This study used a randomized controlled design with treatment and wait-list conditions to evaluate the efficacy of a culturally adapted version of the Early Pathways program (EP; Fox & Gresl, 2014), an in-home, parent–child therapy program with 137 at-risk Latino children under the age of 6 referred for severe behavior and emotional problems, such as aggression, oppositional behavior, self-injury, and property destruction. EP directly engaged the parent–child dyad, emphasizing parent-directed training, child-led play, psychoeducation, and cognitive–behavioral strategies. Cultural modifications included establishing community partnerships to identify Latino family needs, translation of materials, offering bilingual services, acculturation assessment, and cultural competence training. Multivariate analyses of covariance (MANCOVA) revealed significant differences between the immediate and delayed treatment groups on all posttest measures with the pretest scores as covariates. After the delayed group completed treatment, repeated measures, multivariate analyses of variance (MANOVA) showed significant improvement for both groups on all measures with maintenance at 4- to 6-week follow-up. Outcomes included reduced child behavior problems, increased child prosocial behaviors, improved caregiver limit setting, enhanced caregiver nurturing, improved parent–child relationships, and a decrease in clinical diagnoses following treatment. This study highlights the efficacy of using culturally adapted early intervention services for young Latino children in poverty referred for significant behavior and emotional problems.