Federally Qualified Health Centers (FQHCs) provide comprehensive health care services to millions of low-income, uninsured, and underinsured Americans, including a high proportion of racially and ethnically diverse populations. Given their reliance on federal funding, FQHCs are at the forefront of recent health care reform initiatives, including integrated care and patient-centered health care. These initiatives call for a family-centered approach to care, which provides significant opportunities for psychologists trained in family systems theory. Four pediatric case illustrations demonstrate both the application and challenges of a systemic approach to assessment, intervention, and consultation in the unique setting of the FQHC. We end with a discussion of the competencies and adaptations necessary to provide family-centered services in pediatric primary care FQHC settings.