I think that it is a direct and personal service that I offer my clients. I live in the community I serve; I am available at all hours and on weekends. By living in the community, I am available to provide the same resources as is common in our middle-class communities which often have doctors, lawyers, and other professionals living next door to each other. Individuals such as myself have never been available for the poor community to take advantage of. I believe that my style of handling clients' problems who live in the poor community is the most effective way possible. I'm from the community I serve, I know most of the people, they know me. I know their problems because they are mine also, and I understand the poor people because I am one, and a part of them. (Specht, Hawkins, & McGee, 1968, p. 10).

This chapter examines the roles and effectiveness of staff in community-based, urban, early intervention programs in which the primary goal is improving the caregiving environment and the development of infants and young children considered at risk. In these programs, risk is defined as a consequence of any one, or a combination of, the following factors: growing up in a community with high rates of poverty, violence, crime, unemployment, and so forth; being raised by very young or troubled parents; or manifesting developmental problems or delays. Seldom are those charged with the task of modifying the caregiving environment professionally trained staff such as physicians.