Section 14141 of the Violent Crime Act of 1994 fundamentally restructures the regulation of police behavior in the United States. Since the law’s passage, dozens of police departments have undergone lengthy and complex reforms designed to eliminate a pattern or practice of misconduct. Despite the program’s wide application, neither scholars nor practitioners know much about the efficacy or sustainability of these reforms. This article draws on longitudinal data across several outcome metrics, including citizen complaints, use of force incidence, and civil litigation, and a series of interviews with key stakeholders to examine pattern or practice initiatives in Pittsburgh, PA; Washington, DC; and Cincinnati, OH. Findings suggest that the reform process has the ability to minimize unwanted police misconduct and generate desirable policy outcomes, particularly during the period of Department of Justice oversight. Sustaining these reforms after the settlement agreement is dissolved, however, has proved a challenge.