OBJECTIVES: To examine the impact of state child and adolescent psychiatrists (CAP) workforce on caregiver reported difficulty accessing services for their child aged 3-17 years with any of these mental health conditions:  autism spectrum disorder, cerebral palsy, Down syndrome, developmental delay, mental retardation, ADHD, anxiety, behavioral/conduct problems, or depression. METHODS: A cross sectional study was conducted using state level data from the 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) from 50 states and DC.  Difficulty accessing services was assessed via caregiver reported unavailability of services in the state (N = 18,654) and difficulty getting appointments due to backlogs/waiting lists/other reasons (N = 18,675).  Individual level covariates included: caregiver education level, household income, and child’s functional ability. State level covariates included state median annual household income and state CAP workforce per 10,000 state youth. Generalized Linear Latent and Mixed Model (GLLAMM) procedure was used to conduct a multilevel logistic regression (with random intercepts) and account for survey weights.  RESULTS: Availability: A $1000 increase in median annual household income was associated with greater likelihood of reporting unavailability of services (AOR = 1.03, 95% CI = 1.02-1.03). A one unit increase in number of CAP per 10,000 youth in the state was associated with decreased likelihood of caregivers reporting difficulty using services due to unavailability of services (AOR = 0.99, 95% CI = 0.98-0.99).  Appointments: With increase in every $1,000 in the state median household income, the likelihood of caregiver reported difficulty using services due to appointments increased significantly (AOR = 1.01, 95% CI = 1.01-1.01).  State CAP workforce was not found to be associated with caregiver reported difficulty in getting appointments.  CONCLUSIONS: State contextual factors such as CAP workforce may have an impact on caregiver reported unavailability of services in the state for children with mental healthcare needs.