This article reports on results from a multi-case study on the implementation of Content and Language Integrated Learning (CLIL) in bilingual elementary schools in a monolingual region of Spain (Cantabria) by examining four school teachers' CLIL instructional practices to teach content in a foreign language (English). The study examined whether teachers' instructional practices successfully integrated content and language. Data were collected from four participants using in-classroom observations, semi-structured interviews, and classroom documents (the course syllabus) and then analyzed qualitatively. Findings showed that (a) integration of content, language, and learning strategies was not observed, (b) instructional practices of the observed teachers showed a preference for content teaching, (c) language teaching was overlooked, and (d) teachers lacked academic language awareness and only considered key-content vocabulary. The findings suggest that the lack of awareness of how to practically carry out CLIL in the classroom can compromise the integration of content and language in bilingual programs.