8: Case Review
Defining a Case Review Meeting
Not all MDTs utilize case review, but this guidebook emphasizes and encourages this practice. Case review is a process by which the MDT regularly convenes to:
- Discuss the older adult’s well-being
- To share information efficiently
- To determine what additional information is needed by various MDT members
- To assign specific tasks to the appropriate individuals
These procedures allow team members to draw on the knowledge, experience, training, and resources of the other professionals attending the case review meeting.
Characteristics of Case Review
- Written documents that include criteria for case review procedures and meetings.
- Consensus that case review is a forum for reviewing cases on a regularly scheduled basis.
- Consensus that case review is an informed decision-making process with input from all necessary MDT members based on the needs of the case.
- The presence of a designated individual who coordinates and facilitates the case review process, including notification of cases that will be reviewed.
- Routine participation of all MDT members.
- The presence of a mechanism for communicating recommendations from case review to appropriate parties for implementation.
Benefits of Case Review to MDT Members
There are a number of benefits associated with case review that flow directly to the MDT members. During case review:
- Additional forms of elder abuse may be uncovered. For example, in discussing a financial exploitation case, an MDT member mentioned that the caregiver/daughter leaves her bedridden mother for days at a time. Another MDT member observed, “Isn’t that neglect?”
- MDT members learn from each other. For example, a police officer can bring medical documents and photographs to a meeting and get immediate feedback from a nurse or physician regarding the level of suspicion and concern.
- Work is divided among the members, preventing duplication of effort.
- The MDT develops innovative and effective care plans for their older clients by drawing on the wisdom of multiple agency representatives and enhances feelings of competency.
- MDT members build stronger relationships with one another, which increases the likelihood that MDT members will coordinate more effectively with one another between meetings.
- Information from multiple disciplines can assist in a more comprehensive and holistic view of the client and the client’s needs. For example, APS caseworkers are guided by the principle of self-determination. Their expertise differs from that of healthcare providers. Therefore, APS may be persuaded by an articulate and impassioned plea by a client who wishes to remain in a questionable situation. A physician, however, may have assessed the client’s cognitive capacity, which will influence the team’s assessment of the situation.
- Information sharing is not only a teaching strategy, but also a way for team members to understand any problems the client may be facing. For example, a client may say something to one professional, who can then convey the relevant information to the team during case review.
The opportunity to discuss the needs of older adults within a group of different professionals is conducive to a greater understanding of and respect for each other’s skills (Johansson, Eklund, & Gosman-Hedström, 2010).
Case Review Can Facilitate Trust among MDT Members
As discussed, one of the most important concepts that will facilitate a smooth-functioning MDT is trust. The success of the MDT is dependent upon establishing trust among the MDT members early and throughout the life of the MDT. Ironically, trust can be facilitated through the adoption of formal (and informal) rules and procedures because it introduces predictability.
If teams cannot critically evaluate their own innovations in a safe, shared, intellectual space, they are doomed (Disis & Slattery, 2010).
There are variations in the degree of formality among MDTs, but it is generally preferable to have formal rules and procedures in place, a factor that also contributes to building trust. Some areas to consider include:
- A summary of the proceedings (written records of meetings typically in the form of minutes; minutes may or may not be disseminated to MDT members; some teams only circulate a list of action items).
- Signed MOU (a signed agreement regarding the terms of membership and an agreement to replace representatives who can no longer serve).
- Case review guidelines (what information to include in case presentations and the order in which to present information; Toolkit item: Discussion of Case Review Logistics, provides an example).
- Policies and procedures manuals (provided to each MDT member; see Toolkit item: Sample Protocols and Policies, for examples).
- Job descriptions (done less frequently, but outlines specific duties and responsibilities of each representative and requirements for MDT participation).
- MDT new member orientation manuals (general information on elder abuse, pertinent laws, research articles, policies, mission statements, confidentiality agreements, and by-laws).
- Acceptable behavior during case review meetings, always with an eye toward building trust among the MDT members (see Toolkit item: Ground Rules during Case Review Meetings)
Case Review Meeting Logistics…and Bring Food
The Toolkit item: Discussion of Case Review Logistics, presents a description of a number of issues related to meeting logistics that the MDT may want to discuss. And always bring food to meetings. Consistent across MDTs is the finding that providing food increases attendance and likely good will. Food can be as simple as cookies and coffee, but providing some nutritional incentive is highly recommended.
Case Review Meeting Ground Rules
The Toolkit item: Ground Rules During Case Review Meetings provides an expansive list of ground rules for the MDT to discuss and consider adopting.
MDT Tip
Consider establishing ground rules for team communication, both within the meeting and in electronic communications. Rules can include expectations for respectful communication, best practices for giving constructive feedback, limiting the use of technical jargon or acronyms without providing an explanation for those terms, policies and procedures for information sharing, and anything else your team values that will facilitate productive communication.
The Case Review Meeting
There are many ways to structure a case review meeting, and many activities that can take place as part of a team’s standard practice. Many of the responsibilities in the case review meeting will belong to the MDT Coordinator. Below is a general outline of steps and activities in a case review meeting, along with tips for the MDT Coordinator. Each team will need to decide for themselves what will happen in their meetings and to whom each responsibility will belong.
Meeting Launch Coordinator Tips
- Open the meeting
- Have members sign-in
- Allow for natural conversation and encourage team members getting to know each other
- Welcome everyone once you have everyone (or most everyone) at the meeting
- Review confidentiality agreements/procedures
- Go over any news or housekeeping items
- Review any important policies or procedures (Is this needed? Do you have new members? Are you addressing any issues around policies or procedures that have come up?)
- If this is a hybrid meeting make sure to:
- Introduce the person assisting with the technical support and let virtual attendees know how to reach this person with questions
- Introduce participants attending virtually
- Ensure that the virtual attendees can see/hear the presentation and the team members discussing the case
In-Person and Hybrid Case Review Meeting Structure
Meeting Launch
Consider beginning the meeting with a presentation of the agenda and a brief reminder of the purpose of case review, any announcements, and short informal exercise to get members talking socially.
Case Presentation
A member of the MDT presents a case. Information provided may include the type of abuse, the dynamics involved, MDT client characteristics, abuser characteristics, the MDT client’s wishes, any services the client may have accessed in the past, and identification of the presenting problem (what aspect of the case is the presenter struggling with). Some MDTs require information submitted in advance (to enable the preparation of PowerPoint slides) while others do not. Typically, each case will require 30 minutes of presentation, discussion, and recommendations so be sure to allow sufficient time to review the cases on the agenda in the allotted meeting time.
In addition to reviewing new cases, some MDTs review old cases to provide an opportunity for status updates and to allow for discussion.
Case Presentation MDT Coordinator Tips
- Ensure that any agreed upon support for the presenter is in place.
- Some members may feel more comfortable having their supervisor or a teammate or another member with information about the case sitting with them to assist with questions or provide moral support. Others may wish to sit by the MDT Coordinator for support.
- Other types of support can include reasonable accommodations such as ensuring accessibility of the meeting space or equipment adaptation.
- Introduce the presenter and turn over speaking time to the presenter.
Case Discussion
Next, the case is opened up for discussion among the MDT members. Any MDT member may ask questions, request more information, or brainstorm about potential solutions. For example, if there are capacity or mental health issues that warrant emergency removal orders, it may be beneficial to discuss these options with the group to determine if there are less restrictive means of advancing safety.
The team should discuss the case from a variety of perspectives. Reaching a consensus on the underlying cause of the problem will facilitate a unified solution. Framing the problem has tremendous implications for which interventions are selected, with important consequences for MDT clients.
During the case discussion, the meeting facilitator should help the team to remain focused on the goals of case review, and help the team prioritize those goals to best meet the needs and wishes of the client they are serving. There are many goals that may pertain to each case. These goals may include: ensuring client safety, securing assets, establishing services, preventing future abuse, seeking justice through the courts, accessing family mediation, re-establishing familial connections, securing housing or safe placement, requesting medical or psychological evaluations, among many other possible goals.
Case Discussion Coordinator Tips
- Set the tone
- Choose facilitation style in advance (see above)
- New teams may need a more direct facilitation style – calling on members to generate participation and build trust
- Choose facilitation style in advance (see above)
- Ensure the psychological safety of the team
- Stop and redirect the conversation if a member begins demonstrating counter-productive behaviors
- Ensure that everyone has a clear voice in the discussion
- Call on people who have not commented
- Ask for clarification if needed
- Go deeper
- Encourage all perspectives and thinking outside of the box
- Come to consensus
- Identify potential recommendations
- Develop an action plan
- Review the action plan
- Adjust the action plan
- Assign tasks to team members
Repeat the case presentation and discussion process for each case heard at the meeting
Case Recommendations Discussion
As part of the case discussion, potential recommendations will be identified and adopted that include a record review, new ideas regarding services in the community, suggestions for the next step a team member should take, or a house call. Any further discussion of the risks and benefits occurs at this point. Any dissenting opinions should be formally recorded. MDT members are given assignments that are recorded to ensure follow through.
Recommendations and Summary
The MDT Coordinator will write a formal summary of the recommendations adopted by the MDT. The MDT may want to develop a case review data collection form (or some other method of tracking meeting data). Assignments for follow-up are made at this point. The meeting minutes are written and distributed as soon as possible to all MDT members (if that is the MDT’s protocol). Consider including in the minutes:
- A description of the condition of the client
- Other needed services/testing and who is responsible
- Diagnosis and prognosis (if applicable)
- A statement regarding the client’s capacity to consent
- Recommendations for services
- Goals, time frames, and follow-up plans
After a thorough discussion, a plan of action should be developed and adopted by the MDT, with MDT members carrying out the recommendations. The information captured in the plan of action will assist the team in measuring the success of each case. Accountability is important for the MDT members and survival of the MDT; therefore, assignments should be made explicit during the meeting. Consider recapping assignments and expectations just before the MDT adjourns.
Case Updates
The MDT Coordinator (or whomever the MDT chooses for this role) has responsibility for following up with MDT members assigned particular tasks to enhance accountability. In addition to distributing meeting notes, which contain a summary of assignments, some MDTs use email reminders to ensure MDT members are aware of their commitments. There should be an expectation that at the following meeting the MDT Coordinator will ask each team member for case updates.
During the case update portion of the meeting, ask the original presenter to report back to the MDT as to whether the recommendations and insights of the MDT were helpful. The MDT Coordinator will provide information and updates from case coordination efforts between meetings. This feedback holds members accountable, validates the MDT member’s advice, and builds trust among the MDT members.
Meeting Closure
When closing the meeting, it can be helpful to review any housekeeping protocols to which the team adheres, note when the next meeting will be held, answer any lingering questions the team members may have, and show gratitude for the work of the team. Structure and predictability in case review meetings can increase engagement and foster a sense of trust and familiarity for an MDT.
Meeting Closure Coordinator Tips
- Remind members of pertinent confidentiality protocols (if needed)
- Collecting/shredding documents
- How to coordinate outside of the meeting
- Schedule follow-ups with MDT members
- Thank everyone for their time
Case review involves the MDT members gathering (in person or virtually) to discuss particular cases. Many benefits accrue to MDT members who participate in case review. However, working out the myriad logistics and group rules is important for case review meetings to function smoothly. And bring food!