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There has been an increasing prevalence of mental and behavioral health conditions in children and adolescents in the United States, which has been exacerbated by the COVID-19 pandemic. However, many youth struggle to access behavioral health care. Tele-behavioral health, the delivery of mental health services through videoconferencing and other digital technologies, has emerged as a strategy to facilitate access. There is broad evidence supporting clinical effectiveness of tele-behavioral health across multiple psychiatric and behavioral health conditions. Multiple established care models exist for the delivery of tele-behavioral health. Here, we discuss key facilitators and barriers to implementation of tele-behavioral health, with important considerations including clinical appropriateness, provider training, and organizational support, in addition to essential safety and confidentiality considerations in care delivery with children and adolescents. There are also health equity implications in the use of tele-behavioral health, which can potentially reduce disparities in access to behavioral health care. However, important considerations remain to ensure that telehealth use is accessible and does not exacerbate inequities. Finally, there are emerging directions in the field of tele-behavioral health, particularly in the integration of artificial intelligence (AI).