Results strongly suggest that race played a role in serious mental illness (SMI) designation. Because this designation served as the portal to specialized mental health treatment services, the overall results indicate that African-American youths had diminished access to treatment when compared with Caucasian youths. Although data analyses did not conclusively indicate whether there were significant differences in the screening and assessment results between African-American and Caucasian youths, race was a significant factor in SMI assignment even when controlling for these possible race group differences on the Initial Health Care Screening (IHCS) self-report of previous mental health encounters. Although there were few differences between African-American and Caucasian youths on the Massachusetts Youth Screening Instrument-2 (MAYSI-2) scales and no difference on the Youth Level of Service (YLS) total score, it was reported that Caucasian youths were four times as likely as African-American youths to be designated SMI. Five explanations for the results are documented. Implications include that creating standardized procedures, post-screening, and documentation of final team decisionmaking has the potential to provide a richer analysis of sources of service disparity. Data were collected from 937 male youths, 12 to 18 years old, admitted to a secure care facility. Tables and references