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Early Intervention and Early Childhood Special Education (EI/ECSE) are critical services for children with disabilities and their families. Urban areas are charged with providing EI/ECSE services to a large number of children, who come from diverse racial, cultural and linguistic backgrounds and whose parents may or may not have economic resources. To better understand the nuances of EI/ECSE systems in urban contexts, stakeholders in one large, Mid-Atlantic, U.S. city were interviewed in order to examine the process of accessing EI/ECSE. Participants included parents, medical professionals, early care providers, and special education personnel. Artifacts were also reviewed and analyzed using content analysis to inform the research questions and verify findings. Findings showed a strained system with both structural and situational challenges.