A total of 116 children and adolescents who were approved for emergency psychiatric hospitalization were randomly assigned to home-based MST or inpatient hospitalization. The comprehensive and individualized nature of MST fits with the multiple needs and comorbid conditions of youths presenting psychiatric emergencies, and MST has been effective in engaging families in treatment. The current study used assessment to examine symptomatology, antisocial behavior, self-esteem, family relations, peer relations, school attendance, and consumer satisfaction at three times: within 24 hours of recruitment into the project, shortly after the hospitalized youth was released from the hospital (1-2 weeks after recruitment), and at the completion of MST home-based services (average of 4 months postrecruitment). Study findings show that MST was more effective than emergency hospitalization at decreasing youths' externalizing symptoms and at improving their family functioning and school attendance. Hospitalization was more effective than MST at improving youths' self-esteem. Consumer satisfaction scores were higher in the MST condition. The authors conclude that the findings support an intensive, well-specified, and empirically supported treatment model, with judicious access to placement, as an effective family-based and community-based alternative to the emergency psychiatric hospitalization of children and adolescents. 2 tables and 45 references