This study is a randomized clinical trial designed to test the psychosocial efficacy of a pre- and postpartum home visitation model for women at-risk for out-of-home placement of their newborns. Two hundred twenty-five pregnant women with high risk pregnancies for psychosocial reasons were recruited into the study and randomly assigned to an experimental ( n = 125 ) or control condition ( n = 100 ) when they presented for prenatal care at a large urban clinic. After an average of 16 months of exposure to the intervention, women in the experimental group reported significantly greater access to services and there was a trend for the experimental group to show a decrease in psychological distress. At 10 months, there was a trend for experimental group women to experience an increase in social support, but this was not sustained at 16 months. Although the difference was not statistically significant, a higher percentage of women in the experimental group had children in out-of-home living arrangements. There was also a trend among those with children in placement, for children of experimental group women to be placed in extended family care rather than foster care more frequently than controls. The implications of the findings for interventions with at-risk families are discussed.