SMART Policy Podcast
Podcast by the UT SMART Initiative. Host Jeremy Kourvelas speaks with experts from across the recovery ecosystem - representing healthcare, prevention, law enforcement and more - about local, state and federal drug policy to find out what is and isn't working to make this fight against addiction a little easier.
SMART Policy Podcast
Finding Opportunities to Save Lives With Overdose Fatality Review Teams
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You're listening to the Smart Policy Podcast, a production of the University of Tennessee's Institute for Public Service. Overdose Fatality Review, or OFR, is a fairly new and yet already proven strategy for identifying gaps in recovery ecosystems. In other words, you bring people together from healthcare, law enforcement, criminal justice, harm reduction services, and more to jointly examine cases of fatal overdoses and find out how these people fell through the cracks.
SPEAKER_05Any encounters they might have had with law enforcement or the criminal justice system, looking at treatment history and any other factors, and that can include your local conditions as well, to really better understand where those missed opportunities for prevention and intervention might occur and prevent a future overdose deaths.
SPEAKER_01Lauren Savitskis works for the Institute of Intergovernmental Research on behalf of the Bureau of Justice Assistance to provide technical assistance for the implementation of OFR teams across the country.
SPEAKER_03You really do see, oh hey, look, something could have happened there. You really do see that clearly. When you put them on an OFR, it's a different conversation that you will have in most other settings.
SPEAKER_02When you can get outside of your space and see the situation from the lens of others in the field or other disciplines, you see different opportunities. You see all these other strategies that you can consider because you're hearing them from a different set of eyes and minds. Really, when you're dealing with something as innovative and as new as an OFR model, you have to consider the creative options in order to keep increasing its effectiveness.
SPEAKER_04I think we're the exception to the rule, actually. Most of the time it's it's housed within a health department. I think it's helped us being in the medical examiner's office to be able to be the foundation for the OFR.
SPEAKER_01Trevor Henderson, Smart's Middle Tennessee Substance Use Response Consultant, joins Lauren as well as Charina Cathy of the Knox County Health Department and Denise Martin of the Rutherford County Medical Examiner's Office to provide perspective on how OFR teams have been implemented in Tennessee, showcasing how varied and dynamic the strategy can be. In this conversation, we explore why this strategy breaks down data silos, identifies actionable solutions, and leads to long-term relationships, including opportunities for further innovation.
SPEAKER_02My name is Sharina Cathy. I am the substance misuse response coordinator at the Knox County Health Department. For context as well, I don't directly facilitate the OFR. Ryan he'll introduce himself. He's the facilitator, but I oversee him.
SPEAKER_03So my name is Ryan Hood, and I am a public health educator at the health department, but I also facilitate the OFR meetings for Knox County. You all know me, uh Trevor Henderson. I am the Substance Use Response Consultant for Middle Tennessee with the UT Smart Initiative.
SPEAKER_04Hi, I'm Denise Martin. I am the supervisor with the Rutherford County Medical Examiner's Office in Tennessee. And I also facilitate the Rutherford County OFR meetings.
SPEAKER_05Hello, my name is Lauren Savitskis. I am with the Institute for Intergovernmental Research. We are a training and technical assistance provider through the Comprehensive Opioid Stimulant and Substance Use Program. And I'm a senior research associate with that company.
SPEAKER_01Well, I think to get started, why don't we have Lauren? You are our nationwide expert. I would love it if you could give us a quick breakdown of what an OFR is.
SPEAKER_05So I work on behalf of the Bureau of Justice Assistants and in partnership with them on the comprehensive opioid stimulant and substance use program. One of the things that we are focused on is overdose fatality review or OFR, as you're going to commonly hear us say today. So what is an OFR? Well, the purpose of an OFR is really to effectively identify systems gaps and innovative community-specific overdose prevention and intervention strategies. In practice, OFRs are really looking at reviewing a series of confidential death reviews or case reviews, as you might hear it called today, by a multidisciplinary team. So this team is going to examine a decedent's life cycle in terms of drug use history, comorbidity, major health events, social emotional traumas that can include your adverse childhood experiences, any encounters they might have had with law enforcement or the criminal justice system, looking at treatment history and any other factors, and that can include your local conditions as well, to really better understand where those missed opportunities for prevention and intervention might occur and prevent a future overdose deaths. So then as jurisdictions begin looking at a series of uh case reviews or death reviews, they start to see patterns of those needs and opportunities, not only within a specific agency, but really across all the various systems that are working in a community to prevent overdoses or substance use. So as you start blending input from public health, public safety, all of the providers and the community partners that are around this table for OFRs, you really develop these program and policy recommendations to improve coordination and collaboration across agencies and improve the community conditions within a jurisdiction to prevent future overdose deaths.
SPEAKER_01It's quite a process. Uh seeing how it plays out is really, really fascinating. You can see in a particular individual, like, well, you see, he or she, or either one, uh whatever, it was arrested uh on this date, um, showed up at the ER a week later, or yeah, and and you go through chronologically points of interaction. It's kind of like a sequential intercept map, but with multiple different sectors all uh all represented. And uh it really highlights the crucial periods of of intervention. You really see where a weak spot is, or the strong spots too. But in particular, since we're looking at people who are are uh deceased, it kind of ipso facto, you end up seeing the weak spots probably more than anything else.
SPEAKER_03I mean, for what it's worth, Jeremy, my experience with an OFR is that um I would argue this is nearly the only way to really see weak spots. Um, again, you if you any given country pulls up information from a death and toxicology, those things, those by themselves can be revealing, but it's only whenever you put that information beside those emergency department visits, the law enforcement interactions that you know that's what reveals these moments where you really do see. Oh, hey, look, something could have happened there if we had an intervention in place or a service in place or a position um that we know could have made a difference. You really do see that clearly. You see so many opportunities uh in retrospect. And and I'm I'm unaware of anything else um that can do that, any other tool that can do that within this um world of trying to address overdoses. Um I'm curious if the others feel the same.
SPEAKER_02Well, I can certainly add on to Trevor's comment in that the one of the most wonderful impacts that you quickly see with a collaborative work group model is things like this, where silos of information suddenly become shared more readily and more easily. And it's not to say that all of the agencies and stakeholders that are trying to respond to the any overdose issues that they're seeing in their community are incapable of doing it. It's more so that when you can get outside of your space and see the situation from the lens of others in the field or other disciplines, you see different opportunities. You see all these other strategies that you can consider because you're hearing them from a different set of eyes and minds.
SPEAKER_01Yeah, breaking down data silos, that's one of the defining features of what is known as public health 3.0, uh, the sort of current era of how we think about public health systems. Uh there's a uh a widespread call for integration with public health, public safety, also as many sectors as you can get of a community to be sharing data, as well as resources and a number of other initiatives that are part of this. But it really seems like OFR is a perfect strategy to address that kind of thinking. Uh with addiction, it's it's often called the everything problem, or it's important to think of this in terms of recovery ecosystems. How many stakeholders or what kinds of stakeholders could be involved on an active OFR? And of course, right, what we have representation for both Knox County and Rutherford County, so we have a couple of examples from Tennessee here.
SPEAKER_04I'm happy to jump in on that one, Jeremy. Um so you know, our base crew, uh our researchers are with the medical examiner's office. So we have the advantage of accessing a lot of this information uh, you know, on the front end because we are looking at the terminal overdose event, unfortunately. Um and we are already interacting with a lot of the different stakeholders that are involved in that investigation. So you know we have law enforcement uh DA's office. Um we also have uh representatives from jail and the workhouse, those from the medical field, so as well as those in preventative efforts. So, you know, we have a crew of people. Uh, we also have epidemiologists and those that are tracking the data, so um, both from the educational field and state health departments. Um, so those are our sort of our base um stakeholder model. Um, and uh we have had some great collaborative efforts and um attendance at our meetings. So we've we've been learning a lot from from different fields. It's it's a good group, good crew of people.
SPEAKER_05Yeah, I'll hop onto that too. So I believe OFRs are a very magical group of people who come together and share aggregate data as it relates to the community, as well as OFR, decedent case review specific data to really blend all of that together to come up with the best, most informed initiatives that are relevant to the community. Um, and part of that is having those multidisciplinary partners and sectors represented from those different agencies so that you can better understand the entirety of the landscape. So it's really blending public health professionals, public safety agencies, providers. But we do think of an OFR inclusive of some core members, which would include your medical examiner or coroner, depending on what state you hail from, um, your public health professionals, public safety agencies, including first responders, anyone who's involved with the criminal justice system, um, healthcare systems like hospitals, uh, behavioral health providers, and then child protective services as well. And then additional members are obviously just as important as it relates to your community. So, what harm reduction practitioners or service providers? So you have peer support and recovery involved, and you would need to examine your local jurisdiction to figure out the appropriate agencies or individuals who might um be responding to substance use within the community and invite them to participate.
SPEAKER_01What is uh launching an OFR look like? And typically who who you'll need a champion, I imagine. I I suspect that probably starts with the examiner's office. Uh, Denise, as you said, that's where most of the uh individuals in question are going to come from. Is that a good place to house it? Or are there other stakeholders that could house an OFR in a community?
SPEAKER_04I think we're the exception to the rule, actually. Most of the time it's it's housed within a health department. We were just fortunate enough to be able to get the grant. You know, it seemed to make sense because we do have access and we delayed with a lot of these different agencies in our investigations, which is sadly the fatal event. So I don't believe we are the usual facilitators of the OFR. Um, I think it's been advantageous for us to be this in this format because when I've been uh collaborating with some of the work groups that uh Lauren has facilitated, um it seems that there has been somewhat of a roadblock in getting some of the medical examiner records and the medical records for these individuals, uh, whereas we're already privy to that information. So I think it's helped us being in the medical examiner's office to be able to be the foundation for the OFR. Um I would like us to eventually partner with the health department. I think we could um, you know, collaborate more intimately if we were partnered. So that is something that we are looking to do in the future, but I don't think we are the norm. Knox County might want to chime in on that.
SPEAKER_01I was gonna say in Knox County, uh the health department does run the OFR, I believe, correct?
SPEAKER_02Yes. Our OFR team is housed in our health department and it's run by health department staff. So we have our facilitator, Ryan, who is a public health educator, and then one of our epidemiologists from our epidemiology division supports with the case data review and understanding and interpreting local data trends and so on and so forth. And I would say when it comes to champions for our health department, we already had a very strong, healthy relationship with our regional forensic center. And truly, without that, this would not have happened. Without that invested personal interest and passion from our forensic center, we would have been fighting an uphill battle, to be quite frank. But thanks to them already wanting to start the ball rolling and our epidemiologists wanting to be a part of this conversation, and then so many area partners also having a vested interest. It while I wasn't a part of the original starting of the OFR team, the current restructuring of the Knox County OFR was actually a very seamless transition.
SPEAKER_01Yeah, quick shout out to uh Chris Thomas at uh the regional forensic center there, um located in Knoxville. He's uh quite a champion uh in in fighting back against the consequences of addiction. Uh and we've had him on the show before. He's a great guy. Thank you for talking about his passion there, uh, Sharina. I'm interested to know uh about the transition. I I think that's uh potentially an interesting facet.
SPEAKER_02Yes. So perhaps one of the scariest words one could hear in a professional setting is restructuring. And admittedly, it does have some potentially nefarious tones to it. But really, when our OFR team started, we were the first in the state. There were a lot of things to consider, there were a lot of options to explore, and it was still a pretty new field. So we weren't sure what would work best. And then once the county started to approach normal activities after the COVID-19 pandemic, we saw, okay, perhaps this would work better to accommodate our community's growing needs. And so in the spring of 2023, we restructured the Knox County OFR team. And we did that because we found that there were certain voices still missing from the table. Um, some had stepped away. You know, there were just so many changes over the past few years. And so we took advantage of that. We put the um when the previous facilitator stepped away to another position, we took advantage of that time to streamline the roster, to look again at the process. We met with Lauren and other folks at IIR to see what other OFRs were doing and what works for them. And it was a very insightful experience. As a result, like I said, restructuring sounds like a daunting time, but it helped us more effectively utilize our time, our person power, um, our overall efforts. So, for example, with when it comes to staffing, I think one of the first concerns is we might not have enough people for this. And we kind of had the same concern, but then we secured some grant funding. We added or moved around some of the existing workloads of one of our epidemiologists to provide that support. Ryan came on. And as a public health educator, the O of our responsibility only makes up a part of his overall work. And so, you know, providing community education is the bulk of it. And when you take an existing position that can reasonably adopt some of the O of our responsibilities, it alleviates some of that financial burden and some of that other resource burden that might otherwise come in when you have to restructure and create a new position altogether. Does that answer your question?
SPEAKER_01Yeah, no, absolutely. Uh and in fact, uh, you happen to have invoked yet another dreaded word in this space, funding. Uh but I do think that's an important space uh and and consideration. In Tennessee, there have been efforts to come up with some sort of state-implemented funding mechanism. There have been a couple of different attempts at that. But right now it it sounds like the OFRs in Tennessee are locally funded uh or sourced. Is that the case?
SPEAKER_02I'm not sure about you, Denise. I saw we unmuted at the exact same time. Great minds think alike. But yes, for the Knox County OFR, we are funded in large part by the OD2A as well as our local county funds.
SPEAKER_01By local county funds, do you mean opioid abatement settlement funding? The health department. Um, gotcha. Okay. All right. Denise, I'm so sorry to cut you off.
SPEAKER_04No worries. Um, we were funded by the BGA COSAT grant. Um, unfortunately, that's coming to a close. We did get an extension, fortunately, because we had a delay in our start of our funding uh through no fault of our own. But unfortunately, that is gonna come to a close this year. So we will be looking for different funding efforts. Trevor has been very helpful and pointing me the right direction to where to look for those. So, although, you know, we all have a passion for this work, it's exposed our medical examiner team to a different way of helping the community. Um, typically, you know, we're you know, from medical examiner's office, we are restricted to um helping families understand what's what's happened, providing answers to the questions they may have, unfortunately, about the fatal event, uh, working with the criminal justice system when appropriate. Uh so this has enabled us to have a different use for the for the information that we have in our office. So we are all very strong about in our in our passion about continuing these efforts. So we will we will do it one way or the other, um, even if it's just uh you know utilizing our team when we can uh to keep this OFR going. So again, our hopes are to truly partner with our health department to see whether they can help us uh with that with those efforts going forward. Obviously, you know, we still uh have an epidemiologist from the health department that works with us, so I don't see that relationship stopping. But uh in regards to you know cold, hard cash, um we will be looking for other funding efforts going forward, but um, you know, the OFR won't stop. Even if they even if we can't find the money, we'll we'll find a way to make it work.
SPEAKER_05Yeah, OFRs are often scalable. So we have sites that are fully funded, they staff three, four positions to uh facilitate, coordinate, collect data for OFRs. We also have OFRs that have no funding whatsoever. So it's all about uh how scalable and how big or large you would like your OFR to be and have the capacity to do so. States and local jurisdictions use the COSEP funding that Denise had. They look at opioid settlement dollars to try to fund that local dollars, OD2A, nonprofits, SAMHSA has some dollars that OFRs can utilize for this structure as well. Unfortunately, Fatality Review doesn't have a direct funding stream, which would be incredibly helpful if it did, but there are ways that local jurisdictions have been able to find dollars to support this effort or go it without any funding for this particular endeavor. And they're incredibly successful. It's all about, as you mentioned earlier, the championship, finding someone who is passionate and wanting to move this project forward, or like Denise mentioned, not stopping. They'll go forward whether they find the funding or not because they see the value and utility of bringing these partners together uh to talk about these cases and develop these recommendations.
SPEAKER_03Right. Maybe just pick up on something Denise said in particular, which really um sparked off a thought for me, which is you know, she mentioned about facilitating the OFR, sort of really exposing her medical examiner's office to a different way of doing work. I mean I would argue that that happens for all participants in an OFR. Um it's you know, as Sharina mentioned the data silos earlier, it's also the physical silos of those positions and individuals. When you put them on an OFR, it's a different conversation that you will have in most other settings. I mean, certainly in a in a public health world, you might be in regular meetings with some of these folk. But by virtue of the OFR being a closed meeting with um agreements to not share data outside of that, you're having a very particular conversation that you are not going to have anywhere else. I really think that exposes law enforcement, public health, hospitals, uh probation, just you know, right across the range to a different way of engaging with these other professions, which I think then starts to extend outside of the OFR in other ways. And Jeremy, I know that um you had Eric from the Nashville Jail on and in the past. And he talked about the um naloxone vending machines at the Nashville jail.
SPEAKER_06Right.
SPEAKER_03And Eric would say it was his participation in the Nashville OFR many years ago that helped him see that his work with inmates needed to extend beyond the release date of those inmates. They were not, he would do great work with them while they were in the jail, but as they left his care, things were not going well for some of them. So what could he do to try and make a difference as they went out the door?
SPEAKER_00Around October of 2022, I was on a uh overdose fatality review. We were reviewing a female individual who had overdosed. And that individual, the touching point, was the behavioral care center. And I was like, what? This can't be happening. Well, we've got to do something. I've got to do something.
SPEAKER_03And and that came out of those conversations in an OFR, which really break down how you see your work and how far your work can extend.
SPEAKER_01So Denise mentioned that you've provided some advice on how to seek funding for this, Trevor. If you're a county government listening, what advice would you give them on seeking funding for an OFR? What are some approved uh uh sources?
SPEAKER_03Well, I mean, my first port of call is if you haven't already applied for a COSAP grant, is to look at that. Um, I I know that um in my previous life uh working in public health in Nashville, uh, it was that grant that I used to get an OFR up and running in Nashville. The grant was relatively easy to apply for. Um, the the BJA team were super supportive and really helpful. That introduced me to Lauren and the IIR team. And uh, you know, that that relationship has still continued to this day. But uh where Denise is right now where that grant is is ending, I certainly have been talking to her about approaching the county authorities and talking about their opioid abatement settlement funds. Um, you know, this work is so important and can really inform so many other strategies that a county might be about to fund, that that this could be a vital driver of those strategies that could support them over the next 18 years of those settlement funds to make sure you're really being data-driven but also really tackling the problem at its roots. I I see the OFR as that important that I do think it should be a prioritized consideration where possible. Otherwise, I think you could be throwing a lot of money at a lot of really worthy strategies, but I'm not too sure how we really identify are these getting at the roots of the problems or not.
SPEAKER_01Okay, so not only is it an approved use, it's uh one that might be able to enhance other strategies. If used well and supported properly, yes. Sharina, Denise, would you like to comment on that?
SPEAKER_02Sure. I I will mention, you know, especially as far as recommendations for other counties go into what Trevor said, um, when it comes to overdose, I think unfortunately there is still a lot of stigma attached to the conversation. And so some people may not realize that they aren't asking perhaps the most effective questions when it comes to tackling the issue. So when you're talking with your community, make sure do your community stakeholders actually know the extent that they have as a group to impacting the situation, how they're being impacted in turn. Do they understand that they really do have the capacity to make a difference? And it doesn't, like Lauren said, it doesn't necessarily have to take millions of dollars or even thousands. Um, you can always scale your strategies to accommodate the resources that you currently have. And then when you have all this information, you can discuss it with your stakeholders and whoever else has a say in the formation of an OFR team in that area. You might get some questions, which is totally normal. Openly receive those questions, respond to those concerns, and then show them through the model itself how an OFR team can not only be a time effective model, but the most financially and person power resource effective model to overspond or to responding to overdoses.
SPEAKER_01So, what are some actionable findings that y'all have encountered? What are some key takeaways that have already been uh discovered in in uh running OFRs?
SPEAKER_05So overdose fatality reviews are finding recommendations across the spectrum and being able to implement that based on their community's readiness. So we see overdose fatalities reviews looking at criminal justice-related strategies, social determinants of health strategies, linkage to care, peer recovery, grief support has been something that's been coming up time and again. And through that, the development of the Next of Kin interview and working with bereaved loved ones after an overdose loss and connecting them into care as well. So that ranges the gamut of what the findings are, and it's not always implementing a brand new strategy. It's not bringing sometimes it is, sometimes it is bringing a brand new program, bringing a deflection team to your jurisdiction, but sometimes it's enhancing the work that's already being done and using your aggregate data to inform that work. So communities have, you know, a saturation with Narcan, yet they're still seeing overdose deaths occurring within that, you know, a specific zip code. And the the OFR is finding that. So they say, hey, we need to deploy more community naloxone in this area or send our deflection team to this hotel motel, where we're seeing, you know, often a lot of overdoses occurring. So it varies based on who your partners are at the table and the data that teams have access to. But overall, it's looking at policies, programs, procedures, who can call whom and developing those relationships that was mentioned earlier around, you know, there people are coming to the tables, agencies are coming to the table, and they're forming relationships in that room. It is bringing in policies, procedures, um, changing, you know, implementation strategies, uh, becoming more informed of what's going on within a community, but it's also about building those relationships across these multidisciplinary partners so they can better work together in the systems and programs that they have.
SPEAKER_01Okay, that's fantastic. Loving that uh just a natural byproduct is relationships that will naturally follow up on uh Trevor, that's kind of like what uh Eric Bowder experienced, uh, which led to a major implementation uh down the line that connecting the dots came from participating in an OFR. Okay, so usually the last question I ask is what policies are might you recommend to enhance uh the given strategy that we're talking about? Uh but I can go ahead and uh seed this conversation a little bit. Uh when our in our conversation with Chris Thomas, he said uh a major gap is that medical examiners are not able to access mental health records without a court order. I'm seeing some some heads being nodded here. Um how much of a gap is that uh with an OFR?
SPEAKER_04I would say it's a it's a huge gap. Um, you know, when we're trying to rebuild these histories to to see where we could really implement some positive strategies, preventative efforts and treatment efforts. That type of information is so important. And it's you know, we've it's been a historic issue, you know, with uh our medical examiner investigations prior to the OFRs that uh mental health professionals and uh facilities just do not want to part with this information. You know, we can certainly uh understand their hesitation in trying to convince them that this information could provide such good results in a you know a setting such as an OFR. It's just been an uphill battle.
SPEAKER_06Right.
SPEAKER_04There's uh thoughts on you know, trying to get legislation changed um so that they feel legally able to share this information, but it's been a historic issue with trying to get these sort of records, but it could provide uh so much insight into these decedent case histories and stories that could really provide us some valuable information.
SPEAKER_05So it's critical that OFRs have an understanding of substance use history treatment as well as mental health treatment, and it is incredibly challenging oftentimes to access those records. OFRs are building these timelines of interactions and engagements, and oftentimes whether a person is in treatment and how they access those treatment is imperative to understanding their life course and what services were offered to them. So not being able to access that information is can can be prohibitive. I will say continuing to invite your mental health providers to the table, even if they can't share that case-specific data, where they can share what programs and policies they do have in place, what they would like to have in place, why there's what their system you know really needs to operate, is still really helpful for an OFR to develop recommendations because treatment can speak and substance use treatment can speak on their overall policies and protocols in a general sense, which can still lead to recommendations and improve quality of care for all individuals who are accessing their services.
SPEAKER_01That's a very uh insightful way to approach this, I think. It's there's a saying we've encountered in other areas of of this space that is fighting back against addiction is share information, not data, uh, if there is uh sensitivities or or legal considerations to be had. At an aggregate or a system level uh perspective, it can still be very informative. And I guess at the end of the day, that's that is what OFRs are seeking to do, but almost in the inverse, they they meet collectively and discuss specifics and then come back with system-level uh gaps to identify. In that same vein, I've noticed some interesting workarounds too. I've even seen social media, public social media data uh uh be taken into consideration uh with a particular deceit and say they were a very prolific uh user of a given platform. If it's posted publicly, it's public information, and there has been some interesting findings therein. I that struck me as a really uh fascinating way to make up additional information gaps. Any thoughts on that?
SPEAKER_05Yeah, there's lots, and I would love to hear the local perspective as well. I don't want to hug all this face, but uh, there is a tool called the Nexivkin interview, which can inform some of the information that may or may not be presented within an OFR. So it is a trained individual who actually does outreach with um not a legal Nexivkin, but a loved one, a friend, a family member of the decedent who has died and helps to fill in those gaps. And it's an actual conversation between that interviewer and the person who has lost someone to a drug-related death. And they talk through, you know, what was their childhood like, what were their engagements with criminal justice, all these different pieces to really expand upon the different encounters and help to fill in the gaps if your treatment provider cannot give information or even those barriers to care. It might not be found in a record that they didn't come to an appointment because they lost transportation. But the next of kin would be able to share that. And then that enriches the conversation that your core record providers are sharing because it really informs what was occurring that we don't see in a record so that we can talk about those social determinants of health and those different interventions that might not be in, let's say, a medical file. So using social media, using next of kin interviews, looking at an obituary to see who the survivors were talking about, the children who are, you know, now lost a parent really helps inform an OFR in, I don't want to say non-traditional ways, but in other ways to get information that may not be in a report source.
SPEAKER_02And to add to that, um, those are actually some of the strategies that we employ at the Knox County OFR. For example, our behavioral health providers who can't necessarily provide specific data, we continue to invite them and encourage them to attend our meetings, to participate in conversation, and they do because they are able to look over the lifespan of their career and their knowledge and say, these trends seem to be safe to share, these strategies seem to be the most salient to the issue. Let's discuss this. And we really value that partnership because truly to have an effective partnership, it can't just be what the other person expects or what one party expects, right? It has to accommodate both parties' interests and see where we can meet in the middle ground and then work from there to what is the most beneficial impact for the community. And then when you're looking at other gaps, such as going on social media and looking at obituaries, we've found quite a lot of information through that approach. For example, there may be a decedent who had a social media account, and you find out that they were survived by one or two children who posted nothing about their past loved one, um, in which case they were most likely estranged. And that can also lead to conversations around maybe the the social aspect of the decedent's life, up to the up to their overdose, up to their passing, or any other social determinant conversation points. Um, you would think that the more conventional ways to get information are the only tried and true. But really, when you're dealing with something as innovative and as new as an OFR model, you have to consider the creative options in order to keep increasing its effectiveness.
SPEAKER_01Lauren, I would love it if you could talk about what OFR legislation can look like.
SPEAKER_05There are many states that have a law that allows them to share related data to overdose fatality review. So the Legislative Analysis of Public Policy Association or LAPA began to look through all of the various states to see what OFR language was already curated and in law at that time to help develop a model law that states can take and adapt based on their own jurisdictional need and apply this language to allow OFRs, both at the state and local level, have access to records and put different requirements in place, such as you know, reporting or you know, um data analysis, those different pieces. But it really allows for local jurisdiction to have the ability to access records in a confidential manner and share that information within the OFR case review meeting to help inform that decedent case review.
SPEAKER_01All right. Well, uh any other potential recommendations or considerations for someone looking at implementing an OFR in their in their area?
SPEAKER_03I would recommend, if you're considering it, that you reach out to Lauren and their team and talk to them. They are the national experts on this. Um, I think all of the rest of us have hugely benefited from their wisdom and and uh experience. Um, and they're incredible to work with and just so supportive and uh can provide you with templates and language and all sorts of things. Lawrence, is there still an um annual OFR meeting at the national level?
SPEAKER_05Yeah, there is. So we have this amazing website called OFRTools.org, and it has all of these resources for new and existing sites to tap into to help inform their program. So if I were just starting an OFR within my jurisdiction, I would go to that website and there's a specific section called launch your OFR. And it has all of the resources that you need to get started. It has confidentiality forms, sample data sharing agreements among your partners, sample agendas so you better understand what you're going to even be talking about within an OFR meeting. There's opportunities to join our peer mentor program, which matches you with a veteran site and you get to observe them and walk with them so they can help you stand up your OFR. Or if you're a current OFR, enhance the work that you're doing and say, oh, that would really work in our jurisdiction. We never considered doing it here. Let's take that back and apply it. So all of these resources are free to any OFR, regardless of your funding. Um, so I would really start there and tap into those resources because you don't have to recreate the whale. It also has an OFR email exchange, which is a network of OFRs across the country. And you just literally send an email out and say, Hey, I'm struggling getting my law enforcement partners to the table. How have you been able to recruit that? And people all around the country will send you everything they've tried, all of their strategies. You need a sample data sharing agreement. They've got you. It's a really great way to crowdsource and get the best information from OFRs across the country in a one-stop shop. We do have a national forum that Trevor alluded to. And it is we meet yearly, we bring in different OFRs to present on what they're doing, as well as having different trainings from national providers. And so it's a really great opportunity to network with your peers, but also enhance your learning and the work that you're doing within your jurisdiction.
SPEAKER_02So one thing that I do want to mention is encouraging people to keep in mind that this conversation is not, it doesn't only have the potential of being sensitive regarding the decedents and anyone who has uh survived them, but it can also be a bit sensitive for the providers and the partners themselves. Like, for example, we have seen that one of the service gaps in our area is not realizing that there are generational cycles of addiction. Many of our decedents had parents who used drugs in the home and while the decedents were children, or even used with them when they were adolescents or when they were adults at various points in their lives. And we think, well, of course, DCS, the school system, all of those providers, they should just be aware of this problem. So why aren't they fixing it? But in reality, most of the times they don't know that this is happening. And then being a part of an OFR helps them identify that gap. So, all that being said, when you're coming together to have these conversations, just keep in mind that we may not have all of the pieces. Certain partners might be learning this information for the first time, too. And this is really a collaborative learning process together, where in making this OFR team, you're also making a structure for all of these professionals and these disciplines to come together and support one another, too.
SPEAKER_01Right, that's an excellent, excellent point. Well, Ryan, thank you all so much for joining me on the Smart Policy Podcast. I really greatly appreciate it. For more episodes on in-depth discussions on Tennessee policies related to substance use disorder by a range of local experts. Please subscribe to us wherever you get podcasts and visit our website at smart.tenesse.edu. I'm Jeremy Corvellis. Thank you for listening and see you next month.