferences, workshops and “train-the-trainer programs.” Topics
covered in training sessions include fraud prevention, medical issues, APS and its role in
receiving reports (including services offered, who must report, and what to expect once a
case has been assigned to APS for investigation and follow-up), how to recognize and
Multidisciplinary Teams 18
investigate fiduciary abuse, real estate fraud, and how to gather evidence of incapacity for
guardianships and lawsuits.
Approximately one-third of MDTs (32.3%) produce other materials (not related to
training) including brochures, laminated law enforcement cards that list elder abuse
statutes, resource cards for law enforcement, a video on victim impact, a video on FAST,
websites, annual reports, newsletters, resource guides, public service announcements, and
handbooks. Replication materials produced by teams include videos and how-to
manuals.
Other activities and accomplishments cited by respondents included the
development of interagency agreements (25.8%), legislation (19.4%), a protocol for law
enforcement, and referral guidelines for APS workers. One team was developing a
volunteer program to recruit retired bank personnel to assist in investigating financial
abuse cases. The program is patterned after a successful model developed in Oregon.
Conclusions
This study was a first effort to shed light on the role, processes, varieties and
accomplishments of MDTs on a national level. Although limited in sample size (it did
not study the hundreds of teams that have emerged nationwide in the last two decades), it
underscores the benefits and costs of teams, highlights trends, and provides insight into
the challenges teams face. Further, it reveals some of the difficulties program planners
and policy makers address in anticipating the direct and indirect costs of operating teams.
Several findings are noteworthy. Assisting workers resolve difficult abuse cases
is frequently cited as the primary goal of teams and is why some teams were initiated.
Although this function was rated as the most important performed by teams, the
overwhelming majority of teams also identify service gaps and update members about
new services, resources, and legislation. This finding suggests that, although case
reviews are important in themselves, as previously believed, they frequently reveal
systemic problems and point to the need for new services, resources, legislation, and
information about new resources and developments.
Also noteworthy is the importance of legal expertise and input on teams. Police
and sheriffs, prosecutors and public guardians are among the six most commonly
Multidisciplinary Teams 19
included disciplines represented on teams, surpassing such groups as medical
professionals and domestic violence advocates.
The relatively mild concern for breaches in confidentiality was also surprising in
light of anecdotal evidence to suggest otherwise (i.e., a fatality review team in California
refrained from reviewing cases until the state passed legislation that permitted the sharing
of information).
Reported costs of operating teams varied widely, with some teams clearly not
knowing their true operational costs, although it was obvious that costs were incurred. It
may be that teams should examine, through systematic outcome evaluation, their true
costs and benefits at regular intervals to determine whether they meet their operational
goals or whether such goals can be reasonably achieved.
In conclusion, MDTs play a key role in communities’ response to elder abuse and
are highly valued by those who participate. Among the benefits they cited were
strengthening community relationships, eliminating or ameliorating turf wars, promoting
team work and cooperation, providing assistance on cases referred for guardianship,
helping clients secure improved medical care, and enhancing members’ understanding of
services. Clearly, the strength of MDTs is their ability to mobilize professionals from a
wide range of disciplines to confront the complex and growing problem of elder
mistreatment.
Multidisciplinary Teams 20
References
Manitoba-Seniors-Directorate. (February 1994). Abuse of the elderly: a manual for the
development of multidisciplinary teams. MDT Working Group on Elder Abuse,
Winnipeg, Canada.
Wasylkewycz, M.N. (1993). Elder Abuse Resource Centre, a coordinated community
response to elder abuse: One Canadian perspective. Journal of Elder Abuse and
Neglect, 5, 21-33.
Wolf, R. S. (1988). Elder abuse: Ten years later. Journal of the American Geriatrics
Society, 36, 758-762.
Multidisciplinary Teams 21
Appendix A
Questionnaire on Multidisciplinary Teams
National Committee for the Prevention of Elder Abuse
Thank you for agreeing to participate in a study of Multidisciplinary Teams (MDTs) being conducted by
the National Center for the Prevention of Elder Abuse (NCPEA).
Please complete this questionnaire to the best of your knowledge (you are welcome to add rows to the
tables or provide additional information at the end of the survey) and return it by October 4, 2002 to
Pamela Teaster by e-mail: pteaster@uky.edu or fax: 859.323.2866.
Should you need clarification regarding the questions asked, please contact:
Pamela B. Teaster: Ph: 859.257.1412 x484, e-mail: pteaster@uky.edu
Fax: 859.323.2866
CONTACT INFORMATION:
Name of Team: _____________________________________________________
Completed by:_______________________________________________________
Title and Affiliation:__________________________________________________
Telephone Number: ___________________________________________________
E-mail Address: _______________________________________________________
1. Functions of the Team. Please rate the importance of the following functions of your team by
checking the appropriate box. Use the following scale, and please make comments or indicate that
the function is not applicable.
(1) = No Importance, (2) = Somewhat Important, (3) = Important, (4) = Very Important, (5) = Essential
Function(s) (1) (2) (3) (4) (5) Comments or Not
Applicable (NA)
Provide expert consultation to service
providers
Plan and carry out coordinated
investigations or care planning
Identify service gaps/systems problems
Advocate for needed change (e.g.,
funding for services)
Plan and carry out training events
Keep members up to date about new
services and programs, legislation,
Multidisciplinary Teams 22
services, etc.
Other (specify)
2. Types of Cases Reviewed. Some teams have a special focus. They may address certain types of
abuse only, certain types of clients, or certain aspects of cases. What type of abuse cases does your
team discuss? ( Check all that apply, and please make comments).
(√ ) Type(s) of Cases Reviewed Comments
All types of abuse and clients
Exclusively financial abuse cases
Fatalities
High risk cases
Team focus is on medical aspects of cases
Other (specify)
3. Case Presentor(s). Who can present a case? (Check all that apply, and please make
comments).
(√ ) Case Presentor(s) Comments
Anyone in community
Team members
Only certain members (specify)
4. Level of Formality. Some teams have special procedures or resources. (Check all that apply, and
please make comments).
(√ ) Level of Formality Comments
Contracts or memoranda of understanding
with members
Contracts or memoranda of understanding
with members’ agencies
Job descriptions detailing the roles of
consultants
Guidelines for case reviews
Term limits (if yes, please specify)
Orientation materials (if yes, please specify)
Policy and procedures manual
Proceedings of meetings are summarized in
writing
Proceedings of meetings are summarized and
disseminated to members
Membership categories (e.g. only certain
people can present cases)
Other (specify)
Multidisciplinary Teams 23
5. Administration. Who coordinates your MDT? (Check all that apply, and please make comments).
(√ ) Administration Comments
Area agency on aging
APS
City or County funds
More than one agency operates the team
(specify)
Other agencies (specify)
6. Funding and In-kind Support. Please indicate the sources of funding and in-kind support for your
team. Types of support may include funding, staffing, meeting space, etc.
(√ ) Source of Support Monetary
(indicate
amount)
In-kind (specify)
Area agency on aging
APS
Other Community Agency
(please specify)
7. Sources of Technical Assistance. Does your team receive on-going support or technical
assistance from any of the following? (Check all that apply and please specify where possible).
(√ ) Source of Technical Assistance Agency and Type of Assistance
National organizations (specify)
State agency (specify)
State coalition (specify)
Other (specify)
8. Confidentiality. How does your team ensure confidentiality? (Check all that apply, and please
make comments).
(√ ) Confidentiality Comments
We don’t use the names of clients
being discussed
Team members sign a confidentiality
statement
State law allows for the sharing of
information
Other (please specify)
Multidisciplinary Teams 24
9. Members. Who can join the team? (Check all that apply, and please make comments ).
(√ ) Members Comments
Individuals
Non-profit agencies
For-profit agencies
10. Member Affiliation. (Check all that apply, and please make comments).
(√ ) Member Affiliation Comments
APS
Aging service providers
Public guardians
Police and/or Sheriffs
Prosecutors
Domestic violence advocates
Mental health professionals for the
elderly
Mental health professionals for the
non-elderly
Personnel from financial institutions
including banks, brokerage houses,
savings and loans
Clergy
Physicians (specify type)
Nurses
Victim Witness assistance advocates
Retired professionals
Other (specify)
11. Attendance. Estimate, to the best of your ability the average number of people who attend
meetings. (Check all that apply, and please make comments).
(√ ) Attendance Comments
Fewer than 4
Between 5-10
Between 10- 20
Between 20 – 30
More than 30
Multidisciplinary Teams 25
12. Frequency of Meeting. How often does the team meet? (Check all that apply, and please make
comments).
(√ ) Frequency Comments
Weekly
Every two weeks
Monthly
Every other month
Quarterly
As needed
Other (specify)
13. Challenge(s). What challenges has your team encountered? (Check all that apply, and explain the
significance of the challenge).
(√ ) Challenge(s) Comments
Lack of participation by certain groups
(specify)
Client confidentiality was breached
Members have concerns that
confidentiality will be breached
Private practitioners have used
meetings to market their services
Members do not participate regularly
Animosity between members
Lack of follow-through by members
Lack of cases
Certain groups fail to present cases
Members don’t feel time is well spent
Other (specify)
14. Contract Provisions. Does your team have a contract for members? (If yes, check all that apply,
and please make comments. If no, continue to Question 15).
(√ ) Contract Provisions Comments
Requirements to attend a certain
number of meetings
Membership terms (length of time)
Confidentiality
Commitment to provide consultation
outside of meetings
Prohibitions against using meetings to
market services
Other (specify)
Multidisciplinary Teams 26
15. Tangible Products. What tangible products has your team produced? (Check all that apply, and
please make comments).
(√ ) Tangible Products Comments
Sponsored or worked with legislators to
sponsor legislation (specify)
Organized a training event (specify)
Developed materials, brochures, etc.
(specify)
Conducted a needs assessment
Developed interagency agreements or
protocols
Other (specify
16. Evaluation. Has your team ever been evaluated? If yes, please specify.
17. Materials Created. Please list resource materials that you have created for team members or
other community groups.
18. Other. Please use the space below (and feel free to add pages) to make any other comments that
you would like to make about your Multidisciplinary Team.
Thank you for completing our survey!
