There has been a recent trend towards increasing accountability of mental health care providers through the use of treatment outcome measures, in order to reduce spending and improve patient care. This qualitative study utilized focus groups to elicit input regarding the need and possible content involved in creating an improved outcome measure specifically designed for severe emotionally disturbed (SED) children and adolescents. We conducted 60-90 minute focus groups with each of the following three separate constituent groups who are regularly involved in the care of SED youth at the Utah State Hospital (USH), including a) hospital clinical staff, b) affiliated education staff, and c) parents/primary caregivers; as well as clinical staff at a community mental health youth outpatient clinic, the Wasatch Mental Health (WMH) Youth Outpatient Program. While the groups agreed that a new unified system of tracking outcomes could be beneficial as an aid in improving outcomes, their greater concern is about a lack of communication between disciplines and between levels of care. Six broad domains were divided between two sections of Internal versus External Locus of Control (Internal: Behavior, Social/Emotional, Academic/Cognitive, and Strength-Based Assessment; External: Collaboration among Care Providers and Family) and 23 subdomains were generated based on themes identified from the focus groups' responses. We also compared these domains and subdomains to ones previously generated by a USH pilot study and found some overarching similarities, but also some notable differences and both should be considered in any future outcome measure created. However, the most prevalent theme we found was a desire for an increase in collaboration and communication between constituencies and throughout levels of care, which is vitally important to improve care and long-term outcomes of SED youth.