Engaging families in the behavioral health assessment process for child welfare-involved youth is a best practice standard in obtaining vital information about the context affecting their safety, permanency, and wellbeing. As family functioning plays a role in successful reunification for youth out-of-home care (OOHC), family engagement may also increase the likelihood of buy-in, clinical treatment participation and outcomes. The purpose of this study is to explore the relationship between standardized assessment domains of child and family needs and the prescription of family-focused treatment. Results suggest that there were overall low rates of prescription of family-focused treatment. There were significant differences in the prescription of family-focused treatment based on youth identified trauma, behavioral, emotional and family needs. Despite the impact of family functioning on placement, the low rate of prescribed family-focused treatment may reflect barriers such as communication and collaboration between providers, distance between family and placement, or a siloed approach to treating children in OOHC separate from their families. Approaches to address these barriers are discussed.