The Chesapeake Bay Program’s (CBP) Science and Technical Advisory Committee (STAC) organized and led a workshop on the science and practice of stream restoration in order to summarize the state of knowledge in order to identify ways to improve stream restoration outcomes. The workshop identified a general framework for explaining the main factors leading to stream restoration outcomes: stream degradation has occurred, leading to regulatory and policy motivations that prioritize project goals, which leads to restoration approaches, assessment and monitoring efforts, and ultimately stream restoration outcomes. In the Chesapeake Bay watershed, stream restoration often occurs in response to Clean Water Act (CWA) mandates to reduce nitrogen, phosphorus, and sediment loads to the Bay. Reviews of stream restoration outcomes summarized at the workshop showed that, in general, stream restorations have led to minimal improvement to stream aquatic biota, effective ‘stabilization’ of channel form over time, moderate improvements to water quality, and short-term negative impacts to riparian vegetation. The fundamental finding of the workshop was that often the primary goal of stream restoration projects is to improve geomorphic stability in the restored reach and downstream water quality, and not to improve local ecological conditions through ‘uplift’ (improvement of one or more ecosystem functions through a restorative activity; a term defined in Appendix D), and therefore these projects often do not improve aquatic macroinvertebrate or fish communities. This conflict in goals is a shortcoming of the currently most common regulatory driver for stream restoration (reducing downstream loads of N, P, and sediment) that could be addressed directly through diversifying goals to include biotic uplift, as biological benefit is an assumed condition for the permitting and crediting of stream restoration projects. It is also likely that current understanding of stressors and drivers of stream ecosystem health is insufficient, and that reach-scale restoration focused on geomorphic restoration is not removing the actual sources of stream health impairment that may arise in the upstream watershed. More science could help to identify how to improve the ecological condition of streams through management. The outcome of stream restoration monitoring has revealed that while geomorphic and hydrodynamic functions of stream restoration projects may be achieved, biotic stream function improvements remain elusive. As such, ensuring uplift may be achieved by avoiding restoration projects that risk resources in higher-quality streams and riparian corridors. Reach-scale restoration often does not effectively mitigate the watershed-scale stressors of stream ecosystems. If a desired outcome of stream restoration includes ecological uplift, then focusing efforts on improving stream ecology could help meet that goal.