2023 National Forum on Overdose Fatality Review
FORUM RESOURCES
To get the most out of the Forum, we recommend that you review these resources before attending.
Any resources provided by the speakers will be available below. Participants should visit this page throughout the conference to access most current resources.
2023 FORUM RESOURCES
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Family-centered Practice Recommendations
Meeting Presentation - 1/20/2023
The Allen County, Indiana, overdose fatality review (OFR) team has found a recurring theme in its recommendations: a need for familial support. In the 3 years since Allen County started its OFR, it has become increasingly evident that mothers and families are struggling with substance use. Many of the deaths occurring are happening within 12 months of giving birth, with children present at the place of death or with children placed in relation or foster care. In light of these findings, Allen County has refined its OFR processes to include ad-hoc members of the OFR team in all meetings; those representatives being those from the Department of Child Services, maternal health providers, grief counselors, and pediatricians, as well as a clinical social worker who specializes in family-centered therapy. With these additional members, the team is able to assess the aspects of familial support that could have made a difference in the case, including individual, family, community, and societal factors. This session will review findings and identified interventions related to building support for families, providers, and systems impacting overdose deaths.
This presentation was in the Concurrent Session 4: Applying Emerging and Innovative Strategies breakout. -
Federal Tribal Resources and Response: 2023 Forum on National Overdose Fatality Review
Meeting Presentation - 1/20/2023
This presentation briefly covers information and resources from Substance Abuse and Mental Health Services Administration (SAMHSA).
This presentation was in the Concurrent Session 4: Tribal Communities’ Response to Drug Overdose breakout. -
Federal Tribal Resources and Response: BJA Funding Resources to Support Substance Use Disorder Efforts in Tribal Communities
Meeting Presentation - 1/20/2023
This presentation briefly covers some funding opportunities to support substance use disorder efforts in tribal communities.
This presentation was in the Concurrent Session 4: Tribal Communities’ Response to Drug Overdose breakout. -
Plenary Session 3: Overdose Fatality Review and Substance Misuse Interventions in the Emergency Department
Meeting Presentation - 1/20/2023
Knox County, Tennessee, established its overdose fatality review (OFR) team in 2021, and as of October 2022, the team had reviewed 105 cases. In its first annual report, the OFR team identified hospital emergency departments (EDs) as a high-priority setting for substance misuse interventions and overdose prevention. Of the first 105 cases the team reviewed, 22 were excluded because of lack of medical data. Among the remaining 83 individuals with sufficient data, there were 711 lifetime ED visits. Of these 83 individuals, 69 visited the hospital within 1 year of death, totaling 335 hospital visits. Chart notes showed a pattern across individuals of leaving the hospital against medical advice, and OFR team members inferred from their experience that withdrawal symptoms played a role in many of these cases. Each hospital visit represents an opportunity to intervene and prevent a death by overdose. University of Tennessee Medical Center (UTMC), a local hospital system that is represented on the OFR team, has begun a pilot program to bridge the gap between hospitals and drug treatment programs by initiating medication for opioid use disorder in the ED and then a warm handoff to a grant-funded intensive outpatient program (also represented on the OFR team). The OFR team has convened a work group to evaluate the success of UTMC’s program and discuss expanding it to other area hospitals, especially those with existing peer navigator programs. The work group includes the founder of a national ED/medical staffing company and representatives from local behavioral health providers.
This presentation was the first plenary for day 2. -
Plenary Session 4: Addressing Gaps in Substance Use, Overdoses, and Recovery
Meeting Presentation - 1/20/2023
With a population of 2.5 million residents and 55 overdose deaths per month, Riverside County became the first county in California to establish an overdose fatality review (OFR) team. The Riverside County Overdose Data to Action (RODA) Program’s OFR multidisciplinary team meets monthly to review selected overdose cases within a pre-identified focus area (e.g., individuals experiencing homelessness, the Native American population, youth aged 15 to 24, etc.) to fill gaps in knowledge of local overdose trends and increase coordination and collaboration among partner agencies. The RODA Program utilizes Jamboard to facilitate each decedent’s review and engage the 10-plus team members to discuss the circumstances leading up to the decedent’s death. During these discussions, the OFR team develops recommendations to prevent substance use, overdose, and death. The recommendations are added to an action plan to track progress. The RODA Program monitors the action plan and brings in the appropriate partners to carry out the activities. OFR recommendations have been integrated into prevention activities, including a harm reduction mass media campaign, quick response (QR) codes on substance use resources for first responders, and harm reduction and naloxone training. The OFR team has proved to be a valuable tool for informing programmatic activities and strengthening partnerships among entities that share the common goal of reducing overdoses.
This presentation was the second plenary for day 2. -
Tribal Information Sharing and Response Case Studies: Anita Welch Lossiah
Meeting Presentation - 1/20/2023
This workshop featured discussion from tribal representatives on their responses to drug use and overdose in their communities. Topics will include the development of multidisciplinary governance structures to guide the decision making; pulling together multiple streams of information across agencies; using tools such as the Overdose Detection Mapping Application Program (ODMAP) and overdose fatality review (OFR) to better understand the nature of drug use; and creating active partnerships between public health and public safety to intervene with individuals at risk for overdose.
This presentation was in the Concurrent Session 4: Tribal Communities’ Response to Drug Overdose breakout. -
Tribal Information Sharing and Response Case Studies: Clinton Alexander
Meeting Presentation - 1/20/2023
This workshop will feature discussion from tribal representatives on their responses to drug use and overdose in their communities. Topics will include the development of multidisciplinary governance structures to guide the decision making; pulling together multiple streams of information across agencies; using tools such as the Overdose Detection Mapping Application Program (ODMAP) and overdose fatality review (OFR) to better understand the nature of drug use; and creating active partnerships between public health and public safety to intervene with individuals at risk for overdose.
This presentation was in the Concurrent Session 4: Tribal Communities’ Response to Drug Overdose breakout. -
Wisconsin Department of Corrections Overdose Fatality Review Team: A Statewide Implementation and Review by a Government Agency
Meeting Presentation - 1/20/2023
Beginning in 2015, the Wisconsin Department of Corrections (DOC) began a coordinated response to the opioid epidemic that continues to have a devastating national impact. Through the implementation of many initiatives that focused on medication-assisted treatment service delivery to those under the Wisconsin DOC’s care and control, harm reduction, and evidence-based practices, the overdose fatality review (OFR) committee continued to see fatalities from this disease. In 2020, leaders across the Wisconsin DOC embraced a concept to review the fatalities at a state level to better understand the processes and policies that the OFR team could improve upon to lessen overdose fatalities in its correctional population. The Wisconsin DOC’s OFR team is modeled after other national teams, but its uniqueness stems from statewide membership and coordination that reflects the diversity of Wisconsin. Wisconsin is home to 72 counties, which vary greatly from urban to rural and in race, age, income, and service level for responding to the opioid epidemic. The Wisconsin DOC supervises clients in all 72 counties (and a Native American territory), and as a result, its fatality review team reviews cases from all 72 counties. The team reviews two fatalities per month, with overall leadership offered by the Medical College of Wisconsin. Cases are selected with consideration for age, race, gender, geographic location, toxicology reports, and other factors suspected to contribute to the fatality. The Wisconsin DOC is eager to share its experience, project data, policy improvements, and lessons learned for other states to replicate.
This presentation was in Concurrent Session 4: Applying Emerging and Innovative Strategies breakout. -
A Multiregional Approach: The Coroner's Role in Overdose Fatality Reviews
Meeting Presentation - 1/19/2023
Oftentimes, activities related to fatal overdoses within a certain county may have been initiated in an adjacent county and vice versa. Since the opioid epidemic does not recognize county lines, critical case data may be difficult to attain from neighboring agencies because of differing case management software programs and/or lack of internal tracking of overdose case data. Smaller counties may experience hurdles in uploading overdose information to stakeholder databases, such as the Overdose Detection Mapping Application Program (ODMAP) and the State Unintentional Drug Overdose Reporting System (SUDORS), because of limitations in funding and a lack of supportive personnel to enter data and detect the circumstances leading to fatal overdoses and identify opportunities to prevent future overdoses. When overdoses cross county lines, it is difficult to see critical investigative links between separate fatalities. It is also difficult to recognize individuals or groups who are at risk and in need of harm reduction outreach and lifesaving resources. To address these issues, the Charleston County, South Carolina, Coroner’s Office will soon begin a grant-funded project to adopt a multiregional approach to overdose fatality reviews (OFRs). The Charleston County Coroner’s Office will work with five neighboring county coroners’ offices to improve intercounty opioid investigation protocols and perform faster uploading of data to national stakeholder databases, thus providing more accurate regional opioid death statistics, which will be provided to local, state, and federal agencies that analyze opioid-related mortality rates. By assisting smaller, adjacent counties in their case data upload, the Charleston County OFR team anticipates an increase in the total number of fatal overdoses as refinement and capture of overdoses are recognized.
This presentation was in the Concurrent Session 1: Real-life Examples From the Field: Data Partnerships in Action breakout. -
Applying Process Improvement Approaches to Recommendation Selection
Meeting Presentation - 1/19/2023
As the practice of overdose fatality review (OFR) evolves, techniques for recommendation development, prioritization, and implementation to help prevent overdoses are emerging. To assist communities with overdose prevention strategies through public health and public safety partnerships, the Centers for Disease Control and Prevention (CDC) and the Office of National Drug Control Policy (ONDCP) support the Overdose Response Strategy (ORS). ORS teams of public health analysts, working with the CDC Foundation, and drug intelligence officers, working with the High Intensity Drug Trafficking Area (HIDTA) programs, participate in and support local reviews. After reviewing approaches from Philadelphia, Pennsylvania, Winnebago County, Wisconsin, and other jurisdictions, the OFR team in Lexington County, South Carolina, created a unique approach for developing recommendations and applying Lean Six Sigma process improvements, facilitated by the ORS public health analyst. This presentation will describe the team’s process for identifying gaps/needs, generating and prioritizing solutions, and creating action plans. The presentation describes results of two prioritization exercises and recommendations that were implemented, including adding members for new sectors; educating members about Handle With Care protocols for referring children experiencing trauma to additional support; and seeking strategic partnerships and resources for community outreach, mobile services, and linkage to care. By describing methods and results of the process in Lexington County, attendees will be able to apply tools like a benefit-effort matrix and voting techniques for focusing partner resources and identify ways this process can achieve system improvements to prevent overdoses.
This presentation was in the Concurrent Session 1: Real-Life Examples From the Field: Operationalizing the National Standards breakout. -
Building an Overdose Fatality Review Program in a Large Urban Setting: Recommendations for OFR Program Development
Meeting Presentation - 1/19/2023
The city of Chicago, Illinois, is home to more than 2 million people. In 2021, the city lost 1,316 community members because of drug overdose.* The city had previously explored implementing an overdose fatality review (OFR) to support the existing programs offered throughout the city to address drug overdose, but it lacked the staff to work through the initial planning process. In spring 2022, the Chicago Mayor’s Office and the Chicago Department of Public Health partnered with the Overdose Response Strategy (ORS) public health analyst in Illinois to begin the process of developing an OFR for the city. This presentation demonstrates the impact of leveraging existing partnerships to build a robust OFR program and highlights the effective utilization of existing resources such as the Bureau of Justice Assistance’s Comprehensive Opioid, Stimulant, and Substance Abuse Program (COSSAP) technical assistance tools and state and national ORS program subject-matter experts in the field. In addition, this presentation will walk through challenges faced by the Chicago OFR planning team, such as refining case selection methodologies and data sharing scenarios in a state without legislation specific to OFR, and draw attention to the innovative solutions and recommendations that resulted from these challenges.
*Source: Illinois Department of Public Health Death Statistics: Drug Overdose Death by County.
This presentation was in the Concurrent Session 1: Real Life Examples From the Field: Operationalizing the National Standards breakout. -
Collaboration Within Rural Communities
Meeting Presentation - 1/19/2023
Since the suicide and overdose fatality review (SOFR) team in Whitley County, Indiana, was formed in August 2022, it has learned so much. Within the rural community, the team was able to form quickly because everyone knew each other well because of their roles in the county. Within the team’s review process, the team has received significant and detailed information from the county’s prosecutor’s office, sheriff’s department, police department, Department of Child Services, and emergency department. All collaborative partners work very closely and well together and choose to find a resolve versus just engage discussion.
As information was brought to the table and discussed, the importance of developing a timeline of the decedent’s life was critical. The timeline helps the team identify gaps in services very quickly.
Recommendations that the SOFR team have identified so far are:
- Follow-up counseling for suicide attempts in the teenage years
- Gaps within mental health care in the county (three communities within the county do not have a community mental health office)
- Stigma around men receiving counseling through a divorce
- Recovery supports needed in the county
Implementing: Mission 25 is launching a Recovery Engagement Center (REC) to provide multiple pathways to recovery. This is a longtime needed service for Whitley County. The REC will open in late fall 2023.
Resources: Mission 25 and the health department are providing naloxone; the police department’s “Handle With Care” program was discussed for children who lost a parent or loved one by overdose or suicide; the Department of Child Services is providing family care.
This presentation was in the Concurrent Session 2: OFR in Action: Rural Communities breakout. -
Data Gap or Opportunity? Infusing OFR With Creative Data Collection
Meeting Presentation - 1/19/2023
This workshop will focus on jurisdictions who focused on the assembly of key, local stakeholders representing public health and public safety to address the problem of drug overdoses occurring in their communities. Through the use of information sharing tools such as the Overdose Detection Mapping Application Program (ODMAP), data dashboards, and overdose fatality review (OFR), these stakeholder groups have turned data into actionable responses to the opioid crisis. Panelists will discuss the evolution of their information sharing practices, including instances where the implementation of one process led to the use of an OFR. Panelists will also discuss their process for regular surveillance of data and how it informs the delivery of services in their communities.
This presentation was in the Concurrent Session 1: Real-life Examples From the Field: Data Partnerships in Action breakout. -
Emergency Medical Services/Peer Support Rural Response Teams: An Innovative Model for Enhancing Linkages to Care
Meeting Presentation - 1/19/2023
In rural Sauk County, Wisconsin, if you are seen by emergency medical services (EMS) for anything substance use-related—stomach pains from drinking too much or an accidental or intentional overdose, for example—you receive a follow-up visit from response teams. A collaboration among Public Health Sauk County (PHSC), WisHope (a recovery community organization), and all six local EMS agencies, Sauk County Response Teams (SCRTs) are composed of EMS and a WisHope peer recovery coach. The teams make in-home or in-jail visit attempts to streamline a connection to needed services. The Sauk County Overdose Death Review Team recommended, planned, and helped implement SCRTs. The team reviewed multiple deaths in which the decedents had been previously seen by EMS for nonfatal incidents. The team also held a meeting to map area gaps in service delivery after a drug-related EMS incident and prioritized SCRTs as a solution to enhance linkages to care. PHSC applied and was awarded a grant, formed a planning committee, and hired an experienced consultant. SCRTs launched in May 2021. The teams receive about 10 referrals per month, and follow-up visits end in a successful connection with the client or a household member about half the time. Clients receive warm handoffs to services such as long-term peer support, treatment, harm reduction (Narcan, fentanyl test strips, education), and others (FoodShare, food pantries, health insurance, health and mental health care appointments, job training referrals, housing assistance, etc.). Monthly activity reports track referrals, rates of contact, clients’ ages and genders, and substances used.
This presentation was in Concurrent Session 2: OFR in Action: Rural Communities breakout. -
Expansion of Emergency Medical Services' Naloxone Leave-behind Program in Philadelphia, Pennsylvania
Meeting Presentation - 1/19/2023
Most decedents reviewed in Philadelphia, Pennsylvania’s overdose fatality review (OFR), OD Stat, had at least one interaction with emergency medical services (EMS) prior to their deaths. Philadelphia EMS has a naloxone leave-behind program, but the review team noted that many of the decedents would not have qualified for leave-behind naloxone and the accompanying education because they were not always using opioids. Much of the drug supply in Philadelphia is contaminated or adulterated with fentanyl, meaning that people who do not purposefully or knowingly use opioids could still be at risk for a future overdose. OD Stat pulled together a small subcommittee of public health and EMS staff members to review EMS’ current naloxone leave-behind policy. The policy at the time was to provide naloxone to people following a nonfatal opioid overdose. The Philadelphia OFR provided qualitative data from OD Stat showing that opioid overdose decedents often had EMS contacts prior to their overdoses for stimulant or hallucinogen-related calls. The OD Stat team recommended that the Philadelphia Fire Department/EMS update its policy to provide naloxone to any individual who uses drugs regardless of whether they knowingly use opioids or have experienced an overdose. By expanding its reach, EMS could provide education about widespread fentanyl contamination and increase its distribution of naloxone. EMS updated its internal policy and circulated an all-staff memorandum as of October 2020. Leave-behind naloxone was paid for through a grant funded by the Commonwealth of Pennsylvania. OD Stat tracks the number of leave-behind naloxone kits provided by EMS on an annual basis.
This presentation was in Concurrent Session 2: OFR in Action: Urban Communities breakout. -
How a Local County Health Department Garnered Stakeholder Support to Establish a Fatality Review Team
Meeting Presentation - 1/19/2023
This presentation describes the methodical steps taken and lessons learned in developing the Broome County, New York, Accidental Injury and Death Review (AIDR) team. Opioid overdose prevention staff at the Broome County Health Department focused on the details and planning of the fatality review team to set it up for sustainability, right down to the name of the review team. Broome County intentionally expanded the name of the team to AIDR to include not only fatal overdoses but also individuals who were injured (survived an overdose) or died by suicide. Every step in the planning process was thought out for future needs as they relate to both substance use and mental health. A key strategy in the development of the team was meeting one-on-one with stakeholders to garner support as part of the process and get their buy-in and recommendations prior to the first meeting. By investing the time up front and fostering the relationships among partners at the table, the overdose prevention staff members developing the AIDR team gained valuable input from the multidisciplinary team and were able to engage them in participating without hesitation. Stakeholders were instrumental in formulating recommendations and suggestions and providing subject-matter expertise. In addition, the Broome County program staff researched successful overdose fatality review teams and were mentored by two fatality review teams, along with the coordinator of the child fatality review team in Broome County. Learn how public health professionals used a personal relationship approach by focusing on stakeholders’ strengths and proficiency to develop the AIDR team in Broome County.
This document details Broome County, New York's path to establishing an OFR team and provides lessons learned, next steps, and a timeline of the steps taken to earn support of community stakeholders. -
Intended and Unintended Outcomes of Building Comprehensive Multidisciplinary Overdose Fatality Review Teams
Meeting Presentation - 1/19/2023
The Michigan Public Health Institute (MPHI) began establishing overdose fatality review (OFR) teams in Michigan in 2021. Following case reviews, MPHI sought feedback, surveyed teams, and followed up on information gaps. This resulted in several community-based, often team member-led presentations that have provided unexpected learning opportunities. The review of the case of a veteran who died because of an overdose left team members with unanswered questions, especially regarding the services and resources available to this particular population. As a result, a review team member connected MPHI with a representative from the Michigan Veterans Affairs Agency, who presented to the team about these issues and ended up joining the team. Michigan’s Children’s Protective Services representatives presented information to teams regarding what happens when children experience the loss of their parents due to overdose. In addition, the largest harm reduction agency in the region provided training on Narcan access and administration, as well as the services that the agency provides. Finally, MPHI asked emergency medical services (EMS) to share its criteria for naloxone administration, post-overdose substance use disorder treatment resources provided by EMS and any changes MPHI should recommend where those resources do not exist, treatment for non-opioid overdoses, and whether the need for naloxone reversal is increasing from previous years. MPHI has invited additional groups to educate its teams regarding information from their respective disciplines in order to enhance team capacity and efficacy. Increasing teams’ awareness of the various resources available in their communities is crucial to ensuring a robust review process that produces better-informed recommendations to prevent overdoses in Michigan communities.
This presentation was in the Concurrent Session 1: Real Life Examples From the Field: Operationalizing the National Standards breakout. -
Leveraging Community Collaboration to Implement Harm Reduction Strategies
Meeting Presentation - 1/19/2023
While establishing overdose fatality review (OFR) teams in Michigan, the Michigan Public Health Institute has naturally fallen into the model of working collaboratively with a review team and a separate community action group that drives forward the recommendations presented by the review team. These community action groups are existing groups that meet in each county, such as an opioid task force or a substance use coalition. Muskegon County’s OFR team works with the Muskegon Opiate Task Force acting as the community action group. Following each quarterly review, an infographic displaying the recommendations that resulted from each review is created. One case helped identify a municipality where there was a disproportionately high count of overdoses happening in that region’s hotels. Because of this finding, the team recommended the availability of Narcan at hotel front desks and common areas. The Muskegon Opiate Task Force, along with the implementation of this recommendation, placed “I Can Narcan” stickers on external windows of hotels and other establishments to indicate the presence of Narcan in that building. This allows external bystanders to take note of the presence of Narcan in a particular building, but especially for those who are using at the hotel. The review team has made several other recommendations around increasing access to naloxone, such as training all law enforcement officers to carry and administer naloxone. The task force continues to collaborate with law enforcement agencies to move this recommendation forward, and since the first review team meeting, the task force has helped change the policy and practice of one law enforcement agency in its jurisdiction.
This presentation was in the Concurrent Session 3: Collective Conversations: Leveraging Community Collaboration breakout. -
New York City's Three-pronged Approach to Creating Change
Meeting Presentation - 1/19/2023
The New York City, New York (NYC) RxStat initiative was established in 2012 and has included overdose fatality review (OFR) meetings since 2016. The past 2 years have brought many changes to RxStat. Today, RxStat has three meeting types, each with a clear goal and structure. These meeting types include:
- Drug trends meetings, which focus on high-level overdose trends and policies.
- OFR meetings, designed to unearth missed opportunities for overdose prevention and intervention.
- Action meetings, which create shared accountability and result in concrete recommendations and action items.
NYC has more than 2,000 fatal overdoses each year; the RxStat initiative cannot hope to review every case in its OFR meetings. Instead, it selects cases by theme to help focus the conversation in each OFR. Then, a subsequent action meeting focuses on how to take the gaps identified during the OFR and turn them into specific, achievable recommendations. In this presentation, the RxStat initiative will provide an overview of the goals and structure for all three meeting types and provide one to two case studies that provide an overview of:
- A theme the RxStat initiative chose for an OFR meeting.
- The process for selecting OFR cases that fit that theme.
- Gaps identified during the OFR meeting.
- Recommendations generated by the action meeting, including any workgroups created.
- Final actionable outcomes that resulted from the process.
This presentation showcases how RxStat moves from OFR case review to action and will provide examples of OFR themes that have resulted in fruitful discussion and action in NYC.
This presentation was in Concurrent Session 2: OFR in Action: Urban Communities breakout. -
Oneida County—Turning Data Into Action: Use of ODMAP and Overdose Fatality Review to Guide Decision Making
Meeting Presentation - 1/19/2023
This workshop focuses on jurisdictions who focused on the assembly of key, local stakeholders representing public health and public safety to address the problem of drug overdoses occurring in their communities. Through the use of information sharing tools such as the Overdose Detection Mapping Application Program (ODMAP), data dashboards, and overdose fatality review (OFR), these stakeholder groups have turned data into actionable responses to the opioid crisis. Panelists discuss the evolution of their information sharing practices, including instances where the implementation of one process led to the use of an OFR. Panelists will also discuss their process for regular surveillance of data and how it informs the delivery of services in their communities.
This presentation was in the Concurrent Session 1: Real-life Examples From the Field: Data Partnerships in Action breakout. -
Overdose Detection Mapping Application Program (ODMAP) Overview
Meeting Presentation - 1/19/2023
This presentation provides a brief overview of ODMAP.
This presentation was in the Concurrent Session 1: Real-Life Examples From the Field: Data Partnerships in Action breakout. -
Overdose Fatality Review Teams as Community Catalyst
Meeting Presentation - 1/19/2023
Overdose fatality review (OFR) teams represent multisector community stakeholders coming together to address substance use challenges in their communities. The heart of the work that these teams do is the development of recommendations—for the agencies, the community, the region, and the state. What if we conceptualize the work of the OFR as community systems development? What can happen when the team itself becomes the subject of recommendations (e.g., we recommend that this team help move our local system through the stages of the community readiness model)? If we start to track and show the outcomes of that—how individual agencies made process/policy changes or the new connections or collaborations made across team members’ agencies—those can be leveraged to set the foundation for continued, and more complex, efforts. This presentation discusses the case study of the LaPorte, Indiana, OFR team and how its work and collaboration contributed to the county being awarded a “community catalyst” grant to develop and implement a crisis intervention team (CIT). This effort will involve the participation of every law enforcement jurisdiction in the county and training for officers on utilizing the community system to provide appropriate responses and resources in crisis incidents such as overdose, suicide, or domestic violence. Patterns and recommendations identified by the OFR team can inform planning stage processes and training decisions. The OFR team will then have the unique ability to evaluate practical outcomes of CIT responses in future case reviews to provide a direct feedback loop for continuous improvement recommendations.
This presentation was in the Concurrent Session 3: Collective Conversations: Leveraging Public Health and Public Safety Partnerships breakout. -
Overdose Fatality Review: A Rural Community Approach
Meeting Presentation - 1/19/2023
A suicide/overdose fatality review (S/OFR) can impact community change and policies. Having the right participants at the S/OFR is critical to positive community engagement. Bringing together cross-sectors of a rural community to create change can bring remarkable success and significant challenges! Protecting our children and future community leaders is a great reason to work toward a solution and put bias aside. In 2019, the Jay County, Indiana, community developed an S/OFR. In 2020, it reviewed its first decedent. Since that time, the county has been able to make strides toward the following:
- Adjustments to programs, processes, policies, and practices to meet changing priorities in the community’s needs
- Developing relationships with different sectors to implement substance use prevention strategies
- Engaging decision makers and community leaders to support substance use prevention policies, programs, and infrastructure
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Overdose Fatality Review's Influence on Innovative Harm Reduction Services and Messaging
Meeting Presentation - 1/19/2023
This presentation shares how, through the overdose fatality review (OFR) process, demographic trends in overdose deaths resulted in the development of an outreach plan and a marketing campaign using harm reduction interventions to target high-risk communities, including African-American, LGBTQ+, Latinx, and those experiencing homelessness. Columbus Public Health (CPH) is the lead agency for the Columbus and Franklin County Addiction Plan (C&FCAP) and a participating member in the Franklin County, Ohio, Overdose Fatality Review (OFR). In addition to the public health administrator from CPH’s Alcohol and Drug Services Division attending the OFR, a CPH epidemiologist attended in order to compile the demographic information, key findings, client histories, and other personal information of the individual cases. Based on the findings, an analysis of each decedent was performed, and a cross-examination brought forth emerging trends and areas to identify gaps in service including the African-American, LGBTQ+, Latinx, and homeless populations. Results also indicated that there was a slight increase in overdose deaths during the holiday season in specific neighborhoods, which resulted in geo-fencing messaging. With members of the C&FCAP, including the coroner; those with lived experience; grassroots organizations that focus on the homeless population and victims of human trafficking; and the quick response teams, a messaging campaign was developed and implemented.
This presentation was in the Concurrent Session 3: Collective Conversations: Leveraging Community Collaboration breakout. -
Plenary Session 1: We Heart You: Recover in Our Community
Meeting Presentation - 1/19/2023
Established in 2018, the Winnebago County, Wisconsin, overdose fatality review (OFR) team has pursued numerous recommendations that have positively affected the community over the past 4 years. This plenary session will highlight recommendations that came out of Winnebago County’s OFR team meeting and were implemented to connect people to resources, utilize peer-led programs, break stigmas, and begin changing the culture of an entire community.
After the OFR team discovered that few OFR cases had connections to the recovery community, the team recommended to support and expand a substance-free culture that engages many stakeholders in the community and focuses on the support of individuals and families that are on a path to recovery. The initial phase of implementation included adding people in recovery to the OFR table, starting a sounding board to understand the relevance of OFR recommendations, and hosting community conversations with people in recovery to better understand their journeys and how the community could be more supportive. Participants will learn how this recommendation grew to be the “We Heart You” campaign, which included the creation of the We Heart You resource and referral card, the implementation of a public service announcement (PSA) focused on how to use the card, and the hosting of a community event. Ripples in the community were created from this event, and since that time, Winnebago County has created the We Heart You App, a peer-led rapid response team, and a PSA that breaks down the stigma of people who have been impacted by substance use disorder and humanizes recovery. After this session, the PSA video will be made available to any community that needs an inspirational template on the thriving recovery community with inputted local resources.
This was the first plenary on the first day of the OFR National Forum. -
Plenary Session 2: Implementing Overdose Fatality Review Recommendations to Save Lives
Meeting Presentation - 1/19/2023
In partnership with community partners, the Lackawanna County, Pennsylvania, District Attorney’s Office established a local, multiagency overdose fatality review (OFR) team in 2020 to examine the contributing causes of overdose fatalities in Lackawanna County. This plenary session will focus on two separate recommendations involving community education and awareness, harm reduction strategies, and decriminalization of fentanyl test strips.
Through cases reviewed by Lackawanna County’s OFR team, it became clear that the risk of fentanyl overdose did not simply or predominantly lie with heroin use. The review of these cases led to the recommendation for a deeper analysis of fentanyl-related overdose deaths and to increase awareness of this local data and risk of fentanyl overdose. In order to do this, the Lackawanna County District Attorney and the Mayor of Scranton, Pennsylvania, held a press conference, where they presented data and stressed that fentanyl was being seen laced in all street drugs, not just heroin, and that there had been several local overdoses due to pure fentanyl being disguised as other drugs and pills. The press conference was covered by local media and disseminated both in the local newspaper and TV news coverage. A one-page fentanyl educational document was also developed and disseminated to the OFR team, the local recovery coalition, and other relevant community partners. This press conference led to extensive discussions with a wide variety of community partners regarding the decriminalization of fentanyl testing strips. In addition, both the Pennsylvania District Attorneys Association and the City of Scranton publicly advocated for a state bill to decriminalize fentanyl testing strips following these discussions, which passed in October 2022.
Another recommendation that Lackawanna County’s OFR team was able to identify, develop an action plan for, and implement involved ensuring that all Lackawanna County police departments have access to naloxone as well as training on naloxone administration and local resources. Through collaboration between the Lackawanna County District Attorney’s Office and Pennsylvania Ambulance, this recommendation was successfully implemented and then expanded to other sectors throughout the community. Because of a significant number of school nurses requesting naloxone through Lackawanna County’s naloxone-by-mail initiative, as well as increased overdoses due to fentanyl pills being disguised as medications such as Percocet and Vicodin—which are increasingly popular with high school students—the OFR team also generated a similar recommendation to ensure naloxone access and education in all Lackawanna County schools. The Lackawanna-Susquehanna Office of Drug and Alcohol Programs took the lead on this initiative and sent a letter to all the school superintendents, and the Lackawanna County District Attorney’s Office mailed letters to all police chiefs in Lackawanna County, with telephone follow-up completed for anyone who did not respond. All schools and police departments were provided with naloxone, resources, and training as needed and appropriate. One hundred percent of Lackawanna County schools and police departments now have naloxone and resources onsite and were provided training, if needed, as a result of the findings and recommendation from the OFR team.
This was the second plenary on the first day of the OFR National Forum. -
Ross County—Turning Data Into Action: Use of ODMAP and Overdose Fatality Review to Guide Decision Making
Meeting Presentation - 1/19/2023
This workshop focuses on jurisdictions who focused on the assembly of key, local stakeholders representing public health and public safety to address the problem of drug overdoses occurring in their communities. Through the use of information sharing tools such as the Overdose Detection Mapping Application Program (ODMAP), data dashboards, and overdose fatality review (OFR), these stakeholder groups have turned data into actionable responses to the opioid crisis. Panelists discuss the evolution of their information sharing practices, including instances where the implementation of one process led to the use of an OFR. Panelists will also discuss their process for regular surveillance of data and how it informs the delivery of services in their communities.
This presentation was in the Concurrent Session 1: Real-life Examples From the Field: Data Partnerships in Action breakout. -
Strengthening Partnerships With State Public Health and Increasing Stakeholders' Knowledge by Identifying Underreporting of Somali Overdose Deaths Through Overdose Fatality Reviews
Meeting Presentation - 1/19/2023
According to the Minnesota Department of Health’s (MDH) 2021 Overdose Data Report, Black Minnesotans are three times more likely to die of a drug overdose than white Minnesotans. As home to one of the largest Somali populations in the nation, Minnesota’s Somali community has been underrepresented in overdose data. When collecting data on race and ethnicity, Somalis are often classified solely as Black, with no mention of the relevant ethnic subgroup. In 2017, MDH identified that the state lacked specific data to address the needs of the Somali community. Voices from the community demonstrated anecdote stories of overdoses of Somali youth. To address this issue, MDH launched pilot overdose fatality reviews (OFRs) in 2019, which recommended applying the OFR model using a culturally specific lens in the Somali community. The following year, using funding from the Centers for Disease Control and Prevention Overdose Data to Action grant, MDH partnered with Alliance Wellness Center—a culturally specific provider specializing in treatment and recovery for Somalis. During OFR implementation training, the OFR team lead shared concerns about the deeply rooted stigma surrounding overdoses in the Somali community as a barrier to community participation and facilitation of OFRs. To address the cultural stigma and build organizational capacity, the OFR team conducted prevention interviews before implementing OFRs in the community. Through these deep conversations, the OFR team captured the Somali community’s collective voice and identified barriers preventing community discussion on overdose deaths.
This presentation was in the Concurrent Session 2: OFR in Action: Urban Communities breakout. -
Turning the Tide for Grieving Families: Marion County, Indiana, OFR Subcommittee's Efforts to Improve Grief Connections
Meeting Presentation - 1/19/2023
To address the grave issue of substance misuse and the resulting fatalities in Marion County, the largest county in Indiana, the Marion County Public Health Department (MCPHD) formed a multidisciplinary overdose fatality review (OFR) team in November 2020 with the purpose of recommending data-driven changes based on the circumstances around overdose deaths in the county. From December 2020 to May 2022, a total of 33 overdose deaths were reviewed, and seven themes emerged, with the top three being mental health and stigma, health care access, and substance use awareness. After a year of case reviews, the team decided to form three action-oriented subcommittees based on the recommendations: (1) grief support, (2) advocacy, outreach, and information, and (3) access to care. Despite barriers, the subcommittees are continuing to perform exceptional work in terms of converting recommendations into action. The OFR team identified that families of decedents need easy access to grief support and mental health resources, especially at the coroner’s office, when their grief is still fresh. The grief support subcommittee acted by assembling grief support and mental health resources to share with the grieving families. It also advocated for the addition of a social worker among the coroner’s office staff who is trained to educate the family members regarding substance misuse and mental health needs. This has fostered empathetic surroundings for the families and encouraged them to seek help from the right sources. This initiative is a significant step toward reducing substance use stigma in the community.
This presentation was in the Concurrent Session 2: OFR in Action: Urban Communities breakout. -
Working Together to Leverage Multidisciplinary Partnerships to Implement Recommendations
Meeting Presentation - 1/19/2023
The York County, Pennsylvania, Overdose Fatality Review (OFR) Team was established by a joint initiative among the City of York Bureau of Health, the York Opioid Collaborative, and the County of York Offices of the Coroner and District Attorney. The purpose of the OFR team is to identify drug overdose fatality trends; improve incidence data to accurately record the number of overdose deaths in a county; define effective strategies for coordinating overdose prevention strategies; recommend statutory, regulatory, and policy changes; promote coordination among agencies that investigate drug fatalities and provide services to families; and develop plans for enhancing efforts of partner organizations. Recommendations to date have focused on communication, information/resource sharing, training, referring to services, naloxone distribution, and education opportunities. The recommendations generated are presented to the OFR team’s governing committee, the Public Health and Safety Team (PHAST), that supports and provides resources for implementation. The “We Care, York” initiative was developed based on a recommendation identified during the OFR team’s first case review in June 2021. The recommendation was to create a referral-to-help card that partner agencies could share with at-risk individuals and their loved ones, based off Winnebago County, Wisconsin’s “We Heart You” initiative. “We Care, York” links individuals experiencing a mental health and/or substance use crisis to services and ensures that individuals are aware of resources in the community when they find themselves in need to minimize the stigma associated with seeking help.
This presentation was in the Concurrent Session 3: Collective Conversations: Leveraging Public Health and Public Safety Partnerships breakout.