The Resources, Education and Care in the Home (REACH) program was a multiagency service model designed to prevent and reduce post-neonatal morbidity and mortality in high-need communities. REACH targeted infants born to low-income teenage mothers, mothers with limited or no access to prenatal care, infants and mothers discharged early from the hospital, and families with psychosocial problems. A hospital-based registered nurse case manager coordinated mothers’ contacts with participating REACH agencies, made referrals to social service organizations, and provided counseling. Families typically received home visits when children were two weeks; six to eight weeks; and 4, 8, and 12 months old, with additional visits as necessary. Home visitors provided parent education; conducted infant, parent, and environmental assessments; and collected information on child health and development.