Examined 6-month post-recruitment clinical and placement outcomes for 31 youths with serious emotional disturbance (SED) at imminent risk of out-of-home placement in the Hawaii Continuum of Care (COC). Youths were randomly assigned to multisystemic therapy (MST) adapted for SED populations or to Hawaii's existing COC services. Assessments were conducted at intake and 6 months after referral. In comparison with counterparts in the comparison condition, youths in the MST condition reported significant reductions in externalizing symptoms, internalizing symptoms, and minor criminal activity; their caregivers reported near significant increases in social support; and archival records showed that MST youths experienced significantly fewer days in out-of-home placement. The findings generally replicate the favorable short-term outcomes observed previously for MST with youths experiencing SED.