Although care within a medical home increases parental satisfaction with health care services and improves health care utilization, significant racial/ethnic and language disparities persist in health care settings. Integrated, team-based approaches can decrease health disparities. The current study examines medical records of 2,353 youth who received a behavioral health consultation in an urban, residency training pediatric primary care clinic. A three-phase, mixed-method approach was used to examine whether differences in clinician-identified presenting concerns and recommendations were present across English-, Spanish-, and Other-language-speaking families. Findings reveal disparities among language groups in presenting concerns and referral to behavioral health services. Factors in medical record documentation also differed across language groups and by provider type. Recommendations for further research, identification, and assessment of psychosocial concerns for families with limited English proficiency (LEP) and development of evidence-based approaches for families with LEP in primary care are discussed.