Direct-care paraprofessionals' recognition of psychopathology of varying severity in persons with mental retardation was evaluated. Factors that may influence paraprofessionals' decisions to initiate referrals for mental health services on behalf of individuals with mental retardation were also evaluated. Results suggest that staff members recognized and differentiated psychopathology of varying levels of clinical severity. Results also suggest that paraprofessionals are more likely to initiate making a referral when professionals are perceived as being competent in treating individuals with mental retardation, and when providers' interventions are consistent with the referring agency's philosophy.