The Rhode Island Child Clinical Trials Collaborative (RI-CCTC) at Hasbro Children's Hospital, Women & Infants Hospital and Brown University, is an ideal clinical center for the ECHO ISPCTN. We will build on our successes in the initial award period, in which we were a top enrolling site, developed a new network neonatal opioid withdrawal trial protocol, and provided leadership to the network through our committee work. Our state's demographic includes many underserved, minority and immigrant children, who have high rates of infant mortality, asthma, obesity, prematurity, mental health problems and special health care needs. This high risk population has not been previously included in many clinical studies, and thus is benefitting both directly and indirectly from the RI-CCTC's work. Rhode Island is uniquely organized for population-based clinical research: it has one major obstetric hospital (80% of all deliveries in the state), one children's hospital (90% of all pediatric admissions in the state) and one health department, as well as an engaged community. These factors allow for effective enrollment, retention and follow-up of study participants in clinical trials, giving the RI-CCTC the potential to make a strong impact. We have leveraged our rich network of collaborations with many existing research, education and public health programs, as well as affiliations with national research networks. These partners share our commitment to children's health and child health research. The Brown University School of Public Health and the Alpert Medical School, recently received a large gift to create the Hassenfeld Child Health Innovation Institute (HCHII), which is focused on understanding the prenatal, perinatal and postnatal factors that lead to childhood asthma, obesity and autism. The RI-CCTC will leverage the resources of the HCHII to create a much broader and more powerful research network to serve children in the state of RI. Investigators in the Schools of Public Health and Medicine have considerable expertise in the study of environmental exposures and their impact on children. The contact PI, Thomas Chun MD, MPH, has extensive experience with multi-center networks and their leadership, through his experience with the ECHO ISPCTN and the Pediatric Emergency Care Applied Research Network. Co-PI Abbot Laptook similarly is a leader in both the ISPCTN and the NIH funded Neonatal Research Network. Senior Faculty Development Leader and co-PI Phyllis Dennery MD, has had consistent NIH funding for her basic/translational research, has participated in many training grants and multicenter clinical trials, and has won mentoring awards. This team will ensure the continued success of the RI- CCTC in fulfilling the goals and mission of the ECHO Program. Our Specific Aims are to: 1) Continue to provide new opportunities for underserved patient enrollment in ECHO ISPCTN studies by building on our current collaborations between our academic research centers ...