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Abstract Background For nearly two decades, it has been widely recognized that individuals in jail settings have a high prevalence of opioid use disorders (OUD) and are highly susceptible to fatal overdose upon their release. This setting provides a public health opportunity to address OUD with Medication for Opioid Use Disorders (MOUDs). Yet, 56% of jails do not provide MOUD, creating a pressing need for better implementation approaches in jail and the hand-off to the community. Two successful implementation strategies, NIATx external coaching and the Extension for Community Healthcare Outcomes (ECHO) case management telementoring model, were compared to address this persistent treatment gap. Methods This 2 × 2 design compared high (n = 12) and low (n = 4) dose coaching with and without ECHO in a 12-month intervention and 12 M sustainability period. The national trial included 25 jails and 13 community-based partners. MOUD trends for buprenorphine, methadone, injectable naltrexone, and combined MOUD between the study arms were assessed. Results Jail sizes ranged from 24% with 500 daily population, and community-based treatment providers ranged from 63% with 500 average monthly OUD intakes. New patient counts were found to significantly increase across the intervention phase for buprenorphine (p

Millions of people worldwide have experienced abrupt and traumatic disruption in the flow of their personal life story as a result of stroke and the onset of aphasia. For each one who survives and embarks on the journey toward recovery, their unique and evolving narrative yields gems of wisdom borne of the experience. This wisdom is shared with others through interpersonal narrative exchange and engagement, which foster biographical coherence and provide sources of hope to others on the path toward a productive and fulfilling life. This case study illustrates how a biography-based approach to stakeholder-engaged research merges personal stories in three ways. First, the case illustrates how the personal and professional stories of the candidate research team members merged to form the team through networking over time. Second, the biography-based approach led the team to identify the written personal accounts of 259 people living with aphasia as the raw data set for their research, with the intended goal of mining gems of practical wisdom from these written biographical works. Third, the case illustrates how the biography-based approach draws on the personal stories of in-hospital experiences of research team members with aphasia to prospectively hone the initial research focus. Specifically, the team will tap the collective voice within the written accounts to evaluate the in-hospital experiences of people with aphasia. The ultimate goal will be to catalyze participatory action, in collaboration with transdisciplinary health care providers, to advance responsive, person-centered health care. The authors address challenges and priorities in stakeholder-engaged research team development, the importance of honing a research focus, and the identification of research dissemination venues. Oral and written accounts of life with aphasia offer a timeless and potentially rich source of wisdom that can be tapped through the process of stakeholder-engaged research.

The juvenile justice system is charged with the welfare of the children it serves, yet less is known about the prosocial behaviors of adolescent youthful offenders. This study identifies patterns of prosocial behavior for 7 years among serious adolescent offenders, the correlates of each pattern, and associated patterns of secure placement. Using 7 years of monthly data from the Pathways to Desistance Study (N = 1,354), we used group-based trajectory models to identify longitudinal patterns of positive youth behaviors related to school and work among serious adolescent offenders and a joint trajectory model to assess the relationship between trajectories of institutional placement and positive youth behaviors. Four groups were identified that demonstrated a high, low, medium, and dips-then-rises likelihood of gainful activities throughout the study period. Gainful activities were negatively associated with risk for delinquency across multiple domains. Juvenile justice interventions should consider prosocial promise in addition to risk for delinquency.

Abstract Background Recent jail detention is a marker for trait and state suicide risk in community-based populations. However, healthcare providers are typically unaware that their client was in jail and few post-release suicide prevention efforts exist. This protocol paper describes an effectiveness-implementation trial evaluating community suicide prevention practices triggered by advances in informatics that alert CareSource, a large managed care organization (MCO), when a subscriber is released from jail. Methods This randomized controlled trial investigates two evidence-based suicide prevention practices triggered by CareSource’s jail detention/release notifications, in a partial factorial design. The first phase randomizes ~ 43,000 CareSource subscribers who pass through any Ohio jail to receive Caring Contact letters sent by CareSource or to Usual Care after jail release. The second phase (running simultaneously) involves a subset of ~ 6,000 of the 43,000 subscribers passing through jail who have been seen in one of 12 contracted behavioral health agencies in the 6 months prior to incarceration in a stepped-wedge design. Agencies will receive: (a) notifications of the client’s jail detention/release, (b) instructions for re-engaging these clients, and (c) training in suicide risk assessment and the Safety Planning Intervention for use at re-engagement. We will track suicide-related and service linkage outcomes 6 months following jail release using claims data. Conclusions This design allows us to rigorously test two intervention main effects and their interaction. It also provides valuable information on the effects of system-level change and the scalability of interventions using big data from a MCO to flag jail release and suicide risk. Trial registration The trial is registered at clinicaltrials.gov (NCT05579600). Registered 27 June, 2023.

In 2018 we celebrated 25 years of development of radar altimetry, and the progress achieved by this methodology in the fields of global and coastal oceanography, hydrology, geodesy and cryospheric sciences. Many symbolic major events have celebrated these developments, e.g., in Venice, Italy, the 15th (2006) and 20th (2012) years of progress and more recently, in 2018, in Ponta Delgada, Portugal, 25 Years of Progress in Radar Altimetry. On this latter occasion it was decided to collect contributions of scientists, engineers and managers involved in the worldwide altimetry community to depict the state of altimetry and propose recommendations for the altimetry of the future. This paper summarizes contributions and recommendations that were collected and provides guidance for future mission design, research activities, and sustainable operational radar altimetry data exploitation. Recommendations provided are fundamental for optimizing further scientific and operational advances of oceanographic observations by altimetry, including requirements for spatial and temporal resolution of altimetric measurements, their accuracy and continuity. There are also new challenges and new openings mentioned in the paper that are particularly crucial for observations at higher latitudes, for coastal oceanography, for cryospheric studies and for hydrology. The paper starts with a general introduction followed by a section on Earth System Science including Ocean Dynamics, Sea Level, the Coastal Ocean, Hydrology, the Cryosphere and Polar Oceans and the “Green” Ocean, extending the frontier from biogeochemistry to marine ecology. Applications are described in a subsequent section, which covers Operational Oceanography, Weather, Hurricane Wave and Wind Forecasting, Climate projection. Instruments’ development and satellite missions’ evolutions are described in a fourth section. A fifth section covers the key observations that altimeters provide and their potential complements, from other Earth observation measurements to in situ data. Section 6 identifies the data and methods and provides some accuracy and resolution requirements for the wet tropospheric correction, the orbit and other geodetic requirements, the Mean Sea Surface, Geoid and Mean Dynamic Topography, Calibration and Validation, data accuracy, data access and handling (including the DUACS system). Section 7 brings a transversal view on scales, integration, artificial intelligence, and capacity building (education and training). Section 8 reviews the programmatic issues followed by a conclusion.

Abstract Background The national Stepping Up Initiative has attracted over 500 counties interested in reducing the use of jail for individuals with mental health disorders. This paper identifies socioeconomic, criminal legal, and health care factors that predict the likelihood of counties joining Stepping Up. Results After performing variable selection, logistic regression models were performed on 3,141 U.S. counties. Counties designated as medically underserved and/or mental health staffing shortage areas were less likely to participate in this initiative. Logistic regression models showed that larger counties (populations over 250,000) with better health care infrastructure, more mental health providers per capita, higher percent of Medicaid funded drug treatment services, and at least one medical school, were more likely to join Stepping Up. These counties had lower per capita jail populations, higher concentration of police resources, and higher pretrial incarceration rate. Conclusions County-level health care delivery factors are major contributors to a county’s likelihood, or willingness, of engaging in Stepping Up reform efforts to reduce jail population with mental health disorders issues. Therefore, improving availability and accessibility of medical and behavioral health care in different communities, may facilitate efforts to address the unnecessary incarceration of individuals with mental health disorders.

Criminal legal system involvement (CLI) is a critical social determinant of health that lies at the intersection of multiple sources of health disparities. The COVID-19 pandemic exacerbates many of these disparities, and specific vulnerabilities faced by the CLI population. This study investigated the prevalence of COVID-19-related misinformation, as well as its relationship with COVID-19 information sources used among Americans experiencing CLI. A nationally representative sample of American adults aged 18+ (N = 1,161), including a subsample of CLI individuals (n = 168), were surveyed in February-March 2021. On a 10-item test, CLI participants endorsed a greater number of misinformation statements (M = 1.88 vs. 1.27) than non-CLI participants, p < .001. CLI participants reported less use of government and scientific sources (p = .017) and less use of personal sources (p = .003) for COVID-19 information than non-CLI participants. Poisson models showed that use of government and scientific sources was negatively associated with misinformation endorsement for non-CLI participants (IRR = .841, p < .001), but not for CLI participants (IRR = .957, p = .619). These findings suggest that building and leveraging trust in important information sources are critical to the containment and mitigation of COVID-19-related misinformation in the CLI population.

This pilot proof-of-concept study examined the feasibility and acceptability of a Continuing Care mobile application (app) designed to meet the recovery and personal support needs of individuals under justice supervision who were receiving outpatient substance use disorder (SUD) treatment. The study included adults on probation or parole who were enrolled in an outpatient SUD treatment program (N = 15; 86.7% males). Participants were instructed to utilize the Continuing Care app daily for 4 weeks. At the end of the study, they completed a satisfaction questionnaire. Of the 15 participants enrolled in the study, 12 (80%) completed the Continuing Care app modules and the satisfaction questionnaire, and all of these participants indicated high levels of satisfaction with the app (on a scale of 1-10, Mean = 1.8, SD = 1.2). The Continuing Care app was well-utilized and perceived as valuable by this group of low-income, underserved, and hard-to-reach individuals. Further research is needed to refine app content and evaluate its ability to meaningfully enhance and extend the benefits of SUD treatment.

Alcohol is present in a large proportion of sexual assault cases. However, research largely overlooks the role that providing alcoholic beverages – particularly those with high-alcohol- content and/or whose flavors mask the taste of alcohol – may have in making young people more vulnerable to being assaulted. This research is especially important given the rise in the availability of sugar-sweetened alcopops and their high-alcohol-content counterparts “supersized alcopops,” which contain up to 5.5 standard alcoholic drinks. In the current study, we examined whether alcopops and supersized alcopops, relative to beer, were involved in disproportionately more sexual assault cases involving victims who were minors (< 18 years old) rather than adults. In this secondary data analysis, we used Nexis Uni to search legal documents for the brands of supersized alcopop (Four Loko), alcopop (Smirnoff Ice), and beer (Bud Light) most commonly consumed by underage drinkers. Inclusion criteria were U.S. sexual assault cases occurring from 2010 to 2019 and involving victims who consumed one of these three alcohol brands. Two researchers coded information from the case facts, compared coding, and reaching consensus. Thirty-six cases were included for analyses. Compared to victims of sexual assault who consumed beer, victims who consumed supersized alcopops or alcopops were significantly more likely to be minors. Similar results were observed after adjusting for the victim being given the alcohol by the perpetrator, which was strongly associated with the victim being a minor. This study provides initial evidence that sexual assault perpetrators may disproportionately use alcopops and supersized alcopops for the sexual victimization of minors.

BackgroundSelf-reported antiretroviral therapy (ART) adherence measures that are associated with plasma viral load (VL) are valuable to clinicians and researchers, but are rarely examined among groups vulnerable to dropping out of care. One-seventh of all those living with HIV pass through incarceration annually and criminal-justice (CJ) involved people living with HIV (PLH) are vulnerable to falling out of care. We examined the association of self-reported ART adherence with VL in a criminal-justice sample compared to a routine-care sample.MethodsSamples: We examined data from a multisite collaboration of studies addressing the continuum of HIV care among CjJ involved persons in the Seek, Test, Treat, and Retain cohort. Data pooled from seven CJ- studies (n = 414) were examined and compared with the routine-care sample from the Centers for AIDS Research Network of Integrated Clinical Systems' seven sites (n = 11,698).MeasuresIn both samples, data on self-reported percent ART doses taken were collected via the visual analogue scale adherence measure. Viral load data were obtained by blood-draw.AnalysisWe examined the associations of adherence with VL in both cohorts using mixed effects linear regression of log-VL, and mixed effects logistic regression of binary VL (≥ 200 copies/mL) outcomes. Interactions by CD4 count and self-reported health status were also tested.ResultsAmong the CJ sample, the coefficient for log-VL was - 0.31 (95% CI = - 0.43, - 0.18; P

AimApproximately 40% of children who have an in-hospital cardiac arrest (IHCA) in the US survive to discharge. We aimed to evaluate the impact of post-cardiac arrest hypotension during targeted temperature management following IHCA on survival to discharge.MethodsThis is a secondary analysis of the therapeutic hypothermia after pediatric cardiac arrest in-hospital (THAPCA-IH) trial. "Early hypotension" was defined as a systolic blood pressure less than the fifth percentile for age and sex for patients not treated with extracorporeal membrane oxygenation (ECMO) or a mean arterial pressure less than fifth percentile for age and sex for patients treated with ECMO during the first 6 h of temperature intervention. The primary outcome was survival to hospital discharge.ResultsOf 299 children, 142 (47%) patients did not receive ECMO and 157 (53%) received ECMO. Forty-two of 142 (29.6%) non-ECMO patients had systolic hypotension. Twenty-three of 157 (14.7%) ECMO patients had mean arterial hypotension. After controlling for confounders of interest, non-ECMO patients who had early systolic hypotension were less likely to survive to hospital discharge (40.5% vs. 72%; adjusted OR [aOR] 0.34; 95%CI, 0.12-0.93). There was no difference in survival to discharge by blood pressure groups for children treated with ECMO (30.4% vs. 49.3%; aOR = 0.60; 95%CI, 0.22-1.63).ConclusionsIn this secondary analysis of the THAPCA-IH trial, in patients not treated with ECMO, systolic hypotension within 6 h of temperature intervention was associated with lower odds of discharge survival. Blood pressure groups in patients treated with ECMO were not associated with survival to discharge.

Abstract This manuscript is the product of the authors’ discussions, literature overview, and consultation with experts in the field, and identifies important gaps in the evidence base for substance use disorder (SUD) treatment effectiveness within criminal justice (CJ) settings. Lacking from the extant literature are longitudinal investigations of treatment related outcomes during and after incarceration. Such studies could provide rich contextual data about treatment delivery and effectiveness across the CJ continuum, and would provide important insight into individual characteristics (e.g., motivation, treatment modality preferences, treatment completion rates, etc.) as well as institutional and environmental factors (e.g., appropriate staffing, space limitations for individual treatment sessions, distribution of medications, etc.). We also identified the importance of reproducibility within CJ research, and the unfortunate reality of too many single studies conducted in single (or relatively few) correctional facilities. Some of this has been because the studies designed to produce that evidence are not prioritized for funding, which has continually placed researchers in a position where we cannot make firm conclusions or recommendations based on available evidence. The importance of replicating the foundational studies in this field cannot be overstated. We hope this article spurs other researchers to join in the healthy process of questioning the existing state of the CJ-based SUD treatment research, what should be re-examined, and how we can lay a stronger foundation for the future.

Abstract Background The relationship between healthcare service accessibility in the community and incarceration is an important, yet not widely understood, phenomenon. Community behavioral health and the criminal legal systems are treated separately, which creates a competing demand to confront mass incarceration and expand available services. As a result, the relationship between behavioral health services, demographics and community factors, and incarceration rate has not been well addressed. Understanding potential drivers of incarceration, including access to community-based services, is necessary to reduce entry into the legal system and decrease recidivism. This study identifies county-level demographic, socioeconomic, healthcare services availability/accessibility, and criminal legal characteristics that predict per capita jail population across the U.S. More than 10 million individuals pass through U.S. jails each year, increasing the urgency of addressing this challenge. Methods The selection of variables for our model proceeded in stages. The study commenced by identifying potential descriptors and then using machine learning techniques to select non-collinear variables to predict county jail population per capita. Beta regression was then applied to nationally available data from all 3,141 U.S. counties to identify factors predicting county jail population size. Data sources include the Vera Institute’s incarceration database, Robert Wood Johnson Foundation’s County Health Rankings and Roadmaps, Uniform Crime Report, and the U.S. Census. Results Fewer per capita psychiatrists (z-score = -2.16; p = .031), lower percent of drug treatment paid by Medicaid (-3.66; p

Background: For nearly two decades, it has been widely recognized that individuals in jail settings have a high prevalence of opioid use disorders (OUD) and are highly susceptible to fatal overdose upon their release. This setting provides a public health opportunity to address OUD with Medication for Opioid Use Disorders (MOUDs). Yet, 56% of jails do not provide MOUD, creating a pressing need for better implementation approaches in jail and the hand-off to the community. Two successful implementation strategies, NIATx external coaching and the Extension for Community Healthcare Outcomes (ECHO) case management telementoring model, were compared to address this persistent treatment gap. Methods: This 2 × 2 design compared high (n = 12) and low (n = 4) dose coaching with and without ECHO in a 12-month intervention and 12 M sustainability period. The national trial included 25 jails and 13 community-based partners. MOUD trends for buprenorphine, methadone, injectable naltrexone, and combined MOUD between the study arms were assessed. Results: Jail sizes ranged from 24% with < 100 and 24% with > 500 daily population, and community-based treatment providers ranged from 63% with < 50 and 7% with > 500 average monthly OUD intakes. New patient counts were found to significantly increase across the intervention phase for buprenorphine (p <.01) and combined MOUD (p <.01). Injectable naltrexone and methadone showed no consistent, significant gains. For sites with low coaching without ECHO, new patient counts for combined MOUD were predicted to increase by 47.44% during the intervention phase and 7.30% during the sustainability phase. ECHO demonstrated that MOUD use did not significantly increase compared to coaching across MOUDs in the intervention phase (p =.517). High- and low-dose coaching showed no significant differences in MOUD use during the intervention phase (p =.124). Conclusions: Coaching emerged as a more effective implementation strategy than ECHO for increasing buprenorphine use in jail settings. In practice, ECHO sessions offered considerable overlap with coaching strategies. While high-dose coaching had greater gains for MOUDs overall than low-dose coaching, those gains were statistically insignificant, suggesting low-dose coaching to be more economical. To increase MOUD use in jail settings, jurisdictions should focus on new MOUDs so all three MOUDs are available and enhance the post-incarceration continuum of care. Trial registration: Name of registry: ClinicalTrials.gov. Trial registration number: NCT04363320. Date of registration: 2020–07-30. URL of trial registry record: https://clinicaltrials.gov/study/NCT04363320?term=molfenter&rank=7. [ABSTRACT FROM AUTHOR]

Interagency teams are considered an evidence-based change practice, but there is a paucity of research examining them in criminal justice (CJ) and behavioral health (BH) reform contexts. This study draws on qualitative interviews (n = 52) and survey data (n = 791) from BH and CJ leaders across the United States to examine who is on them, what they do, and effective strategies for building and sustaining them. Findings indicated that CJ–BH interagency teams often incorporate agencies from a range of CJ, BH, social service, and health agencies. Teamwork focused on connecting clients to resources or contributing to CJ–BH coalitions and resource centers. Although the team-building strategies learning about/from other agencies and system integration were significantly associated with developing more collaborations, consensus-building activities were not. These findings suggest that interagency teams need not necessarily reach consensus on goals and vision prior to working together, as this can be built through collaboration. [ABSTRACT FROM AUTHOR]

AIM:Although recent out-of-hospital cardiac arrest (CA) trials found no benefits of hypothermia versus normothermia targeted temperature management, preclinical models suggest earlier timing of hypothermia improves neuroprotective efficacy. This study investigated whether shorter time to goal temperature was associated with better one-year outcomes in the Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital Trial. METHODS:Patients were classified by tertiles of time to attain assigned goal temperature range (32-34°C or 36-37.5°C) following ROSC. Outcomes in the first tertile ("earlier") Group 1 were compared with second and third tertiles ("later") Group 2. Separate analyses were, additionally, completed for hypothermia and normothermia intervention groups. Three one-year outcomes were examined: survival; Vineland Adaptive Behavior Scale (VABS-II) score≥70; and decrease in VABS-II≤15 points from baseline. RESULTS:In the entire cohort (n=281), median time from ROSC to goal temperature was 7.4 [IQR 6.2-9.7] hours: Group 1, 5.8 [IQR 5.2, 6.2] and Group 2, 8.8 [IQR 7.4, 10.4] h. Outcomes did not differ between these groups. For hypothermia subgroup, survival was lower in Group 1 than 2, [10/49(20%) versus 47/99(47%), p

Abstract Background Fidelity assessment tools can assess whether a program embraces a core set of principles and performs well. A quality fidelity tool with valid scales can be a feedback loop to identify areas that need further work to improve the program. Using data collected from 1816 correctional and reentry programs in the United States in the construction sample and 761 programs in the confirmation sample, this study examined the internal consistency of the Risk-Need-Responsivity (RNR) Program Tool, an online resource to capture information about structural features of a program. Results The study reports on reliability statistics and factor analyses to highlight individual subscales. Six scales emerged and had acceptable to excellent levels of internal consistency. These scales are staffing, reward-and-sanction, clinical standards for programs, coaching, program duration, and risk-need assessment. Conclusions This article discusses fidelity scales from the RNR Program Tool and provides guidance on the importance of tool development processes to ensure accurate, valid, and reliable scales. The purpose of the RNR Program Tool is to create a modern, online tool integrating both the empirical (research) literature on effective practices and clinical standards on quality programming. This process minimizes the need for consultants by giving program administrators the ability to gather information on their programs, score them, and receive instant and targeted feedback with recommendations for improvement to assess their programs against empirical standards in the field. Furthermore, it provides a standardized tool that administrators can use to examine what type of individuals fare better in their programs. The provided targeted feedback can give the programs the ability to seek technical assistance or guidance in specific areas that can strategically strengthen their program.

Abstract Background Communication-based activities and products (i.e., training programs, webinars) are a critical component of implementation strategies that relay information to various audiences. Audience perceptions of communication effectiveness contribute important insight into the processes and mechanisms through which an implementation effort may succeed or fail. To advance research on this front, a psychometrically sound instrument for measuring perceived communication effectiveness (PCE) is needed. Methods An expert panel identified the theoretical foundations and conceptual domains of PCE and drafted preliminary items. Five focus groups of correctional professionals who had recently completed an implementation leadership training reviewed the items and provided feedback for refinement. Revised items were then included in a survey-based evaluation of an ongoing eLearning curriculum designed to improve the practices used by front-line probation officers in supervising individuals in the field. The factorial structure of a final 6-item scale as well as its convergent, divergent, and predictive validity was evaluated using data from the evaluation surveys (N follow-up = 358, N baseline+follow-up = 159). Results Confirmatory factor analysis of the final scale of PCE demonstrated adequate fit. PCE was strongly correlated with measures of implementation outcomes (acceptability, r = .819, p < .001; appropriateness, r = .809, p < .001; and feasibility, r = .754, p < .001), yet uncorrelated with a scale of need to evaluate (r = − .051, p = .422), demonstrating both convergent and divergent validities. The predictive validity of PCE was evidenced by significant associations between PCE and key training outcomes, including perceived staff use of evidence-based practices (β = .230, p < .05), agency climate (β = .261, p < .05), and value concordance (β = .209, p < .05), after controlling for baseline values and other confounders. Conclusions The PCE scale is psychometrically sound and can be a useful tool for gauging audience receptivity to and the potential impact of communication-based implementation activities and products.

PurposeSubstance use is linked with poor outcomes among people living with HIV (PLWH) and is associated with mental health disorders. This analysis examines the impact of decreasing substance use, even without abstinence, on depressive symptoms among PLWH.MethodsData are from PLWH enrolled in the Centers for AIDS Research Network of Integrated Clinical Sites cohort. Participants completed longitudinal assessments of substance use (modified ASSIST) and depressive symptoms (PHQ-9). Changes in substance use frequency were categorized as abstinence, reduced use, and nondecreasing use. Adjusted linear mixed models with time-updated change in substance use frequency and depressive symptom scores were used to examine associations between changes in the use of individual substances and depressive symptoms. Analyses were repeated using joint longitudinal survival models to examine associations with a high (PHQ-9 ≥10) score.ResultsAmong 9905 PLWH, 728 used cocaine/crack, 1016 used amphetamine-type substances (ATS), 290 used illicit opiates, and 3277 used marijuana at baseline. Changes in ATS use were associated with the greatest improvements in depressive symptoms: stopping ATS led to a mean decrease of PHQ-9 by 2.2 points (95% CI: 1.8 to 2.7) and a 61% lower odds of PHQ-9 score ≥10 (95% CI: 0.30 to 0.52), and decreasing ATS use led to a mean decrease of 1.7 points (95% CI: 1.2 to 2.3) and a 62% lower odds of PHQ-9 score ≥10 (95% CI: 0.25 to 0.56). Stopping and reducing marijuana and stopping cocaine/crack use were also associated with improvement in depressive symptoms.ConclusionsWe demonstrated that both substance use reduction and abstinence are associated with improvements in depressive symptoms over time.

Purpose – A truly successful continuous improvement review (CIR) visit does more than merely check the boxes for a positive recommendation. It builds the story of the school and should be an opportunity for its culture to shine through. The purpose of this paper is to demonstrate how to facilitate a successful CIR visit by moving from the basics of accreditation to understanding, implementing and “living” best practices. Design/methodology/approach – Short tenure and high turnover among business school deans, mean that the majority of those leading the CIR may have no previous experience with the process. Findings – This study begins by providing an overview of the role of accreditation and the role of the dean in the accreditation process. With a combined experience of over 35 years in the dean role and having served on or chaired over 35 accreditation visits, the authors share their experiences and offer a seven-step process for understanding and implementing best practices in the Association to Advance Collegiate Schools of Business accreditation process. Originality/value – The suggestions offered in this study should help schools enhance long-term positive outcomes and serve as a guide to those navigating the CIR process.