We will utilize clinical records from patients screened in integrated primary care settings to identify patterns and differences in who engages in behavioral health care after screening at risk for depression, anxiety, or substance misuse, and how that engagement impacts outcomes. The purpose of the analysis is to identify if there is disproportionate utilization based on personal demographics, geography, or other structural factors. For providers, identifying these patterns can provide a starting point for adapting patient engagement approaches to increase retention and improve outcomes across patients. At the health system level, the results help to identify training and capacity needs to better support all types of patients. Attendees will learn specifically about the role that rurality plays in engagement in care as well as the impacts of integrated primary care in Montana, a large, frontier state.