We developed predicted change trajectories and a warning system designed to identify psychotherapy cases at risk for treatment failure as observed in archival Youth Outcome Questionnaire data (parent/guardian-report) from 363 children and adolescents (ages 4–17) served in an outpatient community mental health system. We used multilevel modeling procedures to develop models of predicted change based on demographic information. Controlling for the effects of age on intercept, no other variables were significant in the model. The warning system we created from half of the sample (n = 181) correctly identified 71% of treatment failures in the other half of the sample (n = 182), defined as cases whose symptoms were significantly higher at the end of treatment compared to symptoms at intake. As over half of youth cases in this usual care setting did not demonstrate reliable improvement in symptoms, these results further emphasize the value of patient-focused research in monitoring patient progress and prompting changes in the treatment approach if suitable progress is not observed.