School-based mental health clinics are the ideal venue to provide mental health services for youth due to their accessibility and lack of stigma compared with other community treatment centers. There were challenges associated with the abrupt shift to remote education and clinic services caused by COVID-19, but some school-based mental health clinics excelled in their implementation of telehealth services. This study of New York schools found four main facilitators to implementing telehealth services among school-based mental health clinics: (1) strong collaborative relationships between the clinic and school setting, (2) active and responsive leadership, (3) provider experience in conducting telehealth, and (4) provider flexibility to accommodate the needs of children and families. Factors were identified at every level of the school-based mental health clinic and system that helped to facilitate exemplary telehealth service delivery and implementation.