Abstract: Applied Behavior Analysis (ABA) therapy organizations are increasingly transitioning from traditional, in-person service models to digitally mediated telehealth systems; however, this shift introduces complex operational, cultural, and ethical challenges. While telehealth offers opportunities to expand access to behavioral health services for bilingual and culturally diverse communities, many ABA providers lack the organizational development expertise, technological literacy, and strategic business competencies necessary for the sustainable implementation of these services. This qualitative study examines the organizational readiness, data protection practices, workforce preparedness, and caregiver engagement factors that influence telehealth adoption through semi-structured interviews with fifteen participants, including telehealth experts, ABA clinicians, and certified organizational development professionals. Findings highlight barriers related to fragmented digital workflows, privacy concerns surrounding sensitive behavioral data, and disparities in access to technology and trust among multilingual families. Insights emphasize the need for interoperable data systems, culturally responsive engagement strategies, and comprehensive professional development to preserve treatment fidelity. Results inform actionable recommendations to support the creation of equitable, secure, and resilient telehealth ecosystems that can meet evolving payer expectations, mitigate systemic disparities, and enhance patient satisfaction in a competitive behavioral healthcare marketplace. Keywords: Applied Behavior Analysis (ABA), Telehealth Adoption, Digital Transformation, Organizational Development, Behavioral Health Technology, Technology Literacy, Interoperability, Treatment Fidelity JEL Codes: O30, O32, O33, M15