The authors assessed the effectiveness of a home visitation program in enhancing the early parenting history of infants born at medical risk--a population that is at risk for mistreatment. A randomized clinical trial design was used to compare the effects of a cognitively based extension of the Healthy Start home visitation program (HV+) with a visitation condition that did not include this component (HV). In the HV+ condition, they observed (a) a lower use of corporal punishment, (b) greater safety maintenance in the home, and (c) fewer reported child injuries. The sample (N = 102) was primarily Latino; however, the effects of the intervention were not qualified by ethnicity, maternal education, or immigration status. (Contains 2 tables.)