Thursday, January 19 — Opening Day
8:00 a.m. – 5:00 p.m.
8:30 a.m. – 8:50 a.m.
Welcome, Housekeeping, and Overview of National Standards
8:50 a.m. – 9:50 a.m.
9:55 a.m. – 10:40 a.m.
PLENARY SESSION 1: We Heart You: Recovery in Our Community
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.
- Know how to leverage OFR relationships to engage the local communities in order to educate on addiction, recovery, and mental health; break stigmas and connect individuals to resources.
- Know how to engage the recovery community with OFR work.
- Leave with access to a PSA template on recovery that can be tailored for each community with its own local resources.
10:45 a.m. – 11:30 a.m.
PLENARY SESSION 2: Implementing Overdose Fatality Review Recommendations to Save Lives
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.
- Thoroughly understand the process by which recommendations were generated and implemented by Lackawanna County’s OFR team and utilize this knowledge to replicate a similar recommendation, if desired.
- Articulate the collaboration among OFR partner agencies during recommendation implementation.
11:30 a.m. – 12:45 p.m.
Lunch (on your own)
12:45 p.m. – 2:00 p.m.
CONCURRENT SESSION 1: Real Life Examples from the Field: Operationalizing the National Standards
Building an Overdose Fatality Review (OFR) Program in a Large Urban Setting: Recommendations for OFR Program Development
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.
- Describe the process and the OFR National Standard tools that the Chicago OFR planning team used to identify and recruit key partners for the OFR panel.
- Identify strategies used to address challenges around data sharing and case selection processes.
How a Local County Health Department Garnered Stakeholder Support to Establish a Fatality Review Team
This presentation will describe 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.
- Hear how the Broome County Health Department describes its success working with a multidisciplinary team to establish an inclusive fatality review team.
- Describe why establishing the name of your review team is a key factor when developing your team.
Intended and Unintended Outcomes of Building Comprehensive Multidisciplinary Overdose Fatality Review Teams
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.
- Share unintended outcomes from OFR teams in Michigan.
- Describe how establishing comprehensive multidisciplinary OFR teams can build community capacity.
Applying Process Improvement Approaches to Recommendation Selection
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 will describe 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.
- Apply process improvement approaches for identifying gaps/needs, generating and prioritizing solutions, and creating action plans in the context of recommendation development.
- Describe tools like a benefit-effort matrix and voting techniques for focusing partner resources.