This study assessed the proportion of large, child-serving community mental health centers that used medication guidelines. Two hundred clinic directors from across the country completed an hour-long semi-structured interview, and 152 of these directors answered whether or not medication guidelines were used at their clinics. Half of these clinics' directors reported that their prescribers followed any form of medication guidelines. Governmental agencies and professional medical societies were among the most common sources of information regarding which specific guidelines to follow. Utilization of standardized child outcome measures, but not the employment of a child psychiatrist, was related to following medication guidelines. Despite the mental health field's recent emphasis on disseminating evidence-base practice, many directors reported their clinics did not use any pediatric medication guidelines.