Case examples highlight ethical, clinical, and system dilemmas arising from implementing a systems-of-care approach for children with psychiatric disorders and their families in the United States and Canada when the child or a family member is not a legal immigrant. Similarities and differences between systems of care in the United States and Canada are highlighted. Attendees gain an understanding of the ethical and clinical dilemmas that arise in service systems for children and families due to immigrant status and inadequate resources, and learn to identify appropriate approaches to resolving these ethical, clinical, and systems dilemmas.