Among 233 youths treated at a community mental health center, 51 were living with their grandparents. Youths who lived with grandparents were more likely to be male, African American, and younger. Frequent psychiatric diagnoses included oppositional defiant disorder, depressive disorders, and anxiety disorders. Common reasons for youths' placement with grandparents included parents' absence, substance abuse, or incarceration; abuse by parents; and death of parents. Caregivers were most often maternal grandmothers, and more than one-third of the grandmothers were age 62 or older. The findings highlight the need to develop treatment interventions for youths who are living with their grandparents and to create public policies to support grandparent caregivers.