South Carolina (SC) is a leading state for the delivery of comprehensive school mental health (SMH) services, involving mental health education system partnerships. Currently, more than 60% of SC schools include mental health clinicians from the state Department of Mental Health; there is a widely endorsed goal 100% of SC schools to have at least one SMH clinician within a few years. Leveraging SMH helps address the systemic barriers for youth access to behavioral health services, particularly the effects of federalism and segmentation of services. The present article will discuss background on the development of SMH in SC, major policy initiatives and communities of practice that are propelling the work forward, best practices, and guiding principles for addressing barriers related to youth behavioral health.