Facilitate your meeting

This module will assist overdose fatality review (OFR) facilitators in effectively facilitating review meetings to build trust and identify recommendations to prevent future overdose deaths.

Facilitator’s Role


An effective facilitator is a neutral convener who is a good listener, develops trust with partners, encourages group participation and engagement, leads but does not direct discussion, and guides the group towards collective problem solving to craft recommendations.

Ideally, to maintain objectivity and a sense of equality among partnering agencies and members, the facilitator should be a representative from a neutral lead agency, such as local public health or community coalition, and will not report to a principal agency such as the police department, the mayor’s office, or a behavioral health service agency.

The facilitator is responsible for ensuring that members agree with following guiding principles:

  • The “North Star” (a shared goal of reducing overdose deaths)
  • Overdose deaths are preventable
  • Substance use disorder is a chronic, treatable disease
  • Use of multisector data to inform response strategies
  • Continually improve OFR process and prevention activities

Visit the CDC Foundation’s Public Health and Safety Team (PHAST) Toolkit to learn more about these guiding principles.

Meeting Agenda


A successful OFR meeting will cover specific steps. A sample agenda can be found in Module 2 Resources and more information on these steps in the OFR Manual.

This step should include member introductions, updates from previous meetings, upcoming events, data presentation, review case selection criteria, and other announcements.

  • Member introductions: Attendees share their names, titles and their agencies’ names and roles in preventing overdose fatalities.
  • Updates from previous meetings: Members share status updates on any delegated action items or recommendations from previous meetings.
  • Data presentation: At the beginning of the year, present an overview of the prior year’s fatal and nonfatal overdose deaths. At each subsequent meeting, present the year-to-date number of overdose fatalities and any noticeable trends (e.g., changes by overall numbers, demographics, or substance type). Understanding overdose fatalities (e.g., who is at risk for an overdose and where overdose deaths are happening) requires an ongoing and real-time analysis of overdose trends. Using a standard report will help partners understand long-term trends in fatalities and allow them to plan and develop new strategies or modify existing ones. Data and analysis from these reports can also be invaluable for promoting public awareness and outreach, as well as for applying for grant funding. A sample summary data report is included in Appendix B. Also, refer to the CDC Foundation’s PHAST for more guidance about presenting data at an OFR meeting.
  • Review case selection criteria: If not all overdose deaths within a jurisdiction are being reviewed, remind the review committee about which criteria were used to select the case.

The facilitator reads aloud the meeting goal(s), guiding principles, and ground rules included on the agenda handout. Ask participants whether they want to add any new ground rules.

  • A sample list of ground rules is included in Appendix B.
  • Guiding principles listed in Section 3B.

The facilitator or coordinator collects members’ reviewed and signed confidentiality forms and answers any related questions. Confidentiality is discussed in more detail in Module 4. Collect Your OFR Data.

  • Confidentiality agreement: This essential form needs to be signed at the beginning of each review by the members present. A sample confidentiality agreement is included in Appendix D.
  • If more than one case is reviewed at a meeting and some members arrive mid-meeting, the facilitator needs to make sure that they sign and submit the confidentiality agreement when they arrive.
  • Interagency agreement: This agreement needs to be signed by senior leadership of each participating agency (including any ad hoc agencies) before they participate in any reviews. The agreement states the role of the agency in the reviews. A sample interagency data sharing agreement is included in Appendix D.
  • The facilitator is responsible for reminding team members that the meeting is closed and that the information shared in the meeting shall not be discussed outside the meeting, as outlined in the agreements they have signed.

The facilitator presents the decedent’s basic case information.

  • The facilitator presents the case summary developed by the coordinator, as outlined in Section 2B. Coordinator’s Activities, Step 6. Summarize Case(s).
  • If each member is given a summary document, all documents should be collected at the end of the meeting.

The facilitator calls on each member to share what he or she knows about the decedent, his or her social connections, and the overdose incident. The information shared helps members understand more about where the decedent lived, socialized, worked, and played to help identify risk factors and missed opportunities for prevention and intervention that may have contributed to the overdose death.

The facilitator calls on members to share their summary reports, as discussed in Section 2C. Members’ Activity, Step 4. Prepare a Summary, starting with the medical examiner and first-responder agencies, to report out in reverse chronological order, for assistance with developing an incident timeline. The facilitator will then determine the best approach to receive report outs from the remaining members, based on the specific case.

The facilitator actively guides the group discussion by encouraging members to ask questions. The group discussion will clarify timeline of significant life events and identify missed opportunities for prevention and intervention. The facilitator may want to use the strategies outline in Section 3D. Meeting Facilitation Strategies.

The facilitator summarizes significant case information and draws a timeline of key activities, ideally on a whiteboard.

The facilitator leads a problem-solving discussion as outlined in Figure 2.1 to identify recommendations for change in practices or policies that may have prevented this overdose death and may prevent those in the future.

The facilitator reviews and clarifies actionable recommendations, assigns individuals responsible for any action items, reflects on the meeting’s process and findings, and collects any participants’ handouts containing case information.

  • The facilitator recaps how the meeting went and relates today’s review to other cases or to a larger context, such as by saying, “Today’s case involved a heroin-laced fentanyl, and there has been an increase in such reported cases in recent months from this area of the city.”
  • The team determines whether the investigation is complete or whether more information is needed.
  • Remind members of confidentiality and collect any papers with confidential information.
  • Remind members of the time and location of the next meeting.

Measuring Meeting Success


The facilitator wants to make sure that meetings are as successful as possible. The OFR process is always evolving in response to members’ needs and changes in data trends. In addition, the identified recommendations impact large system issues, and it may take time to effectively make noticeable improvements. Therefore, it may be helpful to have some short-term measures to determine whether the OFRs are successful.

How do you know if an OFR is successful?

  • Agencies continue to send staff members to the reviews.
  • Members contribute to the discussion.
  • Members are open to feedback and are not defensive.
  • Members come more prepared for each meeting.
  • Members linger after the meeting has formally ended to network with other members.
  • Members begin to see connections between seemingly unrelated overdose deaths and develop a shared analysis.
  • Agencies report that the information is useful to their daily work.
  • Each agency is working on at least one recommendation during the year.

In addition to the above measures of success, the facilitator will want to connect with members between meetings to get feedback on the overall OFR process and meetings and identify strategies for improvement.

Meeting Facilitation Strategies


An OFR meeting is a combination of information sharing, group brainstorming and problem solving, strategic planning, and decision making. The meeting facilitator actively participates in the discussion, moving it from information sharing to problem solving using the following strategies.

  1. Thank members
  2. Encourage person-first language and respect for the decedent and survivors
  3. Summarize members’ comments
  4. Solicit a variety of solutions/recommendations
  5. Address misinformation
  6. Acknowledge all potential solutions
  7. Ask open-ended questions
  8. Ask clarifying questions
  1. Ask reflective questions
  2. Encourage all to participate
  3. Ask for help
  4. Encourage team building
  5. Anticipate possible areas of tension or bias
  6. Politely redirect members
  7. Remind members of the “North Star” and guiding principles

OFR Resources


10 Tips to Facilitate a Successful Overdose Fatality Review

Publication — 3/2/2022

Centers for Disease Control and Prevention (CDC): Social Determinants of Health

Online Resource — 1/26/2021

COSSAP Overdose Fatality Reviews and COVID-19 Virtual Case Review Meetings

Report — 4/20/2020

From the Field: Traumatic Brain Injury and Opioid Use Toolkit

Online Resource — 10/19/2020

From the Field: OFR Timeline Samples

Report — 1/27/2021

From the Field: Sample Facilitator Job Description

Publication — 5/5/2021

Guidance for Facilitators: Beyond Facilitation—The Cultivation of an Overdose Fatality Review Team

Publication — 7/14/2021

New to OFRs Affinity Group: Facilitate Your OFR Meeting

Video — 5/10/2022

Office for Victims of Crime: The Vicarious Trauma Toolkit

Online Resource — 1/15/2021

OFR Facilitation Checklist

Publication — 3/31/2022

Overdose Fatality Review (OFR) and COVID-19 Response

Webinar — 5/7/2020

Sample Interview Questions: Facilitator Role

Publication — 5/7/2021

Sample List: Facilitator Qualities

Publication — 7/22/2020

Sample Template: Meeting Minutes

Publication — 7/22/2020

Sample: Governing Committee Report Outline

Publication — 7/22/2020

Sample: OFR Agenda

Publication — 7/22/2020

Substance Abuse and Mental Health Services Administration (SAMHSA): Overcoming Stigma, Ending Discrimination Webcast

Webinar — 3/28/2018

Substance Abuse and Mental Health Services Administration (SAMHSA): Why Addiction is a 'Disease' and Why It’s Important

Webinar — 4/26/2018

Uncovering the Connection Between a History of Problematic Substance Use and Brain Injury Matters in Overdose Fatality Review

Webinar — 6/3/2021

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