Indigent children and families face significant economic, social, and environmental challenges that complicate their psychiatric care. Being aware of the clinical and ethical issues and developing the necessary knowledge and skills to intervene more effectively can significantly improve the psychiatrist’s ability to provide quality care. This panel presents the case of an 11 year old male from Atlanta and discusses issues commonly seen with treatment interventions in low-income families, problems related to family interventions and parenting, ethical issues faced by clinicians, and advocacy in mental health in a low socio-economic setting. The importance of examining mental health issues of children and adolescents of minority groups in urban settings is one of the most pressing issues in mental health care today, given that these children are affected to a greater extent by stressors including poverty, violence, under supported schools, substance use, and other health epidemics.