overdose fatality review - the pdmp training and … is overdose fatality review? •modeled after...
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Overdose Fatality Review
Erin Haas and Laura Bartolomei-Hill Department of Health and Mental Hygiene
BJA Grantee meeting
3/30/2017
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Overdose in Maryland
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What is Overdose Fatality Review?
• Modeled after other mortality review teams (CFR, FIMR, etc.)
• Multi-agency/multi-disciplinary team assembled to conduct confidential case reviews of overdose deaths
Provides a framework for analyzing what could have prevented a drug overdose death, in order to ultimately identify ways to prevent future similar deaths’
• Department of Health and Mental Hygiene (DHMH) provides technical assistance & death records to teams
• Team members bring info from respective agencies about decedents to inform review
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Goals of OFR - H-G § 5-903
• Promote cooperation and coordination among agencies involved in investigations of drug overdose deaths or in providing services to surviving family members
• Develop an understanding of the causes and incidence of drug overdose deaths in the county
• Develop plans for and recommend changes within the agencies represented on the local team to prevent drug overdose deaths
• Advise the Department on changes to law, policy, or practice, including the use of devices that are programmed to dispense medications on a schedule or similar technology, to prevent drug overdose deaths
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OFR in Maryland
• Established as a pilot in 3 jurisdictions with the support of a HR13 grant; now operational in 19 jurisdictions
• Local OFR teams meet at least quarterly to review cases
• Teams have met over 205 times and reviewed over 518 cases
• Teams include representatives from:
- Local Health Dept
- Law Enforcement
- EMS
- Local Hospital
- Treatment providers
- Prevention Office
- Dept of Social Services
- Public Education
- Parole and Probation
- Detention Center
- Crisis Services
- Community Colleges
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OFR Outcomes: Trend Identification
• 1064 trends observed in 412 cases
o Mental Health diagnosis or treatment history (162)
o Somatic Health Condition (113)
o Previous overdose (96)
o Pain management (79)
o History of Suicidal ideation or attempt (72)
o Intimate Partner Violence (68)
o History of alcohol abuse/DUI (67)
• Emerging trends
o Overdose deaths occurring in a hotel or motel
o History of traumatic brain injury
o History of childhood trauma
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OFR Outcomes: Recommendations
• 265 System-Level Recommendations coded into 9 macro categories
1. Integrated Care
2. Underserved populations
3. Law Enforcement
4. Prevention Education
5. Harm Reduction
6. Information Sharing
7. Criminal Justice Institution
8. Standardization
9. Service Enhancement
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OFR Outcomes: Examples
• Partnership between Baltimore County Health Department peer outreach workers and law enforcement to engage overdose survivors
• Based on a reviewed case, the Washington County team learned that a decedent was ruled ineligible for residential treatment following a short incarceration, as jail time counted as "sober time." As a result, the team recommended changes in the required criteria for admittance to a residential facility upon release from incarceration.
• Identification of strategic sites to focus Naloxone and other OD prevention activities, including homeless shelters, emergency rooms, and local detention centers
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HR16: OFR Expansion and Innovation
• Develop protocols for and pilot team coordination of services provided to surviving family members and outreach activities to prescribers and other healthcare providers associated with decedents selected for case review
– Beginning in Year 2, two local OFR teams will begin writing protocols for and conducting outreach to surviving family members and health care providers
• Create an integrated online portal for overdose fatality review data transmission and reporting through CRISP
– Streamline access to PDMP, CRISP, OCME, and OFR reporting data
– Improve capacity for local and statewide analysis
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HR16: OFR Expansion and Innovation
• Enhance PDMP-related technical assistance to teams
– Expand technical assistance and training for PDMP data to improve its use during case review and inform outreach activities
– Create PDMP guidance document
– Develop PDMP web-based training for Local OFR teams
• Conduct program and grant activity evaluation
– University of Maryland Systems Evaluation Center will evaluate grant activities by attending selected team meetings, analyzing OFR data, and conducting stakeholder interviews
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OFR Staff
Laura Bartolomei-Hill, LGSW
Overdose Fatality Review Coordinator Office: 410-402-8491 Email: [email protected]
Erin Haas, MPH Local Programs Manager Office: 410-402-8574 Cell: 443-827-0735 Email: [email protected] Department of Health and Mental Hygiene Behavioral Health Administration Spring Grove Hospital Center 55 Wade Avenue Catonsville, MD 21228