Methods: Data came from an online survey conducted by the Child Advocacy Centers (CAC) of Texas in partnership with the Texas Institute for Child and Family Wellbeing. A convenience sample of 333 MDT members from 66 CAC across Texas was obtained for this analysis. Measures included access to medical examinations, MDT characteristics (LE and CPS collaboration and equal decision-making responsibility), and type of community (rural, mid-size and urban).
Results: The majority of MDTs (87%) had collaboration from LE and CPS. Communities were split between urban (42%), mid-size (40.8%), and rural (17.2%). Notably, in urban communities, 67.2% of respondents reported that children who needed medical examinations could access them, compared to only 45.5% in rural areas. Moreover, 61.7% of respondents in MDTs with LE and CPS collaboration reported accessibility, compared to only 29.3% of respondents in MDTs without this collaboration. MDTs located in urban communities had 3.3 higher odds (95% CI= 1.7, 6.3) and those in mid-size communities had 2.1 higher odds (95% CI=1.1, 4.1) of accessibility to medical examinations than those in rural communities. MDTs that had equality in the decision-making process had 3.2 higher odds (95% CI=1.6, 6.4) of reporting accessibility to medical examinations than those that reported inequality in the decision-making process.
Conclusion and Implications: These results suggest that most MDTs in Texas have existing collaboration between LE and CPS. These MDTs may have slightly higher odds of access to medical examinations, but these odds diminish when other factors are controlled for. Community type and equality in decision-making process were the two variables most strongly associated with access to medical examinations, suggesting that rural-urban inequities and horizontal decision-making may be more important to focus on than participation from specific personnel in MDTs. The findings from this study offer empirical evidence on the importance of team dynamics and collaboration for MDTs addressing child maltreatment in their communities. Therefore, it is not enough for MDT members such as LE and CPS to collaborate, but equal power in the decision-making process and addressing rural-urban inequities are necessary.