This report presents the first of a series of findings from the Community-Oriented Palliative Care Initiative (COPCI), an innovative program testing new approaches to caring for individuals with progressive, life threatening illness. Developed and supported by the United Hospital Fund, the project was designed to initiate collaborations among health care and social service organizations, with the goal of reaching seriously ill individuals and their caregivers earlier in the course of illness and providing a broad range of coordinated services. Six such networks of diverse partners received a total of $2.1 million in grants over the two-year period from mid-2000 into 2002. The urgency to provide alternatives to current standard practice is underscored by the number of individuals affected: in New York City alone, in the year 2000, some 46,000 people died of diseases typically marked by a lengthy course from diagnosis to death. While many could have benefited from appropriate and timely palliative care services, most did not receive them. The Fund reasoned that networks including not only hospitals and hospices but also social services agencies and other community resources could collectively respond, earlier and more fully, to the complex combination of medical, social, psychological, and spiritual needs that typify the months and years leading to death. Local expertise and resources should determine the structure of each network, the partners involved, and the specific model for service delivery. Drawing on the experiences of the six pioneering projects, this report focuses on the challenges of creating such new networks.