School districts with integrated PreK to Grade Three systems have demonstrated strong growth in student achievement, a narrowing achievement gap, and significant benefits for English Language Learners. Leading change to create an integrated PreK-3rd education and connect early learning programs with the K-12 system is not easy. Superintendents require courage to take the first step, persistence and political skills to encourage organizational and community engagement, and a relentless focus on results to measure progress and build momentum. As a growing number of districts initiate and implement PreK-3rd efforts, how should superintendents lead the change? What are their key challenges? What is the pivotal role of the superintendent? How long does it take to show results?