Participation in decision-making procedures of young people in care is considered a key element that affects their current or future living circumstances and might improve the quality of decision-making on and delivery of provided services. This narrative literature review, covering the period 2000–2016, focuses on the opportunities of young people to participate, the challenges and facilitators to participation, and the outcomes of care related to participation. Sixteen studies met our search criteria. Several studies show that young people seem to have limited possibilities to “meaningful” participation in decision-making. Various challenges and facilitators in the participation process emerge with regard to the level of the young person, the professional, and the (sociocultural) context. None of the studies provides evidence for a connection between the “amount” of youth participation in decision-making and/or treatment during the care process and the outcomes of residential care. Implications for research and practice are reflected upon.