Washington County epidemiologist nationally recognized for innovative approach to suicide prevention

For Immediate Release: Monday, October 22, 2018

Dr. Kimberly Repp, chief epidemiologist with Washington County Public Health, received the 2018 National Susan P. Baker Public Health Impact Award from the National Association of Medical Examiners at their annual conference last week.

This competitive $500 award can be given once a year by the National Association of Medical Examiners for the best manuscript and presentation. Competitors are evaluated by judges on the potential contribution to public health, translating research into action that benefits public health, and potential to increase appreciation for the role of forensic research in advancing public health.  

Dr. Repp was recognized for developing and implementing an innovative suicide surveillance system in Washington County that involves a unique collaboration between the medicolegal death investigators (MDIs, also known as deputy medical examiners) and epidemiologists. The system has been proven to save lives and is influencing national practice.

“Suicide has been identified as a top health concern in Washington County in the last two community health needs assessments,” says Dr. Repp. “Our county is one of the first in the country to have a suicide fatality review involving robust partnerships between health care providers, law enforcement, public health and death investigators working on system-level interventions to stop suicide. The only missing piece of the puzzle was comprehensive surveillance data for each death.”

The recognized gold standard for violent death risk factor data is the National Violent Death Reporting System (NVDRS), with Oregon as one of the six founding members. Information collected in the NVDRS includes suicide risk factor and circumstance information such as whether the decedent was in a financial crisis at the time of death or had a previous suicide attempt, among many others.

“Washington County’s demographics are unique enough that we weren’t comfortable using three-year-old state-level data to represent our residents,” says Repp. “We wanted to see if there was a way to get more community-level information.”

To understand the death investigation process, and to assess if additional information was available through a standard death investigation, Dr. Repp shadowed the county’s MDIs on well over 200 violent death investigations over a span of nearly two years. The purpose was to determine what information was available at the death scene that 1) wasn’t included in the NVDRS 2) wasn’t in the death record and 3) could be valuable for intervention and prevention efforts in public health.

As a result of this fieldwork, Dr. Repp worked with the MDIs to develop a data collection tool called the Consolidated Risk Assessment Profile form. MDIs complete the form within 24 hours of each suicide, based on information they gather at the scene.

By using this tool, Repp and her team of epidemiologists are able to track near real-time trends to find the most at-risk community members for suicide.

“In the span of a month, we noticed that the MDIs each had a case where the decedent surrendered their pet at a shelter shortly before the suicide,” says Repp. “Within two months, our suicide prevention team had provided training to every staff, volunteer and veterinarian at the county’s animal shelter.”

Within three months of receiving this training, shelter staff had already identified and intervened with seven people surrendering their animals who stated they were going to harm themselves after being asked by staff if they were planning suicide. These individuals were immediately connected to the county crisis line.

“It’s an honor to be recognized for this important work,” says Repp. “But our medicolegal investigators deserve recognition, too. This work is only possible because of their compassion and dedication to preventing suicide in Washington County. It has been humbling to work side by side with them in the grimmest of circumstances.”

Since presenting her findings at the annual conference in West Palm Beach last week, Dr. Repp has received hundreds of emails and dozens of requests for presentations and trainings from across the country and into Canada and Mexico.

“Each loss from suicide is devastating to our community,” says Dr. Repp. “This work demonstrates the importance of studying the dead to help keep the living alive. Our suicide surveillance and prevention system is simple, inexpensive and highly effective, and demonstrates that saving a life can be as simple as asking a question.”

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