Research indicates that adolescents tend to have the lowest rate of primary care service utilization compared to younger children (AAP, 2008). Potential factors leading to lower utilization may include negative provider perceptions, confidentiality concerns, and decreased knowledge of available services. However, despite lower service utilization, adolescents often report interest in discussing behavioral health and other sensitive concerns with their primary care clinician, and these discussions have been associated with greater satisfaction and better outcomes (Tylee et al., 2007; Byczkowski et al., 2010). Primary care visits present a unique opportunity for clinicians to introduce behavioral health services to adolescents and families, potentially reducing gaps in access to care. Behavioral health concerns may arise if an adolescent endorses mood or behavioral problems on screening questionnaires used in pediatric primary care to identify youth at-risk for anxiety or depression. When available, referrals to integrated behavioral health services can be beneficial, however, pediatricians are often at the forefront of managing behavioral health concerns. Clinicians may feel ill-equipped to manage behavioral health concerns during primary care visits, as these concerns may raise questions about adolescent confidentiality and disclosures, family-clinician communication, ethics, and in some cases patient safety and legal considerations. Additionally, clinicians' approach to discussing behavioral health issues during primary care visits has many implications for adolescent and family engagement with subsequent behavioral healthcare. Especially given the nationwide shortage of behavioral health services and increasing psychological concerns for youth during the COVID-19 pandemic, clinicians are likely to benefit from increased knowledge of adolescent engagement in behavioral health discussions in primary care. This presentation will describe barriers affecting adolescent engagement in behavioral healthcare discussions in primary care, as well as ethical, legal, and safety considerations in the context of these discussions. We will also identify strategies to enhance these patient, family, and primary care clinician discussions.