The objective of the study was to examine differences in pediatric resident perceptions and practices related to child mental health conditions in continuity clinic settings with versus without on-site mental health professionals (MHPs). A 20-item questionnaire, based on the American Academy of Pediatrics Periodic Survey Number 59, was administered to pediatric residents in a medium-sized program from 2008 to 2011. Of 130 residents surveyed, compared with their peers, those practicing with the on-site MHPs were more likely to report mental health services as very available in their clinic (odds ratio [OR] = 39.7; P = .000). Residents with on-site MHPs inquired more frequently about attention-deficit/hyperactivity disorder (ADHD; OR = 2.96; P = .029) and referred more frequently for ADHD (OR = 3.68; P = .006), depression (OR = 2.82; P = .030), and behavioral problems (OR = 3.04; P = .012). On-site MHPs in continuity clinics offer great potential to improve resident education and patient care. Additional research is necessary to further understand their impact.