Opioid overdose deaths and the rise in problematic opioid use patterns that indicate the development of opioid use disorder (OUD) have reached crisis levels in the United States. The highest risk for OUD and other substance use disorders (SUDs) associates with use instigated before 14 years of age. The Poison Center Network reported 102,940 opioid-related exposures in Texas from 2000-2017, including 21,723 exposures attributed to adolescents. Deaths attributed to opioids numbered 16,843 from 1999-2015, with 2,200 deaths in the age range of 15-24 years, tracking with a steady escalation over this period. While Texas ranks among the states with the lowest rate of opioid overdoses per capita, a 7.4% increase was reported between 2015 and 2016. The Ecosystem Optimization for Translation (EOT) optional function will harness our rich information technology and clinical and research excellence to create a Project ECHO (Extension for Community Healthcare Outcomes) network. UTMB’s networking in rural and underserved communities is historically strong and this experience is a central strength of the goal of the EOT to address existing gaps in integrated care in SUDs/OUD. The initial focus for the teleECHO network builds on the existing relationship with community physicians in 14 family medicine clinics in rural and underserved Texas counties to promote integration of OUD/SUD and mental health services into family medicine practices. Telementoring will create a community of practice across healthcare workers (physicians, faculty, residents, students) to facilitate case-based learning and disseminate best practices in OUD/SUD care, improve quality of care of patients, and build the relationships required to conduct research in rural and underserved communities. Partnering with the Texas Regional CTSA Consortium (TRCC), the EOT will work with the UTMB Regional Maternal and Child Health Program (RMCHP) network of 31 clinics to enhance teleECHO with targeted, women- and pregnancy-centered topics based upon contemporary knowledge of OUD/ SUDs and mental health disorders. This partnership will capture a quantitative and categorized electronic health record database for epidemiological surveillance and clinical research in opioids, other risk factors and their interactions in maternal-perinatal mortality and morbidity. To inform the use of contemporary knowledge, the teleECHO network will be expanded with adolescent-centered topics, delivered through a community of practice with teachers and healthcare providers in schools. Working with these schools and communities, we will translate our evidence-based findings into practice via a Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) approach focused on evidence-based substance use and violence prevention programs. The EOT is a pivot in emphasis grounded in our collective strengths to move us to a future in which the best practices of health care for OUD/SUDs, and evidence-based, culturally sensit...