Objectives: The multisite Course and Outcome of Bipolar Youth (COBY) study found that children diagnosed with bipolar disorder, not otherwise specified, who have first and second degree relatives with bipolar disorder have a nearly 50% chance of converting to bipolar I or II disorder within 4 years. This talk will describe a program of family-focused treatment (FFT) for youth at risk for bipolar disorder, which used a definition of risk similar to the COBY study. We review early outcomes from a pilot randomized trial. Method. 30 youth (ages 9-17) who showed early prodromal signs of bipolar illness, in combination with a positive family history of bipolar disorder in a first-degree relative, were recruited. The youths received 12-16 sessions of FFT for high-risk youth (FFT-HR) with their parents and siblings, or a 1-session comparison family treatment. FFT-HR consisted of sessions of psychoeducation, communication enhancement training, and problem-solving skills training. Participants in both conditions were maintained on pharmacotherapy from study psychiatrists when appropriate. Outcome evaluations were conducted every 4 months by independent evaluators. Results. Relative to the youth in the brief treatment control condition, youth in FFT-HR showed improvements in depression symptoms from a pretreatment to a post-treatment follow-up. Discussion. Family-based treatment may produce short-term gains in clinical functioning among children at risk for bipolar disorder. Longer-term follow-up of participants in the randomized trial will determine whether early psychosocial intervention can delay the onset of fully syndromal bipolar I or II disorder and enhance quality of life among high risk youth.