Treatment for youth at clinical high risk for psychosis (CHR-P) presents an opportunity for early intervention with the capacity to decrease the burden associated with a potential psychotic illness later in life. However, significant barriers prevent youth at CHR-P from accessing specialty mental health services. Few studies have examined the pathways to care for youth at CHR-P within the U.S. health system. The present study reports the results of a codebook thematic analysis of qualitative interviews conducted with 15 families of youth at CHR-P. We inquired about their experiences navigating the health system to eventually arrive at the CHR-P specialty program, including help-seeking events and referrals, attributions for CHR-P symptoms, and barriers and facilitators to care using a semi-structured interview guide. Caregivers reported confusion and uncertainty regarding symptom attributions. They also disclosed the significant challenges to obtaining mental health care including mental health literacy, illness stigma, provider availability and appropriateness, and adequacy of referrals. Notably, most youth at CHR-P had encounters with emergency services during their help-seeking journey. Our results help define targets for future policy, research, and clinical efforts to improve access to specialty care for youth at CHR-P in the U.S.