PROJECT SUMMARY During the first four years of the ECHO IDeA States Pediatric Clinical Trials Network (ECHO ISPCTN), the Montana Pediatric Clinical Trials Site (MPCTS) has been successful in building the necessary infrastructure, team, and partnerships to participate effectively in multi-center clinical trials. The newly formed infrastructure includes clinical and research offices, dedicated exam and consultation rooms for participants, database and computer facilities and clinical research expertise from several centers through the University of Montana. The research team is comprised of a pediatric clinician/scientist as principal investigator, two research nurses, an epidemiologist and a recently added second pediatrician. Each team member has gained experience through multiple professional development opportunities, which have included ECHO ISPCTN Data Coordinating and Operations Center-offered didactic presentations, manuscript writing team membership and leadership, clinical trial protocol development leadership, and most importantly the invaluable growth that occurs with participation in three ECHO ISPCTN clinical studies. The team is now well positioned to gain further from a robust clinical research skills development plan designed by a new Senior Faculty Development Leader, who has extensive expertise in both clinical trials and mentorship. We are ready to participate in the next phase of ongoing ECHO ISPCTN trials as well as clinical trials in development. To facilitate continued and successful pediatric clinical trial participation, we have established relationships with the major pediatric inpatient facilities in the state, including their healthcare providers and research institutions, as well as with outpatient pediatric practice groups and care providers throughout western Montana, including the Family Practice Medicine Residency and Partnership Health Center, a Federally Qualified Health Center. We have also gained support from a newly formed innovative rural outreach organization, Ahana, a telemedicine collaborative for afterhours care in rural communities. Our established and active engagement with two IDeA program-supported Clinical and Translational Research Centers in Montana has and will continue to serve as valuable resources in professional development, research design and biostatistics, and community and stakeholder engagement, the last of which is critical as we extend our ECHO ISPCTN activities into more rural areas of the state. The ECHO ISPCTN has provided a pathway for including sites in clinical trial research that have not historically done so. As we look toward the future, the overall goal is to build on the ECHO ISPCTN?s and MPCTS?s successes and leverage existing infrastructure to expand the reach of ECHO ISPCTN clinical trials into rural and underserved areas in Montana. More inclusive and generalizable pediatric clinical trials will improve both the quality of clinical trial research and the health of children across the ECHO ISPCTN.