Someone once told me that to get people really interested in a meeting you need to either make it free to attend or provide food. Well, thanks to funding from the North Carolina Judicial College, we are doing both for an upcoming workshop at the School of Government.  It will be held March 2-3, 2023, and will bring together diverse stakeholders from around North Carolina to begin the process of forming and developing adult protection multidisciplinary teams (MDTs). Each team may send up to seven people to participate in the workshop. The application period is now open and runs through January 13, 2023. You can learn details about the workshop and apply here.

I’ve included information below from an earlier post about MDTs in case you are new to the topic. To learn more about adult protection MDTs in North Carolina, visit https://protectadults.sog.unc.edu/ The Adult Protection Network site includes a map of North Carolina MDTs and a directory of professionals working in the field of aging and adult services in the State. If you are looking to connect with others in your community to form an MDT and apply for the workshop, it is a great place to start your search.

What is an MDT?

An MDT is a group of professionals in a geographic region who commit to working together toward a common goal.  An adult protection MDT works to find ways to prevent and respond to adult abuse, including physical, emotional, and sexual abuse, self-neglect and caretaker neglect, and exploitation, including financial exploitation.  (Read my three part series on protecting against elder abuse in NC here, here, and here.)

Adult protection MDTs have gained traction because adult abuse, neglect, and exploitation is a complex problem that is difficult to detect, prevent, and remedy. Adults may be ashamed of being a victim, lack mental capacity, or have an ongoing dependency on an abuser for care or financial support. Adult abuse, neglect, and exploitation may occur in a variety of settings, from private residences to adult care homes. The perpetrators range from family members to caregivers to strangers. There is no one field, system, or set of laws that controls the problem; a single profession or service system is rarely, alone, enough to address it. The problem tracks across disciplines and implicates areas such as physical health, mental health, financial matters, residential care, law, domestic violence, and social work.

For example, Adult Protective Services (APS) may intervene to provide protective services to a disabled adult and resolve the crisis for that particular adult. APS does not have authority to prosecute the perpetrator of the abuse and, therefore, the perpetrator is able to simply move on to another victim. Or, an adult who is the victim of abuse and lacks capacity is unable to consent to protective services offered by APS. APS then seeks a court-appointed guardian to make decisions the adult is unable to make that will protect the adult from abuse. APS then works with the court appointed guardian to ensure protective action is taken on behalf of the adult.

Types of MDTs

There are as many different types of MDTs as there are groups that form them.  One of the benefits of an MDT is its flexibility; each group is able to design what works best for their team or community based on the composition of their community and community resources.  However, MDTs generally break down in two main types: (i) case review teams, and (ii) systemic review MDTs. See Georgia J. Anetzberger, The Evolution of a Multidisciplinary Response to Elder Abuse, 13 Marquette Elder’s Advisor 107, 119 (2011).

In a case review MDT, team members recommend specific, complex cases for review by the MDT and collaborate on resolving that case. A case review team may have an information sharing agreement in place that allows them to share information about specific cases.   A case review MDT may specialize in particular types of cases, such as a fiduciary abuse specialist team (FAST) that focuses on financial exploitation or a fatality review team that focuses on investigating and prosecuting adult abuse-related deaths.

In a systemic review MDT, team members work together to address systemic problems and service gaps and develop information networks. This may include:

1. Disseminating information about new services, legislation, and policy changes to members of the MDT
2. Increasing community awareness by offering trainings to the community, including vulnerable adults, caregivers, clergy, and financial institutions
3. Establishing and reinforcing reporting protocols among members
4. Increasing understanding of the various roles, responsibilities, and limitations of each of the professionals on the MDT
5. Creating self-help materials for dissemination in the community

It is possible for a single MDT to be both a case review MDT and a systemic review MDT.

MDT Team Members

Who participates on an MDT will depend on the needs and resources of a particular community as well as the purpose of the MDT. See United States Department of Justice, Elder Justice Initiative, Developing an Elder Abuse Case Review Multidisciplinary Team in Your Community, ch. 3 (2015) [hereinafter US DOJ MDT Guide].  Some MDTs have members authorized to conduct case reviews and other members that only serve to address systemic issues.  Some MDTs engage technical advisors to consult on issues that require specialized knowledge such as forensic accountants, geriatricians, and neuropsychologists.

The composition of the MDT may grow and change over time.  It may be preferable when starting out to have a small group to build a strong foundation. Id. Possible MDT members include representatives from adult protective services, law enforcement, the district attorney’s office, area authorities on aging, judges, ombudsman, hospitals, mental health, domestic violence agencies, and private attorneys in the fields of elder law and estate planning.  The US DOJ MDT Guide provides information on selecting team members including:  (i) identifying potential members, (ii) desirable characteristics of members, (iii) limiting membership, and (iv) member recruitment.

The Role of the Court on MDTs

Judges, including clerks of superior court who preside over adult guardianship cases in NC, are limited in their ability to serve on MDTs.  A judge or clerk could serve on a systemic review MDT but could not serve on a case review MDT.  This is because judges and clerks must remain impartial and should not be involved in responding to specific cases that come before them outside of a judicial proceeding.

Judges and clerks may participate and are important actors in systemic review MDTs to improve the administration of justice.  Judges and clerks can be effective community conveners.  Judicial leadership gives a sense of urgency to a matter and emphasizes the importance of an issue.  See National Center for State Courts, Court Guide to Effective Collaboration on Elder Abuse, at 5 (2012).  Participation in systemic review MDTs may help the court to better assess capacity, craft more dynamic and tailored court orders, and more effectively oversee cases. Id.

There are a number of potential benefits to the formation and implementation of adult protection MDTs in a community.  I hope you will consider joining with others in your community and submit an application to attend the workshop.  For questions about MDTs and the content and purpose of the workshop, contact Kristy Preston (kpreston@sog.unc.edu) with the North Carolina Adult Protection Network MDT Help Desk. For questions about workshop registration or logistics, contact John Sherman (sherman@sog.unc.edu).