Early childhood mental health consultation (ECMHC) is the primary strategy implemented by Head Start programs to address the social and emotional needs of children and their families, but little is known about the attributes of early childhood mental health consultants (MHCs) that contribute to consultants' relationships with Head Start staff and to consultation outcomes. The present study examined how attributes of MHCs contribute to positive relationships between the MHCs and Head Start staff and to improved consultation outcomes. Seven attributes of rural and urban mental health consultants were examined: MHC training, supervision, and support; MHC understanding of consultant role; MHC relationship with Head Start staff; relationships with Head Start families; knowledge of and experience with Head Start; knowledge of early childhood best practices; and cultural sensitivity. This mixed methods study combined a secondary analysis of a national survey (Green, Everhart, Gordon, & Gettman, 2006) of 407 Head Start staff and 57 mental health consultants with a qualitative study using telephone focus groups with 26 rural and urban MHCs who worked with Head Start programs in Alaska and Oregon. Hierarchical linear models of the national survey of Head Start staff and MHCs suggested that Head Start staff reports of positive relationships with MHCs were associated with MHCs who reported positive relationships with families and staff and who reported that they received training, supervision, and support. Qualitative results indicated that effective MHCs share a mutual understanding of their role with the Head Start staff and provide culturally sensitive services. In addition, the focus groups provided specific information about how MHCs develop relationships with Head Start staff and families and about MHCs' need for need for training, support, and supervision. Finally, the focus groups revealed that MHCs who provide services in rural areas must understand the role of relationships in rural communities, respect the rural lifestyle, and overcome the challenge of isolation. The findings of this mixed methods study provide valuable information about the nature of relationships between MHCs, Head Start staff, and families and have implications for ECMHC practice, policy, and research. (author abstract)