An estimated 10% to 20% of youth in primary care exhibit behavioral symptoms and may go underdetected. Most screeners identify risk base of symptoms alone, irrespective of functional impairment. To address this issue, the Pediatric Symptom Checklist-17 (PSC-17), a widely used symptom screener, was combined with functional impairment and current behavioral services enrollment items to form the Pediatric Behavioral Health Screen (PBHS) and assessed compared to the full Child Behavior Checklist (CBCL). A total of 267 youth between 6 and 16 years of age were administered the screener and the CBCL. Areas under the receiver operating curves approached or exceeded 0.90 in all analyses, reflecting excellent classification accuracy. Almost no false negatives were observed among currently untreated cases with functional impairment. No differential item functioning was found. Performance of the PSC-17 as a pediatric primary care behavioral health screener supported previous research, and additional functional impairment items to form the PBHS appeared useful, particularly for interpreting borderline range scores.