System reform processes need to be adaptable enough to meet the rapidly changing context (within states/tribes, systems, and organizations) and the needs of youth and their families. Our system design work focuses on the robust infrastructure required for standardized care pathways to be comprehensive, integrated, and adaptable to meet the evolving needs of youth and their families and providers in the care setting including technology, clinical expertise, information systems, and communication channels. This infrastructure needs to include electronic health record systems, clearly defined care standards, care coordination platforms, data analytics tools, telehealth capabilities, and secure communication channels to ensure seamless collaboration among different providers. Furthermore, an infrastructure to support effective care pathways needs to encompass training and workforce development activities for agency staff to ensure they have the necessary skills and knowledge to effectively implement and utilize the pathways. It includes standardized protocols and guidelines for care delivery, as well as mechanisms for monitoring and evaluating the effectiveness of the pathways. The infrastructure prioritizes interoperability and data sharing to enable seamless communication and coordination of care across different settings and providers. Needed considerations include reimbursement models that incentivize the delivery of evidence-based care, as well as administrative processes to ensure efficient workflow and resource allocation.