The primary care setting is the "linchpin of the new health care delivery system" (Haley et al., 1998, p. 237), and given the high volume and the incredible variety of patient complaints (Pruitt, Klapow, Epping-Jordan, & Dresselhaus, 1998), pediatric primary care providers have little time for counseling caregivers regarding developmental or psychological problems. Reisinger and Bires (1980) found that on average, pediatricians spent 97 seconds with an infant under five months and 7 seconds with an adolescent providing anticipatory guidance. Despite the lack of time available for addressing developmental and psychological concerns, there is a clear need for primary care, "the de facto mental health system" (Strosahl, 1996, p. 1), to address the needs of the more than 7.5 million children and adolescents This chapter was authored or coauthored by an employee of the United States government as part of official duty and is considered to be in the public domain. Any views expressed herein do not necessarily represent the views of the United States government, and the author's participation in the work is not meant to serve as an official endorsement.