Youth engagement is increasingly recognized as a preferred approach and often necessary step in the treatment of emotional and behavioral disorders. The purpose of this study was to explore the degree and quality of youth engagement in the therapeutic process, compare engagement scores between youth accessing residential and day treatment, and explore the association between engagement and interpersonal difficulties in a sample of youth with an emotional and/or behavior disorder in residential and day treatment programs based in Southern Ontario. Cross-sectional surveys of standardized measures were administered to youth and a separate survey to their Prime Workers. Relevant constructs included client engagement (as rated by youth and Prime Workers), and youth-rated behavioral screen, interpersonal problems and family functioning. Both Prime Workers and youth rated youth as moderately high in their level of engagement in therapy. Furthermore, Prime Worker and youth ratings did not significantly differ statistically, suggesting that youth may have actually engaged at a moderate level. Interpersonal problems were shown to be negatively associated with youth engagement, and family functioning approached significance for only youth in residential treatment. Assessing youth engagement during the treatment process as an intervention technique may highlight areas where greater clinical efforts are needed. Future considerations include testing methods of sharing and discussing results of an engagement measure within the context of a one-on-one clinical encounter with youth.