This paper describes a community-based agency's approach to reducing perinatal risk among populations at high medical, familial and environmental risk. Following a descriptive analysis of 96 families enrolled in a maternal outreach program, a case study illustrates how client-sensitive strategies are applied to successfully engage a traumatized population. The intensity and duration of the interventions, the extensive outreach efforts to the family and the dedication and commitment of the staff are not easily replicated but invaluable in helping providers and researchers understand to what extent the impact of severe deprivations and risk can be mediated and potential damage to the newborn prevented. The paper concludes that community-based agencies in partnership with social and clinical researchers from a tertiary care setting provide the key for developing more effective, integrated perinatal care by virtue of the critical density of hard-to-reach patients who can be followed by providers and clinical researchers.