Yesterday, the application period opened for a free workshop we will be hosting September 26-27, 2019 at the School of Government in Chapel Hill.* The purpose of the workshop is to bring together stakeholders from around North Carolina to create and grow multidisciplinary teams (MDTs) to address elder abuse in their respective communities.  You can learn details about the workshop and apply here.  Only teams will be accepted to attend the workshop.  This post provides additional information to consider if you and others in your community are interested in forming a team and submitting an application.

What is an MDT?

A MDT is a group of professionals in a geographic region who commit to working together toward a common goal.  An elder abuse MDT works to find ways to prevent and respond to elder 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.)

Elder abuse MDTs have gained traction because elder abuse is a complex problem that is difficult to detect, prevent, and remedy.  There is no single definition of elder abuse or elder adult under NC law.  Older adults may be ashamed of being a victim, lack mental capacity, or have an ongoing dependency on an abuser for care or financial support.  Elder abuse 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.  It occurs across disciplines and implicates areas such as physical health, mental health, financial matters, residential care, law, domestic violence, and social work.

For example, APS may intervene to provide protective services to an older 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 older adult who is the victim of elder abuse 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 older adult from abuse.  APS then works with the court appointed guardian to ensure protective action is taken on behalf of the older 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.  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 elder 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 older 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.  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 elder abuse MDTs in a community.  I hope you will consider joining with others in your community and submit an application to attend the fall workshop.  If you have any questions, please feel free to reach out to the workshop program manager, Jessica O’Sullivan, at josullivan@sog.unc.edu.

*The workshop is sponsored by the North Carolina Conference of Clerks of Superior Court, the North Carolina Administrative Office of the Courts, and the UNC School of Government.  It is made possible by the NC Governor’s Crime Commission through PROJ012303: NCCCSC AOC Elder Abuse & Financial Exploitation 2017.