Objective: This study examined two potential mechanisms linking violence exposure and health risk behavior among adolescents in psychiatric care: sensation seeking and coping with stress through escape behavior. Method: Male (59%) and female adolescents (N = 251), ages 12 to 19 years, from diverse ethnic backgrounds (61% African American, 19% white, 12% Latino, 8% biracial or other ethnicity) completed a computer-administered survey assessing study variables from 1999-2004. Overall clinic consent rate was 41%. Age and gender were included in all analyses. Results: Consistent with the literature on nonpsychiatric samples, violence exposure was associated with both increased substance use and sexual risk taking. Violence exposure was not associated with motivation to engage in risk behavior as a means of escape, although motivation to cope through escape was associated with a greater likelihood of substance use. Sensation seeking was related to substance use and sexual risk taking among all adolescents and with violence exposure primarily within male adolescents. Conclusions: Clinical interventions should promote adaptive coping strategies that emphasize maintaining healthy behavior, effective problem solving skills, and stress management techniques. (Contains 4 tables.)