In the USA, crisis hotlines, such as the National Suicide Prevention Lifeline, have become a valued resource for individuals experiencing a suicidal crisis. Often staffed by trained counselors, crisis hotlines can provide immediate support and can help to identify a caller’s problem and potential solutions, ensure the caller’s safety, and connect them with appropriate resources. Notably, with the introduction of the 988 crisis system in the USA, it is important that crisis hotlines continue to improve their systems of care as their services will be used with increased frequency. This chapter highlights Behavioral Health Response (BHR), a regional crisis hotline located in St. Louis, Missouri, and details methods they have employed to address gaps in youth crisis response with the creation of the Youth Connection Helpline system. This chapter emphasizes the importance of integrating crisis hotlines with other community resources and the value of tracking outcomes to achieve intended goals. Guidance on how to implement and evaluate a youth-focused crisis system is provided.