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Youth in the juvenile justice system as a whole represent multiple challenges, but there is one sub-group of youth known as “multi-system youth”—i.e.., youth with a history of involvement with the child welfare system—who have unique service needs due to their exposure to traumatic events such as child abuse, violence, and neglect. These high-need youth, in the absence of well-attuned programming matching their needs, are provided the same treatment as the rest of the offender population. This population-based study examines how the current treatment practices affect multi-system youth. Specifically, this study examines the youth characteristics, risk factors, pathways to delinquency, engagement with the treatment, and responses to treatment among a sample of multi-system youth compared to the rest of the youth in the juvenile justice system. The results demonstrate that multi-system youth are a highly vulnerable group of youth, being at an extreme risk for dropping out of treatment, facing probation violation charges, experiencing detention placement, and recidivism. Recommendations for prevention and treatment are discussed.