(Brooks-Gunn et al., 2000), 11 of 17 evaluations of parent-focused home-based programs used the HOME inventory (Home Observation for Measurement of the Environment; Caldwell and Bradley, 1984) as a measure of the caregiving milieu, and 8 of the 11 demonstrated at least some positive program influence. In addition, impacts on the quality of the home environment were assessed in four programs that combined home-based and center-based components, two of which (the Infant Health and Development Program and the Houston Parent-Child Development Center) documented modest positive effects (Andrews et al., 1982; Bradley et al., 1989) and two of which (Project CARE and the Teenage Pregnancy Intervention Program) found no intervention-control group differences (Field et al., 1982; Wasik et al., 1990).

The quality of daily family life (e.g., emotional well-being, level of personal control, life satisfaction, and interpersonal relationships) serves as another important protective or risk factor for both child and family outcomes (Crnic et al., 1983; Sameroff et al., 1987). In this context, the protective influences of family cohesion, as well as the adverse impacts of family violence and parental mental illness, are particularly significant. Maternal depression or substance abuse, for example, presents a major threat to child health and development (Bauman and Dougherty, 1983; Downey and Coyne, 1990; Field, 1995; Lester et al., 2000; Mayes, 1995; Seifer and Dickstein, 2000). Similarly, children who witness family violence or who are the victims of physical abuse directly experience significant consequences, such as psychosomatic disorders, anxiety, fears, sleep disruption, excessive crying, and school problems (Cicchetti and Toth, 1995; Osofsky, 1995; Pynoos et al., 1995; Scheeringa et al., 1995).

Few early childhood intervention programs include sufficient professional expertise to treat serious parent or family psychopathology, which can overwhelm the most valiant efforts of a conventional education and support approach. Limited data suggest, however, that attention to such needs may be fruitful. In one example, a home visiting program for socially isolated, pregnant women employed two service models —one focused on providing information and resources and the other on developing a therapeutic relationship between the home visitor and the expectant mother. Follow-up study revealed that women who received the mental health program approach reported fewer depressive symptoms, and the impact was particularly significant for those who experienced multiple risks (Barnard et al., 1988; Booth et al., 1989).

The concept of community can be defined in multiple ways—as a network of social connections, a target for resource allocation, and simply a