A growing number of states and communities are implementing the Pyramid Model in early care and education settings, and in many of these places there are also early childhood mental health consultation (ECMHC) programs operating. This practice brief provides an overview of ECMHC, how it can support the implementation of the Pyramid Model and the issues that arise when administrators seek to integrate these two approaches at the state and local levels. Mental health consultants can: (1) serve as coaches for implementing the Pyramid practices; (2) serve as adjuncts to coaches, by working with children, families and teachers; and (3) use the Pyramid Model to inform and organize their own strategies for working with teachers and families. (author abstract)