Important cultural, linguistic, traditional, and spiritual differences among Native American reservations are likely to go unrecognized to the detriment of children in need of mental health intervention. The authors discuss the impact of these factors on the expressions of psychiatric distress of Native American children, their care-seeking behaviors, and the acceptability of the forms taken by mental health systems that serve them. They suggest new, innovative models of care that can be developed within the context of contemporary Native American culture. Although the roles envisioned for child psychiatrists include the provision of direct clinical service, the authors posit that a model in which child psychiatrists provide consultation and supervision to native outreach and other mental health workers is a more acceptable and potentially more effective use of scarce resources.