There is growing recognition of the multiple and complex needs of families who request services from early head start (EHS) programs. One of the challenges of EHS programs is to screen multiple risks more efficiently so that families can be referred for appropriate support services and so that families who are most in need of EHS services are able to receive them. Meeting this challenge has been cited as a priority for EHS programs and is central to better understanding and addressing infant mental health needs among families who come into contact with EHS programs. Community, state, and federal monitoring systems have been identified as an important mechanism for tracking and improving the well-being of America's children and adolescents. To the extent that predictors of infant mental health problems are known, communities can develop monitoring systems for the purposes of prevention and treatment. The purpose of this article is to identify common limitations of screening and referral approaches in EHS, to describe the process by which one EHS program has begun to address such limitations, and to highlight indications of system effectiveness as well as plans for future evaluation.