This module will assist overdose fatality review (OFR) coordinators in planning OFR meetings and prepare partners to actively and thoughtfully participate in meetings.
The meetings are held when and where most members can attend. The schedules and locations of the entire year’s meetings should be developed at the beginning of the year so that OFR team members can plan accordingly.
A typical meeting will be two to three hours in length and each case will take about an hour, depending on the complexity of the case and the review team’s experience.
The meeting room layout is important for group dynamics and inclusion. Hosting the OFR team meeting in a circle or a hollow rectangle layout gives everyone an equal position at the table and allows for face-to-face interactions by all participants. In addition to having adequate space for desired layout, it is ideal to have a whiteboard in the meeting room for taking notes and displaying the created timeline of significant life events leading up to the decedent’s overdose death.
Given the sensitive nature of the information shared and the need to build trusted relationships, the OFR meetings are closed and not open to the public.
Sometimes, invited guests will participate or observe to learn more about OFRs. Most often, the invited professionals have information specific to the case and are called guest members.
Successful OFR case reviews depend on thoughtful preparation by the OFR coordinator, beginning a month or two before an OFR case review meeting. A list of coordinator activities and a timeline is provided below and in the Coordinator’s Meeting Preparation Checklist provided in Module 2.
Beginning two months before the meeting, the cases to be reviewed at the upcoming meeting need to be selected.
Having timely data is critical for a successful OFR initiative. The medical examiner’s/coroner’s office can be an excellent source for identifying overdose cases and initial case information. If possible, have someone with access to the medical examiner’s/coroner’s data on the case selection subcommittee and the OFR team. Ideally, this person will gather information about overdose fatalities as they occur.
Once cases are identified by the medical examiner/ coroner, allow enough time for toxicology results to be known and police officers to investigate an overdose before selecting the case for review. This will enable the data to be collected and organized for a more complete case review.
It may not be feasible for every OFR team to review every death in its jurisdiction. In this situation, the coordinator may task a subcommittee with developing case selection criteria and/or selecting cases. To help select cases, the following may need to be decided:
Once the core case criteria are determined, further case selection criteria may be needed to narrow the selection of cases to a feasible number. Explore more criteria in the OFR Manual.
Beginning six weeks before the meeting, the coordinator needs to identify guest members, in addition to OFR team members, that he or she needs to recruit.
Agencies that are not already OFR members and that may have provided services to the decedent (such as a behavioral health provider) or that serves the community in which the decedent lived, such as social services or housing and employment supports, may be recruited to participate in a specific case review. The agencies to participate may be identified from the medical examiner’s/coroner’s report or from news coverage about the death.
An email and follow-up phone call to discuss the OFR process and purpose can be an effective method for getting participation. It is important to share and review interagency and confidentiality agreements. Have the agreements signed before discussing details of the case or requesting case information. Sample recruitment letter and agreements are included in Module 1 Resources.
Once interagency agreements are in place and around a month before the meeting, case-specific information should be requested of all team members. The information should be protected in accordance with confidentiality standards. If possible, use an encrypted email to request information about the case.
The email requesting case information should include the decedent’s information listed below and guidance on what information is requested from members, including what specific data members should report out. A sample OFR case email, a member’s guide to collecting case information, and a list of agency-specific data elements is included in Module 2.
Decedent information:
Two weeks prior to the review, an email including the following should be sent to OFR members:
A sample two-week reminder email is included in Module 2.
Prior to the meeting, the coordinator will want to summarize in a PowerPoint presentation or handout additional information identified by reading the obituary, news coverage, or social media posts or by interviewing family members or social contacts to present during the case review. A template for creating and presenting a case summary is included in Module 2.
Two weeks prior to the meeting, reach out and follow up with partner agencies that were responsible for previous action items or recommendations to get a status update to share during the OFR meeting.
OFR teams should consider having a standing agenda item to provide updates on action or tasks completed since the last meeting. Documenting and sharing this information helps build in accountability of all members and subcommittees.
The coordinator is responsible for developing the meeting agenda with input from the OFR facilitator, if this is a different person. More information on developing an OFR meeting agenda is located in Section 3C, and a sample meeting agenda is included in Appendix C.
The coordinator will print and bring agendas, handouts, data use agreements, and any other materials needed during the OFR meeting.
OFR members include OFR core team members and invited guests. Members may begin preparing a month prior to the review meeting.
The more prepared the members are, the more engaged they will be, resulting in a more comprehensive understanding of the incident and what could have been done to prevent it.
Members will receive an email one month prior to the meeting containing the basic decedent information listed below. Most OFR meetings will cover more than one case.
Decedent information:
Members will want to think about each case and any implications it might have for their organizations or agencies and for public policies affecting specific target populations, neighborhoods or communities, and/or topic areas (such as co-occurring mental illness and substance misuse).
Members will need to determine whether their organizations or agencies had contact with the decedents, decedents’ families, or social networks, or whether they provided services to the neighborhoods where the decedents lived or where the incidents occurred.
Follow up with the OFR coordinator if more information is needed to determine whether your organization or agency had contact with or provided services to the decedent(s).
If a member’s organization or agency had contact with someone involved in the case or the incident area, he or she should prepare a summary to verbally share during the OFR discussion.
There are no hard-and-fast rules about what information will be useful in identifying a problem and possible solutions to prevent similar overdose deaths from a systems perspective. However, preparing for the review by answering the questions provided by the coordinator, along with reading the basic decedent case information, is a good starting point.
A member’s guide to collecting case information and agency-specific data element recommendations are available in Module 2.
Important: Before you draft a summary, review the signed data sharing agreement and confidentiality forms, as well as your organization’s confidentiality policies.
Some members may choose to read a prepared summary and others may choose to read from available case file. Ideally, OFR team members will bring their summary and records to be able to reference back to during the meeting to allow additional details to become available as the discussion progresses.
At the review meeting, members will want to ask questions to clarify information and timeline, identify missed opportunities or gaps in services, and suggest strategies to prevent future deaths.
At the review meeting, it is fine to take notes of the discussion, observations, prevention activities, or strategies you want to remember for your agency. Do not document any identifying information about a case that would be considered confidential.
Schedule your day so you can arrive early and stay a few minutes after the review to meet other team members. It is a good networking opportunity and a great way to continue the discussion with other colleagues.
Publication — 5/7/2020
Publication — 7/20/2020
Online Resource — 12/1/2020
Video — 12/1/2020
Report — 7/22/2020
Publication — 7/22/2020
Publication — 7/22/2020
Publication — 7/22/2020
Publication — 7/22/2020
Publication — 7/22/2020
Publication — 7/22/2020
Publication — 7/22/2020
