This study examined careers services provided to young adults with serious mental health conditions. Based on an internet survey and key informant telephone interview of 31 programs nominated for delivering innovative practices for young adults, the state of the field for career services was described. Most programs offered supported education and supported employment along with mental health services. Detailed and written planning was a key feature. Programs emphasized working closely with families, inter-agency collaboration, and use of normative community resources. Programs provided direct skills training for school and work and other life skills. Largely, existing models are being applied. However, providers described unique adaptations including greater flexibility in service delivery, attending to the turbulence and developmental changes characteristic of this age group, use of social media, and a heightened willingness to meet young people where "they are at" both literally and figuratively.