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HomeMy WebLinkAboutAgenda 07-09-2026; 8-f - Approval of the Establishment of an Adult Protection Multidisciplinary Team in Orange County 1 ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: July 9, 2026 Action Agenda Item No. 8-f SUBJECT: Approval of the Establishment of an Adult Protection Multidisciplinary Team in Orange County DEPARTMENT: Social Services ATTACHMENT(S): INFORMATION CONTACT: Session Law 2025-23 MDT School of Lindsey Shewmaker, Social Services Government Presentation Director, 919-245-2817 Crystal Wiese, Social Services Assistant Director, 919-245-2767 PURPOSE: To approve the establishment of a single County Adult Protection Statutory Case Review Multidisciplinary Team (MDT) in Orange County under North Carolina General Statute 108A-1118.2(b). BACKGROUND: Adult Protection MDTs address abuse, neglect, and financial exploitation of vulnerable adults in their communities. The North Carolina General Assembly approved Session Law 2025-23 entitled, An Act Concerning the Establishment of Local Adult Protection Multidisciplinary Teams. Prior to this legislation, three (3) MDT models were available to counties: Systemic Review, Limited Case Review, and Hybrid. Orange County Social Services planned and launched an Adult Protection Systemic Review MDT in January 2025. Members of this Systemic MDT include representatives from Social Services, the Department on Aging, Criminal Justice Resource Department, Housing, Emergency Services, Clerk of Courts, Freedom House, UNC Hospitals, and local law enforcement agencies. Beginning October 1, 2025, Session Law 2025-23 authorized a new type of MDT, a Statutory Case Review Multidisciplinary Team. The distinguishing factor for Statutory Case Review Multidisciplinary Teams is the ability to share confidential information among all MDT members. The law, effective October 1, 2025, allows Boards of County Commissioners to evaluate and determine if their respective county should form its own Statutory Case Review MDT, join a multicounty team, or do neither, in consultation with the Director of Social Services. The Statutory Case Review MDT has eleven (11) mandatory members. The team is required to meet four (4) times per year, review selected active cases in which disabled adults or older adults are being served by APS through the local DSS, and submit annual recommendations to the 2 Board of County Commissioners for addressing systemic problems and service gaps for disabled and older adults. The current members of the Adult Protection Systemic Review MDT, the Director of Social Services, and the Board of Social Services support the creation of a Statutory Case Review MDT in Orange County and request Board of County Commissioners approval to establish a Statutory Case Review MDT under North Carolina General Statute 108A-118.3. FINANCIAL IMPACT: There is no financial impact associated with the creation of the Adult Protection Statutory Case Review Multidisciplinary Team. ALIGNMENT WITH STRATEGIC PLAN: This item supports: • GOAL 2: HEALTHY COMMUNITY OBJECTIVE 3. Provide social safety net programming and the resources needed for our most vulnerable community members (e.g., veterans, unhoused people, foster children, older adults, etc.) RECOMMENDATION(S): The Manager recommends that the Board approve the establishment of a single County Adult Protection Statutory Case Review Multidisciplinary Team (MDT) in Orange County under North Carolina General Statute 108A-1118.2(b). Session Law 2025-23 : New North Carolina Legislation Concerning the Establishment of Local Adult Protection Multidisciplinary Teams Meredith Smith, JD and Kristi Nickodem, JD 4 Overview of Today's Webinar 1. Provide foundational information about multidisciplinary teams and the landscape of MDTs currently operating in North Carolina 2. Identify key features of statutory case review MDTs authorized by Session Law 2025-23 3. Discuss some of the common questions arising as a result of this new law Background on Multidisciplinary Teams What I multidisciplinary I A group of individualswho work togetherwith a shared from a variety ofcollaboratively, bound M• definition of the professionalby a commonproblem they are disciplines... purpose... addressing. 7 Why an Adult Protection MDT? Abuse, neglect, and exploitation of disabled and older adults is: • Difficult to detect • Involves a complex population • Occurs in variety of settings • Caused by a range of perpetrators • Occurs across disciplines 4 No one field, system, or set of laws that controls the problem; a single profession is rarely, alone, enough to address it. .. . 8 Potential Adult Protection MDT Members • County department of social services I � social workers, directors, and attorneys Prosecutors � Law enforcement Area Agency on Aging representatives • Legal aid attorney • Victim services representatives • EMS workers • Clerks of court Judges Magistrates Financial institution employees Mental health professionals • Medical professionals 4 9 County Adult Protection Multidisciplinary Teams The map below identifies county-based adult protection rrlultidisciplinary teams (MDTs) in North Carolina.These teams work together to help vulnerable adults whom a y need protection from abuse,neglect,or exploitation. Below the map is a directory of MDT coordinators who serve as points of contact for the MDT in their county teams. • - • • • . • - County MDT Northeast Regional MDT 5andhills Regional MDT 410 +A Flourish map 1 Types of before • • 2025 S ste m i c Limited Case v H brad MDT Review MDT Review MDT v NC GOVERNMENT Types of before 1, 2025 S ste m i c Limited Case y H brad MDT Review MDT Review MDT y OFfl NCGOVERNME NT 12 Systemic Review M DTs The 2 .Annua[Senior 1. Address Systemic Problems and Service Gaps in the Delivery of Services Re-soura Fair — Review a closed case and identify deficiencies in response Thursday,June 51h 2025 1:00pm-6:00 pm — Members bring specific issues for discussion and problem-solving The Burnsville Town Center 2. Build Information Networks — Cross-training among members — Share programs and events; resources June 75th At ERr1 3. Engage in Community Training and Education : ° ` — Scam Jams W" LDELDERABUSE -- FAWARENESS DAY — Elder Abuse Awareness Days hlWirgStrong Sbpp®rtbiUders — Friends Against Fraud G.S. 108A-118.1(5), eff. October 1, 2025. .. , 13 Role of Judicial Officials on Systemic Review MDTs • Effective community conveners • Gives a sense of urgency to a matter, emphasizes importance of an issue • Provides greater understanding to other actors in the system of the judicial process and relief available (and not available) through court proceedings • Increases understanding of the judge of the nature of the issues before them (nature of capacity and the necessary services), improves oversight, and improves the ability to draft tailored, effective orders fl- UNC � GOVERNMENT Ad m 14 Types of before 1, 2025 S ste m i c Limited Case v H brad MDT Review MDT Review MDT v NC GOVERNMENT 15 • MDT focuses on reviewing and responding to specific cases of L 'Imited Case abuse, neglect, and exploitation involving disabled and older Reveiadults. • There is limited authority to share information among the MDT members. lot *�. APS information Protected health Mental health information information OW l r 1 Substance use disorder Communicable disease Financial information treatment information information Pr �.- . .� .: - • R ! :_ � Must weave Y r-1 together rz Nf� ) _ exc e tions in IOUr AC ! w various r Y r • confidentiality laws.. .. -M �• ... 1T. I.. t y I • I ..-. - y..•y_ _ -"JYa•+w!I.-y1i�+7r✓^s"�+/FlIM�J-� _ « ♦/�- .., b,�'� 18 Confidentiality Agreement or MOU ? • Can establish shared practices and expectations � t. • Cannot override the law x or create greater authority to share 19 Client Consent • Sufficient, but not always an option - Form must comply with applicable laws (depends on parties involved ) No consent = disclosure only allowed to specific parties for specific purposes 21 Other Options • De-identified "case review" • Focus on systemic review and use hypothetical cases 22 Potential Adult Protection MDT Members • County department of social services social workers, directors, and attorneys Prosecutors Law enforcement • Area Agency on Aging representatives • Legal aid attorney • Victim services representatives • EMS workers s rlerLr. ofca,wt MagiStFates �F R ` • Financial institution employees Mental health professionals • Medical professionals 4 ti 23 Types of before 1, 2025 S ste m i c Limited Case v H brad MDT Review MDT Review MDT v NC GOVERNMENT za • The MDT carries out both case Hybrid review and systemic review functions. Review • Possible to alternate meetings or integrate both functions in a single meeting while ensuring only authorized members are at the table MDT when confidential information sharing occurs. Systemic Limited Case Statutory Case Review MDT Review MDT Review MDT Hybrid MDT Statutory Case Review MDTs Session Law 2025 - 23 S. L. 2025-23 : Adult Case Review Multidisciplinary Teams Powers and duties (G.S. 108A-118.3) 1. Review selected active cases in which disabled adults or older adults are being served by APS through the local DSS 2. Submit annual recommendations to the - BOCC for addressing systemic problems I . and service gaps for disabled and older 9 adults 28 Information Sharing Authorized by G.S. 108A-1188 Any MDT member may disclose, unless prohibited by federal law, information relevant to: • 1. performing reviews of selected active cases in which disabled adults or older adults are being ' served by APS through a local DSS; or 2. providing, arranging, or coordinating services on behalf of disabled adults or older adults whose cases have been or are currently under review by the Case Review MDT. lT � C SCHOOL OF �. �l� GOVERNMENT MDT Formation G.S. 108A-118.2 • Each county may establish its own Case Review MDT or participate in a multicounty MDT • Each BOCC may evaluate and determine F, whether the count will establish its own Case Y � - Review MDT or become part of a multicounty team. Must be done in consultation with the DSS director 30 Local law Attorney from the DSS director DSS staff member enforcement officer district attorney's office The public guardian Long-term care Local health director appointed in the A local mental health ombudsman serving or a member of the county by the clerk of professional in the county director's staff superior court A representative A victim advocate A local health care from the local area from a local domestic Additional members provider violence or sexual appointed by Chair agency on aging assault agency 31 �&ME MDT Chair G .S. 108A-118.2(f) ' - • Each Case Review MDT must elect a member to serve as Chair at the pleasure of the MDT ` Chair may appoint a maximum of five additional members to serve on the MDT, representing local agencies or the community at large • Chair must participate in training =r developed by DH HS 32 . �� MDT Meetings - G.S. 108A-118.2(g) _ . l • Minimum of four times per year -- • DSS director must call first meeting • MDT Chair calls subsequent meetings and prepares the agenda, in consultationf� with the DSS director • May hold meetings despite vacancies, _ absences, or failure to appoint a member • Not subject to Open Meetings Law i (see G.S. 108A-118.6(c)) 33 DSS Director Responsibilities 108A-118.4 Develop written operating procedures regarding Assure the MDT defines Bring active cases for review frequency of meetings, which categories of cases it (as selected by director or confidentiality, training of will review an MDT member) members, and responsibilities of members Provide staff support for Report annually to the BOCC MDT reviews as needed (or as otherwise required by the BOCC) 34 DSS Director Responsibilities G.S. 108A-118.4 Maintain records for the MDT: • Minutes of all official meetings • Lists of participants for each meeting • Signed confidentiality agreements i .�. 35 �T Relevant to the MDT reviewing an active case in which a disabled adult or older adult is being served by APS? 1 � Relevant to providing arranging or coordinating services on behalf of a disabled adult or older adult i: whose case is or was under review by the MDT? r • - - THEN Information Sharing G.S. 108A-118.6(a) May disclose to MDT unless prohibited by federal law Limitations on Information Sharing A • DSS must not disclose identity of reporter(s) of A/N/E • Cannot override limitations in federal law • E.g., HIPAA (applies to covered Fi entities), 42 C.F.R. Part 2 (applies to covered information) 5 • Authority to disclose under this law , terminates when the disabled or older adult is no longer being served by APS through the county DSS 37 MDT ConfidentialityAgreement Required by G.S. 108A-118.7(c� Information may be redisclosed only: • as necessary to carry out the purposes of the Case Review MDT; or :Y • as otherwise permitted by State or federal law. lT � C SCHOOL OF �. �l� GOVERNMENT 38 OF Confidentiality of MDT Records/Information G.S. 108A-118.7 • All records and information acquired or generated by MDT are ' l confidential -- • Not subject to Open Meetings LawANN E— May only be disclosed: • To carry out purposes of the MDT • As permitted by state or federal law ' • By court order Information generated in an MDT ' meeting may be shared.... ® �� ®� With a BOCC to make annual _ �®�����8�� recommendations, but must not reveal = �©_ ©����� ' any individually identifying information 39 Li g q • To a local board of social services by DSS director, but must not reveal any individually identifying information about cases �- By an MDT member to their organization/agency to provide or arrange services for a disabled or older adult G.S. 108A-118.7(b) Questions and Answers Does this new law require counties to create an adult protection MDT that meets these requirements .? 42 G.S. 108A-118.2. Case Review Multidisciplinary Team; creation and composition. (a) Creation. — Each county may establish its own Case Review • Multidisciplinary Team or participate in a multicounty Case Review Multidisciplinary Team, as determined in accordance with subsection (b) of this section. Can a statutory case review MDT operate with less than all of the statutorily required members .? 44 G.S. 108A-118.2. Case Review Multidisciplinary Team; creation and composition. (g) Meetings.... The Case Review Multidisciplinary Team may conduct meetings despite vacancies, absences, or failure to appoint a member. How are vacancies filled on a statutory case review MDT?. 46 (e) Vacancies. — Vacancies on a Case Refer to G . S . Review Multidisciplinary Team shall be filled by the original appointing 108Am118 . 2 ( e ) authority. 47 G.S. 108A-118.2(c) provides the following persons appoint the associated member of the MDT: • DSS Director --> DSS staff member • Board of County Commissioners (in consult with DSS and DA) --> Law enforcement officer • District Attorney --> Attorney from the DA's office • Clerk --> Public guardian • Director of the Area of Authority --> Local mental oint Appaing health professional • State Long Term Care Ombudsman --> Long Term • Care Ombudsman U o I • Director of Public Health --> Member of the Director's staff (if the Director does not serve) • Local board of health --> Local health care provider • Director of Area Agency on Aging --> Representative from the local area agency on aging • Local DV or Sexual Assault Agency Director --> Victim advocate from the agency • Chair of the MDT --> Five additional community members Must the officials named in the statute be on the MDT or can designees serve instead ? 49 G.S. 108A-118.2(c) provides that DSS Deirector the "director of social services" shall be a member of the statutory case review MDT. 50 l�mdato�-'��Smbn.—Egg single cvunt��base Review �+Iu asp p `°I�am s cin.'4st of le fo-11 a per ide?1 Le�Irl suwi-visauns F1� ) of'this s�'L seaiom Ball musist of the follmmin pgsom id mtifred i subdivistom f 11 thr _ 1) Df this mlgt6oa from Pal onavy remamtedg011 thatmu]6c&mtvtum CI). The dim of social semices._ A staff m—lml-r of the loml depaitm t of&octal ser*k7ces. dtgat 1 h-y the Aimgor of social l maces. A lcCal lay. enf cemeur-otter. apkwtd by th board a c-o ty ti loom,after ccusuhaica-tuth iie daict attoW s odic-, and the]T.,,1 d a m ent cif socjO serhIces. Lj) din artormer from&distpu atterm°'S - icx. ted bN the district attormg_ L5) mudian Woiraed in the C ow2ty(Ar the Clerk of MM—air courtmer Anxie I 1 of Stec jAof the Viral Statin. f6) A kcal rmmW health ppfing t a0mmed In.the diralm of the area authmw estabaed umdff Chapter 12-2C of the Gmeral%fires_ 17.) The 1mr-tom, cm wb d< ttn-ir-,T im the mt nn';tea lae 1�;r t�� € oftkte k �-Term Fart Omhu6m The d'&-tor of to local� of pgbRc heap or a mem r of the director" staf as des ,d b� the ect�rr_ .L9) A ural hulth carp: rte minted h,the local hotd-of health. Q). A repteseatati3-e from th. xu1 urea ag p cm a usted b ffie diredor at the arta as Lma ��s M the coin I'll ,� adcocate froom° ]awl domestic�,i�aem°Lt or-ReT.uw assail aancv- mi-L-dt her the ap a's amLb--e diuecta. Member�:� y th- -The dh�;ir of the Case Ruin 1��t.lti6Kg _Team it a cmt a maximum of fin-, additiond mmbm rcgCsmtin-ff 10c9asencies or le T iuuludiml, but m..limitedto-RWMfi fig finmcial 'ME=' It ,local hospitals-and mqfofn o4minfions. If an existing MDT re-forms under this statutory model , will some current members have to be excluded .? 52 G.S. 108A-118.2(c). Mandatory Members. — Each single county Case Review Multidisciplinary Team shall consist of the following persons identified in subdivisions oss 'Ibly, (1) through (11) of this subsection, and each multicounty Case Review Multidisciplinary Team shall consist of the following persons identified in subdivisions (1) through (11) of this subsection from each county represented on that multicounty team... 53 G.S. 108A-118.2(c) provides the following persons appoint the associated member of the MDT: • DSS Director --> DSS staff member • Board of County Commissioners (in consult with DSS and DA) --> Law enforcement officer Buta District Attorney --> Attorney from the DA's office • Clerk --> Public guardian • Director of the Area of Authority --> Local mental remember. . . . health professional • State Long Term Care Ombudsman --> Long Term Care Ombudsman Appointing • Director of Public Health --> Member of the Directors staff (if the Director does not serve) • Local board of health --> Local health care providerAuthor•ty Director of Area Agency on Aging --> Representative e from the local area agency on aging • Local DV or Sexual Assault Agency Director --> Victim advocate from the agency • Chair of the MDT --> Five additional community members If my county decides to create a statutory case review team ,, what are some necessary first steps ? 55 1. Talk with your current or potential MDT — decide which path works best for your community and whether to pursue a single county or Statutor y Case multicounty team. Review MDT: 2. Bring the matter to the Board of County Commissioners through the First Steps DSS Director — G.S. 108A-1118.2(b) provides that each board evaluates and determines whether the county will establish a team, in consultation with the DSS Director. 56 How can I find out more? ❑ Sign up to receive weekly emails from the Adult Protection Network at www. protectadults.sog. unc.edu ❑ Register your county's MDT on the website by contacting Kristy Preston, Adult Protection Network Director at kpreston@sog. unc.edu ADULT PROTECTIONNETWORK .. . Supporting.1:1.21 UNC � GOVERNMENT Connecting. Informing. The North Carolina Adult Protection Network k Connecting. Informing. Supporting. Resources — Find Your Peers —► He)P'L)es 4F y A library of tools to help you protect adults from A map and directory of multidisciplinary teams A hub for online technical and legal support for abuse, neglect,and exploitation in your (MDTs) and MDT coordinators working to North Carolina adult protection multidisciplinary community. protect adults in INC. teams. ADULT PROTECTION NETWORK T UNC OF II UNC GOVERNMENT Connecting. Informing. Supporting. UNC School of Government 58 TI,a , r Tt t-- HH NCD S The NC Adult Protection Network is supported by funding from the Division of Social Services at the North Carolina Department of Health and Human Services. • Questions ',? .1 ADULT PROTECTION NETWORK i2 T Tl� C SCHOOL O6 � �l� GOVERNMENT Connecting. Informing. Supporting. I UNC SCHOOLOF �. GOVERNMENT