The safe and effective use of antipsychotic medications for children and adolescents [hereafter youth] in the United States is a critical issue in mental and substance use treatment. Antipsychotic medication use is substantially higher for youth in the United States when compared to rates of use among youth in most other developed countries. In response to the emergence of safety concerns in pediatric antipsychotic medication use, Federal, State, and public¿sector agencies invested in a breadth of systems¿level strategies to monitor antipsychotic medication use and support best practice prescribing. For example, by 2014, 31 State Medicaid programs employed an administrative tool, referred to as prior authorization, to require prescribing clinicians to receive approval before dispensing antipsychotic medications for all or a subset of youth. In recent years, a growing evidence base arose in both the peer¿reviewed and grey literature documenting the effectiveness of prior authorization and other systems¿level.