We examined behavioral markers of caregiver involvement and the ways in which family participation was related to treatment outcomes in 47 elementary school children with SED enrolled in a school-based intensive mental health program. Measures of caregiver involvement included therapeutic home visits, attendance at therapeutic meetings, completion of ratings on the daily point sheet, and extra communications with the therapeutic team on the point sheet. Greater initial impairment was associated with greater caregiver involvement. Greater caregiver involvement was linked to improvement in child thought processes, increased ability to provide emotional and social supports for the child, and greater overall child functioning at discharge. Our findings also reflected increased therapists' attempts to provide additional in-home services in cases where caregivers demonstrated a decline in their ability to provide for their children's physical and material needs, or in which therapists discovered that the family functioning was more impaired than what was initially assessed. We provide a case study that exemplifies many of these findings.