The burgeoning evidence-base for collaborative health care models combined with the limited availability of child mental health clinicians has increased the need for child and adolescent psychiatrists to create partnerships with primary care clinician colleagues. The AACAP Liaisons to the American Academy of Pediatrics join with the 2010 Simon Wile Leadership in Consultation Award winner to discuss “reaching difficult children with difficult problems.” Dr. Harriet MacMillan describes evidence-based approaches to child maltreatment from the perspective of the primary care clinician, while Dr. Deborah Simkin describes consultation work with pediatricians around substance abuse in the juvenile justice system. Dr. George Fouras outlines a web-based approach to facilitate collaborative care around children in foster care and Dr. Michael Storck discusses innovative strategies to care for the American Indian child in remote locations where access is a challenge.