PROJECT SUMMARY/ABSTRACT University of Vermont Medical Center (UVMMC) serves a highly rural region with numerous underserved areas. Children in the region receive primary care in both community-based and UVMMC-affiliated practices, and specialty care at University of Vermont Children's Hospital. Primary care and subspecialty providers have clinical and research expertise in the Environmental Influences on Child Health Outcomes (ECHO) interest areas and established collaborations with the clinical site to facilitate clinical trial access for rural children. Collaboration with the Northern New England Clinical Translational Research Network (NNE-CTR), families, and community groups aids rural outreach. In collaboration with other ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN) sites, the DCOC, and the NIH, the UVM site (UVM) works to improve clinical trials access, develop and implement clinical trials pertinent to rural and underserved children, and train pediatric investigators committed to clinical trials research for this population. A significant discrepancy exists between the burden of disease in the pediatric population and opportunities to participate in clinical research, and rural, underserved, and minority children are particularly underrepresented. UVM's objective is to continue to collaborate with other ISPCTN sites in the development and conduct of multicenter clinical trials with a focus on access for children in rural and underserved communities and to leverage the site's prior successes as an ISPCTN site to further expand the pediatric research capacity at UVM. UVM is committed to remaining an integral part of the ISPCTN, and will advance the goals of the network through the following specific aims: 1. UVM will collaborate in the development and conduct of ECHO ISPCTN clinical trials and provide leadership in the clinical trial development pipeline. UVM will build on the site's previous work, expand the site team, support new investigators, and share resources to develop and conduct clinical trials. 2. Through training, mentoring, and participation in ECHO ISPCTN trials, UVM will expand local expertise in pediatric clinical trial conduct and collaborate with other sites to share this expertise. UVM will expand their Pediatric Clinical Trials Learning Collaborative program that provides clinical research training and American Board of Pediatrics Maintenance of Certification (MOC) credit for QI activities, to improve clinical trials access and monitor regulatory requirement adherence. UVM will leverage resources including the DCOC, ISPCTN site collaborations, IRB, NNE-CTR, and outside research network programs. 3. UVM will enhance access to pediatric clinical trials for rural and underserved children, with the goal of improving the health of all children. The UVM outreach program will leverage existing relationships and collaborations (e.g. rural networks of health providers, NNE-CTR, and community stakeholders) to both o...