ORIGINAL PAPER Integration: Opportunities and Challenges for Family Therapists in Primary Care Melissa A. Fox • Jennifer L. Hodgson • Angela L. Lamson Published online: 28 April 2012 Ó Springer Science+Business Media, LLC 2012 Abstract Integration of behavioral and physical health is becoming critical for the overburdened primary care system. Policy changes are needed to accommodate integration nationally. Locally, medical and behavioral health providers are working together to create models that better fit their patients’ comprehensive needs while respecting the clinical, operational, and financial constraints of the current system. Family therapists trained to work in medical settings have an opportunity to emerge as clinical, research, and administrative leaders in this context. However, a paradigm shift is crucial to adapting their systemic orientation to interactions between individual patients, providers, staff, and healthcare and support systems. This article provides family therapists with: (1) an over- view of the basic structure and barriers of integration, (2) suggestions on how to deliver quality care despite barriers at the local level, and (3) examples of key advocacy efforts representing possible entryways on a larger scale. Keywords Behavioral health Á Family therapy Á Integrated care Á Integration Á Medical family therapy Á Primary care Introduction The infrastructure of the American medical system has created a distinct crevasse between the behavioral health and physical healthcare systems. In a recent national survey, 63 % of urban & suburban and 71 % of rural physicians working in primary care claimed that inadequate access to mental health services affects their patients’ health negatively (Robert Wood Johnson Foundation 2011). In addition, 71 % (suburban), 73 % (rural) and 77 % (urban) would like to write prescriptions for mental health services and have the cost M. A. Fox (&) East Carolina University, c/o Jennifer Hodgson, 108 Rivers Bldg., Greenville, NC 27858, USA e-mail: foxme06@students.ecu.edu J. L. Hodgson Á A. L. Lamson East Carolina University, Greenville, NC, USA 123 Contemp Fam Ther (2012) 34:228–243 DOI 10.1007/s10591-012-9189-3