This paper focuses on outcomes for Infant and Early Childhood Mental Health Consultation (IECMHC) provided to early education teachers as part of a tiered statewide expulsion prevention initiative. In a sample of 360 children (83.3% male, 66.6% White, 88.1% with clinically elevated externalizing behavior at baseline) at risk for expulsion, outcomes from consultation are described, including expulsion outcomes and changes in child behavior. Multiple regression was used to explore the role of teacher engagement in the IECMHC process on child-level behavioral outcomes. Of the referred children receiving IECMHC, 3.9% were expelled. From pre- to posttest, teachers reported significant reductions in behavior concerns (both frequency and the perception of the behaviors as “problematic”) and expulsion risk (based on teacher perception of child behavior). Teacher engagement in the IECMHC process was a robust predictor of change in child outcomes, with greater engagement associated with improvements in child behavior problems and prosocial skills. (author abstract)