The acquittees in the present study were similar to past samples in terms of their clinical characteristics and service utilization histories. They demonstrated significant clinical improvement across almost all domains during the Not Guilty by Reason of Insanity (NGRI) hospital stay and recidivated equal to or less than most prior samples. A variety of individual and community strengths and vulnerabilities were identified as predictors of rearrest and rehospitalization. These factors were incorporated into models that accounted for nearly 85 percent of the variability in the dependent variables. These results suggest that the present system of treatment and conditional release in Illinois, though underdeveloped in many capacities, appears to have improved upon practices used in some other States. In order to treat NGRI acquittees, clinicians and administrators must provide services in the least restrictive settings possible while also reducing the likelihood of future violence. NGRI acquittees occupy a unique position within the criminal justice and mental health systems. Insanity defense pleas and especially insanity acquittals are rare and their existence challenges criminal justice and mental health professionals to integrate large, often bureaucratic systems, more clearly define their respective roles, and balance the need to provide services in less restrictive settings while protecting the community and the acquittees themselves from undue harm. The study of NGRI criminal recidivism has often occurred in the context of research programs. After using 20 published papers about New York State as a case study to demonstrate the progression of 1 loosely organized program of research in the area of NGRI and criminal recidivism and summarizing each of these papers/studies, a sample of all NGRI acquittees conditionally released in Cook County, IL, between January 1, 1983, and December 31, 1995, (n = 93) were examined using the Adult Needs and Strengths Assessment (ANSA) instrument. Tables, figures, appendixes A-B, and references