Adherence to recommendations is important among children that have been sexually abused, given the risk of health problems and the high levels of family stress. This study examined characteristics associated with adherence to recommendations, and parental reports of barriers to following recommendations. All children evaluated consecutively for possible sexual abuse in an interdisciplinary outpatient clinic over a 9-month period were eligible for the study. Parents or other primary caregivers of children attending the clinic completed a Child Behavior Checklist (CBCL). Four months after the evaluation, a clinic evaluation form and a second CBCL was mailed to the primary caregiver. The evaluation form asked about recommendations made during the clinic visit, what services had been implemented, satisfaction with services, and possible barriers to services. The results show that caregivers had positive attitudes toward the clinic, Child Protective Services, and law enforcement. Efforts by staff to communicate recommendations to parents were only moderately successful. Only 9 percent of parents recalled medical recommendations, 79 percent recalled a referral for child counseling, and 43 percent recalled a referral for parental counseling. Adherence to recommendations for counseling was quite poor; only 58 percent of children and 43 percent of parents for whom counseling was recommended actually initiated therapy. Families were more likely to receive and adhere to recommendations when there were behavioral problems and a strong indication of child sexual abuse. Several barriers clearly existed that impeded caregivers in remembering and following recommendations for services. Factors that help explain poor adherence to treatment recommendations include perceived financial problems and lack of knowledge about where to get counseling. Parental ambivalence about whether counseling was needed was frequently cited as a barrier to both parental and child therapy. Practitioners must recognize that recommendations for therapy may not be carried out, and that treatment plans must be realistic. 5 tables, 2 notes, 34 references