The New Mexico Families FIRST project seeks to reduce maternal and infant morbidity and mortality through a nursing case management approach. The responsibilities of this community nurse include outreach, education, and care coordination of Medicaid-eligible high-risk pregnant women and their children. The standards of care for these families are derived from a screening tool that identifies medical, demographic, environmental, and psychosocial risks. Although evaluation of the nurse role and the tools used to identify and care for these women and children has not been completed, sharing the developmental stages of the process should facilitate similar endeavors.