*This post is co-authored with my colleague, Kristi Nickodem.

For years, local stakeholders in North Carolina have been forming adult protective multidisciplinary teams (MDTs)—groups of professionals from different disciplines who find ways to prevent and respond to abuse, neglect, and exploitation of vulnerable adults. Effective October 1, Session Law 2025-23 authorizes each North Carolina county to form a “Case Review Multidisciplinary Team,” whose members will be legally permitted to share confidential information with each other as necessary to investigate, review, and coordinate services for active adult protective services cases. The stated public policy of this new law recognizes that professionals from disparate disciplines have expertise that can promote the safety and well-being of disabled adults and older adults and prevent re-victimization. G.S. 108A-118(a).  This blog post explains the requirements of the new law and addresses some frequently asked questions.  If you are interested in learning more about S.L. 2025-23, we also have a one-hour webinar that is available for free on demand.

Background on Adult Protection MDTs in North Carolina

Before exploring the requirements of the new law, readers should be aware that 74 counties in North Carolina have adult protection MDTs (a map showing which counties is available on the Adult Protection Network website).  These MDTs generally operate using one of three models:

• Systemic Review MDT: A systemic review MDT addresses systemic problems and gaps in services for vulnerable adults. This may include developing information networks between community partners and providing community education regarding the abuse, neglect, and exploitation of vulnerable adults.
• Limited Case Review MDT: A limited case review MDT discusses specific adult abuse, neglect, and exploitation cases, but each MDT member may only disclose information about a specific case to other MDT members when allowed by federal and state confidentiality laws. Different members may be subject to different confidentiality laws, which can make information sharing difficult unless cases are properly anonymized or merely hypothetical.
• Hybrid MDT: A hybrid MDT combines elements of both systemic review and case review. Hybrid MDTs might address these different elements in a variety of ways. Some hybrid MDTs might hold separate meetings for addressing systemic issues and reviewing cases, respectively. Others may integrate both functions in a single team meeting, but limit members who are at the table for case review, so that only members who are permitted to share with each other by law are present during that portion of the meeting.

Starting October 1, in addition to the three models described above, a new adult protection MDT model will be available to counties.  The model is authorized by S.L. 2025-23 and a county may elect to form this type of MDT following the requirements of S.L. 2025-23. For purposes of distinguishing the new model from the other MDT models described above, this blog post will refer to the type of MDT authorized by S.L. 2025-23 as a “Statutory Case Review MDT.” In the new Statutory Case Review MDT model—unlike the other models described above—state law authorizes all MDT members to share confidential information with each other to the extent permitted by federal law.

Requirements for the New Statutory Case Review MDT Model

Under the new law, each board of county commissioners (BOCC) is authorized (but not required) to evaluate and determine whether to (1) form its own Statutory Case Review MDT; or (2) join with other counties to form a multicounty Statutory Case Review MDT. If the county decides to pursue the Statutory Case Review MDT model, the BOCC must consult with the director of the local department of social services when determining whether to form a single county or multicounty MDT. A multicounty Statutory Case Review MDT may be formed upon agreement of the BOCCs of each of the counties involved. G.S. 108A-118.2(a)-(b). (All statutory references cite the new Article 6B of Chapter 108A of the North Carolina General Statutes (G.S.), which goes into effect October 1, 2025.)

Required Members of the MDT

The new law requires particular agencies and organizations to be represented on the Statutory Case Review MDT, each to be appointed to the MDT by a specific individual or entity designated in statute. See G.S. 108A-118.2(c). Each single county Case Review Multidisciplinary Team must consist of the following members:

1. The director of social services;
2. A staff member of the local department of social services (DSS), designated by the director of social services;
3. A local law enforcement officer, appointed by the BOCC after consultation with the district attorney’s office and the local department of social services;
4. An attorney from the district attorney’s office, appointed by the district attorney;
5. The public guardian appointed in the county by the clerk of superior court under G.S. Chapter 35A, Article 11;
6. A local mental health professional, appointed by the director of the area authority established under G.S. Chapter 122C;
7. The long-term care ombudsman serving in the county, to be appointed by the Office of the State Long-Term Care Ombudsman;
8.  The director of the local department of public health or a member of the director’s staff, as designated by the director;
9. A local health care provider, appointed by the local board of health;
10. A representative from the local area agency on aging, appointed by the director of the area agency on aging serving the county; and
11. A victim advocate from a local domestic violence or sexual assault agency, appointed by the agency’s executive director. G.S. 108A-118.2(c).

If counties join together to form a multicounty Statutory Case Review MDT, the team must consist of those same individuals, appointed from each county represented on that MDT. G.S. 108A-118.2(c). The new law does not provide a particular mechanism by which each appointing individual, agency, or public body must appoint a member. Unless the appointing individual, agency, or public body has a standard procedure for similar appointments, a simple letter or resolution naming the appointed individual would seem to be sufficient.

Each Case Review MDT must elect a member to serve as Chair at the pleasure of the MDT. G.S. 108A-118.2(f). The Chair may appoint a maximum of five additional members to serve on the MDT, representing local agencies or the community at large. G.S. 108A-118.2(d).

MDT Meetings

The Statutory Case Review MDT must meet a minimum of four times per year. The DSS director must call first meeting. Following the election of the MDT Chair, the Chair will call subsequent meetings and prepare the agenda, in consultation with the DSS director. Importantly, the Statutory Case Review MDT may continue to operate and hold meetings “despite vacancies, absences, or failure to appoint a member.” G.S. 108A-118.2(g). Statutory Case Review MDTs are not subject to the Open Meetings Law, meaning they are not required to provide public notice of their meetings or open their meetings to the general public. G.S. 108A-118.6(c).

MDT-Related Duties of the DSS Director

The new law lists several specific responsibilities of the local DSS director regarding the Statutory Case Review MDT.  G.S. 108A-118.4. The director must:

1. Bring active cases for the MDT to review. The DSS director may select cases to bring for review or a member of the MDT may request a case to be reviewed, but in either case, it must be an “active case” in which a disabled or older adult is being served by adult protective services. DSS must make an entry in the disabled adult’s or older adult’s protective services record at the time it is selected for review by the Statutory Case Review MDT indicating that it was selected for review (G.S. 108A-118.7(d)).
2. Assure that the MDT defines the categories of cases that are subject to its review. For example, the MDT might decide on a relatively narrow set of cases to review (e.g., financial exploitation cases, cases involving caregiver abuse, etc.) or may keep the scope as broad as allowed by the statute (all cases in which a disabled or older adult is being served by adult protective services).
3. Assure the development of written operating procedures in connection with the MDT’s case reviews, including frequency of meetings, confidentiality policies, training of members, and duties and responsibilities of members.
4. Provide staff support for case reviews as needed.
5. Maintain records, including minutes of all official meetings, lists of participants for each meeting of the team, and signed confidentiality statements from each member.
6. Report annually to the local board of social services, or as otherwise required by the board, on the activities of the MDT.

For a multicounty Case Review MDT, the director of each local DSS represented on the multicounty team has these powers and duties.

Sharing Confidential Information for Purposes of Case Review

One of the primary distinctions between the new Statutory Case Review MDT models and other types of MDTs is that members of the Statutory Case Review MDT model are authorized to share confidential information with each other for the purposes of reviewing an active case, unless prohibited by federal law. Under the new law, each MDT member is permitted to share any information (whether or not confidential under any other state law) with the Statutory Case Review MDT, if such information is relevant to (1) performing reviews of selected active cases in which disabled adults or older adults are being served by APS through a local DSS; or (2) providing, arranging, or coordinating services on behalf of disabled adults or older adults whose cases have been or are currently under review by the MDT. G.S. 108A-118.6(a).

An MDT member cannot disclose confidential information to the MDT if the member would be prohibited from doing so by federal law. DSS also has an additional limitation on its ability to disclose information. The DSS director and the director’s staff cannot share with the MDT any information that discloses the identity of an individual who has reported suspected abuse, neglect, or exploitation of a disabled adult or older adult to DSS, except as allowed by state or federal law. G.S. 108A-118.6(b). DSS should look to 10A NCAC 71A .0802 to determine when the reporter’s identity may be disclosed.

Confidentiality of MDT Records and Information

In addition to providing greater authority for MDT members to share information with each other, S.L. 2025-23 also provides greater protection for the Statutory Case Review MDT’s records. All information and records acquired or generated by a Statutory Case Review MDT in the exercise of its duties are confidential and may be disclosed only as necessary to carry out the purposes of the MDT (or as otherwise permitted by state or federal law). G.S. 108A-118.7(a). MDT members are, however, permitted to disclose information generated in an MDT meeting:

• to the member’s agency or organization as needed to provide or arrange services for a disabled adult or older adult;
• to the local BOCC when the MDT makes its annual recommendations, if any (but such recommendations must not identify or reveal any confidential information about individual adult protective services cases); or
• to a local board of social services by the DSS director when reporting on the activities of the MDT (but such reports must not identify or reveal any confidential information about individual adult protective services cases).

See G.S. 108A-118.7(b).

Each member of a Statutory Case Review MDT is required to sign a statement indicating that the member understands and adheres to the confidentiality requirements of G.S. 108A-118.7, including the consequences of any breach of confidentiality. One such consequence is potential removal from the MDT. If an MDT member fails to sign the required confidentiality statement or comply with the confidentiality requirements, the MDT chair must submit a written recommendation to the appropriate appointing authority for the removal of the member. G.S. 108A-118.7(c).

Nothing in the new law prohibits members of a Statutory Case Review MDT from sharing or accessing confidential information and records as permitted or required by applicable state or federal law. G.S. 108A-118.7(e). This includes, for example, any law that permits the disclosure of confidential information pursuant to the informed consent of a disabled adult or older adult or the authorized representative of a disabled adult or older adult. In other words, the new law provides one pathway for Statutory Case Review MDT members to share confidential information with one another, but it may not be the only legal mechanism by which each member may do so.

Frequently Asked Questions

Session Law 2025-23 authorizes the establishment of Statutory Case Review MDTs pursuant to the requirements described in this post.  With any new legislation, practical and legal questions inevitably arise. This section attempts to identify and answer some of the questions we’ve received to date regarding the application and implementation of this new law.

Does S.L. 2025-23 require counties to create a Statutory Case Review MDT?

No. Counties are not required to establish a Statutory Case Review MDT; it is an optional model that will become available to counties starting October 1, 2025. G.S. 108A-118.2(a).  Instead of establishing a Statutory Case Review MDT, a county may choose to continue operating under one of the existing MDT models described at the start of this post—or opt not to establish an adult protection MDT at all.  However, if a county wants to establish an adult protection MDT and to share confidential information more broadly among team members to the full extent permitted by S.L. 2025-23 and federal law, then a county may elect to form a Statutory Case Review MDT.

S.L. 2025-23 refers to the establishment of Statutory Case Review MDTs for cases involving both disabled and older adults. Do the changes enacted by S.L. 2025-23 expand DSS’s scope of APS cases to include older adults who are not also “disabled adults”?

No. Although the new law refers to both older adults and disabled adults, Statutory Case Review MDTs are limited to reviewing active cases “in which disabled adults and older adults are being served by adult protective services through a local department of social services.”  G.S. 108-118.1(1).  The authority of the county DSS with respect to adult protective services (APS) is limited to receiving and evaluating reports of abuse, neglect, and exploitation of disabled adults. G.S. 108A-14(a)(10), (11). Reading these provisions together, the new law covers disabled adults—including disabled older adults—served by APS, but does not expand DSS’s duty and authority to provide APS to older adults generally.

Must the DSS director serve on a Statutory Case Review MDT?

Yes. The DSS director is a mandatory member of a Statutory Case Review MDT and may not name a designee to serve in their place, including a deputy director. The DSS director has authority to designate a staff member to serve on the MDT, but that person acts as a separate member of the MDT. G.S. 108-118.2(c).  For most other members of the MDT, the appointing authority has discretion over who to appoint.

If a county operating a Systemic Review MDT or a Limited Case Review MDT decides to form a Statutory Case Review MDT, will some current members of the MDT have to be excluded from the Statutory Case Review MDT?

Possibly, yes. A Statutory Case Review MDT consists of the eleven mandatory members listed in G.S. 108A-118.2(c). In addition, the MDT chair may appoint a maximum of five additional members representing local agencies or the community at large to serve on the Statutory Case Review MDT. G.S. 108A-118.2(d). If a current member of the existing MDT is not among the eleven mandatory members and not appointed as an additional member by the chair, they would then be excluded from the Statutory Case Review MDT. This does not, however, preclude them from serving as a member of a Systemic Review MDT if the county elects to operate both a Statutory Case Review MDT and a Systemic Review MDT. There is no limit on the number of people who can serve on a Systemic Review MDT.

Our county is considering which MDT model we want to adopt. We currently have a Systemic Review MDT and wonder if it is possible to have both a Systemic Review MDT and a Statutory Case Review MDT in a single county?

Yes.  The new law explicitly states this: “Nothing in this Article shall be construed to prohibit a county from establishing both a Case Review Multidisciplinary Team and a Systemic Review Multidisciplinary Team.” G.S. 108A‑118.8.

The key to a hybrid approach will be making sure that there is clarity between the members of the two different teams on the different legal parameters that apply to each team (namely, members must understand everything that is authorized or required by the new law, S.L. 2025-23, only applies to the Statutory Case Review MDT). Given that there will be overlap in members between the two teams, it will be important that everyone is clear on how the meetings and teams are different from each other.

How are vacancies filled on a Statutory Case Review MDT?

Vacancies on an MDT are filled by the original appointing authority. G.S. 108A-118.2(e).  The original appointing authority for each member is set out in G.S. 108A-118.2(c) and (d).  For example, the district attorney (DA) is the original appointing authority for the MDT member who is an attorney from the DA’s office.  If a vacancy is created because the attorney from the DA’s office leaves their employment with the DA, the DA would be responsible for filling the vacancy as the original appointing authority.

Is there a process for removing a member from a Statutory Case Review MDT if the member fails to attend or otherwise participate in MDT meetings?

S.L. 2025-23 does not create a process for removing a member from the Statutory Case Review MDT for failing to attend or otherwise participate in MDTs meetings.  It does establish a process for removal of a member when the member fails to sign a confidentiality statement or comply with the confidentiality requirements imposed under the law. G.S. 108A-118.7(c). Under those circumstances, the MDT chair submits a written recommendation for removal of the member to the appropriate appointing authority.  It seems that a similar process could be followed if there is a recommendation for removal of a member for some other reason, such as failure to regularly attend meetings.

If my county decides to create a Statutory Case Review MDT, what are some necessary first steps?

A good first step for any county considering whether to form a Statutory Case Review MDT is to have conversations at the local level to decide what model works best for your community. 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.  If the team members or prospective team members decide to pursue a Statutory Case Review MDT, the DSS director could then take the matter to the BOCC to evaluate and determine whether the county will establish this type of MDT.

If you have any additional questions about MDTs or want to obtain information about what type of MDT to pursue in your community, feel free to reach out to Kristy Preston, Network Director of the Adult Protection Network (APN), who operates the APN Help Desk. More information is available on the APN Help Desk website.