Comparing Practices Used in Overdose Fatality Review Teams to Recommended Implementation Guidelines.

OBJECTIVES: Overdose fatality review teams are a public health and public safety collaboration that reviews fatality cases using a multidisciplinary team to provide recommendations for overdose prevention. No research exists on the case review practices currently being used in these programs. DESIGN: We administered a cross-sectional survey measuring case review practices and perceptions to a convenience sample of overdose fatality review teams. SETTING: We administered the online survey to participants at a national virtual forum on overdose fatality review. PARTICIPANTS: In this study, we examined 30 county-level overdose fatality review teams from 6 states who completed the survey. MAIN OUTCOME MEASURES: We developed measures of case review practices from an overdose fatality review implementation guide. We provided descriptive statistics on the survey items used to measure these practices and examined how practice uptake varied by overdose fatality review team characteristics. RESULTS: Most overdose fatality review teams had adequate representation and membership, but none adhered to all of the practices measured from the implementation guide. The largest gap was in perceived effectiveness and implementation of case review recommendations. In addition, teams that had been reviewing cases for longer reported more adherence to recommended practices. CONCLUSIONS: Overdose fatality case review is a collaboration between local public health and public safety agencies that holds great promise. However, these teams will require additional training and technical assistance with local community support to ensure that recommendations are actionable.

Lost in Transition: The Behavioral Health Needs of Veterans in Eight County Jails.

The behavioral health needs, service utilization, and discharge planning provision of veterans in jails have been understudied, yet practitioners must understand each component to ensure veterans' behavioral health needs are met through linkage to culturally-appropriate services. Thus, this study asked: How do veterans differ from non-veterans regarding behavioral health needs, jail-based service engagement, and discharge planning within jails? How do jails identify veterans and are they referred to culturally-appropriate services? In a booking sample across eight jails, this evaluative, cross-sectional study compared veterans to non-veterans by demographics, criminal/legal outcomes, behavioral health needs, and receipt of jail-based behavioral health and discharge planning services. Additionally, the process by which booking officers and jail-based clinicians identify veterans was assessed. Veterans were more likely to be male, older, to have received mental health services prior to their jail stay, and to misuse alcohol. They are less likely to have insecure housing and misuse drugs. No differences existed for length of stay in jail nor recidivism. Veterans were equally likely to receive jail-based behavioral health services, but less likely to receive discharge planning services. While many veterans identified their military status at booking, just over one-third who received services from clinicians were identified as veterans. Of those identified by clinicians, few were referred to culturally-appropriate services as part of their discharge planning. Practitioners in the criminal/legal and mental health systems need to collaborate and develop processes that successfully identify and link veterans to culturally-appropriate services.

Developing a cascade of care for opioid use disorder among individuals in jail.

INTRODUCTION: The overdose epidemic persists as a public health crisis in the United States. Jails are a critical overdose prevention touchpoint. The risk of overdose postincarceration may be increased if an individual is released without medication for opioid use disorder (MOUD) treatment or transferred to long-term residential treatment. A growing number of studies have examined the difficulties in implementing evidence-based care for opioid use disorder (OUD) in jail settings. METHODS: We use administrative data (July 1, 2020, through September 30, 2020) from four jail facilities that implemented OUD treatment programs. These data included screening data from the Rapid Opioid Dependence Screener (RODS) (n = 2562), along with booking and medication information from jail records, which we used to develop a cascade-of-care. RESULTS: Screening rates varied dramatically by facility, with integration into the jail records management system showing the best outcomes. The prevalence of OUD identified from the RODS was 8.1% and did not vary significantly by facility. Nearly one third (31.3%) of those identified as having an OUD were dispensed medications, with two-thirds receiving methadone and the remaining third buprenorphine. The average length of stay for all screened individuals was two weeks, compared to two months for those who received an MOUD. CONCLUSIONS: Screening for OUD diagnosis is critical to reduce gaps in a cascade-of-care, and our results provide guidance on how to achieve this in jail. Failing to identify OUD and provide MOUD places an individual at an increased risk for fatal overdose. Future studies should consider examining MOUD discharge planning and factors that improve treatment retention following release from incarceration. Our study also illustrates the churn of jail populations and the need for rapid induction of treatment and overdose prevention strategies upon release.