On the whole, multidisciplinary teams (MDTs) are designed to improve outcomes for children and families; amplify limited agency resources; improve child protection and criminal punishment systems’ outcomes; and increase the effectiveness, expertise, and job satisfaction of providers while decreasing burnout. In order to maximize these potential benefits and truly tap into the possibilities an MDT can offer for a community, however, there are several things a team can do. Working towards each of these best practices will help strengthen and guide the MDT as its members work to improve the outcomes of children and families.
Positive Interpersonal Relationships
When executed successfully, MDTs can make a world of difference in how a county handles child abuse cases. Part of the fundamental foundation of successful MDTs is having team members that “play well with each other.” This can be difficult, especially if long-standing conflicts and territorialism plague various departments/agencies in a given area. Additionally, as strong MDTs are comprised of a diverse membership with distinct perspectives and ideologies,[1] interdisciplinary conflicts (e.g. between law enforcement and advocacy) can be common if left unaddressed. This is important to address directly, as having an overarching feeling of social support within the MDT has been found to be predictive of “resilience and positive case outcomes.”[2]
One way to help level the status among team members is by “facilitating a collective team identification.”[3]
When members feel connected and integral to a larger unit (i.e., the MDT), it begins to break down the distinctions and hierarchies between roles and workers, such as if your team includes frontline workers and supervisors. This allows for differentiation based upon specific roles and what each member brings to the table. Team-building exercises can be particularly useful towards this goal.
Additionally, intentionally and regularly creating opportunities for informal contact between team members to help build personal relationships can “help to build rapport and trust between workers across agencies,”[4] serving to mitigate interagency quarrels while improving collective team identity. While this can be difficult given differing schedules, external responsibilities, and limited time aside from work duties, the return on investment is particularly rewarding. If team members are comfortable exhibiting vulnerability and seeking help from partners, they are more likely to have truly collaborative relationships, which are dependent upon “reciprocity… related to information sharing and coordination of case activities.” [5]
In surveys covering multiple MDTs across the US, members consistently cited relationships as being key to “communication and information sharing among the different agencies,” which is unanimously identified as one of the most important aspects of what makes an MDT successful.[6] n addition, ”strong collaborative relationships built over time through shared experiences,” relationships which were “built on knowing and understanding the work of other agencies and disciplines,” team members “having realistic expectations” of each other, and “relying on and trusting the other members of the team” were all recognized as critical components towards success within the MDT. [7] Truly strong and effective MDTs have committed members who, “know their position, know their responsibility, and know and trust their teammates.”[8] Doing the initial groundwork and having candid conversations up front to ensure an MDT is supportive and as familial as possible will go a long way towards strengthening relationships that will continue to benefit the team over its lifetime.
Logistics
While having team members “play well in the sandbox” together is the fundamental underpinning upon which a successful MDT is built and sustained, equally crucial are the logistical frameworks which guide the team. Research is consistent regarding several factors to consider which can substantially strengthen an MDT – these considerations include team size, meeting venue, case review, and the development of an MDT facilitator role. These should be collectively decided early upon and written into a protocol, so as to maximize their potential benefits and allow for tweaking over time as necessary.
Team Size
As meetings are increasingly moving towards online video conferencing formats, it can be easy to bring as many stakeholders into the conversation as possible. Similarly, the pendulum may shift in the opposite direction, heavily restricting the number of voices at the table. While neither approach is inherently invalid, both can be detrimental to a successful MDT. Some currently functioning teams restrict membership only to child protection, law enforcement, and the county attorney; unfortunately, this approach severely limits the benefits an MDT can offer. Conversely, while there are undeniable benefits to including agencies with knowledge of a family’s circumstances, overly-large meetings may hinder participation and stifle efficacy. Moderately-sized groups, however, ultimately “facilitate [superior] performance and communication,” and can help to level perceived status disparities among team members.[9]
Minnesota statute 260E.02 ultimately allows for any child/family-serving agencies to participate on an MDT. While too large of a team can be detrimental, having a variety of perspectives is known to, “enhance team functioning and strengthen the community response to child abuse.” [10] At the very least, in order to truly secure a comprehensive set of viewpoints to best serve both clients and team members, consider including knowledgeable representatives from the following disciplines in the core team:
- Child Protection/Welfare
- County Attorney
- Physical Healthcare
- Mental/Behavioral Healthcare
- Law Enforcement
- Probation/Juvenile Corrections
- Tribes
- Advocacy
In addition to these disciplines, there is a considerable potential benefit to including additional agencies on a team. Some MDTs have chosen to include these fields as parts of specific committees/subcommittees, and some choose to invite them as indicated per their involvement with specific youth and families:
- Safe Harbor Agencies (when sexual exploitation/trafficking is suspected)
- Schools
- Social/Family Services
- Parent Groups
- Relevant Community Collaboratives
- Children’s Advocacy Centers (CACs)
- Early Childhood and Family Education Programs
- Head Start
- Other agencies serving children and families
Co-Location/Neutral Meeting Spaces
An interesting (and potentially difficult) consideration to note in a team’s work is related to the location of its members and meetings. Continuing in the interest of leveling status among MDT members, holding meetings in a neutral location is consistently listed by those currently working on an MDT as a considerable equalizer. [11] Members reliably perceive this proximity as a considerable benefit towards key issues in the MDT model and in facilitating increased collaboration and sharing of information. [12] Given the ever-increasing ubiquity of web-based videoconferencing platforms, there is considerable potential for reaping these benefits while increasing the ease of access for agencies and disciplines physically separated from each other.
That being said, the gold standard for this matter truly is co-location of all individuals involved in an MDT. Understandably, this is unattainable for many teams due to the dwindling resources that MDTs are already working to ameliorate. However, if doable, co-location is known to further build connections, relationships, and rapport among team members; facilitate the ease of information sharing; simplify the process of collaboration; bridge the gap between a statutory and service response, and minimize logistical hurdles of meetings, case review, referrals, and follow-up. [13] [14] [15] [16] [17] [18] [19] [20]
MDT Facilitator Role
Another potential consideration to implement is in the role of the MDT facilitator, who typically assists with the bulk of scheduling meetings, case reviews, and periodic team check-ins. The presence of this role significantly improves the quality of overall collaboration “by reducing the administrative burden on workers associated with” teaming. [21] Having someone in this role who is dedicated to supporting the MDT and its general coordination proves to be a vital resource towards improving case outcomes. [22]
Many teams choose to designate a representative from their child protection/welfare agency as their MDT Facilitator; this is not a requirement, though it has proven to be a successful model. Some teams have chosen to rotate their duties so as to decrease role fatigue and allow multiple members to gain expertise in this area.
Adoption of MDT Guidelines
Once a team has determined what it is able and willing to do in relation to the previous potential considerations, the next step is typically to move forward with the development of team guidelines. As a written synthesis of agreed-upon logistical underpinnings which will guide an MDT, guidelines provide clarity regarding team member/agency roles and responsibilities, helps to onboard new members, grounds a team in its foundational principles, and further serves to minimize interagency conflict. [23] [24] [25] [26] [27] [28] [29]
This set of guidelines should be a living document – nimble, flexible, and malleable as needed to allow for customization over time. If a team institutes a recurring review process to periodically evaluate the state of its MDT, it will then be able to better respond when circumstances and cases arise that reveal limitations to its current approach. Instituting these reviews more frequently within a team “[enables] any difficulties to be resolved more quickly,”[30] and “adaptation and accommodation within” the MDT benefits team members as well as youth and families.[31] To help facilitate the development of a team’s written guidelines, the Alliance has developed resources available as part of our MDT Toolkit.
Endnotes
[1] Young & Nelson-Gardell, 2018
[2] Ballard et al., 2017
[3] Van der Vegt and Bunderson, 2005
[4] Smith, 2011
[5] Young & Nelson-Gardell, 2018
[6] ibid
[7] ibid
[8] Feng et al., 2010
[9] Van der Vegt and Bunderson, 2005
[10] Young & Nelson-Gardell, 2018
[11] Bell, 2001
[12] Ballard et al., 2017
[13] Green, Rockhill, & Burrus, 2008
[14] Newman & Dannenfelser, 2005
[15] Tye & Precey, 1999
[16] Edinburgh, Saewyc, & Levitt, 2008
[17] Humphreys, 1995
[18] Herbert, Walsh, & Bromfield, 2018
[19] Ballard et al., 2017
[20] Jackson, 2012
[21] Lalayants, 2008
[22] Ballard et al., 2017
[23] Betram, 2008
[24] Jent et al., 2009
[25] Darlington & Feeney, 2008
[26] Ells, 2000
[27] Newman et al., 2005
[28] Herbert, Walsh, & Bromfield, 2018
[29] Ballard et al., 2017
[30] Ells, 2000
[31] Ballard et al., 2017