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MDT Guide and Toolkit

MDT Guide and Toolkit

2: Meeting the Needs of Your Community

Needs Assessment, Organizational Structure, Affiliation, and Purpose

In laying the foundation for developing an MDT, many communities initially undertake a needs assessment. In addition, your community will want to consider the organizational structure of the MDT, the MDT’s affiliation, and the purpose of the MDT. Many other decisions will flow from these three initial considerations.

Visit Existing MDT Models

Throughout this process, take field trips to visit other communities that utilize MDTs. It may be easier to find a nearby Child Advocacy Center that can model the MDT approach, as they are far more prevalent than elder abuse MDTs. Most Directors are willing to share their knowledge and experience with others. An added benefit is that Child Advocacy Centers vary in size and scope and you may find one that has comparable demographics to your own community. If you are unable to physically visit an MDT, most Directors would be willing to talk with you on the phone.  

You can also utilize the Elder Justice Network Locator Map to find various types of MDTs throughout the nation. Look to see if there is one nearby that you can visit or find a similar model to contact. Once you have established your MDT, consider adding your team to the map so that others can locate you to learn about your work. Participation is easy – learn how.

Needs Assessment

Your community will likely be required to provide evidence to community stakeholders that a need exists for an MDT. A needs assessment can provide that evidence.

A needs assessment is the systematic process used to identify, analyze and prioritize the needs, assets, and composition of your community. It provides a snapshot of your community at a moment in time. It is designed to be actionable. Because you are hearing from people in your community, your community is more likely to feel a part of the process, support the project, and therefore, support the plan to address the results of the needs assessment. 

A needs assessment can be used to learn many things about your community. It can pinpoint reasons for gaps in your community’s ability to respond to elder abuse and identify new and future performance needs, or help you better understand the population you are serving including their demographics, socio-economic status, religious affiliation, etc. 

To help you get started, visit the Toolkit item: Needs Assessment Planner and Needs Assessment Worksheet. Begin by thinking about what you want to learn about your community and use the needs assessment to answer your questions. For example:   

  • What does your community look like in terms of population demographics?
  • What resources are available in your community to support MDT clients?
  • Who is accessing these resources? Who is not?
  • How accessible are these services?
  • If a desired service is unavailable, how can your community acquire that service?
  • Which resources or services do older adults want?
  • What resources or services do your service providers believe older clients want and will contribute to their recovery and well-being?
  • What barriers to collaboration will need to be addressed?
  • What opportunities for collaboration exist?
  • What funding streams are available?
  • Do other MDTs exist? You may want to coordinate with existing MDTs to eliminate redundancy; one community found a “…confusing array of elder abuse teams…”.
  • What burdens have been placed on agencies due to poor system coordination?
  • What is the cost to your community when older survivors have difficulty accessing appropriate interventions? 

A needs assessment is a systematic method for answering all of these questions. You can conduct the needs assessment yourself, but you may want to collaborate with a community partner who has experience in conducting needs assessments. 

In order to conduct a successful needs assessment, your community will need to take the following steps:

  • First, clarify the purpose for your needs assessment
    • Remember the needs assessment is going to help you reach your goal. State your goal, and how the needs assessment will get you to your goal, in one sentence. This will help clarify your purpose.
  • Determine your methodology
    • Host a listening session  
    • Convene a focus group  
    • Compile a report from existing data  
    • Map assets and resources (compiling a report of existing resources and empowering the community to effectuate change using existing channels)  
    • Direct observation (go into the community with a set of questions and directly observe each item on your list in an unbiased manner)
  • Collect data
    • This involves putting your methodology into action:
      • Determine who you will contact (the number and types of people to answer your questions)
      • Which instruments you will use to gather that information (a pre-set list of questions)
      • How you are going to contact people (by phone, survey, in-person interview)
      • Your plan for analyzing the findings (summaries, statistical analysis, content analysis). For some, this involves a gap analysis where you compare what you have with what you need.
  • Analyze and interpret your findings
    • What did you learn? What does it mean? What are the implications?
    • The thing you want to be careful about is your sample and how the questions are administered to your sample. That is, think about who you want to answer your questions (identify your sample; determine how to find these people and how to access them). Then, in terms of administering the questions, everyone should receive the same set of questions in the same manner. You do not want your findings to be influenced by how the questions were administered.
  • Develop a plan
    • Finally, develop a plan for addressing the gaps identified in your needs assessment. Where are you going to find the resources? 

Coordinator Tip

While needs assessments can be complex, try not to get overwhelmed. Instead lean into your MDT’s diverse expertise and work together. There are tools and resources available to you to help you conduct a needs assessment and to do it well. In addition to this guide, you can utilize the following toolkit items:

Organizational Structure

The organizational structure may depend on which agency initiated the idea of forming an MDT. There are many ways in which MDTs have been started: 

  • Mandated by statute (e.g., ORC Ann. 5101.621)
  • Initiated by local or state policymakers
  • Organized by individuals or groups that have recognized a need for an MDT

This guide tends to focus on community-level case review MDTs. However, there are many ways in which MDTs may be structured. Discuss the strengths and weaknesses of these various options for your community:

  • State level (e.g., task force, coalition)
  • Local level (e.g., case review, systems change)
    • Organization-specific
      • Different disciplines within an institution such as a hospital
  • Community/consortium
    • Different agencies and service systems that work collaboratively
      • Agency–based joint investigations
      • Cadre of community-based and local agency members that coordinate the investigation and services
      • Elder Justice Centers based on the Family Justice Center model
      • Enhanced MDTs – an MDT that adds specialists to their teams such as forensic accountants or neuropsychologists
      • Elder Abuse Forensic Centers – an adapted Enhanced MDT model

MDT Affiliation

MDTs may be affiliated with the host agency in a variety of ways. Your team members can discuss the ways in which an affiliation might advance your team’s goals. It should be noted that affiliations can change over time as needs and relationships change while the MDT remains intact. MDTs are typically affiliated with a:

  • Medical facility (teams exist in Minnesota, New York, California, and Texas)
  • Governmental agency (e.g., adult protective services or the district attorney’s office)
  • Non-profit, such as Area Agencies on Aging
  • Federally Qualified Healthcare Center 

The Purpose of the MDT

MDTs form for a variety of purposes. The purposes listed below are not necessarily mutually exclusive or exhaustive. After reading the various descriptions, your community can discuss ways in which these purposes best meet the needs of your community.

  • Case Review (service delivery and investigation/prosecution enhancement)

    Some MDTs are developed to enhance both the investigation and prosecution of open elder abuse cases while responding to their client’s unique needs. Many of these MDTs focus on:
    • Ensuring the safety of the client and his/her property.
    • Supporting the client by creating an individualized care plan in a timely manner from a variety of disciplines.
    • Collecting comprehensive and accurate information from various team members, for example, by evaluating the client, collecting the evidence required for a case, and accessing the varied expertise needed to prosecute elder abuse.
  • Case Consultation Teams

    Some MDTs are developed to provide expert consultation to service providers and thereby focus on resolving complex open cases and enhancing client safety (e.g., medical case management teams). Complex cases can benefit from the varied perspectives and expertise of MDT members. The MDT acts as a resource for the MDT members rather than providing direct services or investigation (although some MDTs also provide direct services). Service referrals might include physical and social assessments, psychiatric screening, and mental health referrals. In some cases, the team can write a letter with recommendations, identifying the pros and cons of each recommendation.
  • Systems Change (or Community Action Teams)

    Some MDTs are developed to review closed cases in an effort to improve system responses (e.g., investigation, prosecution, service provision) and make recommendations for system improvements. There are also Coordinated Community Response teams (CCRs) as described by the National Clearinghouse on Abuse in Later Life (NCALL). 
Chapter 2: Summary

Conducting a needs assessment will facilitate an evaluation of your community, and provide your community with the evidence it needs to demonstrate to stakeholders that a need exists for an MDT. Other important decisions your community will need to make concern the organizational structure of the MDT, the organization with which the MDT is affiliated, and the primary purpose of the MDT. There are no right or wrong decisions but rather it will depend on the needs of and resources within your community. They are important decisions, however, as all other decisions will flow from these three initial decisions. For more information about foundational activities, see our Toolkit item: Additional Foundational Activities.