Despite the high rates of service for emotional disturbance among child welfare involved youth, much remains to be understood about this population. This study is the first to use longitudinal data to examine the needs and outcomes of children in special education (comparing those with emotional disturbance (ED) and those without) according to child welfare involvement (none, child abuse and neglect report but no services, in-home child welfare services, and foster care). Administrative data linked with special education case file data on 471 youth found that those involved with child welfare were most likely to have an ED diagnosis. Special education assessments revealed that children with in-home services or reports of maltreatment without services generally had equal or greater levels of needs indicated than those placed in foster care. Youth with an ED diagnosis were more likely to experience a negative outcome, such as emergency room treatment for mental health, school problems, or juvenile delinquency. Almost all of the ED youth had child welfare contact by the end of the study period. These findings underline the unmet needs of this population and the need for system coordination to improve their outcomes.