Youth engagement in institutional decision-making is necessary to ensure policy and practice is responsive and relevant to youth and community needs. In particular, it is critical to engage the voices and experiences of youth of Color who have historically been marginalized by healthcare organizations. The present study used multiple methods to examine youth and adult perspectives on the facilitators and barriers to implementing a citywide youth advisory board of youths of Color for a safety net hospital. Data were analyzed using thematic analysis. The findings illustrate the need to employ an antiracist framework to ensure organizational and adult readiness to engage youth of Color in an advisory board. Organizational readiness included assessing organizational culture, clear expectation setting, and creating safe spaces for youth. Adult readiness included adult facilitators who are trained in antiracist and equity-focused practice and the youth-adult partnership model, and a recognition of the bidirectional benefits of youth engagement in decision-making. The implications and recommendations of this study are timely given the historical mistrust between healthcare organizations and communities of Color, as well as the racial health inequities that have been further exposed during the COVID-19 pandemic.