There are significant challenges in understanding the impacts of climate change and developing sustainable adaptation responses. Canada and the US initiated a 6-year, integrated climate impact assessment of the Great Lakes - St. Lawrence Basin. Phase I of the Great Lakes - St. Lawrence Basin Project (GLSLB) on "Adapting to the impacts of climate change and variability" was recently completed. The GLSLB Project is unique in that it examined the complex interactions between climate variability and change, environment and society, and adaptation response strategies. The research framework linked climate-sensitive theme areas of water use and management, ecosystem health, land use and management, and human health with cross-cutting topics addressing climate and biophysical systems, socioeconomic impacts, adaptation, and communication and education. This paper provides a brief overview of the Project but focuses on the challenges of climate impact assessment and water use and management. Topics Include: scenario development, key impacts, communication and stakeholder involvement, adaptation, and "integration". Impact assessments for the GLSLB Project have examined shoreline changes along Lake St. Clair due to water level changes; rural water use conflicts; water resource management in the Grand River, Ontario; water quality changes in the Bay of Quinte watershed; and water diversion issues. They will be used to share some of the "lessons learned" from this Project.