This report describes the Maternal Infant Health Outreach Worker (MIHOW) program which operates in Appalachia and rural Western Tennessee. The program, which constitutes a partnership between community organizations and the Vanderbilt University Center for Health Services, trains local women to use home visitations to educate and support other women in matters related to prenatal care and infant development. An evaluation of the impact of the MIHOW project on prenatal health behavior, infant feeding, and quality of home environment compared client information to information on a comparison group and made use of interviews with clients in their homes. The evaluation showed mixed results concerning prenatal care and pregnancy outcomes, but unequivocal success in the postnatal phase. Monthly home visits made a difference in prenatal self-care and may have had an impact on prenatal care use, but had no apparent effect on the birthweights of infants. The results showed that a family support intervention using paraprofessional home visitors can improve the quality of the home environment of rural low-income children. (RJC)