Established elder abuse MDTs can face unique challenges in their evolution. From the addition and departure of new members to the risk of “scope creep,” EMDTs can become over-extended without considered vigilance.
Join us for this two-part series (Part 1 and Part 2) as Peg Horan of the New York City Elder Abuse Center and Lindsay Calamia from Lifespan of Greater Rochester are here to discuss the intricacies of launching and managing elder abuse multi-disciplinary teams, including:
- Acknowledging and building on member talent
- Celebrating success
- Facilitating member disagreements, and
- How to assess the health of the team
Justice Clearinghouse Editors (JCH): Peg you’re a new presenter for the Justice Clearinghouse. Tell us about yourself.
Peg Horan: It is great to be a part of the Justice Clearinghouse family via the elder abuse webinars. I became a social worker in my late 30s, with an interest in working with vulnerable communities of people who were crime victims. I started out as a service coordinator in the Bronx and Manhattan, assisting people with Intellectual and Development Disabilities (IDD) and their families navigate myriad systems, discrimination and other challenges – including abuse. I joined the Brooklyn DA’s Victim Services Unit after that, and worked exclusively with crime victims with disabilities who were domestic violence and/or sexual assault victims (called the Barrier Free Justice program at Kings County District Attorney’s Office). Eventually, I moved over to the Elder Abuse Unit (EAU), where I reported to the Chief, an Assistant District Attorney. I learned so much from her, as she did from us social workers. It was a multidisciplinary relationship!
During my time in the EAU, I became a member of NYCEAC’s Brooklyn MDT. Wow. The streamlined and rapid response to such complex cases was a real relief. The powerful work of our executive director, Risa Breckman, and her colleagues at NYCEAC/Weill Cornell Medicine was well-known. So when an opportunity arose to join NYCEAC, I took it. It was a wonderful transition from the DA to NYCEAC, largely because I still got to work with the smart, dedicated, experienced people I had known for many years. I started coordinating the Brooklyn MDT and the Manhattan EMDT when I joined NYCEAC on 1/31/2014 (who starts a new job on New Year’s Eve?). Both Brooklyn and Manhattan are EMDTs today. With funding from NYC Department for the Aging, we are rolling out to all five NYC boroughs this year.
Before [the evolution of EMDTs],
professionals responding to elder abuse operated in silos,
unaware of parallel investigations and unable to access the knowledge and resources
needed to respond effectively.
JCH: Many people might not be as familiar with Multi-Disciplinary teams. Can you explain what MDTs are in general, and then explain their role with Elder Abuse cases?
Peg: MDTs are amazing. They bring professionals from across disciplines and systems together to find solutions to reduce risk. MDTs get the right people in the same room at the same time. Powerful. Before this, and a lot of us have been around for the “before,” professionals responding to elder abuse operated in silos, unaware of parallel investigations and unable to access the knowledge and resources needed to respond effectively. Plus, when professionals work in isolation, we are hampered by the limits of our own expertise and authority. So naturally, gaps in care or service duplication would occur. In contrast, MDTs are person-centered, highly coordinated interventions. Core Members, plus guest consultants and our geriatricans, geropsychiatrists and forensic accountants (aka “specialists”) carefully consider each older victim’s situation and individual strengths, needs and preferences to create a response.
NYCEAC launched NYC’s first elder abuse MDT in Brooklyn in 2010. We met three times a month for 1.5 hrs. Then, in September 2012, the New York State Office for the Aging (NYSOFA) received a three-year, $1 million Elder Abuse Prevention Interventions Grant from the U.S. Administration for Community Living (ACL) to initiate and test a program to combat financial exploitation and elder abuse in New York. This pilot, developed by NYSOFA and its project partners, NYS Office of Children and Family Services (OCFS), Weill Cornell Medicine’s NYC Elder Abuse Center (NYCEAC) and Lifespan of Greater Rochester, Inc., focused on preventing and swiftly intervening in financial exploitation of frail adults aged 60 and older through the use of an EMDT. So, the Manhattan EMDT was born – the E for “enhanced” with a forensic accountant. Today both Brooklyn and Manhattan teams are EMDTs – enhanced with forensic accountant, geropsychiatrists and geriatricians – and hear cases of abuse, neglect and financial exploitation. The coordinator deconstructs the case in advance of the meeting date and connects with any professional who has been connected to the case – even if the case is “closed” there. We want as much info as possible because it will inform and generate the best possible intervention. Gathering this info is through simple conversation with the professionals who are closest to the case – the APS caseworker, the police officer, the community-based or hospital social worker. We coordinators ensure that cases are not only eligible for the team, but are ready for the team. This means that the intense prep that preceeds every meeting is done well.
The EMDTs have generated incredible momentum, NYC- and NYS-wide. By the end of 2018 in NYC, all five NYC boroughs will have an EMDT, thanks to the support and funding from the NYC Department for the Aging. And, we are receiving some of the state-wide funding as well, to further enhance our teams. Governor Cuomo announced that by 2020 every county in New York with have an MDT – 62 counties!
Governor Cuomo announced
that by 2020 every county in New York with have an MDT
– 62 counties!
JCH: This sounds like an incredibly practical and logical way for addressing elder abuse cases! Why wouldn’t a community take the MDT approach?
Peg: But, in fact, more counties in NYS and around the country are developing MDTs. With research and awareness of elder abuse building all the time, more professionals are aware of the high prevalence rates and are advocating to local and federal governments for funding. Boots-on-the-ground professionals – Adult Protective Services, community-based organizations, healthcare professionals who make home visits – are seeing the abuse, giving it their all, and realizing that complex cases take more than any one individual’s, or any one organization’s, talents. We do not have to do this alone. And we can’t.
With research and awareness of elder abuse building all the time,
more professionals are aware of the high prevalence rates
and are advocating to local and federal governments for funding.
JCH: Your subsequent webinar discusses how to manage existing multi-disciplinary teams for elder abuse cases. In your experience, what makes running an existing team different than starting a new EMDT?
Peg: When you are on an established MDT, one with some mileage, you are working shoulder-to-shoulder with people in different organizations, with different skills than yours. Enormous respect can grow when we work this closely together, and on situations that are, yes, life-or-death. So, the beauty of running an existing team is that members know how it works, are mutually respectful, and trust that we are all in this together – “this” being assisting a vulnerable person who is in distress and who is fearful (whether or not they can acknowledge their fear). When you are starting a new team, rapport needs to build. Old impressions of another organization will start to fade. Members realize how much they (we) do not know, and that we need each other. Most new experiences generate some anxiety. The fact that the “older” teams in NYC have confronted and met some team development challenges means that if the newer NYC teams face the same challenges we can course-correct quickly, based on past experience.
JCH: What drew you to this line of work? And what keeps you motivated, given all that you see in the course of your career?
Peg: Wanting to work with people who have been victimized is what drew me to the work. What keeps me motivated now is that I have seen the MDT “before” and “after.” As a former team member, and now a coordinator, I have the proof that the MDT approach works, and that together we can effectively, and rapidly, help older adults who are afraid, or worse.