Table 3.

Summary of prevalent PRISM domains and elements with barrier and facilitator valences with key findings

Barriers: Most frequently used PRISM element codes and key findings	Facilitators: Most frequently used PRISM element codes and key findings
1. COVID-19 pandemic (19.4%)	1. Trialability (14.6%)
• Disrupted or suspended programming and screening practices • Limitations on non-jail staff access to facilities	• Option to prioritize high-risk groups • Easy integration into jail management software
2. Trialability (12.0%)	2. Leadership support (12.5%)
• Space and staffing shortages reduce the ability to try out OEND	• OEND buy-in driven by the severity of the opioid overdose crisis among people incarcerated and the experiences of peer jailers with successful adoption
3. Systems and training (10.2%)	3. Interorganizational efforts (11.4%)
• Limited infrastructure for technological solutions (e.g., reliable Internet access)	• Partnerships with local community agencies allowed for OEND • Contracts with communications companies facilitated OEND
4. Interorganizational efforts (9.9%)	4. Readiness for change (9.0%)
• Disruptions to existing partnerships with local community agencies due to the pandemic	• Technological capacity allowed for socially distanced overdose education • Jailers’ commitment to addressing stakeholder misperceptions
5. Staffing concerns (8.7%)	5. Staffing concerns (8.7%)
• Staff turnover/illness • Budget cuts due to lower censuses with pandemic mass releases • High volumes of releases strained staff capacity	• Technological infrastructure supports OEND • Staff with behavioral health/re-entry expertise support OEND efforts

Notes % = frequency of PRISM element code usage across total # of PRISM element codes (matrix-coded by barrier and facilitator). Key findings are in italicized text