This investigation tested the incremental utility of cognitive retraining as a component within a program designed to prevent child maltreatment. High-risk families (N = 96) were randomly assigned to a control condition, home visitation modeled after the Healthy Start program (unenhanced home visitation), or home visitation that included a cognitive component (enhanced home visitation). Mothers were identified late during pregnancy or soon after birth, and their participation continued for 1 year. Lower levels of harsh parenting were found among mothers in the enhanced home visitation condition than among those in the unenhanced home visitation or control conditions. Prevalence of physical abuse (percentage of mothers who were abusive) during the first year was 26% in the control condition, 23% in the unenhanced home visitation condition, and 4% in the enhanced home visitation condition. Benefits were greatest in families that included a medically at-risk child. A linear pattern of benefits was found for child health; as program features were added, benefits for child health increased.