The prevention of juvenile crime and the proper handling of young offenders are critical social policy issues. A variety of diverse policies have targeted youth crime since the inception of the American juvenile court in 1899. Despite the best efforts of policy makers and practitioners, juvenile crime persists as one of the country’s most persistent problems. There is reason to be encouraged and troubled by recent trends in adolescent offending. Current rates of property and personal offenses among youth are lower than they have been in several decades. However, tragic acts of school violence in Colorado, Oregon, and several other states in the late 1990s have created considerable concern about the overall health of America’s youth. Recent trends in juvenile offending within the United States and historical responses to juvenile crime are reviewed. Three critical issues currently confronting the American juvenile justice system are discussed: youth violence, the co-occurrence of mental health and substance abuse problems among young offenders, and female delinquency. Implications for practice and policy are discussed in light of these considerations. The review of American juvenile justice suggests that gender-specific interventions for high-risk and delinquent youth are lacking. Most delinquency prevention and treatment programs are designed for males and thus fail to consider the needs of female offenders. In addition, innovative and effective approaches for violent youth and adolescents with co-occurring mental health and substance abuse problems should be developed. Federal, State, and local policies should support a continuum of prevention, early intervention, and long-term treatment services for high-risk and delinquent youth.