The Multidisciplinary Team Approach
For other issues identified in the assessment process, the standard of care in working with people at risk for targeted violence indicates the multidisciplinary team approach is a recommended model for developing, implementing, and monitoring the various interventions and services needed to reduce the risk of violence. Multidisciplinary teams can be helpful in both addressing risk and protection factors across multiple socioecological levels and in identifying and coordinating multiple intervention components across these levels. For more information on this approach, see, “The Challenge and Promise of a Multidisciplinary Team Response to the Problem of Violent Radicalization.”
While many mental health specialists may be familiar with working in multidisciplinary teams, there are some specific differences involved when addressing the needs of a person at risk for targeted violence.
Law Enforcement
The first major difference you will see in multidisciplinary teams is the inclusion of law enforcement. This person could be a standing/designated member of the team, a community liaison officer who attends as needed, or an officer with a designated targeted violence role within the community. Law enforcement can play a critical role in the work of the team. However, many mental health specialists in traditional care settings (mental health clinics, schools, etc.) may not be used to the inclusion of law enforcement on such teams.
Law enforcement can serve a number of functions on the team. They may contextualize risk factors for violence, share resources that may support the interventions planned for the person at risk, or indicate when changes in the level of risk demonstrated by the individual may require a law-enforcement intervention. As a team member, they participate in the sharing and processing of assessment information, discussions about the range of interventions needed to address the concerns identified, and identify goals for interventions that signify reduction in risk.
As a mental health specialist, you may have concerns about communicating openly in front of law enforcement. You may wonder, “What if I say something and the law-enforcement representative decides a law-enforcement response is required? Since the focus is on the assessment of risk of the individual, can I speak about information related to the family or the individual’s past history? Just what can or should I share in the presence of law enforcement?” Responses to some of these questions will be addressed later in this training under the section titled, “Challenges in Providing Services.”
Involvement of law enforcement in treatment teams can be helpful with regards to making decisions about threat level and interventions regarding safety. However, we are not suggesting that the involvement of law enforcement in multidisciplinary teams extends to patient care situations within healthcare settings with regards to interrogation, confiscating weapons, or other activities that might compromise patient rights, safety, or health outcomes.
For additional information, see the following resources:
- When Health Care and Law Enforcement Overlap
- Police in the Emergency Department: A Medical Provider Toolkit for Protecting Patient Privacy
Information Sharing
The second difference you will see in multidisciplinary teams working in the area of targeted violence is the critical importance of information sharing and the need for clarity about the scope of practice for each team member. More will be said about this issue under the section titled, “Challenges in Providing Services.” Best practices indicate the need to have information-sharing agreements developed and agreed upon by all team members.
For additional information about the role of multidisciplinary teams in working with people at risk for targeted violence, visit the National Association for Behavioral Intervention and Threat Assessment at NABITA.org.
Team Processes
It is important that all team members understand both their roles and the roles of others and have trust in one another. All team members should have the opportunity to share their view and take part in decision making. At times, this equity among team members may be unbalanced because of the hierarchical relationships among disciplines or team members or because of the prioritization of security issues. This can be helped by rotation of leadership roles, regular formal meetings, structured input from all fields, and balanced time management.
Variations of Multidisciplinary Teams
Besides multidisciplinary teams, some settings may operate using collaborative care teams, wrap-around service teams, or other variations of the multidisciplinary team model. In all cases, the main objective is to have a range of professionals and other key stakeholders present to best process the assessment information and develop the range of interventions needed to best serve the person at risk for targeted violence. Mental health specialists should be “at the table” no matter the version of the team the setting utilizes.