The Ohio COP-RCORP initiative uses a Theory of Change to provide a comprehensive description and illustration of how and why a desired change is expected to happen in a given context. A theory of change focuses on mapping out or “filling in” missing pieces between what a program or change initiative does (its activities or interventions) and how these lead to desired goals being achieved. The Ohio COP-RCORP initiative uses a community of practice approach to fill in the missing pieces between the core activity goals of the HRSA Rural Communities Opioid Response Program. The state-level theory of change specifies the team members, strategies, actions, and conditions needed to achieve the COP-RCORP goals of developing and strengthening the consortium, conducting a needs and gaps analysis, and developing strategic plans, sustainability plans, and workforce plans.