Objective: To evaluate the feasibility of dialectical behavior therapy (DBT) implementation in a general child and adolescent psychiatric inpatient unit and to provide preliminary effectiveness data on DBT versus treatment as usual (TAU). Method: Sixty-two adolescents with suicide attempts or suicidal ideation were admitted to one of two psychiatric inpatient units. One unit used a DBT protocol and the other unit relied on TAU. Assessments of depressive symptoms, suicidal ideation, hopelessness, parasuicidal behavior, hospitalizations, emergency room visits, and adherence to follow-up recommendations were conducted before and after treatment and at 1-year follow-up for both groups. In addition, behavioral incidents on the units were evaluated. Results: DBT significantly reduced behavioral incidents during admission when compared with TAU. Both groups demonstrated highly significant reductions in parasuicidal behavior, depressive symptoms, and suicidal ideation at 1 year. Conclusions: DBT can be effectively implemented in acute-care child and adolescent psychiatric inpatient units. The promising results from this pilot study suggest that further evaluation of DBT for adolescent inpatients appears warranted. J. Am. Acad. Child Adolesc. Psychiatry, 2004;43(3):276-282.