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This study documents the high rate of parent andfamily concerns among the families of adolescents(ages 11-18) entering publicly-funded outpatientmental health treatment in San Diego County, andexamines the effects of treatment on familycontextual concerns. Significant improvementsare observed in caregiver strain and familyrelationship quality six months after treatmententry, but not in other family contextual outcomes(parental depression, social support). Parent,family, and adolescent outcomes are significantlycorrelated, with the strongest association betweenreduction of youth externalizing problems andreduction of parental strain and depression. Betterparent-therapist alliance predicts better parentaldepression, strain and family relationship outcomes.Family systems theoretical orientation predictsgreater reduction of parental strain. Increasedattention to family concerns may be critical forimproving the effectiveness of real world youthmental health services and to create morestableenvironments in which youths therapeutic gains canbe fostered and maintained.