Background: Despite federal mandates under the Workforce Innovation and Opportunity Act, the implementation of Pre-Employment Transition Services (Pre-ETS) for transition-age youth (TAY) with disabilities varies considerably. Although prior studies have explored provider preparedness and barriers, few have examined provider-reported practices and perceptions of quality. Objective: This study examined Pre-ETS providers' engagement in service delivery practices, their perceptions of planning and delivery quality, and the supports they need to implement additional Pre-ETS activities. Differences based on provider experience were also explored. Methods: Ninety-five Pre-ETS providers in Tennessee completed the Quality Implementation Tool, a survey assessing frequency of engagement in evidence-based practices, implementation of Pre-ETS activities, perceived planning and delivery quality, and implementation needs. Descriptive statistics, independent-samples t tests, and [chi-squared] analyses were used to analyze quantitative responses. Open-ended responses were analyzed using content analysis. Findings: Providers frequently reported engaging in foundational practices such as tailoring instruction and aligning services with student goals. However, they indicated lower quality and frequency of implementation in areas requiring community engagement, especially work-based learning. Providers with more experience rated their planning and delivery quality significantly higher than those with less experience. Providers identified needs related to time with students, administrative and transportation support, interagency collaboration, and access to training and curriculum resources. Findings underscore the importance of professional development and systemic supports to enhance Pre-ETS implementation for TAY.