The Onondaga County Health Department (OCHD) administers the Early Intervention (EI) and Preschool Special Education (PSE) programs within their county. EI and PSE are both mandated programs guided by federal and state legislation, regulation and policy to provide education and therapeutic evaluations and services for children birth to age 5 with disabilities and developmental delays. OCHD released an RFP in late 2011 and awarded a contract A&O for an operations review to identify steps to improve overall accountability, operational effectiveness and staffing efficiencies within these two important programs. The scope of work included a thorough review and analysis of documents that guide the programs at the state and local levels, interviews, focus groups and surveys with key stakeholders; comparisons of EI/PSE administration and program operations between Onondaga County and other like counties and structured observations of key functions. Data and findings emerging from the all activities were analyzed and synthesized into an exhaustive and coherent set of conclusions and recommendations and presented to the Commissioner, Deputy Commissioner and Fiscal Officer of the Department as well as program directors and staff.