Training Death Investigators to Identify Decedents' Sexual Orientation and Gender Identity

Abstract

There is growing impetus within mortality surveillance to identify decedents' sexual orientation and gender identity (SOGI), but key personnel to this effort (eg, death investigators) are not currently trained to collect SOGI information. To address this gap, we developed a training for death investigators on this topic and tested its feasibility with 114 investigators in 3 states. Participants completed pretraining and posttraining questionnaires that measured 4 perceived outcomes: training relevance, success of delivery, adequacy for future use, and likelihood of future use. Overall, strongly positive responses affirmed the training's relevance, success of delivery, and adequacy for future use. Responses about attempting to identify the decedent's SOGI in future cases were not quite as positive, with close to 80% of the participants saying that they were at least "somewhat likely" to collect this information. Despite design limitations, the study results support the feasibility of training death investigators to gather SOGI information. Although not systematically assessed in the study, investigators' positive endorsement of training outcomes seemed higher in training sites where leadership strongly supported SOGI identification, suggesting that the role of leadership may be key to encouraging SOGI identification among death investigators.

Examining Intimate Partner Violence-Related Fatalities: Past Lessons and Future Directions Using U.S. National Data

“…UCR-SHR and NVDRS collect data from secondary sources to record information about IPV and violent deaths. To improve the quality of information about IPV, identity, and lived experiences of decedents, more training and resources may be needed for CME and LE to help them thoroughly document this information during the initial death investigation (Blosnich et al, 2022 ). For example, CME or LE agencies could introduce systematic probes to ask about IPV during death investigation interviews if the death occurred in connection to a known domestic conflict.…”

Transgender and Nonbinary Deaths Investigated by the State Medical Examiner in the Portland, Oregon, Metro Area and Their Concordance With Vital Records, 2011-2021

“…As other researchers have stated, it is critical that investigators receive training on how to ask those present at the death scene about the decedent's gender identity, why it is important, and have vendor infrastructure to do so. 17,18 The second touchpoint is having a case management system that allows for an easy, standardized selection of gender identities. Currently, MDILog's choices for decedent sex are "male," "female," and "unsure."…”

“…Research capacity includes consistent and methodical data collection for gender identity, which is a cornerstone of public health practice. However, no agency routinely collects information about gender identity at death,17 and training investigators to elicit this information is scarce 18. Oregon was one of the first states to participate in the National Violent Death Reporting System (NVDRS), which contains detailed information on violent deaths, including homicide, suicide, and overdose.…”

“…However, no agency routinely collects information about gender identity at death, 17 and training investigators to elicit this information is scarce. 18 Oregon was one of the first states to participate in the National Violent Death Reporting System (NVDRS), which contains detailed information on violent deaths, including homicide, suicide, and overdose. The NVDRS has a variable to collect gender identity (for violent deaths only) via a checkbox for transgender status but does not have specific gender categories.…”

“…23 Data obtained via death investigation guide federal and state public health efforts to promote and protect the health of American communities, and there is increasing recognition of the significance of sexual orientation and gender information (SOGI) on the risk of violent death; however, SOGI information is not currently identified in the US Standard Certificate of Death. 18 In this study, we used narrative information from the Clackamas, Multnomah, and Washington County Medical Examiner case investigations between 2011 and 2021 to determine and describe transgender status of decedents. To further investigate the concordance between transgender status and the official death certificate sex, we matched data between the ME system and the death certificate.…”