Responding to the need for a universal and comprehensive approach for supporting all families with children from birth through age 5, the Early Childhood Initiative (ECI) was launched by a broad-based coalition of public and private partners brought together by the Cuyahoga County government in Ohio. This report describes the history of ECI, provides a statistical portrait of the early childhood population in Cuyahoga County, and examines ECI's scope and reach of in terms of the early childhood population in Cuyahoga County. In addition, the report details the evaluation findings of sub-studies examining the components of the program: (1) a one-time home visit by a nurse with first-time or teen mothers; (2) intensive home visits for at-risk children up to 3 years of age; (3) expansion and quality improvement of certified home-based child care; (4) child caregiver training, including training related to special needs child care; and (5) outreach and expansion of government-subsidized health insurance coverage for children of low-income families. Findings relate to capacity and systems, service provision and quality, and outcomes. Emerging through the ECI studies were five themes: taking the initiative to scale and expanding capacity; implementing leadership and collaboration; targeting and outreach; attaining and maintaining quality; and policy context and external factors. Both positive aspects and barriers and challenges are discussed for each theme. Recommendations are offered for the program's next 2-year phase. The report concludes by asserting that ECI has greatly enhanced the system of caring for children in Cuyahoga County, has been successful in meeting many of the objectives of the comprehensive package of programs and activities, and continues to pursue the goals of healthy children, effective parenting, and quality child care in Cuyahoga County. (Some chapters contain references.) (KB)