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In 2021, the U.S. Surgeon General issued an advisory on youth mental health, stating that the challenges that youth are facing are unprecedented, hard to navigate, and significantly impacting their mental health.1 Through statewide quality improvement and collaborative learning models, the Care Transformation Collaborative of Rhode Island (CTC-RI) and PCMH-Kids have implemented innovative, pediatric integrated behavioral health (IBH) models to support pediatric medical homes in addressing youth mental health needs, reduce stigma, increase access, and improve care coordination. Early efforts focused on a traditional IBH model and practices were financially responsible for the IBH clinician; despite clinical successes, smaller practices could not sustain the model financially, so CTC-RI shifted its focus to an innovative model that removed financial risk from the practice. More recently, CTC-RI has launched initiatives to expand the pediatric team's capacity to manage the behavioral health needs of its patients and families by providing specialty skill building (e.g., sleep, anxiety, autism), and by adding community health workers to IBH teams. Results from these initiatives indicate that pediatric IBH models are an effective and essential element of advanced primary care.