10: Anticipating Challenges and Troubleshooting

Potential solutions to a number of the barriers identified above are described below. This list is by no means exhaustive, and in many cases, solutions for one challenge may positively affect other challenges as well.

MDT Members Fail to Bring Cases

You may be concerned that although you “built it”, they did not come. This is not an uncommon experience. You will need to establish trust among your MDT members before they feel comfortable enough to bring cases for MDT members to review. Getting to know one another more deeply, resisting the tendency to place blame, and having clear and agreed upon guidelines for all aspects of working together, are all great ways to build a foundation of trust. 

Be patient and persistent as your team grows. Offer assistance in preparing presentations. During the presentation, the MDT Coordinator should facilitate the discussion to tamper down power differentials and avoid “blaming” anyone. 

You may also want to consider holding after-meeting debriefing sessions with presenters to think through what went well and what might be improved in real-time. This prevents negative impressions from festering and works to better prepare team members for their next presentation.

Finally, consider broadening the case consult criteria so more "grey" cases come to the MDT Coordinator. Alternatively, consider if there is a way to simplify intake process.

Lack of Trust

Building trusting relationships is challenging under any circumstance, but particularly when a diverse group of professionals are gathered for the purposes of integration and cohesion. Some team building can occur informally, such as conversations before the case review meeting. More concerted efforts include engaging in team building exercises, attending trainings as a group, engaging in social activities outside of work, and providing a safe zone for MDT members to express their opinions without fear of ridicule or reprisal.

Avoid the Pitfalls of the Blame Game

While reviewing a case, there will be times when the MDT identifies a system failure in which an agency or its representative could have responded in a more proactive manner. Mistakes will happen. While there may be the temptation to blame the agency representative for the failure, refrain. The better approach is to discuss ways to prevent failure in the future. A focus on what is best for the MDT client - rather than how an agency failed - will keep the discussion from derailing. Use this opportunity to focus on how the system can respond better in the future. The MDT must be a safe place for honest expression.

Team Meeting Attendance is Low

Studies find that attendance is an ongoing problem for many MDTs. Absenteeism is partly an issue of not having sufficient time to attend meetings, but it is also an issue of commitment. Team members may not attend if they feel they are not benefiting sufficiently. Determine the underlying reason for lack of attendance. For example, one study found that when the primary focus of an MDT shifted from prosecuting cases to providing services, participation by law enforcement officials declined. Consider videoconferencing or other new technological advances if the appropriate security measures can be assured. Additionally, it may be useful to see if team representatives from local agencies can volunteer to participate in the elder abuse MDT based on their interests rather than being assigned. Sometimes, team members may resent being assigned to a community meeting and resist attending. While this cannot always be avoided, there are often personnel within each agency that would enjoy participating in the MDT if the opportunity was presented. Having team members that value the work of the MDT is crucial to the effectiveness of the team.

Absence of Clerical Support

The MTD Coordinator has many tasks for which s/he is responsible. If possible, consider providing some clerical support. Perhaps an intern from a nearby university could enter data, send out email reminders about upcoming case review meetings, and provide other appropriate clerical support. Volunteers are another option, although considerations about confidentiality and conflict of interest will need to be addressed.

Unequal Status of MDT Members

Teams can be crippled by inequality among the MDT members, stifling the voices of some while other voices remain dominant. When MDT members with lower status feel less confident, they are less likely to voice their opinion, which may result in less advocacy for a client. If social workers are quiet in a room of physicians, the client’s medical needs may be met but not their social needs. However, under most circumstances, medical problems are not more important than social problems so no one discipline should dominate care planning. One way for the MDT to address equity is by acknowledging the inequality among MDT members. Income is one indicator of a status differential. For example, a psychologist earns 2.5 times as much as a social worker. Professional status is also important. Physicians can sometimes be intimating for other MDT members. District Attorneys are sometimes a dominant personality, but also have greater status than most MDT members. In addition, some disciplines hold unfavorable perceptions of other disciplines. For example, “Protective service investigators are not investigators in the way that criminal investigators are investigators.” Such attitudes, whether expressed or implicit, undermine the MDT’s cohesion and ultimately, their ability to work together. The express purpose of the MDT is to elicit all opinions in order to arrive at the best resolution for a client. Ensure that all members are expressing their opinions and that MDT members feel their opinions are valued. Periodically remind each team member that his or her unique knowledge and contribution to the team is invaluable. Perhaps alert your potential MDT members that explicit attempts will be made to equalize the MDT members. Adopting guidelines for how team members will interact and participate in meetings can be a useful tool to head-off potential conflict.

Different Reward Structures

MDT members are likely aware that reward structures differ among agencies, but may fail to consider how that impacts the MDT. Medicine and social services operate under a model of specialization, which reduces the amount of turnover among these disciplines. However, law enforcement values a well-rounded experience and frequently rotates their personnel, resulting in turnover every two years (in many agencies). Likewise, some agencies focus on individual rather than team achievements, which may disadvantage some team members. Another example involves District Attorneys, who focus on cases with the potential for criminal liability, while APS has a wider focus to include noncriminal cases such as self-neglect.

Turnover

It may be frustrating to be always “training” new MDT members, but that is endemic to MDTs. Embrace turnover as an opportunity to broaden the understanding of MDTs for a range of professionals within an agency as well as increasing the number of contacts the MDT has at each agency. Even when an MDT member is rotated off the MDT, that person will have the experience of having served on an MDT, which may influence the way they function in their new position.

Sustainability is Difficult

Sustainability is one of the most vexing challenges associated with MDTs. The MDT may need to be creative and request funding from several sources, both private and public. It should be noted that generally funding becomes easier once the MDT has been operating for some time and has had an opportunity to “prove” (demonstrate) its value. Many MDTs begin with grant funding and then transition to more stable sources of funding once their value is recognized. For example, California’s Santa Clara County now sustains their FAST MDT with state and county funds.

MDT Coordinator’s Salary

Salaries for the MDT representatives are typically supported by the member’s agency. However, the MDT Coordinator may require dedicated funds that can be obtained through contracts and grants, such a state VOCA grant. A related expense may be liability insurance, depending on the tasks performed by the MDT Coordinator.

Hierarchical Structure

The hallmark of an MDT is mutual collaboration and group decision-making. This is not always easy for agencies more familiar with a hierarchical structure. Team training is designed to alleviate this challenge.

State and Local Statutes Stilt Information Sharing

Although the vast majority of states have some provision or mechanism for sharing information (for more information see Toolkit item: MDT Statutory Review 2025), there may be some need for legislative action that makes information sharing explicitly permissible and/or promotes the use of MDTs. Legislative change can be a long process, but it is worth pursuing. However, recognize that there are pros and cons associated with legislation.

Team Goals are Lost

With so many different agendas and mandates represented on the MDT, selecting and maintaining team goals can be challenging. Referring to the mission and vision statement at the beginning of each team meeting can help maintain a focused team.

Stakeholder Resistance

When an MDT is in the initial stages of development, there will always be an agency administrator or two who declines the offer to participate in the MDT, or worse, prohibits an employee from joining the MDT. Your team leader will be an important force in persuading these individuals of the benefits of an MDT. Be persistent.

Case Content is Disturbing

MDT members unfamiliar with elder abuse may find these cases disturbing if not unbelievable. As mentioned, engage the entire team in elder abuse training. The advantages of an MDT are both educational, in affirming these cases really occur, and in providing emotional support when dealing with these disturbing cases becomes overwhelming. Members need to be mindful of secondary trauma by identifying it and getting help for those who need it (see OVC Vicarious Trauma Toolkit).

Losing Focus

By keeping a victim-centered focus, these challenges can be overcome. Hosting an annual working retreat can provide a forum for the team to discuss problems and work together to find solutions. Purpose, goals, mission, procedures, and any other aspects of the MDT can be revisited and improved. Additionally, retreats can assist greatly with team building and provide a forum for cross-training for new members and for those agencies that have high turnover.

In addition to understanding common challenges and solutions and employing a framework to evaluate the root cause of the challenges your team could face, it can be useful for the team to adopt a growth mindset.   

A growth mindset is a psychological concept developed by psychologist Carol Dweck. It is the belief that abilities, intelligence, and skills can be developed and improved over time through effort and learning. Growth-minded individuals perceive task setbacks as a necessary part of the learning process and they “bounce back” by increasing their motivational effort.  Over time, improvements can be seen in their tasks as they have placed value on learning rather than allowing setbacks to halt their progress.

In contrast, a fixed mindset is the belief that abilities, intelligence, and skills are largely static and cannot be significantly changed. Believing that your qualities are carved in stone—the fixed mindset—creates an urgency to prove yourself over and over. It places more value on outcomes (i.e., success or failure) than process, with little room for broader evaluation and improvement.

A growth mindset can benefit your team in the following ways:

• Resilience in the face of challenges: Elder abuse cases can be complex and emotionally challenging. Having a growth mindset means that team members are more likely to view difficulties as opportunities for learning and improvement; they are better equipped to persist in finding solutions and adapting their approaches as needed.
• Continuous learning and improvement: A growth mindset encourages an ethos of lifelong learning. Team members with this mindset are more inclined to seek out training and engage in professional development. This ongoing education enhances their knowledge and skills, making members more effective in their roles.
• Innovation and creative problem-solving: A growth mindset promotes creative thinking and innovation. Team members are more likely to think outside the box, try new strategies, and explore unconventional solutions. This can be particularly valuable in cases where traditional approaches are proving to be ineffective.
• Open communication and collaboration: When individuals believe that they can develop and improve, they are more likely to share ideas and seek input from their colleagues. This fosters the value of open communication and collaboration within the team. Different perspectives and approaches can be considered, leading to more comprehensive and effective interventions.
• Empowerment of team members: A growth mindset empowers team members to take ownership of their professional development. They are more likely to set goals, seek out resources, and take initiative in their own learning. This sense of empowerment can lead to increased confidence and job satisfaction.
• Adaptation to evolving practices: The field of elder abuse prevention is dynamic, with new research, policies, and best practices constantly emerging. A growth mindset enables team members to embrace change and stay current with the latest developments, ensuring that their interventions are informed by the most up-to-date knowledge.  

Most elder justice professionals will see an evolution in their ideas and practices over time. This is also true for teams. Having the ability to see the bigger picture, placing value on learning, and having the flexibility to evaluate and adapt as you learn will greatly benefit the professional development of your team, and yes, down the road will lead to better outcomes.