Many children in this country do not receive the mental health care they need. At the same time, a nationwide movement known as systems of care is providing innovative services for families and children. This article links the ideas inherent in systems of care with ecosystemic family therapy principles and practices. Based on a study of nine innovative systems of care pilot projects in Massachusetts, it describes how these innovative programs, and others like them, have been most successful in increasing access to services and providing for coordinated services. They have been less successful in accomplishing positive clinical and functional outcomes. Change in these systems is often described in terms of how services are provided. Not enough attention is given to the conversations that take place between families and case coordinators and how these conversations lead to long-term change. This article contends that the ways in which services are delivered in these systems of care fit well with ecosystemic family therapy principles and practices. We, as family therapists, have an opportunity to link these two sets of ideas, which share common assumptions and values and increase the likelihood of positive clinical outcomes for children and families.