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This paper describes results from a qualitative analysis of promising policies and practices associated with preventing deaths in prisons. We conducted case studies of several prisons that are diverse in size and populations served. Data collection and analysis included a review of policies relevant to medical care, suicide prevention, substance use and security, as well as semi-structured interviews with key agency personnel responsible for leadership, clinical care, training, and policy. Analysis of the agency personnel interviews resulted in several themes related to best practices and challenges in preventing deaths in prison, including quality of medical care 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 prisons.