Youth who are high risk (YHR) face numerous adversities, and those with Fetal Alcohol Spectrum Disorder (FASD) may experience even more complex challenges due to the compounding impact of brain dysfunction. However, very little research has been conducted to understand or characterize this vulnerable group, or explore potential strategies for supporting their specific needs. In the current study, we sought to characterize some of the adverse experiences of YHR with and without FASD (N = 90) who were attending an innovative school that supports students who have struggled in other educational settings. We also examined services offered at this school and explored whether service access and several social and educational factors differ between youth with and without FASD. Findings indicate that YHR with FASD have more complex needs and a different pattern of service use than YHR without FASD. These findings are discussed in the context of how we might better support YHR and foster successful outcomes.