Behavioral health integration in primary care is identified as an important strategy to achieve early identification and treatment of behavioral health disorders. This paper describes a pilot project designed to test the feasibility and sustainability of integrating behavioral health into pediatric primary care clinics. Five private, fee for service pediatric primary care practices were identified in the greater Houston area to establish behavioral health integration. The practices were supported with establishment of behavioral health integration, specifically with recruitment of the behavioral health provider, training of the clinical and administrative teams, and development of interdisciplinary clinical protocols. Difficulties in implementation included differences between medical and psychological provider’s work cultures, credentialing delays, reimbursement barriers, and behavioral health provider difficulties in meeting productivity targets. Strategies for addressing these issues are discussed
