Submit a referral for Children’s Developmental and Behavioural Supports parent/caregiver behaviour consultation program

Children’s Developmental and Behavioural Supports (CDBS) is a free program available to families who live within Durham Region and have a child with a developmental disability, two years old through to their seventh birthday, who have concerns about their child’s behaviour(s).

An eligible developmental disability includes those :

present limitations in the child’s cognitive and adaptive functioning
impact areas of major life activity including personal care, language skills, and learning abilities
are likely to be life-long in nature

Some examples of eligible developmental disabilities include Down Syndrome, Fragile X, Autism, Angelman’s Syndrome, Global Developmental Delay, Intellectual Delay, Fetal Alcohol Spectrum Disorder, some genetic conditions.

Brief Behaviour Consultation Services are offered to families of children ages two to their seventh birthday, with developmental disability, and who are living in Durham Region. Brief Behaviour Consultation includes:

Development of one to two priority service goals to address interfering behaviours
Caregiver-mediated consultation: coaching parents/caregivers on how to support the reduction of interfering behaviours and to promote skills such as toilet training
5-6 appointments across 8-10 weeks (up to 3 months)

If you are unsure whether your child’s diagnosis qualifies, you may complete this form or contact CDBS for clarification.

Email: behaviouralsupports@durham.ca
Phone: 1-800-372-1102 ext. 2829

Children’s Developmental and Behavioural Supports recognizes that the use of email is a commonly used and preferred form of communication.

By using this form, you acknowledge and understand:

You are agreeing to be contacted by email.
Sharing of personal information via email should be kept to a minimum.
Any personal information that you provide to us via email will only be used to respond to your message and/or provide you with the requested information.
While steps are taken to protect the privacy and security of emails, sending and receiving emails over the internet is not secure. We cannot guarantee the security of any messages sent or received.
You may withdraw your consent to the use of email at any time by contacting us.

Parent/Legal Guardian information

First name

Last name

Primary phone number

Email Address:

Address (include unit/apartment number if applicable)

City/Town

Postal Code

Child's Information

Child's First Name

Child's Last Name

Child's date of birth (yyyy/mm/dd)

Child's Diagnosis

Parent/Legal Guardian Consent

Consent

I confirm that I am the legal guardian of the child OR I represent an agency that has obtained signed consent from the legal guardian to make this referral OR I attest that I am the child’s legal guardian or that I am the child’s current caregiver and there is no legal documentation of guardianship and no known opposition of service.

Notice with Respect to the Collection of Personal Information

This information is collected under the legal authority of the Municipal Freedom of Information and Protection of Privacy Act, 1990; Child, Youth, and Family Services Act, 2017 for the purposes of administering Region of Durham Children’s Developmental and Behavioural Supports programs. Questions about the collection and use of this information should be addressed to the Access and Privacy Office, 605 Rossland Rd. E., Whitby ON L1N 0B2, at privacy@durham.ca or by contacting 905-668-7711 x 2050.

Privacy

More detailed information concerning how and why the Region collects, uses, and discloses personal information is available through Durham Region’s Access and Privacy Office at privacy@durham.ca or by reviewing Durham Region’s Privacy Statement, which may be updated without notice, at Privacy - Region of Durham.