Starting a new job as a Behavioral Health Consultant (BHC) is a complex undertaking. Unlike most new jobs, where one’s existing training has already prepared them for the role, working as a new BHC involves both learning a new job and a whole new set of skills—all at the same time. To further complicate the picture, every primary care clinic is different, and the extent of a clinic’s prior exposure to PCBH ranges from zero to extensive, so there is no one-size-fits-all guidance for helping new BHCs. Yet, despite all the complexity, there are some universals to starting as a BHC, and those are the focus of this chapter. The activities discussed here complement the training outlined in Chap. 7 , with most of them occurring in the same timeframe that training is also being accomplished. To help track the many, many different tasks to complete, we offer a start-up checklist; and we also discuss how to identify and overcome common barriers to success that may arise over time. We also offer suggestions both for BHCs that are replacing a BHC and for those joining forces with one or more BHCs already in clinic.