This study focused on approaches to curriculum, as well as school, principal, and student characteristics in secondary day treatment and residential psychiatric schools. A national random sample of 148 principals responded to a survey. No statistically significant differences existed between respondent and nonrespondent schools with regard to region, public versus nonpublic, enrollment, or locale. More than 80% of schools were accredited by their state department of education. The primary role of day treatment and residential schools was to help youth obtain a high school diploma. The most common basis for curriculum was the use of state curriculum or individual education programs. Math and reading curriculum, instructional materials, and professional development were rarely reported to align to a great extent with state assessments. The authors provide additional results and implications. (Contains 5 tables.)