In Texas, youth who remain in care for more than a year enter Permanent Managing Conservatorship, and a permanency review hearing is held at least every six months that they remain in care. These hearings are a key opportunity for judges to spur progress toward permanency by cultivating collaboration and accountability between parties supporting the youth. Organizations such as the National Council of Juvenile and Family Court Judges and Texas Appleseed have recommended best practices for these hearings. The purpose of this study was to examine the extent to which these best practices in permanency hearings are implemented and explore the relationship between quality hearing practice and permanency outcomes. This study also illustrates how observational methods can be used to illuminate court practice and target areas for reform.