OBJECTIVE: To describe a tiered approach to identifying and addressing developmental and health concerns among low-income preschool children in Head Start. METHODS: Analytic sample consisted of 3- to 5-year-old Head Start students (n = 1171) from 14 centers in Los Angeles County serving predominantly Latino families during 2008-2009. All Head Start students were screened for developmental and health concerns and assigned to 1 of 3 tiers of intervention need: Tier 1 children needed only the usual Head Start curriculum, Tier 2 children needed targeted interventions (excluding special education), and Tier 3 students received special education services. Logistic regressions were used to analyze predictors of each tier, with screening results and socio-demographic variables as covariates. RESULTS: Sixty-nine percent of children were in Tier 1, 25% in Tier 2, and 6% in Tier 3. Tier 2 children most commonly needed mental health services and were less likely than those in Tier 1 to be from primarily English-speaking homes (odds ratio = 0.6, P .01). Tier 3 children were significantly less likely to be female than Tier 2 children (odds ratio = 0.4, P .05). CONCLUSIONS: More than one-quarter of low-income children not in special education may need targeted interventions, particularly mental health services. Although Head Start agencies are required to identify and address these needs, many other early education and clinical settings do not. Establishing screening and intervention guidelines for this intermediate-risk group represents a key policy gap for the child health and education systems. (author abstract)