A recent national survey on the expulsion of preschool children from child care centers reports that centers with access to mental health consultation have lower rates of expulsion than centers without access to classroom-based behavioral consultation. This article uses a series of vignettes from a composite case study to illustrate in detail the ways in which a mental health consultant might intervene at various levels of a child care program and with different members of the child care community--staff and family. The author discusses how each vignette illustrates the enormous complexity of the difficulties to which the consultant pays attention, key skills and strategies the consultant must employ, and the risks and losses as well as the gains inherent in various interventions.