This study examined the rate at which juvenile courts refer youthful offenders to mental health care and organizational factors that may account for variation in treatment referral rates. The study was based on 73 juvenile courts in Tennessee. Data sources included secondary, statewide data on youth referred to the courts in 1997 and responses of judges to the Juvenile Court Survey. Results found: (1) the statewide referral rate was 3 percent; (2) nearly all judges believed that a youth's mental health status should affect their decisions and that assessments are an important tool for decision making, however, few courts typically had evaluations available prior to case disposition; (3) courts with more serious caseloads and drug offenses had significantly higher referral rates than courts with less serious caseloads; (4) higher referral rates were found in courts with more frequent staff communication, where prosecutors tended not to participate in filing petitions, and where determinations of guilt and disposition were made simultaneously; and (5) higher referral rates were found in courts where delinquency was viewed as a result of negative peer influences. (CR)