The emergency department’s role in a psychiatric crisis is to assess for safety, provide crisis interventions, reach a diagnosis, make decisions about disposition and treatment, and provide linkage to the next level of care within the hospital or in the community. The evaluation of children and adolescents involved in the child welfare system brings numerous additional challenges to this already-complex environment, including familial and systemic issues and an almost ubiquitous history of trauma. This article endeavors to increase understanding of child welfare–related issues and provides insight toward using a more trauma-informed and comprehensive approach that incorporates all these factors.