This report stems from a larger study on the outcomes of children and youth who accessed residential treatment or a home-based alternative. In this report an analysis of family descriptive information, the nature of family relationships, and indicators of family functioning for children and youth who have participated in children's mental health services are presented. Results suggest that youth accessing residential treatment have very different family experiences than youth accessing the home-based alternative. Furthermore, the functioning of youth at home improved significantly from admission to discharge, and family functioning was considered "healthy" at follow up; however, family relationships remained problematic. In qualitative interviews with a subsample of youth, varied and complex family relationships were described, and many youth revealed aspirations for positive family engagements. Implications for practice and research are presented. (Contains 5 tables.)