Results show that nearly half of sexually abused children referred to therapy never start it and that Black children are overrepresented among these children; 46 percent of the abused children referred to the Dallas Children's Advocacy Center (DCAC) for therapy over a 6-month period never started it within 2 months. Children least likely to begin therapy were Black versus non-Black; additionally, they were less likely to have mother figures alleged to have failed to protect the child from sexual abuse. In interviews, caregivers who had declined versus initiated therapy were also less likely both to view therapy as emotional help and to say that they enjoyed certain kinds of activities with their children. The odds of therapy entry were over two times lower for Black children compared to a mainly Hispanic sample of White children; this finding suggests that minority status alone might fail to explain fully the lower rates of entry into therapy among Black children. The research suggests that safety plans may effectively increase rates of children's entry into therapy. Further study will likely show that working with caregivers of sexually abused children who decline therapy for these children demands recognizing both the caregivers' and children's needs. If professionals can better identify which sexually abused children are unlikely to get and continue therapy, they can begin to evaluate different ways of working with families to change this trend. Data were collected from the DCAC, the Dallas Police Department, and Child Protective Services case records of all children 3-17 years old who were referred to therapy at DCAC. Tables, references