Prior research has raised concern about the appropriateness of psychotropic medication use and the validity of psychiatric diagnosing for youth in child welfare but has lacked in-depth case information. This study reports results from a psychiatric nurse review conducted with eight youth entering a foster care intervention using case records and multiple key informant interviews. Results revealed extensive histories of unique (nonoverlapping) psychiatric diagnoses (M = 8, range 7-9) and past psychotropic medications (M = 13, range 9-21). The findings highlight the need to improve assessment practices and to create mechanisms that promote greater continuity of psychiatric care.