Screening, Brief Intervention, and Referral to Treatment (S·BI·RT) in pediatric practices normalizes conversationsbetween youth and healthcare providers about alcohol and other substance use, and supports guidance about healthybehaviors. S·BI·RT also identifies youth ages 12-22 whose current use of addictive substances places them at risk fordeveloping substance use disorders, prompting provider brief intervention and referral for further assessment ortreatment before a substance use disorder develops. From May 2014 to June 2017, S·BI·RT was implemented as astandard of care in 23 pediatric practices in three cohorts across 10 organizations in New Hampshire —includingacademic medical centers and FQHCs—serving over 74,000 youth. This case study focuses on strategies associatedwith operationalizing S·BI·RT, specifically training and technical assistance related to clinical workflow, for youth andyoung adults.