The Connection Learning Healthcare System (CLHS) represents a network of academic institutions, state behavioral health systems, and early psychosis specialty care programs in Pennsylvania and Maryland working together to provide the best evidence-based care for persons with first episode psychosis. Developing an integrated, two-state system required unification and harmonization of data collection, training, consultation, research, and dissemination activities. Here we describe the model that supported these efforts and our experience creating an active two-state learning healthcare system. We also review areas of ongoing attention and offer lessons learned.