Empowering clients in the mental health system is a principle for providing care that has developed in response to the once standard approach in which individuals had little to no voice and choice in their treatment plans and were served in very restrictive settings. The system of care (SOC) philosophy provides an approach to mental health service provision for youth that aligns with an empowerment philosophy. In addition to aiming for services and supports to be individualized, strengths based, and culturally appropriate, SOCs are to institute policies wherein youth have voice and choice in their treatment planning through active involvement and in the least restrictive setting possible. The extant literature suggests that adherence to the SOC principles has positive outcomes for youth and their families. This study sought to identify how youth reported voice and choice in treatment related to youth emotional and behavioral outcomes, satisfaction with services, and social support. Responses of 73 youth (and their caregivers) on the Behavioral and Emotional Rating Scale, Second Edition (BERS), Child Behavior Checklist (CBCL), Youth Services Survey (YSS), social support items, and voice and choice items were analyzed using baseline (Time 1) and follow-up data from 6 months to 1 year afterwards (Time 2 or Time 3). Contrary to hypotheses, results from a series of hierarchical regression analyses indicated that there were not any significant relationships between youth reported voice and choice in treatment and behavioral and emotional outcomes, satisfaction with services, and social support. Study implications, limitations, and future directions are discussed.