This session aligns with Breaking Boundaries: Redefining Access and Expansion in Integrated Care by critically examining what happens when ideal models of integrated behavioral health (IBH) collide with the realities of an organization’s structure, readiness, and limitations. Using a real-world case study from Johnson Health Center, we will explore the challenges of implementing an IBH program within an FQHC setting, focusing on staffing, resources, and organizational readiness. Participants will engage in an interactive, case-based discussion, reflecting on their own experiences and learning strategies to navigate these barriers. Much like a morbidity and mortality (M&M) conference in medicine, we will analyze key decision points, adaptations, and when to pivot or compromise for sustainability.