This purpose of this study was to evaluate program level adaptations necessary for ECE programs to fully implement the Pyramid Model with fidelity to promote healthy development for children with disabilities and typically developing children. The current study included two goals. The first goal was to document (1) the frequency of adaptations to current ECE program policies, procedures, and funding allocations and (2) the frequency of how often those adaptations were documented in writing. A second study goal was to more closely examine the adaptations to current ECE program policies, procedures, and funding allocations that were necessary to fully implement the Pyramid Model with fidelity. Achieving these goals may provide useful information for ECE program administrative staff considering Pyramid Model adoption and implementation for their own programs to support healthy development for children with developmental delays as well as typically developing children. Findings will also provide relevant information to researchers studying program implementation and their outcomes, which can aid in future program development for young children. (author abstract)