Parent involvement (PI) is considered necessary in teen pregnancy prevention (TPP) and preventing other adolescent risk behaviors. However, controversy exists regarding the extent to which families are responsible for adolescent sexual decision making. We adapted two frameworks (Kirby’s risk and protective factors and the Parent–Child Connectedness model) to examine parent- and family-based programs and policies relevant to TPP. There is evidence that PI is an important and effective component of TPP; however, the evidence for PI programs is less strong. Although the United States has legislated various PI-related policies in the context of adolescent sexuality, most have hindered the health of adolescents. Furthermore, the United States falls behind other Western industrialized nations when it comes to healthy family-based policies. PI in TPP is important; however, TPP requires multiple levels of intervention beyond the involvement of parents. We make recommendations for how various stakeholders can effectively use healthy family-based interventions in TPP.