This study describes the health services for incarcerated adolescents in Washington State and their utilization, in 12 juvenile detention facilities statewide, including six state (long-term, postadjudication) and six county (short-term, preadjudication) facilities. Findings differed by facility type, with youth at county facilities having more total visits to emergency rooms and more health care visits per inmate for health problems presenting acutely, such as sexually transmitted disease, pregnancy, urologic problems, and trauma. More were on suicide watch and on psychiatric medication. Health care used by youth at state facilities tended to be for more chronic conditions such as dental, dermatologic, nutritional, and respiratory problems. When utilization was analyzed by size of facility, small facilities had fewer health care visits and fewer nursing hours per inmate. According to our findings, there are at least 14 pregnant adolescents and 2 HIV-infected adolescents incarcerated in this state at any time.