A review of child welfare research literature reveals that although multidisciplinary teams are increasingly used to investigate and intervene in child abuse and neglect cases, the field does not know enough about their structural variations, implementation processes, or effectiveness. Moreover, although articles advocating multidisciplinary teams enumerate their apparent strengths, they lack attention to the teams' possible weaknesses. The article discusses implications for future evaluation studies.
Over the past two decades, the increasing prevalence of child abuse and neglect (Kolbo & Strong, 1997; National Committee to Prevent Child Abuse, 1999) has increased pressure on child welfare professionals to act promptly, yet professionally, in reported or substantiated cases (Ells, 2000). Because this problem is complex and multicausal, no single profession or state agency has the ability to respond adequately. Instead, child abuse requires the involvement of multiple professions and community resources. Health care, law enforcement, mental health, and social services, among other agencies, frequently must investigate allegations and provide protection and rehabilitation for the child and family once a caseworker has substantiated child abuse or neglect (Kaminer, Crowe, & Budde-Giltner, 1988).
In response, agencies are using multidisciplinary teams (MDTs) in an effort to be more effective and out of concern that uncoordinated efforts to protect children may cause additional harm to victims. In other words, harm to children can occur not only as a result of maltreatment itself but also because of insensitive procedures used to address maltreatment. Such systemic effects on children may be the result of redundant interviews, intrusive medical examinations, separation from support systems, intimidating courtroom procedures and tactics, and communication breakdowns (Jones, 1991, as cited in Kolbo & Strong, 1997).
The literature advocating MDTs presumes them to be more effective and efficient in achieving their intended outcomes, and more benign in their processes. Researchers claim MDTs result in more accurate assessment and prediction of risk, more adequate intervention (Goldstein & Griffin, 1993; Pence & Wilson, 1994), decreased fragmentation in the delivery process, less role confusion among different disciplines, reduced duplication of services among agencies (Pence & Wilson, 1994; Skaff, 1988), enhanced quality of evidence for lawsuits or criminal prosecutions (Dinsmore, 1992-1993, as cited in Kolbo & Strong, 1997), and improved quality of services (Cohn, 1982; Hochstadt & Harwicke, 1985). In addition, researchers theorize that MDTs reduce traumatization of children and contamination of evidence gathered during the investigative and judicial processes (Saywitz & Goodman, 1996, as cited in Kolbo & Strong, 1997). Finally, some believe MDTs provide mutual support for professionals engaged in emotionally stressful work (Kolbo & Strong, 1997).
MDTs have been popular for decades, however, relatively few studies have systematically evaluated them. Although fragmentation of services to children and their families can be a serious problem in abuse cases (Hochstadt & Harwicke, 1985; Kaminer et al., 1988), no empirical evidence exists that MDTs decrease fragmentation (Straus & Girodet, 1977, as cited in Hochstadt & Harwicke, 1985). More generally, researchers have performed few follow-up studies of MDTs' effects on service delivery and outcomes (Hochstadt & Harwicke, 1985).
This article critically reviews the MDT research literature and summarizes the evidence concerning MDT benefits. The authors pose unanswered questions concerning variations in MDT design and effectiveness. Finally, the article suggests an MDT evaluation agenda for future research.
Team Practice in Child Protection: A Historical Overview
Hospitals have been using MDTs for nearly 40 years (Ells, 2000). …