Female juvenile justice-involved (JJI) youth experience more sexual abuse (SA) than their non-JJI counterparts or their male JJI counterparts. This study examines SA's role among JJI females ( N = 1,307) in a behavioral health diversion program. Results indicate that SA increases the risk of psychological trauma, particularly posttraumatic stress and depression. SA also increases the odds of suicidal behavior, running away, and substance use. SA females have the same odds of successfully completing behavioral health diversion and being charged with any offense or misdemeanor after termination as non-SA females. Implications of research and future directions are discussed.