Improving mental health services for youth in usual care (UC) is one of the most critical issues in mental health services research. Identification of change groups in UC (e.g., recovery, improvement, no response, deterioration) can help researchers gain a richer understanding of UC and facilitate efforts to tailor UC to individuals who may not be responding well to treatment. This study used the reliable change index (RCI; Jacobson & Truax, 1991) to examine change groups within youth UC on two parent report outcome measures—symptom severity and functioning—using a large, naturalistic sample of youth (N = 672) treated in UC served at four clinics operating under a large county-wide public mental health authority. Results indicated that the majority of youth exhibited no reliable change. Furthermore, findings revealed low concordance between how youth were classified on both outcome measures. Multinomial logistic regression was used to predict group membership from an expanded set of youth demographic and clinical variables. Findings indicated that baseline problem severity and lower baseline functioning generally predicted higher likelihood of being classified into a more positive change group. Older age predicted increased likelihood of being in a more positive change group, while diagnosis of an internalizing disorder or serious mental illness (SMI) both predicted greater likelihood of falling into a more negative change group. Overall, these results suggest the importance of a more nuanced understanding of change in UC, as well as work aimed at identifying targets for improvement for youth who are not responding well.