This report examined the efforts made in Colorado, Indiana, Massachusetts, and Rhode Island to develop mental health systems of early identification and intervention for children from birth to age 5. While each state is in a different stage of development, together they provide a picture of progress and opportunities for national change in this evolving area of health care. The study focuses on the process of change and identifies common strategies for achieving innovation. State profiles, examples of major initiatives, and descriptions of exemplary practices illustrate ways that states can improve services and policies. Conclusions underscore the value of articulating a national vision of comprehensive infant and early childhood developmental and mental health systems of care, in which child and family well-being are promoted and needs are identified and treated as early as possible in life.