Poor mental health in childhood and adolescence has a significant impact on both physical and mental health throughout life. However, growing evidence suggests that current levels of child and adolescent mental health (CAMH) care are insufficient to meet the needs of many children and adolescents in the United States as evidenced by increasing rates of mental health problems, inequities in diagnosis, and inaccessibility of services. This article provides a discussion of current problems in CAMH and school mental health services and emphasizes a developmental perspective of CAMH, including the co-occurrence of school difficulties and mental health concerns. A universal design for learning framework for school-wide mental health programs is suggested as a means of addressing barriers to care and promoting prevention and early intervention in CAMH.