Using a Multi-Disciplinary Team (MDT) ApproachCindy Conine, B.S., Lisa Daniel, B.S.,C. Curtis Holmes, Ph.D., Katie Lumsden, J.D. Tina McAfee, B.A., Lieutenant Jamie McDaniel Tara Raffield, M.S., Beverly Sanders, B.A. Carolyn Schomer, M.Ed., M.S.W., Captain Jerry Stewart | ||||||||||||||||||||||||||||||||||||||
What is a Multi-Disciplinary Team (MDT)?One of the core factors related to improved handling of child sexual abuse (CSA) cases includes the creation of a collaboration of efforts from all of the primary disciplines involved. Different communities will have different disciplines represented depending on each community's unique characteristics. However, communities should strive to evolve so that eventually 5 specific disciplines are clearly represented at the core of MDT teams. The 5 core disciplines are:
MDT membership may include other professions/agencies which suit the purposes of that particular community. A national survey by Kolbo & Strong (1997) identified that other frequent participants included professionals from; education, juvenile corrections, family support and child care agencies, and Court Appointed Special Advocates (CASA). The initiatives to utilize MDT approaches now exist in all 50 states, but the approach in each state is unique. Georgia has established a requirement for each county to develop its own protocol on how child abuse cases will be handled (See GA Code 19-15-2 G (http://www.state.ga.us/services/ocode/ocsearch.htm). To explore these protocols, please refer to the section of this web site entitled "Child Protective Services Issues". The logical evolution of a community MDT approach usually results in a Child Advocacy Center (CAC) model. For communities that already have a CAC, the sixth core professional on the MDT should be a child advocate (or other similar CAC staff member). All communities in Georgia do not have access to a CAC. Currently, there are 21 full member CACs in the Georgia Network of Child Advocacy Centers (GNCAC). Some CACs serve more than one county. About another ten communities have centers that are developing but are not yet qualified to be full members. These data also show that, presently, the vast majority of counties in Georgia do not yet have access to a CAC. The GNCAC has a goal of having every community eventually gain access to a CAC, but that goal is far from being a current reality. However, ANY community can use the basics of an MDT approach, even if it is still years away from having access to an organized and fully accredited CAC. In addition, we now know more about what makes MDTs work and how to best use them. One way to think about how to utilize an MDT approach in a specific community is to view the choices as a continuum. Some communities may only be able to utilize an alliance between the Law Enforcement Officer (LEO) and Child Protective Service (CPS) caseworker. Other communities may have fully functioning CACs that are collaborating even further with such issues as domestic violence and/or with other concerns about children/youth/families. Where a community is located on this continuum can assist in determining what new steps to consider. What is clear, however, is that a community should attempt to move forward along this continuum. A Community MDT Continuum
The use of an MDT approach for investigating child sexual abuse can greatly improve a community's response through improvements in:
The essence of the MDT approach is collaboration. COLLABORATIONSome of the key elements of collaboration on CSA cases include:
Accomplishing effective collaboration involves specific behaviors as well as following certain attitudes by the participants. Effective MDTs have members who practice the following attitudes:
However, collaboration is not usually a linear process, and it is not always a smooth process. A number of barriers typically impact communities as they struggle to evolve. Some of those characteristic barriers include:
Problems can occur when agency participants are not clear about their own agency goals and those of all other agencies participating. It is a good idea when building a collaborative MDT team to spell out individual agency perspectives. So participants can be aware of what issues need to be worked on and understand how to interpret reactions from different agency perspectives. This diminishes the sense of disagreements being of a personal nature. Here are some of those issues specific to the agency involved: CPS Perspective
Law Enforcement Perspective
Prosecutor Perspective
Health Care Provider Perspective
Therapy Treatment Provider Perspective
Child Advocacy Center Advocate Perspective
In most communities, collaboration does not occur and then remain the same forever, like building a monument and then admiring it from then on. Instead, collaboration seems to occur in levels. Some communities will be satisfied reaching and maintaining a certain level. Other communities will keep reforming new goals at different levels. Typical levels include:
With an MDT approach, communities can attach these different levels of collaboration and keep them current with the changing of time and community needs. The current reality is that not all communities at this time can afford a fully functioning CAC model although they might at a later date. What can a community do with an MDT approach with or without a fully functioning CAC? Possible activities of an MDT team can include:
Some communities decide to start the activities of an MDT approach by first having joint efforts at interviewing between CPS and Law Enforcement. At this point in our knowledge of what creates the best outcomes in CSA cases, there is no acceptable reason to have a policy of separate interviews by Law Enforcement and CPS. This is often a good starting point from which a Multi-Disciplinary Team can expand. What can we understand about the multidisciplinary nature of joint interviews that can be expanded to better and more efficient practices? The joint interview can:
A growing body of research supports how MDT approaches are a more effective and efficient way to render services to suspected abused children. MDTs can improve the accuracy of overall assessment, prediction of risk, and development of intervention strategies (Chadwick, 1996; Pardess, Finzi, & Sever, 1993; Pence & Wilson, 1994). Other advantages of MDTs include reduced role confusion and duplication of services (Rogan, 1990), and improved quality of evidence (American Prosecutors Research Institute, 1993; Dinsmore, 1992-1993; Hochstadt & Harwicke, 1985). If a community has established regular use of a Law Enforcement/CPS investigative team, what would be the next logical step in the evolution of MDT collaboration? Typically, the next step would be to include a prosecutor who will specialize in handling child abuse cases in court. Communities will often want to include medical and/or mental health professionals to the MDT team. These additions help the MDT team broaden its awareness and expectations of other factors that can contribute to the building of a forensic case. Clearly, the presence or absence of abuse specific symptoms is another valuable addition to the findings of an investigation. Bringing these additional clinical professionals to the team can add a lot in terms of gathering physical evidence on the child, exploring the meaning of behavioral symptoms and the acquisition of test data. This can be done on a case-by-case basis, but inclusion of specialized professionals in a team environment gradually increases the level of everyone's skill and understanding of what is helpful to whom. Bringing these diverse skills and backgrounds together can be powerful as teams share a common mission to protect children from harm. Additional expertise may be needed to address such things as:
Generally, by the time law enforcement, CPS, medical, and mental health professionals have gathered within a team model, a community is at least ready to develop some type of task force or interagency committee focused on the issue of child abuse. As other possible professionals are brought into this process, agency perspectives will again need to be reviewed along with expectations regarding information sharing/confidentiality. Establishing MDTs for the first time can be somewhat complex. Getting people to work collaboratively for the first time can be very challenging. Attention must be paid to the interpersonal dynamics and different working styles, in addition to the official agency policies and procedures. There are also different models that tend to drive different agencies. But by understanding why others believe and act the way they do, it is possible for each team member to begin to focus on the common goal of reduction of child abuse (Pence & Wilson, 1994). Some guidelines for individuals to follow when developing an MDT approach can be helpful. Here are several ideas on MDT membership that can be helpful to a community in the developmental stages of MDT practices:
What should MDT members know how to do, or aspire to learn? That depends entirely on the role they are in. Lets take a look at some commonly needed skills in each of the core disciplines. Law Enforcement
CPS
Prosecution
Victim Advocate (or similarly titled CAC staff member)
Therapy Providers
Health Care Providers
Many communities may wish to move directly to the development of a CAC without first developing a long-term functioning Multi-Disciplinary Team or a long-term functioning task force. Research supports the relatively similar rates of child abuse in most communities. Therefore, in a middle to large sized urban area, it can be safely assumed that child abuse is one of the significant problems in that community. It is naÔve to conclude that a community's low rate of reported abuse means the absence of a problem. We now know that child abuse exists in all parts of the country and at all socioeconomic levels. However, a properly conducted Community Needs Assessment will still be necessary in order to fine tune the plan so that resources are used in the most efficient way possible, and to justify asking for funds from sources. Communities should also know that funding sources are looking for collaboration to get the most out of the dollars spent on projects. Thus an MDT approach fits nicely into what works regarding obtaining funds as well as what works in an efficient community approach to child abuse issues. When economically feasible, communities should seek to continue to evolve their MDT approach in the direction of a CAC model. Larger communities can readily support a CAC whereas more sparsely populated communities might want to consider a regional model. The key to extending collaboration is knowing how to create a CAC and who can help in the process. The very first Child Advocacy Center was formalized in 1985 in Huntsville, Alabama. Former District Attorney, Bud Cramer (presently US Congressman Cramer) first used collaboration among agencies and then formalized an MDT approach. The Huntsville CAC model was eventually taken to Washington with him. Visit Congressman Cramer's Web site for further information. (http://www.budcramer.org) Congressman Cramer obtained funding through the Office of Juvenile Justice and Delinquency Prevention (OJJDP) (http://ojjdp.ncjrs.org) to share the model nation-wide. Congressman Cramer established the National Network of Child Advocacy Centers (NNCAC) (http://www.nncac.org/) which moved to Washington in 1994. It was reorganized and renamed the National Children's Alliance (NCA) in 1999. The Huntsville CAC program became the National Child Advocacy Center (NCAC) (http://www.ncac-hsv.org/). The NCAC is a vital link to intervention efforts in the region, has a comprehensive annual national symposium on child sexual abuse, is a hub for vital research, and an institute for advanced training in specialized areas. In 1995, the regional CACs were formed including the Southern Regional Child Advocacy Center (SRCAC) (http://www.nncac.org/srcac), which serves Georgia as well as 16 other states. The SRCAC provides expertise, materials, and support for communities to start moving in the direction of establishing their own CAC The state of Georgia also established a state network of CACs. The Georgia Network of Child Advocacy Centers (GNCAC) (http://www.gncac.org) also provides direction and funding to assist local communities in development of CACs headed toward full membership in the state network. Currently, GNCAC is under the direction of Mike Buchholz. Children's Alliance, the Southern Regional Child Advocacy Center, The National Child Advocacy Center, and/or the Georgia Network of Child Advocacy Centers. Smaller rural communities may want to consider a regional CAC model in order to justify the expenditure of funds and to obtain enough professional resources to make a CAC model possible. One model showing promise has been the regional CAC designed around the judicial circuit. In rural areas, this usually involves approximately 3-6 sparsely populated counties that are served by the same District Attorney's office. Counties sharing prosecutor(s) reduce the complexity of the issue of multiple jurisdictions-at least at one level. It is also suggested that when training is sought by individuals functioning in an MDT model, consideration be given to training the team together . Not only does this get the information to all of the members the same way at the same time, but it also helps to build team relationships that are vital to the success of the programs involved.Whether a community has a long--established CAC, or is just beginning joint interviews between CPS and law enforcement personnel, an MDT approach can be applied and extended along a continuum with the goals of better efficiency, better validity of case outcomes, and better services to the children and families. This continuum of services with the MDT model in the center makes sense in all of our communities and will serve us well as a way to continually improve efforts to protect children and serve families in Georgia. All CACs create an MDT approach as part of their development. Resources to develop CACs listed previously can also be utilized by a community that simply wants to work toward a mid-level MDT approach without a current commitment to development of a CAC. The current CAC communities providing Full Services, Developing Services, and Exploring the Development of Services in Georgia include the following list (please note that some centers serve more than 1 county):
ReferencesAmacher, E., Cramer, R. Jr., Hall, K., & Lind, J. (1990). The best practices manual of children's advocacy centers. Huntsville, AL: National Children's Advocacy Center. American Prosecutors Research Institute (1994). Legislation mandating or authorizing the creation of multidisciplinary/multiagency child protection teams. Alexandria, VA. Chadwick, D. (1996). Community organization of services needed to deal with child abuse. In J. Briere, L. Berliner, J. Bulkley, C. Jenny, & T. Reid (Eds.), The APSAC handbook on child maltreatment (pp.398-408). Thousand Oaks, CA: Sage Publications. Dinsmore, J. (1992-1993). A safety net of bridges: Interagency coordination on child abuse investigations. Part I. National Center for Prosecution of Child Abuse Update, 5-6 (12-1). 1-2. Fox Valley Technical College and the Office of Juvenile Justice and Delinquency Prevention (1997). Child Abuse and Exploitation- Team Investigative Process Conference, Savannah, GA. Gilbert, C. (2000). The child advocacy center model: A multi-disciplinary team response to child abuse. Presented at the Georgia Council on Child Abuse Annual Conference, Atlanta, GA. Hochstadt, N. & Harwicke, N. (1985). How effective is the multidisciplinatry approach? A follow-up study. Child Abuse & Neglect, 9, 365-372. Kaminer, B., Crowe, A. & Budde-Giltner, L. (1988). The prevalence and characteristics of multidisciplinary teams for child abuse and neglect: A national survey. In D. Bross, R. Krugman, M. Lenherr, D. Rosenberg, & B. Schmitt (Eds.), The new child protection team handbook. New York: Garland. Kolbo, J., et.al. (1994). Children's justice task force: A report on multidisciplinary team approaches to the investigation and resolution of child abuse and neglect. Charleston: West Virginia Department of Health and Human Resources. Kolbo, J. & Strong, E. (1997). Mutidsciplinary team approaches to the investigation and resolution of child abuse and neglect: A national survey. Child Maltreatment. Vol.2, No. 1, 61-71. National Center on Child Abuse and Neglect (1992). Children's justice act grant program: A report to congress on state programs for the investigation and prosecution of child abuse and neglect. Washington, DC. Pardess, E., Finzi, R., & Sever, J. (1993). Evaluating the best interests of the child- A model of multidisciplinary teamwork. Medicine and Law, 12, 205-211. Pence, D. & Wilson, C. (1994). Team investigation of child sexual abuse: The uneasy alliance. Thousand Oaks, CA: Sage Publications. Pettiford, E. (1981) Improving child protective services through the use of multidisciplinary teams. Washington, DC: National Professional Resource Center on Child Abuse and neglect, American Public Welfare Association and National Association of Social Workers. Rogan, M. (1990). The multidisciplinary team approach to child abuse and neglect. In S. Stith, M. Williams, & K. Rosen (Eds.), Violence hits home: Comprehensive treatment approaches to domestic violence (pp. 105-114). New York: Springer. Selinske, J. (1981) A survey of the use and functioning of multidisciplinary teams in child protective services. Washington, DC: National Professional Resource Center on Child Abuse and Neglect, American Public Welfare Association. ReferencesAmacher, E., Cramer, R. Jr., Hall, K., & Lind, J. (1990). The best practices manual of children's advocacy centers. Huntsville, AL: National Children's Advocacy Center. American Prosecutors Research Institute (1994). Legislation mandating or authorizing the creation of multidisciplinary/multiagency child protection teams. Alexandria, VA. Chadwick, D. (1996). Community organization of services needed to deal with child abuse. In J. Briere, L. Berliner, J. Bulkley, C. Jenny, & T. Reid (Eds.), The APSAC handbook on child maltreatment (pp.398-408). Thousand Oaks, CA: Sage Publications. Dinsmore, J. (1992-1993). A safety net of bridges: Interagency coordination on child abuse investigations. Part I. National Center for Prosecution of Child Abuse Update, 5-6 (12-1). 1-2. Fox Valley Technical College and the Office of Juvenile Justice and Delinquency Prevention (1997). Child Abuse and Exploitation- Team Investigative Process Conference, Savannah, GA. Gilbert, C. (2000). The child advocacy center model: A multi-disciplinary team response to child abuse. Presented at the Georgia Council on Child Abuse Annual Conference, Atlanta, GA. Hochstadt, N. & Harwicke, N. (1985). How effective is the multidisciplinatry approach? A follow-up study. Child Abuse & Neglect, 9, 365-372. Kaminer, B., Crowe, A. & Budde-Giltner, L. (1988). The prevalence and characteristics of multidisciplinary teams for child abuse and neglect: A national survey. In D. Bross, R. Krugman, M. Lenherr, D. Rosenberg, & B. Schmitt (Eds.), The new child protection team handbook. New York: Garland. Kolbo, J., et.al. (1994). Children's justice task force: A report on multidisciplinary team approaches to the investigation and resolution of child abuse and neglect. Charleston: West Virginia Department of Health and Human Resources. Kolbo, J. & Strong, E. (1997). Mutidsciplinary team approaches to the investigation and resolution of child abuse and neglect: A national survey. Child Maltreatment. Vol.2, No. 1, 61-71. National Center on Child Abuse and Neglect (1992). Children's justice act grant program: A report to congress on state programs for the investigation and prosecution of child abuse and neglect. Washington, DC. Pardess, E., Finzi, R., & Sever, J. (1993). Evaluating the best interests of the child- A model of multidisciplinary teamwork. Medicine and Law, 12, 205-211. Pence, D. & Wilson, C. (1994). Team investigation of child sexual abuse: The uneasy alliance. Thousand Oaks, CA: Sage Publications. Pettiford, E. (1981) Improving child protective services through the use of multidisciplinary teams. Washington, DC: National Professional Resource Center on Child Abuse and neglect, American Public Welfare Association and National Association of Social Workers. Rogan, M. (1990). The multidisciplinary team approach to child abuse and neglect. In S. Stith, M. Williams, & K. Rosen (Eds.), Violence hits home: Comprehensive treatment approaches to domestic violence (pp. 105-114). New York: Springer. Selinske, J. (1981) A survey of the use and functioning of multidisciplinary teams in child protective services. Washington, DC: National Professional Resource Center on Child Abuse and Neglect, American Public Welfare Association. | ||||||||||||||||||||||||||||||||||||||
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