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This paper describes results from a qualitative analysis of promising policies and practices associated with preventing deaths in jails. We conducted case studies in jails that are diverse in size, region, and populations served. Data collection and analysis included a review of policies relevant to suicide prevention and substance use, as well as semi-structured interviews with key agency personnel responsible for leadership, training, and policy. Analysis of the agency personnel interviews resulted in several themes related to best practices and challenges in preventing deaths in jails, including deaths due to intoxication and suicide. Results from the thematic analysis as well as the policy review are discussed, as well as the implications for policy and practice aimed at reducing deaths in jails.