Child welfare agencies are required to provide services that ensure that children receive adequate mental health care. This study provides a comprehensive view of the emotional and behavioral problems of children who are referred to child welfare services, using nationally representative data. Bivariate analyses compare rates by child demographics, and conditional probability tables present changes in clinical status. Results show that 62% of children have at least one clinical-level score over 3 years. Rates are highest at baseline. Posttraumatic stress most frequently improves, whereas thought, attention, and aggressive/ delinquent behavior problems are most persistent. Sexualized behavior is more common among White and Hispanic children, and boys are reported with more internalizing problems than do girls. Targeted services are needed for young children who experience posttraumatic stress, as is treatment for attention problems that accounts for both biological and environmental components. Distinguishing the effects of age, environment, and assessment methods on boys' internalizing problems is also critical. (Contains 5 tables.)