Referral & Intake Form

Complete the form below to start the referral process. We'll review and contact you within 1-2 business days.

DURGIN HOUSE, LLC

Referral & Intake Form

How would you like to submit?

SECTION 1: PLACING AGENCY / PARENT / GUARDIAN

Include a separate entry for agency, case manager, probation officer, judge, and/or other professional as needed.

Contact 1

SECTION 2: YOUTH CHARACTERISTICS

Complete this section to the best of your knowledge. If an answer is unknown, leave the question blank.

SECTION 2: Youth Characteristics (continued)

Placement Information

Family & Background

Education

Health & Medical

Behavioral & Services

Who We Serve

  • Youth in foster care ages 14–19 in Toledo, Ohio and surrounding areas
  • Youth who may have emotional/behavioral disorders and need treatment services
  • Least restrictive environment with focus on healing
  • Youth working toward reunification, adoption, or lower level of care per treatment plan
  • For youth nearing emancipation: strong focus on life skills for transition

What We Provide

Residential Care

  • 24 hours a day, active treatment 7 days a week
  • Daily activities designed to meet individual needs
  • Home-like environment where youth feel safe and loved

Treatment Services

  • Trauma-informed care with person-centered plans
  • Individual and group counseling
  • Substance treatment coordination
  • Independent living skills training

Referral Process

1

Initial Contact

Reach out via phone or contact form to discuss the referral

2

Assessment

We review the youth's needs and determine fit for our program

3

Coordination

Collaborate with agency, caseworkers, and support systems

4

Placement

Complete intake process and welcome youth to Durgin House

Coordination Partners

We work closely with a network of partners to ensure comprehensive support for each youth:

Child-placing agencies
Caseworkers
Therapists
Physicians
Schools
Family support liaisons
Community partners

Ready to Make a Referral?

Contact us today to start the referral process or learn more about our program.