Disaster risk reduction (DRR) and emergency management (EM) efforts are integral to climate change adaptation (CCA). The integration of DRR with adaptation is globally recognized as a rational use of resources benefiting both areas. There is a substantial literature on the topic, but little on the practice of implementing such integration on the ground. This paper presents some of these experiences at national and agency levels in the south-west Pacific and outlines possible future directions to support policy and practice. Based on the perspectives of practitioners from Australia, Vanuatu and the Solomon Islands, it explores institutional changes with country examples, and the range of constraints and enabling factors in integrating adaptation with DRR and EM practices. The Australian aim of spreading responsibility for CCA and DRR integration through mainstreaming across departments and agencies was seen as effective in increasing whole-of-government approaches. However, in both Vanuatu and the Solomon Islands the concentration of information, responsibility and actions through a single focal point was more effective in reducing overlap and providing a clearer picture of what was being implemented, by whom and where. The findings demonstrate a need to consider the experiences arising from practical implementation of the integration agenda and to document the lessons from this experience in a way that can inform policy and practice.