Children and adolescent psychiatric inpatients (n = 25) versus staff (n = 35) milieu perceptions were measured with the Ward Atmosphere Scale (WAS) Form K (Kids). The perceptions were compared with previous data collected in 1981, 1982, and 1984 on the same unit. The 1993 staff and patients continued to perceive the unit as a therapeutic environment despite recent restrictions on length of stay due to health care reform. The views of the staff and patients were found to be divergent but less so than in previous years. Additionally, the more seriously ill a patient was determined to be, the more negatively he or she perceived the environment. Differences in perceptions between day shift versus night shift and administrative versus non-administrative staff were also found and discussed. Staff perceptions versus their ideal conceptions were also investigated and compared with those of the 1984 staff. The 1994 staff was found to more closely approximate their ideals than the 1984 staff.