This mixed methods study aimed to better understand the training and supervision needs of those in infant and early childhood mental health (IECMH) leadership positions. The study used individual interviews and online surveys to explore the question "What does it mean to be a leader in IECMH and what unique challenges do they face?" 10 IECMH leaders completed individual interviews and 64 completed the online survey. Using qualitative thematic analysis, interview data suggest that while IECMH leaders have extensive clinical training and education, they described challenges related to race, training/development, and feeling prepared and competent in their leadership roles. Data suggest that IECMH leaders use reflective supervision as one way of managing these challenges. This research provides considerations for organizations in regard to educating, training, promoting, and developing IECMH leaders.