Anxiety disorders are among the most prevalent psychiatric disorders for children and youth, affecting 15–20% of youth in their lifetime, however, these disorders are highly treatable with cognitive behavioral therapies. Treatment engagement is of central importance in this divide between need and treatment. This chapter will provide an overview of the literature as it relates to treatment engagement with youth and families, including review of the barriers to care; predictors of engagement, nonresponse, and dropout in CBTs for anxiety; family variables (e.g., caregiver involvement) that impact treatment engagement; and strategies to cultivate engagement over the course of treatment. This chapter will provide information for enhancing engagement with cultural humility, sensitivity to identity, and with a focus on treatment quality equity. Diverse clinical case examples will illustrate real-world scenarios to assist practitioners in promoting CBT treatment engagement and encouraging effective outcomes for anxious children and youth.