Overall Satisfaction

CONSUMER DIRECTED COMMUNITY SUPPORTS (CDCS) SURVEY 

INDIVIDUAL COMMENTS 

A total of 410 survey respondents provided individual comments in response 

to the question about what aspect of CDCS most impacted their satisfaction 

with the program. Respondents often gave more than one answer to the 

question. Comments were sorted into categories of positive comments and 

concerns. 

Categories of positive comments included: 

• Positive comments about the program's flexibility; 

• Positive comments about program outcomes; 

• Positive comments about staffing. 

Categories of concerns included: 

• Concerns about staffing; 

• Concerns about program guidelines; 

• Concerns about the lack of alignment to self determination philosophy; 

• Concerns about the inability to fund certain services. 

POSITIVE COMMENTS 

1. A total of 120 survey respondents offered positive comments about the 

CDCS program's flexibility and reduction in stress: 

• CDCS is a great program; keep it going (49); 

• CDCS is responsive to actual needs (30); 

• Greater control over resources (21); 

• Ability to purchase specific treatments, therapies, equipment, and 

environmental modifications (14); 

Page 1

• Able to make changes throughout the year, can move funds between 

categories, less paperwork (6). 

2. A total of 81 survey respondents identified specific positive outcomes: 

• An increase in community integration (27); 

• Improved family relationships, prevention of out of home placements, 

and respite care (24); 

• An increase in quality of life, freedom, happiness, and self esteem (15); 

• An increase in independence, living where I like, getting a job with 

benefits, and people listening to me (12); 

• Better health and fewer behavior issues (3). 

3. A total of 72 survey respondents listed positive statements about 

staffing: 

• The ability to hire and retain staff, choice and control in selecting staff 

who are qualified, reliable, and caring (40); 

• Helpful, caring case managers (19); 

• Better pay rate is possible so staff feel rewarded and respected (8); 

• We do the training (3); 

• Work hours of staff match individual needs (2). 

CONCERNS 

4. A total of 118 survey respondents mentioned concerns with county staff, 

the amount of effort needed by family members, training, and support 

staff: 

• County staff lack empathy, trust, aren't communicating, have high case 

loads, inconsistency, and micromanaging (49); 

Page 2

Training is needed on how CDGS works, what is possible under the 

program, an orientation to the whole system, accounting, and issues 

dealing with (29); 

Parents should be paid because of the administrative duties and time 

spent as a provider of services (14); 

Need help finding staff (PCAs, respite staff (13); 

Need individual help in understanding this program step by step (10); 

Need a housing specialist, staff should be paid on time, need retirement 

options for in-home staff (3). 

A total of 115 survey respondents stated problems with guidelines, 

paperwork, and inconsistency with the program: 

Guidelines are not understood, are inconsistent, have changed and 

become more restrictive, arbitrary caps are applied, inability to change 

between categories, inconsistency, don't know how to write a plan 

that will be approved (54); 

Processes need simplification, too much paperwork, paperwork has 

increased, too complicated, lack of professional management of the 

program; all forms could be on the web (34); 

Amount of time this program takes, delays in approval, lack of 

timeliness of payments (11); 

Monthly fiscal reports aren't understandable or helpful, need better 

details, reports could be web based, need far better tracking (10); 

Parental fees are too high (3); 

Poor coordination between CDCS and Medicaid (3). 

A total of 52 survey respondents indicated that implementation of CDCS 

is not aligned to self determination philosophy: 

Intent of CDCS is not understood and the program is headed toward 

Page 3

estrictions, one size fits all, promises aren't kept, no longer flexible, 

can't make ongoing adjustments, overdocumentation for $5 to $10 

purchases (39); 

Funding doesn't match needs (11); 

CDCS doesn't help people without an active family member or 

advocate (2). 

A total of 31 survey respondents described the inability to fund certain 

services or inability to achieve certain outcomes: 

Unable to pay for diets, treatments, alternative approaches (9); 

Unable to pay for community integration activities, ways to connect 

kids with disabilities in community settings, eating out, a bicycle (11); 

Unable to pay for transit, vans, and equipment maintenance (4;) 

Unable to pay for occupational therapists and music therapists (3); 

Unable to purchase assorted items such as large purchases by setting 

aside funds overtime, fences, and wills and trusts (4). 

Page 4

Overall Satisfact 

1. Given all the consideration: 

consumer directed support 

2. How likely would you be to 

support program in your co 

3. Has the consumer directed 

that were set for you by yoi 

services department? 

Very 

satisfied 

Neither satisfied 

nor dissatisfied 

Very 

dissatisfied 

• • • • (2f • • 

Very 

likely 

Neither likely 

nor unlikely 

Very 

unlikely 

• of • • • • • 

Exceeded Met 

Expectations Expectations 

FaUed 

Expectations 

• • • • s f a • 

4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages 

please indicate how much you agree or disagree with each statement. Please complete these sections 

from the perspective of the person with a developmental disability. The person who has the 

developmental disability should be directly involved in completing this survey as much as possible. 

Independence I Mobility/Control/Privacy Agree Disagree 

••EHH^^Hi^^lHIBH Strongly Somewhat Neither Somewhat Strongly 

1. I can (even if someone helps me because of my disability) get 

to where I want to go o r • • • • 

2. I have control over my daily schedule • • • • 

3. I have privacy to be alone or with people I choose • • • • 

4. 

5. 

Only people who are supposed to know my personal 

information have access to it 

I can set desired outcomes (goals) for myself 

• 

• 

• 

• 

• 

• 

• 

• 

6. 

7. 

8. 

I can decide about how I spend my money 

I can make decisions that will affect my future 

I am satisfied with my current level of independence 

a " 

a " 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

•

Overall Satisfaction 

• •ni.i.iiii-nn ii ~ Neither satisfied 

" " B - 

" i Very „„rHI*_Kd*H V 

satisfied 

nor dissatisfied «7 

dissatisfied 

1. Given all the considerations, how satisfied are you with your 

consumer directed support proqram? 

2. How likely would you be to recommend a consumer directed 

support program in your county to a friend in a similar situation? 

3. Has the consumer directed support program met the expectation 

that were set for you by your case manager and county social 

services department? Q 

• m • • • • • 

I. What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? i 

2. 

3. 

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consumer directed support program? 




Very 

• d 


satisfied 

1 dissatisfied 

• • • • • 

Very Neither likely Very 

• d 

likely ( nor unlikely unlikely 

j 

• • • • • 

3. Has the consumer directed support program met the expectation 

that were set for you by your case manager and county social ~~ r 

i —^-^~y- 1 

i 

services department? • • • GJ • • • 

Exceeded Met Failed 

Expectations Expectations Expectations 


supports? 

Mi 

Thinking beyond consumer directed_ supports to your overall quality of life, on the following pages 

.please indicate how much you agree or disagree with each statement. Please complete these sections 

;from the perspective of the person with a developmental disability. The person who has the 

^developmental disability should be directly involved in completing this survey as much as possible. 


•••BH^HHHi^HMBIIH Strongly Somewhat Neither Somewhat Strongly 


to where I want to go (t^ 

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please indicate how much you agree "or disagree with each statement. Please complete these sections 



Independence | Mobility/Control/Privacy Agree Disagree 

• • • • • • I I ^ H H l J Strongly Somewhat Neither Somewhat Strongly 


to where I want to go 

or • • • • 

2. I have control over my daily schedule 

I have privacy to be alone or with people I choose 

• 

• 

• car 

• 

• 

• 

• 

• 

CO 

4. Only people who are supposed to know my personal 

information have access to it • • • • 

5. I can set desired outcomes (goals) for myself • • • • 

6. I can decide about how I spend my money • • • w 

7. I can make decisions that will affect my future • • • • 

8. I am satisfied with my current level of independence • • • •




r 


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y nor dissatisfied e 

satisfied 

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dissatisfied 


2. How likely would you be to recommend a consumer directed • " oru kcly unU 

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support program in your county to a friend in a similar situation? . . • Q Q Q Q Q • 

3. Has the consumer directed support program met the expectations Exceeded Met Failed 


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services department? • Q • Q • Q g| 

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* "consumer directed support program? 

2 How likely would you be to recommend a consumer directed 

".^support program in your county to a friend in a similar situation? 

Very 

satisfied 



Very 

dissatisfied 

r 

• • ar • • • • 

Very 

likelv 


nor unlikely 

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, C I J 

OVERALL SATISFACTION m Neither satisfied 

Very 

satisfied 

nor aissauMicu dissatisfied • _ , 

dissatisfied 

1. Given all the considerations, how satisfied are you with your ^ ^— r ' r—. r—. 

consumer directed support program? I&l LI U LI U U U 


, , L i i ,. . , likelv nor unlikely unlikely 

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support program in your county to a friend in a similar situation? .. J | Q [ ] [ ] [ ] [ ] Q 


. , , . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~~r— ^-i 

services department? • • • • • • 


supports? t^L. osJ

OVERALL SATISFACTION . ^ 

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dissatisfied * 



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2. How likely would you be to recommend a consumer directed -^TJ " or kely u n U k e l y 

"f' 

support program in your county to a friend in a similar situation? .. S Q Q Q Q Q [ ] 

3. Has the consumer directed support program met the expectations Exceeded Met Faued 

. . . , , . . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ^ ^ ^ ^ j_ 

services department?... ' • ) 3 • • • • • 

4. What is the one thing that would have the greatest impact on your satisfaction witji consumer directed 

supports? /(i'^c/c*Z

OVERALL SATISFACTION 





Very 

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4. What is the one thing that would have the greatest impact orryour satisfaction with consumer directed 

supports? 

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INDEPENDENCE I Mobility/Control/Privacy Agree Disagree 

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4. What is the one thing that it would wo have the greatest imp impact on your satisfaction with consumer directed 

supports? 

_ 1 

3 3 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages . 

please indicate how much you agree or disagree with each statement; Please complete these sections 



Independence I Mobility/ Control / Privacy Agree 

Disagree 

Strongly Som Somewhat Neither Somewhat Strongly 


to where I want to go a ' • • • • 

I have control over my daily schedule 


• 

• 

• 

• 

• 

• 

• 

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c\i 

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4. 

5. 



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dissatisfied 

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2. Hcjw likely would you be to recommend a consumer directed ^p- noru 

f' ke y unli 

' | keIy 

support program in your county to a friend in a similar situation? .. jjjjf [] Q Q Q Q Q 

3. Ha's the consumer directed support program met the expectations Exceeded Met Failed 

. . . , , , . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~~r—; "-i ^ 

Services department? V> 3 • Q • • • • 


supports? ; 

< v 

Thinking ig beyond consufnsr consurngr directed supports to your overall quality of life, life;-on on the following followir pages 



developmental disability should oe directly involved in completing this survey as much as possible. 

INDEPENDENCE I Mobility/Control/Privacy Agree Disagre 

Strongly Somewhat Neither Somewhat Strongly 


to where I want to go. .. . 

2. I have control over mv daily schedule 

3. I have privacy to be alone or with people I choose. 



V 

5. I can set desired outcomes (goals) for myself 

6. I can 

7. I can 

8. I am ; 

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satisfied 

1 



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dissatisfied 

• j&a • • • r 

• 

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likely 

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nor unlikely 

support program in your county to a friend in a similar situation? .. j^Q • Q Q Q Q 


that were set for you by your case manager and county social ^T* 3 

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Met 

Expectations 

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unlikely 

r 

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supports? . 

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thinking beyond consumer directed supports to your overall quality of life, on the following pages 




2. 

.3¬ 

4. 

5. 

6. 

37. 

Independence \ Mobility / Control / Privacy 

Agree Disagre 

1. I can (even if someone helps me because of my disability) get Strongly Somewhat Neither Somewhat Strongly 

***** 

I have privacy to be alone or with people I choose. 



can set desired outcomes (goals) for myself, 

can decide about how I spend my money ... 

I can make decisions that will affect my future. 

• • • • 

• • • • 

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satisfied 

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that were set for you by your case manager and county social Expectations 


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unlikely 

r 

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FaUed 

Expectations 

services department? ^ T A • • • • • 


supports? 

CU'e, 





INDEPENDENCE [ Mobility/Control/Privacy Agree Disagre 



to where I want to go • • • • & 

I have control over my daily schedule • • • • 


CM' 


information have access to it • JAR • a • 

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CO 

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satisfied tuMieu 



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1. Given all the considerations, how satisfied are you with your ' / ' ' 

consumer directed support program? I J L ^ L J L J L J L J U L 



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f y 

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* 

support program in your county to a friend in a similar situation? .. (2 • • • Q Q • 


that were set for you by your case manager and county social Expectations Expectations— Expects 

services department? • QJ • • • Q • 


supports? 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages ._ 

please indicate how much you agree or disagree witheach statement. Please complete these sections 

from the perspective of the person with a developmental disability. The person who has the v 

% 

developmental disability should be directly involved in completing this survey as much as possible, î" 

) [ ^ P | | ^ n ^ J Mobility/Control/Privacy Agree Disagree 



to where I want to go a • • • • 

2. I have control over my daily schedule . Q Q OF Q O 

3. I have privacy to be alone or with people I choose.... 


information have access to it Q Q| Ql CI Q 

5. I can set desired outcomes (goals) for myself • • OF • • 

6. I can decide about how I spend my money Q Q (J3F Q Q 

7. | can make decisions that will affect my future Q ^ Q Q Q 

am satisfied with my current level of independence Q






Very 

satisfied 



Very 

dissatisfied 

orb • • • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 


Met 



services department? • (3 O G O Q Q 

Failed 

Expectations 


supports? Jib- Ja^ ^hil #QJ>} AS> aUs vie rP* sy*as*jj drîuJx^ 

T n i 

i n 

J?^ 9 beyond consumer directed"supports to your overall quality of life, on the following pages;7/ 

please indicate how much you agreebr disagree witrf each statement. Please complete these sections 

from the perspective of the person with a developmental disability. The person who has the „f :^ 

developmental disability should SecJirectly involved incompleting this survey as much asp^pblef 

l n ^ e 

P 

e n 

d e n C e | Mobility /Control /Privacy Agree Disagree 

HII^H^^MBI^^^HIBII Strongly Somewhat Neither Somewhat Strongly 


to where I want to go Q ef a • • 


• af • • a 

CO 

I have privacy to be alone or with people I choose E f • • • • 


information have access to it A • • • 


6. 

7. 



• 

Q i • 

• 

• 

• 

• 

• 

8. I am satisfied with my current level of independence ri • • • •






Very 

satisfied 

Very 

likely 

E x c e 

3. Has the consumer directed support program met the expectations r. 




nor unlikely 

Very 

dissatisfied 

Very 

unlikely 

• 3 • • • • • 


services department? • • • (0 • • • 

e d 

^ 

Expectations 

Met 

Expectations 

Failed 

Expectations 


supports? 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages a 




INDEPENDENCE I Mobility / Control / Privacy Agree Disagree 








6. I can decide about how I spend my money 

7. I can make decisions that will affect my future 

8. I am satisfied with my current level of independence .. . • 


EL • • • • 

• • • • 

• • • • 

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satisfied dissatisfied 

• QP • • • • • 

Very 

likely 



nor unlikely 

T 

Very 

unlikely 

T 

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Met 

Failed 





supports? 




developmental disabilityshould be directly involved in completing this survey as much as possible. 


WBBKBUtttKBKtBKI^^KKKM Strongly Somewhat Neither Somewhat Strongly 



3. I have privacy to be alone or with people I choose... 


5. 

6. 

7. 

8. 

• • • • 

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• • • Q • 

• B • • • 

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• • • • 

• • • •





support program in your county to a friend in a similar situation? . . 

3. Has the consumer directed support program met the expectations 



Very 

satisfied 



Very 

dissatisfied 

a • • • • • • 


likely / nor unlikely unlikely 

Jsp • • • • • • 

Exceeded Met 


Failed 

Expectations 

• l^Q • • • • • 

\. What is the one thing that would have the greatest impact dn your satisfaction with consumer directed 

supports? . _ _ 5 

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developmental disability should be "directly involved in completing this survey as much as possible. 

Jl^tependen^^j Mobility / Control / Privacy Agree Disagree 


1. I can (even if someone helps me because of my disability) gel 

to where 1 want to go.... • • • • 

2. 1 have control over my daily schedule.. • • • • 

3. 1 have privacy to be alone or with people 1 choose • • • • 

4. 

5. 



1 can set desired outcomes (goals) for myself 

• 

• 

• 

• 

• 

• 

• 

• 

6. 

1 can decide about how 1 spend my money • • • • 

7. 

%, 1 can make decisions that will affect my future • • • • 

8* 

1 am satisfied with my current level of independence . • • • •


Given all the considerations, how satisfied are you with your 


I. How likely would you be to recommend a consumer directed 


Very 

satisfied 



Very 

dissatisfied 

•fa • • • • • 

Very 

likely 




nor unlikely 

T 

Very 

unlikely 

r 

•'a • • • • • 

Met 

Expectations 

Failed 

Expectations 

services department? •fb • • • • • 


supports? , , 

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• 

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a 

• 

• 

• 

• 

6. 

7. 



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• • • 

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8. I am satisfied with my current level of independence 

• 

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a 

• 

• 

•

OVERALL S^SFACTION 

V W , I < 

I ^ 7 ! M I M III'I' IJIIII'I"!mm^m^m^M 

i GIVEN ALL THE CONSIDERATIONS, HOW SATISFIED ARE YOU WITH YOUR 

' CONSUMER DIRECTED SUPPORT PROGRAM? 

\ 

satisfied 

' nor unlikely , unlikely 

^ support program in your county to a friend in a similar situation? . . Q ) ( | Q Q Q Q Q 


that were set for you by your case manager and county social ^T^ 1 

"' , 

Failed 

Expectations 

services department? Q ^ Q Q Q Q Q 


supports? { \ V MV)I\I -VH• ___ 





INDEPENDENCE Mobility / Control / Privacy AGREE DISAGREE 



• • • • 

2. 


• 

• 

• 

• 

• 

• 

• 

• 

4. 

5. 


I can SET desired outcomes (GOALS) FOR myself • 

• 

• 

• 

• 

• 

• 

• 

6. 

7. 

8. 

I can make decisions that will affect MY future 

I am satisfied with my current LEVEL OF independence 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

•

O v e r a l l S a t i s f a c t i o n 





Very 

satisfied 



Very 

dissatisfied 

• • • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 

Q • • Qjgf Q • 

3. Has the consumer directed support program met the expectations Exceeded Met 



E x p y : t a t i 0 

" s E x p e c ? a t i o n s 

Failed 

Expectations 

• • • • • ft • 


supports? ^ , 

Thinking beyond consumer directed supportsJojôur j>verall quality of life, on the fbllomnp]piês|>-. -1 < 

please indicate how much you agree or disagree with eachstatement. Please completelheseêrtions * 

from the perspective of the person with a developmental disability. The person who has'ther 

developmental disability ^should be directly involved in completing thissurvey as much as possible.' ! r 

--' 

I n d e p e n d e n c e | Mobility/Control/Privacy Agree Disagree 

1. ••^•^•i^^HHHIHBl I can (even if someone helps me because of my disability) get Strongly Somewhat Neither Somewhat Strongly 

to where I want to go • • • • 


CO 

I have privacy to be alone or with people-4 ohoooo. • • a • 


information have access to it a a a a 

5. I can set desired outcomes (goals) for myself a • • n • 

6. I can decide about how I spend my money • • • • 

7. 

8. 

I can make decisions that will affect my future • a • a 

I am satisfied with my current level of independence . • • • a





support program in your county to a friend in a similar situation? .. 




Very 

satisfied 

Very 

likely 




nor unlikely 

Very 

dissatisfied 

Very 

unlikely 



4. What is the one thing that would have the greatest impact on your satisfaction satisiacuon with wun consumer ai directed 

supports? 

Thinkinq beyond consumer directed supports to your overall quality of life, on the following pages „ 

please indicate how much you agree or disagree withjeach statement. Please complete these sections 

from the perspective of the person with a developmental disability. The person who hasjhe^:-,%v 



1 

* —I Strongly Somewhat Neither Somewhat Strongly 










• • • • 

• • • • 

• • • • 

S I • • • • 

• • • • 

• • • 

-a • • • • 

• 1 3 • • •




How likely would you be to recommend a consumer directed 


Very 

satisfied 



Very 

dissatisfied 

a • • • • • • 

Very 

likely 


, . . . Expectations 


nor unlikelv 

Very 

unlikely 

1 

3 • • • • • • 

Met 

Expectations 

Failed 

Expectations 

that were S set wwi for 1W» you J WW by WJ your j ww« case WW.WW manager • • iw*i iw.w,wi and w*i county iw wwwi • social +j wwwa*>*> ~T . 

services 

department? 12 • • • • • • 


supports? iSO^W Oâ^'Z^cl 4- Uêjl iOt cvw a a.-^CL " " ' 

wwj^w^wi kw • 

1 1 

^j^jf^~"^ — f ww^ -*—- | i 

Thinking beyond consumer directed supports to your overafl quality of life, on the following pages . 

please inciicatle^ Please complete thes^sgctions 

from the perspective of the person with a developmental disability. The person who has the - 1 


Independence | MobHUy/Control/Privacy 

. v 


1. 

I can (even if someone helps me because of my disability) get 

to where I want to go . • ..... IS • • • • 

2. £l • • • • 

3. • • • • 

4. 

5. 


information have access to it...; 


sr • 

• 

• 

• 

• 

• 

• 

• 

6. 

7. 




a 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

CO






Very 

satisfied 



Very 

dissatisfied 

Ef • • • • • • 

Very 

likely 



nor unlikely 

T 

Very 

unlikely 

r 

rfu • • • • • 

Met Failed 


that were set for you by your case manager and county social Expectations ( 

services department? Q Q Q EJ • • Q Q 

. What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? j_ 

Thinking beyond consumer directed supports to yourovelatrquality of life, on the following pagesT.i^ 

pleasejnjdhca^how much you agneaord Please complete these sections ^ 

from the perspective of the personwithi a developmental disability. The person who hasthe^^r. 

developmental disability should be directly involved in ^completing this survey as much as possibler -"i--? 

FODJÊNDENCE j Mobility / Control / Privacy Agree Disagree 

can (evejiJf_spmeone_helps me berauseof my disability) get 

2. I have control over my daily c^hedule 



5. I can set desired outcomes (goals) for mysc 


7. I can make decisions that will affect my futi 

8. I am satisfied with mv riirront Im/ol nf inHon 


Of • • • • 

• • • a Of 

• • • • 

• • • • 

• • • of • 

• • • • 

• J • • • 

• 2) • • •

: , J 

OVERALL SATISFACTION I 

: 

, : .. GJ Neither satisfied 

— . . , . •••ii.«.il»wi» BM1 Ml Very nor dissatisfied _,. Vt 

*l A 


1. Given all the considerations, how satisfied are you with your ' ^ ' 

consumer directed support program? LJ A-J LI LI LI LI LI 



POru Jikely 

'l support program in your county to a friend in a similar situation? .. Q [ ] [ ] [ ] Q [j 


. . . . f t • . • Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n—— "h 

services department? Q K) • • Q Q Q 

4. What Kd^M^ is the one thing Gm/mtUii-« that would have AtfatfAjV the greatest impact \j\^jJUh on your CiAnh^y satisfaction with consumer . kMyfdr~ directed 

supports? (JPF-A4o dUAtteJL KYU- ddllfiJs/y fl) PsfpPAJtA^J. 

O v e r a l l S a t i s f a c t i o n I 

H Neither satisfied 

W W M m W i 

• f — i • Very „ o r dissatisfied r 


1. Given all the considerations, how satisfied are you with your ' ' „ ' 

consumer directed support program? LI )bi LI LI LI LI LI 

S K r 


2. How likely would you be to recommend a consumer directed ^p noruni'keiy 

support program in your county to a friend in a similar situation? .. [ ] ^ [ ] Q Q Q [ ] 


. . , , , . . i Expectations Expectations Expectations 

that were set for you by your case manager and county social ~^ i ^ 

services department? • • Q • • • • 


supports? . 

Thinking beyond consumer directed supports to your overall quality of life.-on the following pages: 

please indicate how much you agree or disagree with each statement. Please complete thesejsections 

from the perspective of the person with a developmental disability. he person_whoj^the. -v 

developmental disability"should bTdireîyTnvolved in completing this sulv^yaTmuch aspossffi^' 

^ndependenC^ Mobility / Control / Privacy Agree Disagree 

Strongly Somewhat Neither Somewhat Strongl) 



• • • • 

2. I have control over my daily schedule.... • • • • 

I have privacy to be alone or with people I choose • • • • 

CO 


information have access to it • • a • 

5. I can set desired outcomes (goals) for myself _, • • a • 


7. I can make decisions that will affect my future.... • • • • 

8. I am satisfied with my current level of independence a • • • 

u n i i 

l 

>^ 

k e l y


NEITHER .SATISFIED 

VCR 

> NOR DISSATISFIED VTR 

>' 

SATISFIED DISSATISFIED 

• • • • • • 

1 GIVEN ALL THE CONSIDERATIONS, HOW SATISFIED ARE YOU WITH YOUR 

CONSUMER DIRECTED SUPPORT PROGRAM? 

VERV NEITHER LIKELY VERV 

.., • , , , . , i• i i LIKELV NOR UNLIKELY UNLIKELV 

2. HOW LIKELY WOULD YOU BE TO RECOMMEND A CONSUMER DIRECTED — R 1 R— 

SUPPORT PROGRAM IN YOUR COUNTY TO A FRIEND IN A SIMILAR SITUATION? . . ^ ] ] Q Q G Q Q 

3 HAS THE CONSUMER DIRECTED SUPPORT PROQRAM MET THE EXPECTATIONS EXCEEDED MET FAILED 

* JM 

. , , KXPECLATIOAS EXPECTATIONS EXPECTATIONS 

THAT WERE SET FOR YOU BY YOUR CASE MANAGER AND COUNTY SOCIAL ~N ^ ^ 

SERVICES DEPARTMENT? SI • • • • • • 

4. WHAT IS THE ONE THING THAT WOULD HAVE THE GREATEST IMPACT ON YOUR SATISFACTION WITF) CONSUMER DIRECTED 

SUPPORTS? \ivcirjvit K:'.1 -JrJl-^J "rO 'hi' uiCv n 

H>{: 7 ."^ 

•J !• J • 3 

THINKING BEYOND CONSUMER DIRECTED SUPPORTS TO YOUR overall quality of life, ON THE FOLLOWING PAGES 

PLEASE INDICATE HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT. PLEASE COMPLETE THESE SECTIONS 

FROM THE perspective of the person with a developmental disability. THE PERSON WHO HAS THE 

DEVELOPMENTAL DISABILITY SHOULD BE DIRECTLY INVOLVED IN COMPLETING THIS SURVEY AS MUCH AS POSSIBLE. 

INDEPENDENCE S Mobility/Control/Privacy AGREE DISAGREE 

I^MÂUI;^^ X.A.Y^L^^NNNI^ STRONGLY SOMEWHAT NEITHER SOMEWHAT STRONGLY 

TO WHERE 1 WANT TO GO m • • • • 

2. • • • • 

3. 1 HAVE PRIVACY TO BE ALONE OR WITH PEOPLE 1 CHOOSE • • • • 

4. 

5. 

ONLY PEOPLE WHO ARE SUPPOSED TO KNOW MY PERSONAL 

INFORMATION HAVE ACCESS TO IT 

1 CAN SET DESIRED OUTCOMES (GOALS) FOR MYSELF 

• 

• a 

• 

• 

• 

• 

• 

• 

6. 

7. 

1 CAN DECIDE ABOUT HOW 1 SPEND MY MONEY 

1 CAN MAKE DECISIONS THAT WILL AFFECT MY FUTURE 

• 

• 

• 

• 

• 

• 

• 

• 

1 AM SATISFIED WITH MY CURRENT LEVEL OF INDEPENDENCE • • • • 

CO

El Overall Satisfaction 

Neither 

V e r 

y 

satisfied 

satisfied 


V e r 

y 

dissatisfied 

. Given all the considerations, how satisfied are you with your ' ' ' 

consumer directed support program?






Very 

satisfied 

Very 

likely 


, . , . , . . . Expectations 




nor unlikely 

1 

Very 

dissatisfied 

Very 

unlikely 

1 

• • • • • • • 

Met Failed 



services department? Q • • • • • • 

What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? 

t 

I 

A ' K _ _ ft ill) ....... il A / - 

1 o 

Thinking beyond consumer directed supports to your overall quality of life, on the foHowing^ges^, r, 

please indicate how much you agree or disagree'with each statement. Please complete the^s^Jtiohs 

from the perspective of the person with a developmental disability. The person who hj||the^~ ^ 

developmental disability should be"directly involved in completing this survey as"much as possible!"" 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

INDEPENDENCE | Mobility / Control / Privacy Agree Disagree 





I am satisfied with my i 

• • • • 

• a • a 

• • a a 

a m • • • 

• • a • 

a a a • • 

• • LJ • • 

a • • 

- - If-


s a t 

1. Given all the considerations, how satisfied are you with your ^ 

- r Neither satisfied 

very «/• 

. nor dissatisfied 

V e r v 

f i e d 

^ dissatisfied 

consumer directed support program? C3 Q Q Q Q Q Q 


o r u i k e 

2. How likely would you be to recommend a consumer directed - i ^ " ^ 'y umikeiy 

support program in your county to a friend in a similar situation? . 



E x 

t i o n s 

Pft* 


services department? < & • • • • • • 

4. What is the one thing that-woTjldlTaye the greatest impact on your satisfaction with consumer directed 

supports? 

3^ gUoo \MJTU hCLniû IajM "fix. prflfl rT*.^ 


please indicate how much you agree or disagree with each statement. Please complete these sections " 

from the perspective of the person with a developmental disability. The person who has the I 


INDEPENDENCE \ Mobility/Control/Privacy Agree 

Strongly Somewhat Neither 

Disagree 

Somewhat Stroneh 


to where I want to go .-.. Q • • a 

3. 



• 

a • 

• 

• 

• 

• 

• 

• 

c\i 


information have access to it • • • a 

5. I can set desired outcomes (goals) for myself.. • • • • 

CO 

I can decide about how I spend my money ... • • • • • 

7. I can make decisions that will affect my future • a • a 

8. I am satisfied with my current level of independence • s • • •






Very 

satisfied 

T 

Very 

likely 



Very 

dissatisfied 

• • • • • • 


nor unlikely 

1 

Very 

unlikely 

• • • • • • 



E«eeded 

Met Failed 

services department? |Q| Q • Q Q Q Q 



supports? boot 

5. 

6. 

7. 

8. 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages j 

please indicate how much you agree or disagree with" each "statement. Please complete these^cjidns 

from the perspective of the person with a developmental disability. The person who has the"7 r 

f „ 

developmental disability should be directly involved in completing this survey as much as possible.. V 

INDEPENDENCE | Mobility/Control/Privacy Agree Disagree 

^•^•^^•••••^^^••••l Strongly Somewhat Neither Somewhat Strongly 







w • • • • 

• n • • • 

• • • 

• a • • • 

• • • 

• ei • • • 

• M • • • 

• m • • •


smmmmmmmm • Very 


nor dissatisfied VE 

satisfied dissatisfied "7 




J 

• • • • • • 


likely nor unlikely unlikely 

—1 1 1 

support program in your county to a friend in a similar situation? .. ^| [ ] [ ] Q [| [ ] [ ] 


, , , . , Expectations Expectations Expectations 

that were set for you by your case manager and county social ~T I ^ 

services department? S • Q • • • • 


supports? ^ / /r^cJ\ Jt a^JJ ^ 

^rrjuj ^f-miJ I) bs y^r^yt , 1a J i (1,h S^L? 

1 7 


please indicate how much you agree or disagree with each statement" Please complete these sections 



INDEPENDENCE J Mobility/ Control /Privacy Agree Disagree 


1. I 

to where I want to go , • • • • • 

2. I have control over my daily schedule J • • • • 

I have privacy to be alone or with people I choose. • • • • • 

CO 

4. 

5. 




J 

J 

• • 

lit • 

• 

• 

• 

• 

6. 

7. 

8. 




J 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

•






Very 

satisfied 



Very 

dissatisfied 

a • • • • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 

a • • • • • • 



Exp tations 

f 

E x 

t i o n s 

PT —r 


Met FaUed 

Expectations 


supports? 

2. 

3. 

4. 

Thinking beyond consumer directed supports to your overall quality of life! on tire following pages^ 

please indicate how much youagfee or disagree with each statement. Please compteteTthese sections 

from the perspective of the person with a developmental disability. The person who has the, 

developmental disability should be directly involved in completing this survey as much" as possible. 

INDEPENDENCE-1 Mobility/Control/Privacy Agree Disagree 



have privacy to be alone or with people I choose. 


• • • • 

• • • • 

• • • • 

information have access to it .. • • 

5. I can set desired outcomes (goals) for myself • • 



8. I am satisfied with my current level of independence • 

• 

• 

•


u 

-tjB 





Has the consumer directed support program met the expectations 



Very 

satisfied 

T 



Very 

dissatisfied 

T 

• • • • 

Very 

likely 


nor unlikely 

T 

Very 

unlikely 

r 

fi-u • • • • • 

Exceeded 

Expectations 

Met Failed 


..ma • • • • • 

4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed x 

supports? OA A L ^fN(\ *\fx fytA , rwA A P AA \ nrhA jN,hoV /vV> s\QPSVhCX&> 

Thinking beyond consumer directed supports to your overall quality of life, on thefoljowing.pês ji; , 

please indicate how much you agree or disagree with each statement. Please completethesasections 



Independence I Mobility/Control/Privacy Agree 

Disagree 


HHBi^nBHHflMlil^lHHH Strongly Som 

1. I can (even if someone helps me because of my disability) ge 


L 

0 _ • • • • 



• 

• 

• 

• 

• 

• 

• 

• 

CO 




CO 

I can decide about how I spend my money • • • • 




. Given all the considerations, how satisfied are you with your 




Very 

satisfied 



Very 

dissatisfied 

• • • • • • • 

Very 

likely 

1 

i. Has the consumer directed support program met the expectations Exceeded 

2. 

3. 

4. 

5. 

6. 

7. 

8. 


E , 


nor unlikely 

1 

Very 

unlikely 

• • • • • • • 

T 

M w 

Met 

Expectations 

' 1 =--t 

Failed 

Expectations 

services department? gj • • Q Q Q • 


supports? 

Thinking beyondconsumer directed supports to your overall quality of life, on the following pages 

please indicate how much you ag>ee*or disagree with~e¥ch's^ complete these^lections 

from the perspective ofthe person with a developmental disability. The person who has the- 7 

developmental disability should be directly involved in completing thissurvey as much as possible. 

INDEPENDENCE I Mobility/Control/Privacy Agree 

Strongly Somewhat 


to where I want to go. CI 

I have control over my daily schedule [_| 

I have privacy to be alone or with people I choose Q 







• 

• 

• 

• 

__ 

Disagree 

Neither Somewhat Strongly 

• 

• 

• 

• • 

• • 

• •






Very 

satisfied 

Very 

likely 



Very 

dissatisfied 

• • • • • • 


nor unlikely 

Very 

unlikely 

M • • • • • • 


Met 

that were set for you by your case manager and county social T * " 

Expectations 

•—t 

services department? [2 Q Q Q Q Q Q 

Failed 

Expectations 


supports? QJlca}^ IWU." 1B Wjl rjL mmtjl IaiVl (Aorm&L I'F^. 

2. 

3. 

4. 

Thinking beyond consumer directed, supports to your overall quality of life, on the following pages, 



developmental disability should be'directly involved in completing this survey as much as -possible. 




to where I want to go SI 

I have control over my daily schedule Q 








D 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

•





V e r y 

satisfied 



V e r y 

dissatisfied 

• • • • • 

Very Neither likely 

noru 

f 

Very 

lkely 

«rf*eiy_ 

support program in your county to a friend in a similar situation? . . 2 Q Q Q Q Q [ ] 


. . . . , , , . . , Expectations Expectations Expectations 

that were set for you by your case manager and county social ~T~T I ^ 

services department? El • • • • • • 


supports? . 

'i?.,-,! >. > * ^-f-M ~4T> ^ P. "'~ -^nr- ^ •; i — ry A, e.-T" ^"h 

— - —- — ! * ~~ ~~JL 

. i i ^ / , ; 

' ' i \. 

Thinking beyond consumer directed supports to your overall quality of life, on the fojlowing pages 

please indicate how much you agree or disagrees with each statement. Pleaseoomplete'these sections 




^^^^^^^m/mmmmmgl^^^ Strongly Somewhat Neither Somewhat Strongly 

1. I can (even if someone helps me because of my disability) get / 

to where I want to go Q Q 

2. I have control over my daily schedule Q K]{ 

3. I have privacy to be alone or with people I choose Q Qj^ 


.. a 

• • • 

• • • 

• • • 

5. 



.. a • 

a 

• 

• 

• 

• 

• 

• 

6. 

7. 

8. 




... • 

.. ef • 

of a 

• 

• 

a 

• 

• 

• 

• 

• 

•

Overall Satisfaction Neither satisfied 

„. e 

!7 . nor dissatisfied Very 


1. Given all the considerations, how satisfied are you with your „ ' ' 

consumer directed support program? LJ LJ LI LJ LJ LJ 


2. How likely would you be to recommend a consumer directed ''f y 

r i k e l y 

i^,—°° ?' """j"^ 

support program in your county to a friend in a similar situation? .. Q )n [] Q (_ Q (_ 

3. Has the consumer directed support program met the expectations speeded Met Failed 

. . . , . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social -n—r~? ^ ^— 

What services is the department? one thing that would have the greatest impact on your satisfaction ^/H with ^ consume ^ ^ ^ ^ 

supports? 1 JJg^ ^tyff&j^y^tez^ Jj#i rXhZ* 

W- 

ler directed 

Thinking beyond consumerdirected supports to your OVERALL quality OF LIFE, on the following plages^ J 

please indicate how much you agrWoTdisagree with"EABFS1ATEMENT. Please complerthlsefections 

from the PERSPE^CTI^^ T n e p e r s o n who^^g^% 

developmental disability should be directly involved in comfping this survey as much 'ASPOSSBL^;" 

^J^P^den^^j Mobility/Control/Privacy AGREE DISAGREE 



to where I want to go .; 


3. I have privacy to be alone or with people I choose..... \.... 


information have access to it..... 

5. I can set desired outcomes (goals) for mys( 


7. I CAN make decision?? that will aff_r>t m\, t. 

• • • • 

• • • • 

• • • a 

• a a • 

• 5 % • • 

• r_r • • 

1 V • 

B M • • 

• • • •






Very 

satisfied 



Very 

dissatisfied 

• • • • ti • • 

Very 

likelv 


nor unlikely 

Very 

unlikelv 

• • • • • • • 

1 Has the consumer directed support program met the expectations Exceeded Met 

O. 

u , 

° rr- r 3 r- Expectations Expectations 

1—~ 

Faded 

Expectations 


services department? • • • • • • • 

4. What is the one thing thatwould have the greatest impact on your satisfaction with consumer directed 

supports? 

0 Ute^-X^ E M P " A - 





1. 

INDEPENDENCE I Mobility / Control / Privacy Agree 





3. I have Drivacv to be alone or with Deoi 



5. I can set desired outcomes (goals) for myself. 

6. I can decide about how I spend my money . . . 

7. I can make decisions that will affect my future. 

8. I am Rati








Very 

satisfied 



Very 

dissatisfied 

• • • • • • • 

Very 

likeiv 


nor unlikely 

Very 

unlikelv 

• • • • • • • 

Exceeded 

Expectations 

Met Failed 


services department? 13 • • • • • • 


supports? V -ft-^ ; 

•• A-• 





INDEPENDENCE I Mobility/ Control / Privacy Agree Disagree 

_ _ _ _ _ | _ _ _ _ _ _ | Strongly Somewhat Neither Somewhat Strongly 


to where I want to go ® • • • • 



• 

• m 

• 

• 

• 

• 

• 

• 

CO 


information have access to it m • • • • 

5. I can set desired outcomes (goals) for myself m • • • • 

6. I can decide about how I spend my money m • • • • 

7. I can make decisions that will affect my future • • • • • 

8. I am satisfied with my current level of independence . • • • •

OVERALL SATISFACTION H . 

K MBMiTi«m.t^,^».r«ii^^ 'lim 

i|iMi |__B_tlMIM__ 3 V Neither satisfied ^ 

satisfied nor dissatisfied dissatisfied 

1. Given all the considerations, how satisfied are you with your .i^ ' ' 

consumer directed support program? £2 U U U LI U U 

Verv Neither likely Very 

., . _• * _ likclv nor unlikely unlikely 

2. How likely would you be to recommend a consumer directed —p 1 1 — 

support program in your county to a friend in a similar situation? . . ^ [ G [ ] Q Q Q Q 


J 

, Expectations Expectations Expectations 

that were set for you by your case manager and county social ~~t~ ^ " 

services department? JSf • • • • • • 


supports? .— 





1. 

CO 


77 

I Strongly Somewhat Neither Somewhat Strongly 


• Si • • • 


• 

• 

M • 

• 

• 

• 

• 

• 

4. 

5. 



• 

• a 

• 

• 

• 

• 

• 

• 

7. 




• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

CO 

CO



V e r y 



V e r y 




Very 

likely 

LI 


LJ LJ LI 

nor unlikely 

Very 

LI LI 

unlikely 

support program in your county to a friend in a similar situation? .. J^j Q Q Q F) fj G 


, , Expectations Expectations Expectations 

that were set for you by your case manager and county social ~T ~r~ ^ 

services department? • • • J 3 • • • 


supports? Ajg_~mc\)g

Overall Satisfaction j Neither 

satisfied 

V e r y 

nor dissatisfied Vet 


"* J 


r^Kri n ri n n r~l 

consumer directed support program? LJ LJ LJ LJ LJ LJ 



bl 

f y 

. noru 

^' kel? 

support program in your county to a friend in a similar situation? .. I__f[__ [] Q Q Q Q 


. . . i ^ i , . . • Expectations, Expectations Expectations 

that were set for you by your case manager and county social ^ 

services department? J^j LG G G G G Q 


7 

supports? 

— 3 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages ". 

please indicate how much you agree or disagree with each statement. Please complete these'sections 

: 

from the perspective of the person with a developmental disability. The person who has the - ; 

developmental disability should be directly involved in completing this survey as much as possible! 1 

" 

IndSpSndenCe | Mobility /Control /Privacy Agree Disagre 



to where I want to go J^* ^ ^ 

2. I have control over my daily schedule Q| JLGT^ LG 

3. I have privacy to be alone or with people I choose LG LG LG 

4. Only peqple who are supposed to know my personal 

information have access to it JOT LG Q 

5. I can set desired outcomes (goals) for myself J ^ L ^ Q 

• • 

• • 

• 

a a 

• • 

6. I can decide about how I spend my money [_j Q Q ^£-f* A^fr 7 

^ 

I can make decisions that will affect my future LG _J2"^ G G G 

8. I am satisfied with my current level of independence LG LG LG J^L LG


1. Given ail the considerations, how satisfied are you with your 







Very 

satisfied 



Very 

dissatisfied 

r 

• Q / Q • • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 

• am • • • • 

Exceeded 

Expectations 

Met 

Expectations 

Failed 

Expectations 

• •'a • • • • 

4. What is the one thinq^hat wpuld have the greatest impact on your satisfaction with consumer directed 

supports'? 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages ; 


from the perspectivejof,the person with a developmental disability. The person who has the 

developmental disability~should be directly involved in completing this survey as much as possible. ; 

Independence I Mobility / Control / Privacy Agree Disagree 

: —-———- • Strongly Somewhat Neither Somewhat Strongly 


to where I want to go • 

2. I have control over my daily schedule ^ 



information have access to it Q 

5. I can set desired outcomes (goals) for myself • 


7. I can make decisions that will affect my future I3f^ 

8. I am satisfied with my current level of independence u3 

IT 

• • • 

• • • • 

• • • • 

• • • 

• • • 

• • • • 

• • • • 

• • • •


Very 

satisfied 



1. Given all the considerations, how satisfied are you with your « 1 

r 

consumer directed support program? : : m.a • • • • • 



Very 

likely 

3. Has the consumer directed support program met the expectations Exceed* 


Exp 

^ ctations 



nor unlikely 

J 

Very 

dissatisfied 

Very 

unlikely 

• • • • • 

Met Failed 


• • • • • 


supports? 





I n d e p e n d e n c e | Mobility/Control/Privacy Agree 

Disagree 

HBHEOHI^BHHi^HHi^HBHl Strongly Som Somewhat Neither Somewhat Strongly 

1. I can (even if someon 

to where I want to go. 









t 

• • • • 

• 

X 

• • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • • •






Very 

satisfied 

1 



Very 

dissatisfied 

1 

• • \3T\J • • • 

Very 

likely 




— I — 


nor unlikely 

1 ~ - 

Very 

unlikely 

1 

• era • • • • 

Met 

Expectations 

Failed 

Expectations 

a ef Q a Q • a 


supports? . n 

Thinking beyond consumer directed supports to your overall quality of life, on^the following pages 





1. mmm^mJ I can (even if someone helps me because of my disability) get Strongly Somewhat Neither Somewhat Strongly 

to where I want to go ar • • • • 


CO 

I have privacy to be alone or with people 1 choose • • • • 

4. 

5. 



1 can set desired outcomes (goals) for myself • 

• • 

• 

• 

• 

• 

• 

6. 

7. 

8. 

1 can decide about how 1 spend my money 

1 can make decisions that will affect my future 

1 am satisfied with my current level of independence 

• 

• 

• 

ar • 

• 

• 

• 

• 

• 

• 

• 

•


V e r 

y nor dissatisfied V< 

satisfied 

T* J 

dissatisfied 

1. Given all the considerations, how satisfied are you with your JL. r— _ -' 1 / _ ' r 

consumer directed support program? ....... I J LJ LJ Uj. LJ LJ L J 


_ , , . . •• x i likely n o r 

n o r 

unlikely unlikely unlikeli 

2. How likely would you be to recommend a consumer directed —r— 

—i rr- 

1 1— 

r— 

support program in your county to a friend in a similar situation? .. Q QJ LG LL O LG Q 


. . . ., . , . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~i • . • „ 

services department? r • • • • • • 

• I ' ' 


supports? s 

-V-)L^)h>i / ' 4-U rL\ fr\^sC) tX\LLi\\ TT\ a^>-\ • b * ? • - ' / ^ 

Thinking beyond consumer directed supports to your ovîfquality of life, on the following pages .;_« 

_ ib*** ... _ _ ."J. - - -' __ff__??*_**_*__»^_^ -,. . .u ^^X'l^ 

Iplease indicate how much you agree or disagree with eacrrStatement. Please complete these sections 

from the perspective of the person with a developmental disability. The person who has the^f^ss? 

.developmental disability shouldbedirectly involved in^^^teting this survey as much as possible^^ggs 

|hdepend®DS® \ Mobility/Control/Privacy" Agree Disagree 


1. I can (even if someone helps me because of my disability) get _ 

to where I want to go • LJ 7 

• • • 

2. I have control over my daily schedule ... fW^.'.... Q EG LG LG LG 


__£_ 

4. Only people who are supposed to know my personal ^, 

information have access to it.. J\J [LI LG LG CG 

5. I can set desired outcomes (goals) for myself.. 

6. I can decide about how I spend my money ... Q Q LG Q Q 

7. I can make decisions that will affect my future .IFF..... LG T_l LG LG LG 

8. I am satisfied with my current level of independence^" Q LG 1 3 Q LG





V e r y 

satisfied 



V e r y 

dissatisfied 

i$u • • • • • 


likelv nor unlikely unlikely 

-r 1 r 

support program in your county to a friend in a similar situation? . . ^ [ Q [ ) [ ] [ ] [ ] [ ] 

3. Has the consumer directed support program met the expectations Exceeded Met FAUED 

.. . , . . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~~r— "-i ^ 

services department? 3 • • Q Q • • 


S U P P O R T S ? T7n. r-^^/rm IT svn^Js^ VK^ r w i /7^-r~ A 

Thinking BEYOND CONSUMER DIRECTED SUPPORTS TO YOUR overall quality of life, on THE FOLLOWING PAGESII . 

please INDICATE HOW MUCH YOU AGREE OR DISAGREE WITH EADTSTAFEMENT. Please COMPLETE THESE SECTIONS 

FROM THE perspective of the person with a developmentaldisability. The PERSON WHO HAS THE 

DEVELOPMENTAL DISABILITY SHOULD BE DIRECTLY INVOLVED IN ROMPIETING THIS survey AS MUCH AS POSSIBLE. 



• f. I.. O U„. KT„:«I CnnuiiiW Qtm 



2. 

3. 



5. I can set desired outcomes (goals) for mys( 


8. 

• si • • • 

• • • • 

• -J • • • 

• or • • • 

• • • • 

• • • • 

• • • • 

3 • • • •






Very 

satisfied 



Very 

dissatisfied 

a • • • • • • 

Very 

likely 




Expectations 


nor unlikely 

Very 

unlikely 

• • • • • • 

Met 

Expectations 

Failed 

Expectations 


supports? "TF) /TIA/^f ,?U£.p 7/4F Q& oCn P A/w,^ Kuh^m~ .5- /V'OT 






naBj^Manan^^^^^M^H^^J Strongly Somewhat Neither Somewhat Strongly 



2. I have control over my daily schedule ® • • • • 

CO 






J • • • • 

7. I can make decisions that will affect my future 3 • • • • 

8. I am satisfied with my current level of independence a- • • • •






Very 

satisfied 



Very 

dissatisfied 

• a-Q • • • • 

Very 

likely 



—nor unlikely 

Very 

unlikely 

• • • • • 

Met 

Expectations 

Failed 

Expectations 

. . . Expectations 


services department? • • • orti • • 


supports? 

k






Very 

satisfied 

Very 

likely 




nor unlikely 


that were set for you by your case manager and county social Expectations Expectations 

Very 

dissatisfied 

Very 

unlikely 

Failed 

Expectations 

services department? j___ • • • • • • 


supports? 




developmental disability should be'directly involved in completing this survey as much as"possible. 

I n d e p e n d e n c e [ Mobility/Control/Privacy Agree Disagree 

• • I I ^ H B B H H H H H H l l Strongly Somewhat Neither Somewhat Strongly 



2. I have control over my daily schedule.. . . • • • • 



information have access to it • _ • • • 


CD 


7. I can make decisions that will affect my future • i_i • • • 

8. I am satisfied with my current level of independence • ar • • •






Very 

satisfied 



Very 

dissatisfied 

R 

_(• • • • • • 

Very 

likely 



nor unlikely 

T" 

Very 

unlikely 

R 

t_Ta • • • • • 

Expectations 

Met 

Expectations 

that were set for you by your case manager and county social "T/' ~" r 

"i 

Failed 

Expectations 

services department? O • Q Q Q Q I—I 


supports? Qhr- rooA4^| LNQ-> W „ Q >V,lcji^ Q T | ^NRP:,^ 4 4-D V^^.I





V e l 

T 

satisfied 



V e r 

y 

dissatisfied 

• • • _ ( • • • 



i r—; r 

support program in your county to a friend in a similar situation? . . • Q __ __f ______ 



that were set for you by your case manager and county social n ' i/ —t - 

" 

services department? • • • S( • • • 


supports?, , _ ! 




developmental disability should be directly involved in completing this survey as much aspossible. 

jlldependenCe J Mobility/Control/Privacy Agree Disagree 



to where I want to go \- o_r • • • • 

2. I have control over my daily schedule • • • 

I have privacy to be alone or with people I choose. • • EF • • 

CO 


information have access to it ar • • • • 


CD 


7. I can make decisions that will affect my future. . . • • • • 

8. I am satisfied with my current level of independence • • •








Very 

satisfied 



Very 

dissatisfied 

SI • • • • • • 

Very 

likely 

Exceeded 

Expectations 


nor unlikely 

Very 

unlikely 

• • • • • • 

Met 

Expectations 

FaUed 

Expectations 

services department? • J_ • • • • • 


supports? 

-\r E.ot-U r b r ^ - F W ^ **>I_ n__ —_____ 





TNDEPENDENC^j 

Mobility / Control / Privacy Agree Disagree 



c\i 

CO 

m • • • • 

• • • • 



_ • • • • 

5. I can set desired outcomes (goals) for myself _ • • • • 

6. I can decide about how I spend my money _ • • • • 



OVERALL SATISFACTION _ 




. . . likelv nor unlikely unlikely 

2. How likely would you be to recommend a consumer directed —r- 1 1— 

support program in your county to a friend in a similar situation? . . Q G G D D G 


r 3 

, r 

. , Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n * ' 

services department? • • !___ • LG • LJ 


supports? : 

Cx?vv4^l 








V e r 

y nor dissatisfied J. Ve 

satisfied 

f7 _ 

dissatisfied 

1 1 r 

• • • • 

• • • • 

• • • • 



• 

. • • 

• • 

• 

• 

• 



• 

• 

• 

• 

ta • 

• 

• 

• 

I am satisfied with my current level of independence . • • • •





support program in your county to a friend in a simitar situation? .. 




Very 

satisfied 



Very 

dissatisfied 

S • • • • • • 

Very 

likely 

Exceeded 

Expectations 


nor unlikely 

Met 

Expectations 

Very 

unlikely 

Failed 

Expectations 

a • • • • • • 

4. What is the one thing that would nave have tne the gre< greatest impact on your satisfaction with consumer directed 

supports? 0Lu -h> Eo on*X rso »

O V E R A L L S A T I S F A C T I O N " ! 

Very 

satisfied 



1. Given al the considerations, how satisfied are you with your 


^ • • • • • r 

• 


likely 

nor unlikely 



V 7 

Very 

dissatisfied 

Very 

unlikely 

T 

1 3 • • • • • • 

Met 

Expectations 


Failed 

Expectations 

. . . ., , , , . , Expectations •— 

that were set for you by your case manager and county social ~n ~7J ^ ~ 

services department? Q L2I Q • Q Q LJ 

4. What is the one thing that would have the greatest impact on your satisfaction with con 

supports? - T H L * FTJFATTAOFFI KQllfiJmtAA Q /Vl ffifr \H\M 

I J W - T K I ( ^ M M I A J I I I A \ x 

J&\H\jmA (UUAjS^ 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages 14;, 

please indicate how much you agree or disagree with"each statement. Please complete these sections 

from the perspective of the person with a developmental disability. The person who,has the mMmi 

developmental disability should be directly involved incompleting this survey as much as possible, -^r 

I N D E P E N D E N C E I Mobility/ Control / Privacy AGREE DISAGREE 


1. I can (even if someone helps me because of my disability) get A 

to where I want to go ijy A • • 

2. 

3. 

I have control over my daily schedule • • • 

• • • A 



information have access to it • • • • • 

5. 

I can set desired outcomes (goals) for myself • • • • 

6. 


7. 

8. 

• I can make decisions that wil afect my future 

. • I am satisfied with my curent level of independence 

A 

• 

A 

• 

• 

A 

F 

•




• • • • • • 


. . . . . . . . . i ,- • likelv nor unlikely unlikely 

2. How likely would you be to recommend a consumer directed —r 1 

1 1— 

support program in your county to a friend in a similar situation? .. | | Q Q Q G D D 


, , . , , 

r r r 3 

, . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n ^ ~r~ 

services department? m • • • • • • 


supports? n ^T/k< înUxJCÂ -/-n ^0S6AAr* tfj? S^h^M^D (M^ 

W I \,s '"V ' 7\ ' A-V-f^l ^^^^ Y (."-^ f > # _f ' 

Thinking beyond conWmer direafed supports to your overall qualitySii&^^fS&tBSBS^^ 

please indicate how much you agree'or disagree with each'statemenMP^ 

from the perspective of the person with a developmental disability. Jhe person^w^^the_ .. 

developmental disabilityshould be'directly involved in completing this survey as much as possible, i: 


1 I Qtrr>-~i u i_hat Neither Somewhat Stron 


• • • • 

2. 

3. 



• 

• 

• 

• 

• 

• 

• 

n • 


• • ® • • 

5. I can set desired outcomes (goals) for myself • • • 

6. I can decide about how I spend my money • • • • m 

7. I can make decisions that will affect my future • • • • IS. 

I am satisfied with my current level of independence . • • ii • a 

00 

V c r 

y 

satisfied 


V e 

._ _ 

dissatisfied 

— I 1 1




V 7 

V e i 

T 


nor dissatisfied Ve 

f y 

satisfied 

_ ., 

dissatisfied 

I 1 1 

H Q Q • • • • 


r u l k e 

2. How likely would you be to recommend a consumer directed -^p- "° f ' y 

support program in your county to a friend in a similar situation? .. ^ Q [ ] Q Q Q Q 

3. Has the consumer directed support program met the expectations Exceeded Met Faded 

,, , _ , , , x . - , Expectations Expectations Expectations 

that were set for you by your case manager and county social ~ n ^ • 

services department? ] _ _ • • • • • • 


supports? A . . 

__ k 

_y 

Thinking beyond consumer directed supports to.your overall quality of life.-oh the.following pages 

please indicate how much youligreeor disagree with each statement. PleasVcomplete these sections 


developmental disability should be directly involved in completing this survey as much as possible. ; 


GGGGGGM^MI^MLIM^J Strongly Somewhat Neither Somewhat Strongly 


to where I want to go • • • • • 



AR 

._ 

• 

• 

• 

A 

A 

• 

• 

• 

CO 


3 A • • • 

5. _ • • • 

6. • A A • 

7. • • • • 

8. I am satisfied with my current level of independence • • A •

Overal Satisfaction 





Very 

satisfied 

Very Neither 

Likely 

Si 

Has the consumer directed support program met the expectations Exceeded 


E x p 9 n s 

fy 



likely 

nor unlikely 

1 

Very 

dissatisfied 

Very 

unlikely 

1 

• • • • • • 

Met 

Expectations 

Failed 

Expectations 

1 r- 

services department? Of • • • • • • 

4. What is the one thing that would have the greatest est impact impa on your satisfaction with consumer directed 

supports? —r-y^ ^ / ^ - ^ * . . 





Independence j Mobility/Control/Privacy 

Agree Disagree 




_r 2. I have control over my daily schedule • • • • 

CO 

I have privacy to be alone or with people I choose • or • • • 

4. 

5. 

6. 

7. 



I can set desired outcomes (goals) for myself. 



• • 

_r • • 

of • • 

or" • • 

• 

• 

• 

• 

• 

• 

• 

• 










Very 

satisfied 

Very 

likely 




nor unlikely 

Very 

dissatisfied 

Very 

unlikely 

m • • • • • • 



4. What is the, one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? OAjL-i TjtiE- A-s

Overal Satisfaction I Neither 

satisfied 

.*!?, nor dissatisfied 


1. Given all the considerations, how satisfied are you with your ' ' ' 

consumer directed support program? 2_l LJ LI LI LI LJ LJ 


2. How likely would you be to recommend a consumer directed ""'"f^ 

support program in your county to a friend in a similar situation? .. 0 Q Q Q Q Q [] 



services department? JjQ •••••• 

4. What is the one thing that would.have the greatest impact on your satisfaction with consumer directed 

supports? . >'/y/T~ J ~yy ~tf 

,o L ft SO^N s * P s ^ — d 

overal quality of life, T h , n k , n 

b e 

n d 

9 

perspective 

y° consumer 

of agreVr'disagre directed 

the 

supports 

person 

to your 

witha developmental disability. 

on the following 

please indicate how much you witffeach statement. Please complete 

as^posible." 

th^sesections 

*' 

from the The per 

developmental disability should be directly involved in completing this survey as much 

Independence } 

Mobility/Control/Privacv Agree 


V e r y 

Disagree 

Somewhat Stronelv 


to where I want to go _ • • • • 

CM' 

CO 

I have control over my daily schedule. • • • • 

I have privacy to be alone or withpeople I choose _ • • a • 


information have access to it.. ® • • • • 


6. I can decide about how I spend my money • • • a 

7. I can make decisions that will affect my future • _ • a a 

8. I am satisfied with my current level of independence • • a a

OveralI Satisfaction 



V e r 

y 

satisfied 



V e 

.. __ _, 

dissatisfied 


.... . . . . . likelv likely 

n o r 

nor unlikely unlikel] unlikely 

2. How likely would you be to recommend a consumer directed —r —i 1 r— 

1 

1 1— 

support program in your county to a friend in a similar situation? .. SI [ ] Q Q Q Q Q 

3. Has the consumer directed support program met the expectations Exceeded Met Faaed 

. . . . , , • _ . i Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n ^ 

services department? Q [_| Q Q Q Q Q 


supports?^ Y-g» . itJfe . A* iJ0"+*vt$ , yvê as* aA?\t -Zo






Very 

satisfied 

Very 

likely 

E x c e e d e d 

3. Has the consumer directed support program met the expectations „ 






nor unlikely 

Very 

dissatisfied 

Very 

unlikely 

Met 

Failed 

Expectations 

a • 

Expectations 

• • 

Expectations 

• • • 


supports? . „4 r M 

pninking beyond consumer directed supports to your overall quality of life, on the followingJês^ * 

please indicate how much you agree or "disagree with each statement. Please complete^mesesections 

I|from the perspective of the person with a developmental disability. The person who hasfhe -XifrJevelopmental 

disability should be directly involved in completing this survey as much as possible/ * - -. 

lJ2^®P®J^®n^J Mobility/Control/Privacy 



I Only people who are supposed to know my personal 



,1 am satisfied with my current level of independence 



m • • • • 

• ® • • a 

• !il • a a 

IT, a • • • 

• • a • 

• • • • 

• • _ • • 

• _L • • a




5. 






Very 

satisfied 



Very 

dissatisfied 

• • • a • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 

• • • _ ) • • • 

Failed 

• • • • a • • 

Exceeded 

Expectations 

Met 



supports? />/:îW^


Very 

satisfied 



Very 

dissatisfied 


consumer directed support program? A • • • • • • 



Very 

likely 

1 Has the consumer directed support program met the expectations Exceeded 

, Expectations 




nor unlikely 

Very 

unlikely 

• • • • • • 

Met 

Expectations 

Failed 

Expectations 

• • • • • • 


supports? ; 

FTVT 5— * + " M—• 





INDEPENDENCE I Mobility / Control / Privacy AGREE DISAGREE 



to where I want to go • • • • J _ _ 

2. I have control over my daily schedule • • • • __ 




5. I can set desired outcomes (goals) for myself . • • • • 

6. I can decide about how I spend my money • to • • • 

7. I can make decisions that will affect my future • S I • • • 

CO 

• • • •









Very 

satisfied 

Very 

likely 

4. What is the one thing that would have the greatest impact on your satisfaction 

supports? £ Vf^/cjf^rs-f 0^r- r 

^









Very 

satisfied 

Very 

likely 

Exceeded 

Expectations 



Very 

dissatisfied 

• ••••• 


nor unlikely 

Very 

unlikely 

• ••••• 

Met 

Expectations 

Failed 

Expectations 


Supports? ^ in. ik< ^ vsu. yv;Vy a^^Jj A^-C^r-edl f s A 




developmental disability "should be" directly involved in completing thisYurvey as much as possible. 


•_••fl______3_ — 

________________ Strongly Somewhat Neither Somewhat Strongly 


to where I want to go. • • • • 

2. I have control over my daily schedule • • m • • 


A. Only people who are supposed to know my personal 

information have access to it...... • • • • 

cn 

I can set desired outcomes (goals) for myself.. • • • 

6. I can decide about how I spend my money . • • • • 

7. 

8/ 

I can make decisions that will affect my future. • • • • 

1 am satisfied with my current level of independence • • • •









Very 

satisfied 



Very 

dissatisfied 

^ • • • • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 

l§a • • • • • 



Q • • • • • 


supports? CoyvfxKu^ a-_> i f- fS — cW.f ^ c W ujc-Le^^ 

Thinking beyond consumer directed supports to your overall quality of life, on the followjng^ges , 

please indicate how much you agreeor disagree with each statement. Please complete thesesections 

from the perspective of the person with a developmental disability. The person who.hasê.. 

developmental disability should be directly involved in completing this survey as much asjjpssibte.. ; 

I Independence Mobility/Control/Privacy Agree Disagree 

7 

—— • Strongly Somewhat Neither Somewhat Strongly 


to where I want to go > 



4. Only people who are supposed to-know my personal 

information have access to it.. ^ . • 


6. I can decide about how I spend my money ... 


8. I am satisfied with my 

• • a • 

• a a a 

• • a • 

• • • • 

• • • a 

• • • a 

a a a a 

a • 5 • a


"7, 

satisfied 



V c r y 

dissatisfied 

1. Given aii the considerations, how satisfied are you with your _ 1 - 1 ^ r 

consumer directed support program? LJ LI LJ LI LI £j LI 



noru 

f ikely 

support program in your county to a friend in a similar situation? .. 3 Q Q Q Q Q Q 


. , . , . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ^ — ~ ; ^ — 

services department? • • • • J 3 S • • 


supports? 

1£ K0i>Prt Y&OMi? tjuMjXQ 44 If UijK*ZJTF**jr sunxJd AA-f^ 

CRR^. % 7 T- J4A\*jos RITJR^F UU'.< ARF/F fa/*?*x(f^ 

WapÛ • K^RÛJ^R TOY r^TSRJS^-L (AJ/IRKCR ASIFF, - 

JL~)y) tA)J^4V A^SjJ4?sto\ 

Thinking beyond consumer directedsupports to your overall quality of life, on the following pages 

please indicate how much you agree or disagree with each statement. Please completelhese sections 



Independence | Mobility/Control/Privacy Agree 

Neither 

Disagree 

Somewhat Strongly 


to where I want to go. • • • • 

2. I have control over my daily schedule.. • • • 


CO 


information have access to it.... • • • • 




8. 

I am satisfied with my current level of independence • • • • - A ;






Very 

satisfied 



Very 

dissatisfied 

of • • • • • • 

Very 

likely 




nor unlikely 

Very 

unlikely 

•fa • • • • • 

E x p e c t a t i o n s 

Met 

Expectations 

Failed 

Expectations 

T 

services department? C_f • • • • • • 


supports? ~TUfr4- & ^ X , " v I Uh nAriA a* ,V, 4-r o 00 PLo 

VM?0p L A * (hx^ pgjr , i^ôd^M-^ f^Jj J^ T 




developmental disability should be~directly involved in completing this survey as much as possible. 

êpendenC^J Mobility /Control /Privacy AGREE DISAGREE 



2. I have control over my daily schedule Q| 





6. I can decide about how I spend my money Q 

7. I can make decisions that will affect my future Q 

8. I am satisfied with my current level of independence ... • 

• • • • 

• • OK • 

• • • • 

• a" • • 

a' • • • 

or • • • 

• • • 

• • •






Very 

satisfied 

~l 

Very 

likely 

1 





/ 

Very 

dissatisfied 

• • • • • • 


nor unlikely 

T 

Very 

unlikely 

Met Failed 




supports? "hho-r- \-\r- Cr-A.-yx K^,^ QoVno i4- b-e.-e^ Ci , 

rjrgojr o> 4^,^[g J 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages * 





Neither 

Disagree 

Somewhat Strong!; 


to where I want to go El • • • • 

2. I have control over my daily schedule. • • • • 

3. I have privacy to be alone or with people I choose SI • • • • 



5. I can set desired outcomes (goals) for myself • • • • a 

6. I can decide about how I spend my money • • • • __ 


I am satisfied with my current level of independence ... . • • • • 

00




. E 

"7 . nor dissatisfied 

j 

Very 



. • a•.• • • • 


2. How likely would you be to recommend a consumer directed noruniikeiy "nifteiy 

support program in your county to a friend in a similar situation? .. Q • • • Q Q Q 



Exp tetions 

f 

Expec 

f ations 

services department? Q Q f~J Q q q — 

Expectations 


supports? YT\P_CY\M ~> ^ 9 (^t- ~-F° ^ . . R L C ,^T-VK- ~~X~V ^ peh efe^^- 

; A- 

0 

• .i—-TT-, O-'L t .01 M.NO 

ACT" 

R 

£X_VV\ (•,/; 





^ D E P E N D E I T ^ Mobility/Control/Privacy AGREE DISAGREE 



3. I have DRIVACV to be A INN A NR with NPNI 






"V ' 


• • • • 

• • • • 

• • • • 

• J • • • 

• • • • 

• • • • 

• • • a- • 

• • • •






Very 

satisfied 

T 

Very 

likely 

—rr 


. t i_ , . . Expectations 






nor unlikely 

Very 

dissatisfied 

Very 

unlikely 

• ••••• 

Met 

Expectations 

Failed 

Expectations 

• ••••• 

4. What is the one thing that lat would pave have the greatest impact on your satisfaction with cons consumer directed 

supports? 

6 « 



from the perspective of the person wjth a developmental disability. The person who has the 


^JêpendenCeJ Mobility/Control/Privacy Agree Disagree 


1. I can (even if someone helps me because of my disability) get ^ 

to where I want to go . Q Q MJ • Q 

2. I have control over my daily schedule Q C_ j^l Q Q 

3. I have privacy to be alone or with people I choose ...... af • • • • 

4. Only people who are supposed to'know my personal r~i N 

information have access to it........ 

_ • • • U 

5. I can set desired outcomes (goals) for myself M • • • U 

6. I can decide about how I spend my money 0 • • • • 

7. I can make decisions that will affect my future I__ Q Q Q JrV. 

'8. | am satisfied with my current level of independence j__ Q ^ ^ . 9






Very 

satisfied 



Very 

dissatisfied 

oafa • • • • • 

Very 

likely 


that were set for you by your case manaqer and county social Expectations— 



nor unlikely 

Very 

unlikely 

• • • • • • 

Met 

Failed 


• • m • • • • 


supports? 


please indicate how much you agree or disagree with each statement. Please complete these sections " 

from the perspective of the person with a developmental disability. The person who has the- \ :, 

developmental disability should be directly involved in completing this survey as much as possible. - 

Independence | Mobility/Control/Privacy AGREE DISAGREE 

_HE__HHHJ^HHHHHB_HJ Strongly Somewhat Neither Somewhat Strongly 


to where I want to go. • • a • 

2. I have control over my daily schedule • • a • 

3. I have privacy to be alone or with people I choose • • a a 

4. 

* • • 

5. 



I can set desired outcomes (goals) for myself • 

• 

• 

• 

• 

a 

a 

6. 

7. 

I can decide about how I spend my money .... 



• oar' • 

• • 

• 

• 

• 

• 

a 

• 

a 

CO

TLF^ , . . , 

."7 

satisuea satisfied 



V e r y 

dissatisfied 

dissatisfi 

RVEFT ALL THE CONSIDERATIONS, HOW SATISFIED ARE YOU WITH YOUR ~~T_~ I R— 

TLUMER DIRECTED SUPPORT PROGRAM? • • • • • • • 

. Very Neither likely Very 

LIKELY WOULD YOU BE TO RECOMMEND A CONSUMER DIRECTED 

nor unlikely N O R U K E L Y 

F 

unlike] 

SORT PROGRAM IN YOUR COUNTY TO A FRIEND IN A SIMILAR SITUATION? 

• ••••• 

IAS THE CONSUMER DIRECTED SUPPORT PROGRAM MET THE EXPECTATIONS Exceeded Met Faaed 

»_IAT WERE SET FOR YOU BY YOUR CASE MANAGER AND COUNTY SOCIAL Expectations Expectations Expectations 

PERVICES DEPARTMENT? . • • • • • • 

,0VHAT IS THE ONE THING THAT WOULD HAVE THE GREATEST IMPACT ON YOUR SATISFACTION WITH CONSUMER DIRECTED 

I SUPPORTS? ____ 

JSSSS?9 BEYOND CONSUMER DIRECTED SUPPORTS TO YOUR OVERALL QUALITY OF LIFE, ON THE FOLLOWJHG PIGESÛ: 

IP?®!? 

9 I N D 

'CATE HOW MUCH YOU AGREE OR^DISAGREE WIT'H R 

EACH STATEMENT. PLEASE BOMPLETE"THESELES^TS 

*J|ROM THEPERSPECTLVEJOFTHE^PERSON WTTHA DEVELOPMENT^ DISABILITY. THE PERSON WHO H A S ^ ^ I ^ 

DEVELOPMENTAL DISABILITY SHOULD BE'DIRECTTYTNVBLVES INCOMPLETING THIS SURVEY AS MUCH AS"POSSIBIE^ T;/ 


HFLHH_I_^_|_FLJ_fl~_H~M_J_H Strongly Somewhat Neither Somewhat Strongly Stron 

1. I CAN (EVEN IF SOMEONE HELPS M E BECAUSE OF MY DISABILITY) GET 

TO WHERE I WANT TO GO 

2. I HAVE CONTROL OVER M Y DAILY SCHEDULE 

3. I HAVE PRIVACY TO BE ALONE OR WITH PEOPLE I CHOOSE 

4. ONLY PEOPLE WHO ARE SUPPOSED TO KNOW MY PERSONAL 

5. 

6. 

INFORMATION HAVE ACCESS TO I T . . . . . . . . . . 

8. I AM SATISFIED WITH M Y CURRENT LEVEL OF INDEPENDENCE 

• • • • 

• • • • 

• L A • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • • •

Overall Satisfaction j 





Very 

satisfied 



Very 

dissatisfied 

• A • • • • • 

Very 

likely 


, . . . Expectations T 


nor unlikely 

Very 

unlikely 

A • • • • • • 

Met 

Expectations 

Failed 

Expectations 


services department? • ^ • • • • • 


supports? ^ / e y / ^ / V / Y T / - We. l/)c\L>e. t/eri/ M ?9 tfy* 

sner.Az sm&u be. VER^ hlFFE#£NT -fror* 

zither oê^* 


please indicate how much you agree or disagree with e^cjiitatement. Please complete these sections 




•M^^â^^|a^^^|^|^^^^^J Strongly Somewhat Neither Somewhat Strongly 



2. I have control over my daily schedule • • S I • • 

I have privacy to be alone or with people I choose • • S I • • 

CO 


information have access to it XJ • • • • 

5. I can set desired outcomes (goals) for myself • • • • • 



8. I am satisfied with my current level of independence GL • • •


7*7 

satisfied 



V A 

7 

dissatisfied 

1. Given all the considerations, how satisfied are you with your ' _/ ' f 

consumer directed support program? LJ ULI U LJ LJ LJ Q 


2. How likely would you be to recommend a consumer directed ^p, p o r 

l k e l y 

"^ 

support program in your county to a friend in a similar situation? .. |]J Q Q [] Q [] Q 


""^'y 

. , , _ | a * Expectations Expectations Expectations 

S 

2 5 

T— 

that were set for you by your case manager and county social ~n——7 E 

services department? • El • • • • • 


supports? -""fUg GULC^-Cvrr-






Very 

satisfied 

Very 

likely 





Very 

dissatisfied 

• • • • • • 


nor unlikelv 

Very 

unlikely 

a • • • • • • 

Met Failed 


services department? Qp • • • • • • 


supports? Jt HiiLî;' , -^)VL OK) u^toM pAtnAGjn . 

7. 

8. 

0' 

Thinking beyond consumer directedjupports to your overall quality of life, ontheJolJowing pages 

please indicate how much you agree "or disagree with each statement. Please complete these sections 

from the perspective of the person with a developmental disability. The personi whohas the l. ; 

developmental disability should be"directly involved in completing this survey as 7 

rhuch'tis*p^sl6le^f T 

::' 


^••^•^••••^•••^•H Strongly Somewhat Neither Somewhat Strongly 



2. I HAVE CONTROL OVER MY DAILY SCHEDULE. 

3. I HAVE DRIVACV TO BE ALONE OR WITH nem 




6. I can decide about how I spend my money .., 

• El • • • 

• • • • 

or • • • • 

El • • • • 

• < • 

• • 

• • • • 

• • • • 

• 4Sf • • •






Very 

satisfied 



Very 

dissatisfied 

a-a • • • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 

[_r5 • • • • • 

, . , . . • Expectations 

Met 

Expectations 

, 


Failed 

Expectations 

that were set for you by your case manager and county social ~ n ^ ^-r— 

services 

department? • • • • • 

X. What is the one thing th 

supports? 


please indicate how much you agree or disagree with each statement Please complete these sections 


developmental disability should bedirectly involved in completing this survey as much as possible. 



1. I can (even if someone helps me because of my disability) get J 

to where I want to go • oar • • • 


3. I have privacy to be alone or with people I choose.... ...... • • • • 


information have access to it... El Q [3 Gl Q 

5. I can set desired outcomes (goals) for myself • or • • • 

6. I can decide about how I spend my money Q Q^^Q Q Q 

7. I can make decisions that will affect my future.. ... 

8. I am satisfied with my current level of independence ... • ®r • • • 

T









Very 

satisfied 

Very 

likely 

Exceeded 

Expectations 

•7* 



Very 

dissatisfied 

Neither likely Very 

nor unlikely unlikely 

Met 

Expectations 

FaUed 

Expectations 

• ••••• 

. What is the one thing that would have the greatest impact on your satisfaction with consume/ direqted 

supports? -JJIFLM m N?) P 'FFI)/A/I < J/U>H*DFI}/








Very 

dissatisfied 

• • • • • • 


nor unlikely 

T 

Very 

unlikely 

fiu • • • • • 


E 

t e t i 

*pf °°s 

Expectations 


Failed 

Expectations 

services department? J 3 • • • • • • 

4. What is the one thingât would have the greatest impact on your satisfaction with cqnsumerdjrected 

supports? ( Jj\MYU\ h W y T " ~ 

Thinking beyond consumerîrecte^ ypuroverall quality of life, on the following pages" - 

please indicate how much you agreeTor 'disagree with each statement Please compiete these sections 

from the perspective of th^geng^th'a^dÎopmental disability. The person who has the^ 

developmental disability should be ftirecflylnvoivffi incompleting this survey as much as'pbsslbieT*^-- 

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

Independence | Mobility/ Control / Privacy Agree Disagree 




I have control over my daily schedule. 







I am satisfied with my current level of INDEPENDENCE 

• a • • 

• • • • 

• • a • 

• • • • 

• a • • 

• • • a 

• • a a 

a • • •






Very 

satisfied 

1 



Very 

dissatisfied 

• • • • r 

• 

Very 

likely 

1 


Expectations 


nor unlikely 

T 

Very 

unlikely 

r 

• • • • • 

Met 

Failed 





supports? , 

Thinking beyond consumer directed^suppprts toybuî>yerall quality, of life, on the followjn^^^pî ^ 

please indicate howmuch you agreeôr "disagree wjth each statement; Please completetheWsejctjpns 

from the perspective of the person with a deyejopmental disability. The person who has^the^; 

developmental disability should be directly involved in completing this survey as much as possfifeî K 




to where I want to go • • • 53 • 

2. I have control over my daily schedule Q Q T^l Q Q 

3. I have privacy to be alone or with people I choose Q Q ])__| [__l CJ 


information have access to it • y • • • 

5. I can set desired outcomes (goals) for myself • h • • • 

6. I can decide about how I spend my money Q Q Q Q 


8. I am satisfied with my current level of independence C__ Q ^ ^


V e r y 

satisfied 


V e r 

y 

dissatisfied 



a^6 • • • • • 


2. How likely would you be to recommend a consumer directed -^r^ " or lkely unt kely 

"f 'l support program in your county to a friend in a similar situation? .. Q[ [] Q [] [] Q Q 


. . . . , . . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social \ , ^ 

services department? Q • Q Q Q Q 


supports? _ _ _ _ _ _ _ _ _ - i 

KXtWn \oV






Very 

satisfied 



Very 

dissatisfied 

Ef • • • • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 


Met 



services department? • Q • Q^Q • • 

Failed 

Expectations 


supports? V






Very 

satisfied 



Very 

dissatisfied 


Met 



services department? • (__f • • • • • 

Very 

likely 

T 


nor unlikely 

T 

Very 

unlikely 

T 

Failed 

Expectations 


supports? k\, f 

h\L-MKu& -P/NrVr4ce , STA-f-P < f>4 C^-_ /V^'-A 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages^ 

please indicate how much you agre¥~6r disagree with each statement. Please complete theselsectiohs 









6. I can decide about how I spend my money .. 


8. I am satisfied with mv current level of indeDen 


J si • • • 

or • • • • 

• • • • • 

or • • • • 

• • • • 

• • • • 

• • • • 

• • • •


V e r 

y 

satisfied 


s 

V e r y 

dissatisfied 

sausueu y uiaaauan 

1. Given all the considerations, how satisfied are you with your ' ^/' ' ' 

consumer directed support program? LJ LJ LJ LI LJ LJ LJ 


2. How likely would you be to recommend a consumer directed iikefy n»r«niiMy uniikeiy_ 

support program in your county to a friend in a similar situation? . . _ _\ Q Q Q Q Q 


. . . . , , . . . , Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n i / ^ — 

services department? • • • 13 • • • 


supports? -i 

Thinking beyond consumer directed supports tayourôveralI quality of life, on the following pages^ 

please indicate how much you agree or disagree wijfêach statement. Please complete thesesections 

from the perspective of the person with a developmental disability. The person who has the" 

developmental disability should be directly irivolveUihcbmpleting this survey as much as possible. : 

Independence | Mobility /Control /Privacy Agree Disagree 



to where I want to go • • • a 

2. I have control over my daily schedule • • a-" • • 

3. I have privacy to be alone or with people I choose • • $y • • 

4. 

5. 




• 

• 

• • • 

• 

7. 



• 

• 

• 

• 

a" • • 

a • • 

8. I am satisfied with my current level of independence • • a • • 

CD


V e r 

y nor dissatisfied v 

satisfied 

«* 

dissatisfied 


consumer directed support program? LJ Cj IM' LJ LJ U LJ 


2. How likely would you be to recommend a consumer directed ^- ^ "°nin«iy uniikeiy_ 

support program in your county to a friend in a similar situation? . . LJ^j3 D Q Q Q Q 



Exp 

f tatlons E x p e c a t i o n s 

i 

Expectations 

services department? • Q JJJ Q • Q Q 

4. What is the one thing that would have the greatest irppact on your satisfaction with consumer directed 

supports? |A0'^ ~"T~ /, £JL 7%- ja-QcK p-f /gilâ cJgH To 

h^l^r -hA**\ v/WA -^hthil. v 4,Uo lifo 4hji 

ftdr ^ _ 

Thinking beyond consumer directedjsupports to your overall quality, of life, on the following pages « 

please indicate how muchi you agreelohdisagree with each statement. Please completetheseêctions 

from the perspective of the person with a developmental disability. The person who'has*the : 



•••^•••^^^••^^^^•••l Strongly Somewhat Neither Somewhat Strongly 



2. I have control over mv dailv schedule .Cv>?\ S'tV ^7.^ 

3. I have privacy to be alone or with people I choose • • Q • 


6. 

7. 

8. 

• • • • 

• • • • 

• • • • 

• • • 

• • • • 

• • • • 

• • • • 

• • • •






Very 

satisfied 

1 



Very 

dissatisfied 

• f_j • • • • • 

Very 

likely 

T 


nor unlikely 

T 

Very 

unlikely 

• 0 • • • • • 



Ex 

T* at 

' 0 

" s 

— rservices 

department? • £i • W| • • • 

Met 

Failed 



supports? tvn\\\u ViPYnri (UoV -to . nu\p,AgcVtyS of-rur 

CVMVifi \)\^vs TyvJri, ÂDDiumnh, DoJXi -tivrand 


please indicate how much you agree or disagree with each stafenfpnt. f 

Please complete these sections 

from the perspective oUhe person with a developmental disability. The person who has the 

developmental disability should bedirectiy involved in completing this survey as muchaspossible. 

Independence I Mobility/Control/Privacy A G R E E 

^m^^mi^^GL Strongly Som 









DISAGREE 


a • • • 

• a • • 

a • • • 

• 

• • 

• • 

• 

• 

• 

a • • • 

a 

a 

• 

• 

TV 

• 

• 

• 

• 

R









Very 

satisfied 



dissatisfied 

T 

Q • • • • • • 

Very 

likely 

Exceeded 

Expectations 


nor unlikely 

Very 

unlikely 

Met Failed 


a • • • • • • 

4. What is the one thing that would have the greatest impact on your satisfaction with consurner directed 

supports? 

7. 

—dY-pUi^ a \ - , A \ ^ L -U> r A o J - f*u-e.\r^ rv r\£-t,Nrw. 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages _... 

please indicate how much you agree or disagree with each steFementr Please complete thesejsections 

from the perspective of the person with a developmental disability. The person who has th^ 

developmental disabilityshould be directly involved in competing this survey as much a^pc^sjblelS&i 

Independence 1 Mobility /Control /Privacy Agree Disagree 

•___H____________________| Strongly Somewhat Neither Somewhat Strongly 









• • • • 

a a j a a 

• • a • • 

• • • • 

• • • • 

• • • 

a • • • 

• • • •








Very 

satisfied 



Very 

dissatisfied 

• • El • • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 

• • El • • • • 

Exceeded 

Expectations 

Met 

Expectations 

Failed 

Expectations 

services department? Q Q 13 Q Q Q Q 

What is the one thing that would have thagreatest impact on ypuc satisfaction with consumer directed 

supports? 

fl\JfS Ofl/n c^MAAr^ MM cy>d>XJ f_-vTT 

_22_^__ 

Thinking beyond consumer directedjsupports to your overall quality of life, on the following pages .. . 

please indicate how much you agree o£o*isagre^ Please complete th§se sections 


developmental disability should be directly involved incompleting this survey as much as possible. ~ 

5. 

6. 

7. 

8. 

Independence I Mobility /Control /Privacy Agree Disagree 

^___I^^^^^^^^^__I_^J Strongly Somewhat Neither Somewhat Strongly 





• • • • 

• • is • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• si • • •









Very 

satisfied 



Very 

dissatisfied 

• ^ • • • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 

ft Q • Q • Q • 



• qi • • • • • 


supports? 

(-lexib)hK/ . bark ohsabtecj 

O ^ q n C YYJLAS. 'T^s-b-ir-ho^ o o s e r v i c e s ' 

_ _i i _ i i \ZT V I " L L T 

""hinking beyond consumer^directed supports to your overall quality of life, on the following pages 

...ase indicate how much'you agree or disagree witffeach statement Please complete these sections 


developmental disa^biliVshouidbe^directly involved incompleting this survey as much as possible. 

Independence I Mobility/ Control / Privacy Agree Disagree 

WKKUK^KKKKKKKKKKIK^^——\ Strongly Somewhat Neither Somewhat Strongly 




3. I have privacy to be alone or with DeoDle I choose 




6. I can decide about how I spend my money , 


8. I am satisfied with my current level of independence Q 

• • • • 

• a • • 

• • • • 

• a • a 

• • ® • a 

• • _ • • 

• • j • • 

• • • •






Very 

satisfied 



Very 

dissatisfied 

0 • • • • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 

a • • • • • • 



Exp 

f tations 

services department? [Q • • • • • • 

Met Failed 


4. What is the one thing that would have the greatest impact on your satisfaction with consumer, directed 

supports? 

Thinkjng beyond consumer directed supports to youVoâl quality of life, on the following pages . 

please indicate how much you agree or disagree witfeacrTstatement. Please complete thesesections 


developmental disability should be directly involved ih'cpmpTeting this survey as much as possible! 

Independence | Mobility /Control /Privacy Agree Disagree 






information have access to it...... 




8. I am satisfied with mv current level of inrtanprv 

m • • • • 

• • • a 

_ • • • • 

• • a • 

Q • • • • 

• a • a 

• • • a 

m • a • •






V e r y 

satisfied 



V e l 

T 

dissatisfied 

Very 

likely 




nor unlikely 

T 

Very 

unlikely 

Met 

Failed 


services department? UtKQ • • • • • 

4. What is the one thing ng thaf-would th have the greatest-impact on your satisfaction with consumer directed 

supports? 

5. 

6. 

7. 

8. 

Thinking beyond consumer directecf supports to ^&WSSnl\Quality of life, on the following pages" 

please indicate how much youfaglôri'aisagree'wlSlêaS^btement. Please completethese^sections 

from tire perspective of the person with a developmental disability. The person who has the 

developmental disability should be directly involved in^mpeting this survey as much asl^stoief'VSf 



1. I can (even if someone hejps me because^ my disability) get 

to where I want to go.. t^lWU. .^V f .XfclUfe . WMVS 

2. I have control over i 

3. I have privacy to be alone or with people I choose _\ 



• • • • 

• • • • 

• • • • 

da • • • • 

• • • • 

• • • • 

• • • • 

• • • •

Overall Satisfaction _ 




1. Given all the considerations, how satisfied are you with your ' ^ ' ' 

consumer directed support program? — y@ '—I LJ LJ U LJ 

y*i Very Neither likely Very 


Thinking beyond consumer^djrected^supports tqyour overajl quality of life, on the following pages 

please indicate how" much you^ree'ordisagree with each statement. Please complete thes^sections 


developmental disability should pe directly involved in completing this survey as much as possible. 


f • Strongly Somewhat Neither Somewhat Strongly 

I can (even if someone helps me because of my disability) get m 

to where I want to go ?. • 5} • • • 


• • • • 

3. I have privacy to be alone or,with people I choose _ Q Q Q 

v 

4. Only people who areûpposed to know my personal 

information have access to it. Q Q JQ Q Q 

5. I can set desired outcomes (goals) for myself Q CJ JQ Q Q 

6. I can decide about how I spend my money Q Q XlJ Q Q 

7. I can make decisions that will affect my future F_ Q Ij ~\ ~\ 

8. I am satisfied with my current level of independence _\ _\ _\ _\ 

V e r y 

noru 

f' kely 

support program in your county to a friend in a similar situation? . . j^Q Q [] Q Q Q 


, i , . , . . . , Expectations Expectations Expectations 

that were set for,you by your case manager and county social ~n—— ^-i ^ 

services department? • IB • • • • • 

4. What is the one tiling that would have the greatest impacôn your satisfaction with consumer directed 

supports? 

V e r 

y

^vlrall Satisfaction 





Very 

satisfied 



Very 

dissatisfied 

E K F _ • • • • • 

Very 

likely 

T 


nor unlikely 

T 

Very 

unlikely 

T 

Q T J • • • • • 

3 Has the consumer directed support program met the expectations Met 

Failed 

E » * « J « I 


, , • . . . Expectations 

3 S E T IOR Y U U U Y Y U U I O A S E M C U I C I Y E I E M U U U U I U Y S U U I A I • • • 


services department? G _ M • • • • • 


supports? ' 

X,- 

(A H 

H • / Q 

P"hinking beyond consumer directed supports to your overall quality of life, on the following pages 


Jrom the perspective of the person with a developmental disability. The person who has the 


JNDGPEHDGNCE I Mobility / Control / Privacy A G R E E DISAGREE 

1; I can (even if someone helps me because of my disability) get 


2.' I have control over my daily schedule 

J R - . 

%. ° 

5. 

6. 

1 n a v e 

n | 

P 

r i v a c 

y 

t 0 b e 

alone or with people I choose. 

y people who are supposed to know my personal 

J 

.-4 P 


• • A 

• • • 

• • A 

• • 

I _ R 

• 

" • • 

• • 

• 

• 

• 

• 

• 

• 

• • 

• • 

• 

• 

• 

• 

• 

• 

A






Very 

satisfied 



( • • • • • • • 

Very 

likely 


, . , , . . . . Expectations 


nor unlikely 

1 

Very 

dissatisfied 

1 

Very 

unlikely 

1 

A • • • • • • 

Met 

Expectations 

Failed 

Expectations 

T 




supports? _. 


I III L L 111 IWLL IIMIHL J IIIHL || LLLLLLLLLLLLJAILJMJJLILLLLI Very Neither satisfied 

satis4, nor dissatisfied 

v-iivcn an me uunsiueranons, now satisned are you with your ' .~~ZT—i— 

1. consumer Given all the directed considerations, support program? how satisfied are you with your 

/ 

LJ LJ LJ LI LI Lj Q 


2. How likely would you be to recommend a consumer directed ^p. POru 

f kcIy 

support program in your county to a friend in a similar situation? .. ^ LJ Q LJ LJ LJ LJ 

3. Has the consumer directed support program met the expectations Exceeded Met F«ued 

„. ... „ _ . , . , . . , Expectations Expectations Expectations 

that were set for you by your case manager and county social V^-, ^ 

services department? / L J • LJ LJ LJ LJ LJ 

4. What is the one thing that wduld have the greatest impact on your satisfaction with consumer directed 

SUPPORTS? J)h*\ i--R&d*>Hv8F? ÛÎAL^J S)L^1 -RLL^F- ^j^^L—I - ^ ^ ^ 

o f o n t h e 

Thinking beyond consumer directed supports to^tpvej^!J^!^ # ^ _ _ _ _ _ & ^ 

please indicate how much you agree or disagree with each statement. Please complete.!^g«gg£ 

from the perspective of the person with a developmentaldisability. The person wnoi 

developmental disability shouldije directly involved in completing this survey as much.aspossgie^^,^ 

J Independence Mobility / Control / Privacy 

AGREE 

DISAGREE 







can decide about how I spend my money ... 

can make decisions that will affect my future. 


T A 


a • • a 

• • JHP • a 

• • • a 

a • • • • 

• • • • 

• a • a 

• • a • 

a • • a 

 

I I R 7 /




>. How likely would you be to recommend a consumer directed 


Very 

satisfied 

1 



Very 

dissatisfied 

• • • • • 

Very 

likely 





nor unlikely 

Very 

unlikely 

• UJZLQ • • • 

Expectations 

Met 

Expectations 

Failed 

Expectations 

• • • • M Q • 


supports? 

Thinking beyond consumer directed supports to your overall quality of life,-on.theJpjlcwjng^^ês^f 

please indicate how much you -a^reeôr clisagreewitri each statement. Pleasei TOmpiete^h^seisections 

from the perspective of the person with a developmental disability. The person who hasShe ? 


Independence J Mobility/Control/Privacy Agree Disagree 

m H J ^ H I H i l H H Strongly Somewhat Neither Somewhat Strongly 









• • • • 

• • • A 

• • • • • 

• • • A 

• • • • 

• • A A 

• • • A 

• • 3^ A A





V e r 

y 

satisfied 



V e , 

T 

dissatisfied 

• E ^ A • • • • 


likely nor unlikely 

nomniikeiy 

unlikeli 

unukeiy 

H1 

f y 

' I -7 I I 

support program in your county to a friend in a similar situation? . . Q |7^f • • Q Q Q 

3. Has the consumer directed support program met the expectations Exceeded Met FAUED 

that were set for you by your case manager and county social Expectations E ^ a - , Expe_tations 

services department? Q Q SfQ Q Q Q 


supports? £GRYC^^F-^R- /U^JB^^J^-^ —F-K*. 

:upports? Crryc^^-^R- M^-JU^^JJ^R^^..^ T-J^, —/-4^ - ^ H * ^ 

_ 

gÛG /\JL0-$ Û*JR ~7V/U. ^ST^ ^ W - ^ 


please indicate how much you agree or disagree with each statement. Please complete theseêctions 

from the perspective of the person with a developmental disability. The person who has the. 



_____B____________H______| Strongly Somewhat Neither Somewhat Strongly 



AR • • • • 

2. I have control over my daily schedule.... 


• 

• 

• 

AR 

A 

• • 

• 

• 

CO 

4. 

5. 


information have access to it... . 

I can set desired outcomes (goals) for myself.. 

• 

• 

• 

• 

A 

• 

• 

• 

6. 

7. 

8. 



I am satisfied with my current level of independence . . 

A 

A 

• 

A " • 

• 

• 

A 

• 

A 

• 

• 

•






Very 

satisfied 



Very 

dissatisfied 

A • • • • • • 

Very 

likely 





nor unlikely 

T 

Very 

unlikely 

A • • • • • • 

Expectations 

Met 

Expectations 

1 

Failed 

Expectations 

^ Q Q • Q Q Q 


supports? 4^/1 M>IN^ I o4.IT,W I 

Thinking beyond consumer directed supports to your overall quality of life, on the foljowing pages 





_____________________________ Strongly Somewhat Neither Somewhat Strongly 


to where I want to go • • A • 

2. • • A • 

CO 

I have privacy to be alone or with people I choose • • • A 


• • • • 

5. A • • • 

CD 

A • • A 

7. _I A A A • 

8. I am satisfied with my current level of independence . • SI • A A






Very 

satisfied 

—I 



Very 

dissatisfied 

p - Q Q Q Q Q Q 

Very 

likely 




nor unlikely 

T 

1 

Very 

unlikely 

r 

&\ • • • • • • 

Met Failed 


services department? • Ijl Q Q Q Q Q 


supports? D/^ IMSMAXV v*. .h









Very 

satisfied 



Very 

dissatisfied 

1 

• ^ • • • • • 

Very 

likely 


nor unlikely 

T 

Very 

unlikely 

r 

•^S • • • • • 



• • • (_£• • • 

What is the one thing that lat would have havettie the greatest i impact on your satisfaction with consumer directed 

supports? 

\on\s>\ a^5Â-/^4f0ir^T^Trx-, ^ o^rM-a tapper; j , ^ I 

Thinking beyond consumer directed supports to your overall quality of life, on thes foJIo^hgâgesT 

please indicate how much you agree or disagree with each statement. Please complele trieseêctions 

from the perspective of the person with a developmental disability. The person who has the, 

developmental disability should be directly involved in completing this survey as much as posspter " 

Independence I Mobility/Control/Privacy 


2. 

3. 

4. 

5. 

6. 

7. 

8. 

have control over my daily schedule tCcd 



I can set desired outcomes (goals) for myself.. ^fi0.^j(KKn c 

I can decide about how I spend my money . . .feo 

I can make decisions that will affect my future, •fe*) .Sj/M>v^ 

I am satisfied with my current level of independence ... ...... • 

{Yx& 

^^tq gree Disagree 


• • • • 

• • • • 

• • • • 

a 

• a 

• • 

• 

• 

• 

• 

• 

a 

• 

• J-i 

a 

a • 

• a 

• •






Very 

satisfied 

Very 

likely 

1 



Very 

dissatisfied 

• • • • • • 


nor unlikely 

Very 

unlikely 

1 

• • • • • • 


Met 



services department? • • SI • • • • 

Failed 

Expectations 

T 

\. What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? ^j'T^Ff i" Afo^ stt . "Jury* QY-e-r 

Thinking beyond consumer directed jsupports to your overall quality of life, on the following pages~: 

please indicate how much you agree or disagree with eacffstatement. Please complete these sections * 

from the perspective of the person with a developmental disability. The person whoH@heJ;"" FS^ 

developmental disability should be directly involved in completing this survey as much as possible. _ 


* *" Strongly Somewhat Neither Somewhat Strongly 


to where I want to go • A • • 

2. I have control over my daily schedule • A A • 

3. I have privacy to be alone or with people I choose. • • • • 




6. I can decide about how I spend my money A ® • • A 


8. I am satisfied with my current level of independence • • • A






7*7 J 

satisfied 



V e r 

y 

dissatisfied 

• A • • • • • 

Very 

likely 

—I 

E x c e 

3. Has the consumer directed support program met the expectations r, 



nor unlikely 

1 

Very 

unlikely 

T 

• Q • • • • • 

e d 

^ 

Met Failed 


services department? • A • • • • • 


supports? /t/M.Mp0A/JWlL; JAM ad/iMU/ifAjrfhierftoe 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages^. 

please indicate how much you agreeor disagree with each statement. Please complete th^sesections 


developmental disability should be directly involved in completing this survey as much as~pbssible. 

Independence I Mobility/Control/Privacy AGRE DISAGRE 

g g ^ g ^ n a n J Strongly Somewhat Neither Somewhat Strongly 


to where I want to go • J • • • 

2. I have control over my daily schedule • _ • • • 

I have privacy to be alone or with people I choose • _ • • • 

CO 


information have access to it • _ • • • 


6. I can decide about how I spend my money • • • _ • 

7. I can make decisions that will affect my future • • • _ • 

8. I am satisfied with my current level of independence • _ • • •

Overall Satisfaction 1 

V e r y 



V e r y 


1. Given all the considerations, how satisfied are you with your t • : ^ • 1 • r 

consumer directed support program? "—I LJ LJ LJ LJ LJ 


2. How likely would you be to recommend a consumer directed " or 

"f' lt£ly 

" nl 

f e 

' y 

support program in your county to a friend in a similar situation? .. ^ [][][] Q Q [] 


. . . . - . . . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~N / i ^ 

services department? .. -Jjt$T. . ^fV7.-. y*$. . FFFUS . y«2/T. • • M • • • • 


supports? -7_> &F/OK? RFUFPPRFS FLED VSSORRY 77l*?. 

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Very 

satisfied 

Very 

likely 



Very 

dissatisfied 

• • • • • • 


nor unlikely 

Very 

unlikely 

A • • • • • • 

Exceeded 

Expectations 

Met 

Expectations 

FaUed 

Expectations 

• A • • • • • 

\. What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? 

CJ~-SLa Q R X W a Cjv^^Z 

si 1 

Thinking beyond consumer directed supports to your overall quality of life, on the following râges . 


from the perspective of the person with a developmental disability. The person who haijhe^. ^ 

developmental disability should bVdirectiy'involved in completing this survey as much as possible. 

Independence I Mobility / Control / Privacy AGREE DISAGREE 

• ^ • • • ^ • ^ • ^ • ^ • ^ • ^ • ^ • ^ J Strongly Somewhat Neither Somewhat Strongly 


to where I want to go ZR • • • • 


I have privacy to be alone or with people I choose • 

• • 

• 

• 

• 

• 

• 

CO 






00 

I am satisfied with my current level of independence • EF • •









Very 

satisfied 



Very 

dissatisfied 

• 13 • • • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 

JAQ • • • • • 



• • u m • • • 


supports? prrvyii^ iW/^Y JP)r RV ^T-FRCVYDL SU PFE>RR je.'. Spec-taJ, 

7. 

18. 


please indicate how much you agree or disagree with each statement. Please complete the'se^ctioris 

from the perspective of the person with a developmental disability. The person who has the ~ I, 

developmental disability should be directly involved in completing this survey as much as possible." 











• • • • 

• • • • 

• • • • 

• • • • 

• • J • • 

• • • • 

• • • • 

• • • •

Overall Satisfaction J Neither satisfied 

. e 

"7 nor dissatisfied Very 


1. Given all the considerations, how satisfied are you with your ' ' 

consumer directed support program? ûa. LI U U LJ LI LJ 


2. How likely would you be to recommend a consumer directed p noru 

f kely 

support program in your county to a friend in a similar situation? .. Q Q Q • Q Q 


that were set for you by your case manager and county social Expectations Expectations __p_s 

services department? • Ml • • • • • 


rhinkina bevond 

Thinking beyond consumer directed supports to your overall quality of life, on the following pagest 

please indicate how much you agree or disagree with each statement PleWe^mptetTt^ 

from the perspective of the person with a developmental disability. The person who fflsWS 

developmental disability should be directlylnvdlved in completing this siifvey as much aVposSef~ 

jn^P^denC^ Mobility/Control/Privacy 


to where I want to qo 

2. I have control over my daily schedule... 



information have access to it...... 




8. I am satisfied with my current level of independence _\ 

Agree 


Disagree 


• ( A • • A 

•

Ôver-all Satisfaction 


* consumer directed support program? 



3 Has the consumer directed support program met the expectations 



E 

Very 

satisfied 



Very 

dissatisfied 

1 

• • ^ • • • • 

Very 

likely 


nor unlikely 

E 

Met 

*^£ 


Very 

unlikely 

r 

Failed 

Expectations 

• • • • • • • 


supports? TJNDIHJ FC-A SCRINCEJSR 

Thinking beyond consumer directed[supports to your overall quality of life, on the tofe^jn^Êli^ 3 

-^ 

please indicate how much you agree or "disagree with each statement. Please'complete theseisections 

from the perspective of the person witha developmental disability. The person WHOTE^^'F:developmental 

disability should be" directly involved in completing this survey as much as possjbte^ -_- 

I Independence Mobility / Control / Privacy Agree Disagree 

I Qtrnnoiv Snmpwhat Neither Somewhat Stron 


• _ • • • 

a 2. • • • 

CO 



• _ • • a 

5. • • • • 

6. • • • • • 

7. I can make decisions that will affect my future • a • • 

CO 

f WJf-.ki-. - ... 



^ er 

y 

satisfied 

nor dissatisfied .. . 

dissatisfied 



i 

0 • • 

1 

• • • 

r 

• 



likely 

—rnor 

unlikely 

1 

unlikely 

-t— 

support program in your county to a friend in a similar situation? .. ^| Q [_ [] Q [] Q 


. . . . , . . . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~T ^ ^ 



supports? frf A-W Q\-\u\Li^ 4o , CX ^ 0 

^ ^T. -W> CV.P^LUW 

r\\ CCE \Q ^ ^ , ^ni^,c\n Ui) -Wij^rc^ CH o_t\v»^X

Overall Satisfaction"! 





Very 

satisfied 



j 

Very 

dissatisfied 

• jtf • • • • • 



• Iftti • • • • 

Failed 


Expectations 

r r 

L . , . i c< . i . . Expectations Expectations Ex T 


that were set for you by your case manager and county social ~n v / ' 

services department? • Q i LJ LJ • 


supports? /VW^^^*>x^ 

Thinking beyond consur^rêcted supports to your overall quality of IH&onthe joltowmgj^ges 

please indicate how much you agree~or"disagree with each statement. Please complete thejesections 

from the perspective of the person with a[developmental disability., X h 

?7Bife°P ^feS^S^ 

developmental disabilityfshould be directlyjnvblved in completing this survey as much as Pj^sjble. 


: : ———I Strongly Somewhat Neither Somewhat Strongly 


3. I have privacy to be alone or with people I choose.. 




I am satisfied with my current level of indepen< 

• a a • 

• • • a • 

• • a a 

• a • 0 • 

a • a • 

• • a • 

• a • a 

• • a a 

•






Very 

satisfied 



Very 

dissatisfied 

• a • • • • • 

Very 

likely 


that were set for you I by your case manager and county social 


^Pf* 3 


nor unlikely 

Very 

unlikely 

• a • • • • • 

^ 

Met 

Expectations 

Failed 

Expectations 

T 

• a m • • • • 


supports? 

f ,V^> I •i C •< ».Q _____ 

J _ _ 

V 1 \ M 

Thinking beyond consumer directed supports to your overall quality of ilfe'on the following pages __ 

please indicate how much you agree or disagree with each statement; Please complete these sections 

from the perspective of the person with a developmental disability. /The person who hasthe 7 

'* : 

, 

developmental disability should be directly involved in completing this survey/as mucha^pp^bje}^ s? 


____________________________ Strongly Somewhat Neither Somewhat Strongly 







6. I Can rlPPiHo ahnilt hnw I cnonH mw mnnow 

8 


- I am satisfied with my current level of independence [__ 

fa • • a • 

• • • a a 

• a • a 

a • a a 

• • • • 

• • • • 

a • • • 

• • • a •






Very 

satisfied 

Very 

likely 

1— 


i • i Expectations 




Very 

dissatisfied 

T 

• • • • • • 


nor unlikely 

Very 

unlikely 

1 

• • • • • • 

Met 

Expectations 

Failed 

Expectations 



supports? 

U E T V 

Thinking beyond consumer directed supports to your overall quality.of life, on the followingpages ^ 

please indicate how much you agree'br disagree with each statement,. Please complete these sections 




^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ J Strongly Somewhat Neither Somewhat Strongly 


to where I want to go EL • • • • 


3. I have privacy to be alone or with people I choose • • • • _ 


information have access to it A • • • • 

5. I can set desired outcomes (goals) for myself .• A • • m 

6. I can decide about how I spend my money • A • A 

7. I can make decisions that will affect my future A A • A _ 

I am satisfied with my current level of independence . • • A A









. 


E 

"7 , nor dissatisfied Very 


• • EFA • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 

• • OTA • • • 



• ••••FAB 


supports? ^f///)A_,7 ^TJFJN 




developmental disability should be directly involved in completing this survey as much as possible. '• 




to where I want to go Q 

2. I have control over my daily schedule |~__} Q 

3. I have privacy to be alone or with people I choose Q Q. 


information have access to it f~~j/ l~"~J 

5. I can set desired outcomes (goals) for myself EL • 


7. I can make decisions that will affect my future Q i 


• • • 

• OAF • 

• • 

• • 

• • • 

• • • 

• • • 

• • •






Very 

satisfied 



Very 

dissatisfied 

• !_••••• 

Very 

likely 




nor unlikely 

Very 

unlikely 

• w • • • • • 

Met 

Failed 


services department? • A J A • • • • 

4. What is the one thing that would,have the greatest impact on your satisfaction with consumer directed 

supports? 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages^ , 





_ ~ _ ~ S t r o n g l y Somewhat Neither Somewhat Strongly 





4^ Only people who are supposed to know my personal 





_ • • • • 

• • • • 

• • • • 

_ • • • • 

• _ • • • 

• • • • 

_ • • • • 

• • • • •

Overall Satisfaction B 

» r 

V c r y 

satisfied 



V e r y 

dissatisfied 


consumer directed support program? LI LI U LI LI 


o r u k e l y 

2. How likely would you be to recommend a consumer directed " ^ 

support program in your county to a friend in a similar situation? . . Q Q Q Q LI LI LI 


. . . . r _ i _ , , . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~T ^ — 

services department? • Q • • Q • • 


Supports? I v 

". fv . - -


. , , satisfied 



V e r y 

dissatisfied dissatisfi 

1. Given all the considerations, row satisfied are you with your 

1 

- 1 

r~ 

consumer directed support prozrar.? • Sf • • • • • 

2. How likely would you be to recornnend a consumer directed 

Thinking beyond^pnsurnes-dB^g^jpports to your overall quality of life, on the following pages *=_ 

please indicate how much jba ape or disagree with each statement^ Please complete these sections 

from the pejrsjecjh/e of ttepsssawfth a developmental disabili^^The person who has the £ 

developmentalLdjsabirrfy^tj^tejirectiy involved incompleting thts'survey as much ^possible.' f 

j Independence Ifcolfty/ control / Privacy Agree Disagree 

to where 1 want to cc —... 9 

2. 1 have control overrav_-W5-netf_le a 

CO 

1 have privacy to beataîrwfepeopie | choose a 



• • • • 

• 3 • • 

• • a 

4. Only people who ajssinccsattoicnow my personal 

information have accsssiDi—,, • • a a 

5. 1 can set desired o_rones ccass) for myself • • • • 

a a 6. 1 can decide about ht» raenr my money 

n • • 

7. 1 can make decisions tarmisfcz my future • • • • 

8. 1 am satisfied with rm-âresrfeae; of independence • a a J • 

M1 

f y 

noru 

" Ukel 

y unm~iy support program in your county r = friend in a similar situation? .. • • • • • • 


that were set for you by your cas rnanager and county social 

Exp 

f tations 


services department? Q Q ^ [] Q Q Q 

4. What is the one thing that »coc -a* the greatest impact on your satisfaction with consumer directed 

supports? r^,-M •

"Overall Satisfaction 





Very 

satisfied 

Very 

likely 



services 

department? _\ 




nor unlikely 

Very 

dissatisfied 

Very 

unlikely 

Met 

Failed 

JUS 

Expectations 

/ Expectations 

cApevmumis Expectations 

H2 • • • • • 


supports? 

ffhinking beyond consumer directed supports to your overall quality of life, on the following pages 

fplease indicate how much you agree or disagree with each statement. Please complete these sections 

|from the perspective of the person with a developmental disability. The person who has the 

^developmental disability should be directly involved in completing this survey as much as pdssible. 

jbZ* 1 

re 

Jndênde^p^J Mobility / Control / Privacy 



|(3. I have privacy to be alone or with people I choose. 

JL* 

n 

? 

l v 

e o , e w 

P P 

n 

o are supposed to know my personal 


5 

- I can set desired outcomes (goals) for myself. 

6 

- I can decide about how I spend my money ... 

c a n 

make decisions that will affect my future. 



• or • • • 

of • • • • 

or • • • • 

• • • • 

car • • • • 

• • • • 

• • • • 

• • • •


V e r 

y 

satisfied 


V e , 

T 

dissatisfied 

1. Given ali the considerations, how satisfied are you with your 



2. How likely would you be to recommend a consumer directed — nor 

"f' kely 

support program in your county to a friend in a similar situation? .. [] |j Q Q [) Q Q 


. . . . , , , . . i Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n — 

services department? • TSI • • • • • 


supports? 

— 

/ 



from the perspective of the person with a developmental disability. The person who has the - 

developmental disability should be directly involved incompleting this survey as much as possible. 7" 


__W_W__W_m___________\ Strongly Somewhat Neither Somewhat Strongly 


• • • • 

2. 

3. 

• M 

• 

• 

• 

• 

• 

• 

• 


i :—i r 

• • • • 



7. I can make decisions that will affect my future J Q • • • • 







Very 

satisfied 



Very 

dissatisfied 

• Q X I • • • • 

Very 

likely 



nor unlikely 

Very 

unlikely 

A L L • • • • • 

Expectations 

Met 

Expectations 

Failed 

Expectations 

that were set for you by your case manager and county social —T —7—• r~ 

services department? • _f_\ • • • • 


supports? 

LOSS 'X^^rCiiCsC 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages . = 




INDEPENDENCE I Mobility /Control /Privacy Agree Disagree 

WUKBBH—W^^NT&U—M^K—WLL Strongly Somewhat Neither Somewhat Strongly 

1. 1 can (even if someone helps me because of my disability) get 

to where 1 want to go • • • • 

2. 1 have control over my daily schedule • • • • 

3. 1 have privacy to be alone or with people 1 choose • • A A 



5. 1 can set desired outcomes (goals) for myself • • • • 

6. 1 can decide about how 1 spend my money . • • • • 

7. 

"1 

8. 

m 

1 can make decisions that will affect my future • A • or • 


Overall Satisfaction M 

services department? • 3 • • • • • 


supports? THE/IE 7 S TOO MiltTI PA/)£AWOAK ' 

|thinking beyond consumer directed supports to your overall quality of life, on the following pages 

;please indicate how much you agree or disagree with each statement. Please complete these sections 

ifrpm the perspective of the person with a developmental disability. The person who has the 

(developmental disability should be directly involved in completing this survey as much as possible. 

Independence | 

Mobility /Control /Privacy Agree Disagree 



to where I want to go ."..' 12 • • • • 

2. I have control over my daily schedule • • _ • • 

I have privacy to be alone or with people I choose.... • J • • • 


information have access to it ® • • • • 

5. I can set desired outcomes (goals) for myself • • _ • • 

CD 


V e r 

:!7, nor dissatisfied y 



r 1 1 

— 

consumer directed support program? Q C— Q — Q C_) Q 


2. How likely would you be to recommend a consumer directed noruniikeiy mJiMy 

support program in your county to a friend in a similar situation? .. Q 3 • Q Q Q Q 



Exp 

f tations 






HMWHFFTIyggawwW^TW-wfamtwarr-RFIITI JM/WFLBMFL Neither satisfied 

satisfied 

n o r 

dissatisfied 

Given all the considerations, how satisfied are you with your - T ^ -7—7 dissa 

f sr 

' ed 

consumer directed support program? Q Q Q J




have, ^/f&aAif 



Very 

satisfied 



Very 

dissatisfied 

a • • • • • • 

Very 

likely 

— I 


nor unlikely- 

Very 

unlikely 

1 

• • • • • • 


that were set for you by your case manager and county social ^T* 3110 

" 5 

services department? • Q • • • • 




supports? jjô^ sT/rfk uMds fNg^n U~h r\ S W>||,( ivi Ct (/ C-OUttTr&-5 LorfA 

«?, tfrnzhojpJ* fUrfJ" ac'tonWy c^rî O at i (U^c^lk/ FN *






^7 , 

satisfied 



V e r 

y 

dissatisfied 

• • m • • • • 



a gi 

• • • • • 




services department? • Q Q f__t _\ • • 


supports? 

• j 1 i '• 1 

&pft a^TM r {^r 


'please indicate how much you agreeor "disagree with each statement. Please complete these sections 



1. 

5. 

6. 

7. 


^^^B^BHHHHÎ^H^H^HHHI Strongly Somewhat Neither Somewhat Strongly 






*- information have access to it 



• • • • 

• • m • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • _x • •


1. Given ali the considerations, how satisfied are you with your 




Very 

satisfied 

1 

Very 

likelv 

3. Has the consumer directed support proqram met the expectations Exceeded 

., . , , , , . . Expectations 

7 



Very 

dissatisfied 

R 

• • • • • 


nor unlikely 

T 

Very 

unlikely 

R 

• • • • • 

Met 

Expectations 

Failed 

Expectations 

that were 3 set for you by your case manager and county social ~n V / < 

r 

" 



ê&S 

supports? / 

RTSR, C 

, 

^p2J iy3QxkL 

Thinking beyond consumer directed supports to your overall quality of lifeôrrthe following pages 

please indicate how much you agree or disagree with each statement. PleasVcomplete these(sections 


developmental disabilitylshbuld be directly involved in completing this surveyâs much as possible. 

Independence I Mobility/Control/Privacy AGREE DISAGREE 








5. I can set desired outcomes (goals) for mys< 


8. 

• 0 • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • • •

Overall Satisfaction • 

V e r 

y 



V e r 

y 


1. Given all the considerations, how satisfied are you with your R\Vn n R~l R~l R~i R~i 

consumer directed support program? LA LJ LJ LJ LI LJ LJ 


2. How likely would you be to recommend a consumer directed " oru 

f lkely 

support program in your county to a friend in a similar situation? .. QTLJ* Q Q Q Q Q 


. . . . r i . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ^ ^ 

services department? QT Q Q Q Q Q Q 


supports? C^rrv\ o X!AXP ^^t^) 

Thinking BEYOND CONSUMER DIRECTED SUPORTS TO YOUR OVERAL QUALITY of life, ON THE FOLOW 

PLEASE INDICATE HOW MUCH YOU AGRE OR DISAGRE "WITH EACH "STATEMENT. Please COMPLETE 

FROM THE PERSPECTIVE of the person with A developmental DISABILITY. The PERSON WHO HASLKE 

DEVELOPMENTAL DISABILITY SHOULD BE DIRECTLY INVOLVED IN COMPLETING THIS SURVEY as MUCH 


H^^BH^HL^HLLIHHI^^HRIL Strongly Somewhat Neither Somewhat Strongly 

1. 

2. 



•r I have control over my daily schedule.. • 

• 

• 

• 

• 

• 

• 


4. 

5. 


information have access to it... 


• 

• 

• 

• 

• 

• 

• 

• 

7. 



or 

• 

• • 

• 

• 

• 

• 

• 

CO 

CO 

I am satisfied with my current level of independence or • • • •


Very 

satisfied 

1. Given al the considerations, how satisfied are you with your 


Very 

likely 


support program in your county to a friend in a similar 

7 

situation? 



Very 

dissatisfied 

• J 2 F A • • • • 


nor unlikely 

T 

Very 

unlikely 

r 

ujd • • • • • 

Met 

Expectations 


FaUed 

Expectations 

that were set for you by your case manager and county social Expectations /—___ 

4. What services is department? the one thing that wpuldhave the greatest impact Q on J 2 your Q satisfaction Q Q Q with Q consum 

supports? f\j 

CM icmM 

7 ^ *v mi 1 

Thinking beyond consumer directed supports to your 6Wal(quality of life, A on the falowing'pari 

please indicate how much you agree or disagre with each statement. Please complete th 

from the perspective of the person with a developmental disability. The person who hasfte^-^ 

developmental disability should b1e*dlrectly involved ^completing this survey as mbchâ^possiB 

INDEPENDENCE | Mobility/Control/Privacy Agree 


•A 

Disagree 


1. I can (even if someone helps me because of my disability) get • • P 

2. to I have where control I want over to my go daily schedule • Q • _ • • 

3. have privacy to be alone or with people I choose _\ • /—^ • • 


4. information have access to it.. 

• yd • A A 

5. 

I can set desired outcomes (goals) for myself U • • • 

6. 

I can decide about how I spend my money Q • • A 

7. I can make decisions that wil afect my future • _ • A 

8. I am satisfied with my curent level of independence J—t^ • LJ* • •






Very 

satisfied 

—I 



Very 

dissatisfied 

1 

53 • • • • • • 

Very 

likely 




nor unlikely 

Very 

unlikely 

T 

Met Failed 


services department? • |v_| Q Q Q Q Q 


supports? 

Thinkingijeyond consumer directed supports tayoîroverajl quality of life, on the following pages 

please indicate how much you agree or disagree witêac^'statement. Please complete these sections 


developmental disability should be directly involved incompleting this survey as much as possible. 

l, n 

d®P®ndenCe I Mobility/ Control /Privacy Agree Disagree 

_________________________________ Strongly Somewhat Neither Somewhat Strongly 


to where I want to go • AR • • • 


CO 




5. I can set desired outcomes (goals) for myself . • • • • OR 


• • • • OR 

7. I can make decisions that will affect my future • • • • AR 

CO 

I am satisfied with my current level of independence • • • • OR



consumer directed, support program? 

2. How likely would you be'to recommend a consumer directed 

V e r y 


V e r 

nor dissatisfied . 

^ J 

# • • • • • • 




1 R 


* • 

• Q • • • • 


., . . , . . . . . 


Expectations 

~n—~~~ 

Expectations 

^ 

Expectatii 

services department? Q £2^-1 LI GL Q LI 


supports? - 

PoAihfs oy minor PhilAMm AhmllJ lit aMc fc> ~\ 


please indicate how mucrfyou agree or disagree with each statement. Please complete theseisections 

from the perspective oHhe person with a developmental disability. The person who hasJthe 

developmental disability Should be directly involved in completing this survey as much as possible? 

Independence I Mobility/Control/Privacy A G R E E DISAGREE 

^ • • • • • • • • • • • ^ ^ • • L Strongly Somewhat Neither Somewhat Strongly 



* • • • • 


CO 

• • • • 

• 





7. 



• 

• 

• 

• 

• 

• 

• 

• 

I am satisfied with my current level of independence • • • • 

CD 

CO






Very 

satisfied 



Very 

dissatisfied 

^ • • • • • • 

Very 

likely 




nor unlikely 

Very 

unlikely 

SI A A A A A A 

Expectations 

Met 

Expectations 

T 

FaUed 

Expectations 

services department? 0 0 • • • • • 


supports? 

PAPIER COORK } ®s> 

Thinking beyond consumer directed supports to your overall quality of life, on the foltowing pages 

please indicate how much you agree or disagree with each statement. Please "complete these sections 

from the perspective of the person with a developmental disability. The person who has^he; 

developmental disability should be^directiy involved in completing this survey as much as possible. 


___________________________ Strongly Somewhat Neither Somewhat Strongly 


to where I want to go ® • • • • 

CM 

CO 

I have control over my daily schedule • J • • • 

I have privacy to be alone or with people I choose • EL • • • 



5. I can set desired outcomes (goals) for myself • • • • • 


7. I can make decisions that will affect my future • • • J • 

8. I am satisfied with my current level of independence . • • • • •








Very 

satisfied 



Very 

dissatisfied 

n m • • • • • 

Very 

likely 

Exceeded 

Expectations 


nor unlikely 

Very 

unlikely 

• ••••• 

Met 

Expectations 

Failed 

Expectations 

services department? _ _ _ • • • • • • 

4. .What is the one thing 

supports? 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages s 



developmental disability stioufd be" directly involved incompleting this survey as much as possible. 

5. 

6. 

7. 

8. 

Independence | Mobility /Control /Privacy Agree Disagre 

____________________________ Strongly Somewhat Neither Somewhat Strongly 






• • • • 

• • • • 

• a • • • 

• m • • • 

• • • a 

• • a • 

• • • • • 

• • • •






Very 

satisfied 

Very 

likely 

—I 




nor unlikely 

Very 

dissatisfied 

Very 

unlikely 

1 

• • O • • • 

3. Has the consumer directed support program met the expectations ^ ce 

f^ 

Met 



services department? • Q • • Q • • 

Failed 

Expectations 


supports? 

Thinking beyond consumer directed supports to yqurôwBrall quality of life, on the following pages 

please indicate how much you agree or disagree Witê^cfrstatement. Please complete these sections 

from the perspective of the person with a developmental disability. The person who has the - - 


2. 

3. 

l nC 

tePg n 

denCe I Mobility 





7. I can make decisions that will affect my futi 

8. I am satisfied with mv current level of indeo 

/Control /Privacy Agree Disagree 


• • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • si • • 

• • • •






Very 

satisfied 



Very 

dissatisfied 

• • JIGRA • • • 

Very 

likely 


nor unlikely 

T 

Very 

unlikely 

R 

JP-T) • • • • • 



Exp 

f tations 

services department? • • • < S T • • • 

Met FaUed 



supports? QXqjP\


1. consumer Given al directed the considerations, support program? how satisfied are you with your 

likely would you be to recommend a consumer directed nomnukeiy 

support program in your county to a friend in a similar situation? .. Q Q Q 

that were the consumer set for you directed by support your case program manager met and the county expectations social ~T / i 

Exceeded 

4. services What is department? the one thing that would have the greatest • impact •/Q. on your • • satisfaction • • 

supports? 

w 

2. How 

3. Has 

V c r 

y 

satisfied 



V e r y 

dissatisfied 

j_£A • • • • • 


Met 

. . . . , , . . . . Expectations Expectations Expectations 

F,Jl, riaci INGVU^S T^X- pArll -few- pzsaak*^ 

{r^&r 

A.( 

-FCC?^ U






Very 

satisfied 



Very 

dissatisfied 

• • ta • • • • 

Very 

likely 



nor unlikely 

Met 

Expectations 

that were set for you by your case manager and county social Expectations ^ 

Very 

unlikely 

FaUed 

Expectations 

services department? • • L} • • • Q 

4. What is the one thing that WOULD HAVE the GREATEST IMPACT on YOUR SATISFACTION WITH CONSUMER DIRECTED 

SUPPORTS? -JZ-~T 1 y> / , ^^L^^^/£L-J!LZ ^ 

7 


please indicate how much you agree^pr disagree with each statement. Please complete these sections 



5. 

6. 

7. 

8. 


_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Strongly Somewhat Neither Somewhat Strongly 





• SI • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • 51 • • 

• • • • 

• • • •






Very 

satisfied 

Very 

likely 


Expectations 




nor unlikely 

Met 

Expectations 

Very 

dissatisfied 

Very 

unlikely 

Failed 

Expectations 


services department? SJ • • • • • • 

4. What is the one thing thiat would have the greatest impact on your satisfaction with consumer directed 

supports? if flr^rifo nhn m^nor tk






Very 

satisfied 

Very 

likely 



••••• 


nor unlikely 



E x p c t a t i o n s 

^ 

1 

Expectations 

Very 

dissatisfied 

Very 

unlikely 

1 

Failed 

Expectations 

services department? Q §2j Q Q Q Q Q 


supports? 

Il 



consumer directed support program? , 


."7 

satisfied 



V e r y 

dissatisfied 



T - 1 R 

support program in your county to a friend in a similar situation? .. |^ Q Q Q Q Q Q 

3. Has the consumer directed support program met the expectations EXCEEDED MET FAILED 

.. , , , . . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n——— "-i 

services department? • JSJ • • • • • 


supports? \OV\o^ niir rr^r.ci R P N G J L O S W-s A L I A A . H > R SlLT S C O 

suports Thinking beyond consumer directed to your overall quality of life, on the following pages" 

please indicate how much you agree or disagree with eacTiitetement Please complete these^sections 

from the perspective of the person with a developmental disability. The person who has the, |Lv 

developmental disability should be'directly involved in completingIhls survey as much aspossible. c 

* ^ 

Independence | Mobility /Control /Privacy A G R E E DISAGREE 


to where I want to go a 


a a • 

2. I have control over my daily schedule.... • • • • 

a a I have privacy to be alone or with people I choose • • 

CO 

T - 1 R 





7. I can make decisions that will affect my future • • a • 







Very 

satisfied 



Very 

dissatisfied 

& a • a • a • 

Very 

likely 




nor unlikely 

£)•••••• 

Very 

unlikely 

Met Failed 


T 

services department? ]gj Q Q • Q Q Q 

4. What is the one thing that would have the greatest impact on your satisfaction wittrconsumer directed 

supports? 

to ^t-c\irc?_ fW to IAJN\U/\Q T \ W 

~jy/-rvn 

î?y " ^top hvu) CTiQ npQj





V e r y 

V e r 

nor dissatisfied y 

satisfied 

• • oib • 

dissatisfied 

• • 


2. How likely would you be to recommend a consumer directed "^"f^ unU 

, kely 

support program in your county to a friend in a similar situation? .. [] Q Q [][][] 

3. Has the consumer directed support program met the expectations Exceeded Met , Failed 

that were set for you by your case manager and county social ^T 43 

" 0 

" 5 E x p e 

services department? • Q • QfQ Q Q 

^ / Expectation. 

4. What is the one thing thatwould^haye the greatest impact on your, satisfaction with consumer directed 

vvnai is ine one ming tnatwould have the greatest impact on your satisfaction with consumer dii 

supports? LerjKû^X^^, o io^Jly fi^^JLXj Jf%





Very 

satisfied 



Very 

dissatisfied 

g Q Q Q Q Q Q 

Very 

likely 


nor unlikely 

support program in your county to a friend in a similar situation? .. "gj [J [] [] G Q Q 



1 

Very 

unlikely 

Met 

Failed 


services department? £J • Q • Q • • 


supports? ( Urn A RKSU] BTSU& A^YW OMd nw (rjAllxi!^ ^'IXJUJ H> \rd6b 

Thinking beyond consumer directed supports to your overall quality of life, on the folowjngpagesj 

please indicate how much you agree or disagYl^ complete theseêctions 

from the perspective of the person wjth a developmental disability. The person who hasYhe 

developmental disability should be 7 

directly involved in^mpieting this survey as much as p^pfblel 

Independence | Mobility / Control / Privacy Agree Disagree 



2. I have control over my daily schedule.. .Tte UAOWP. 

3. I have privacy to be alone or with people I choosje--... 




6. I can decide about how I spend my money .TO •^j £ 

^^- 

7. I can make decisions that will affect my futureHw .Ljcu-i^ 

8. I am satisfied with my current level of independence ... 

• a • • 

• • • a 

• • • • • 

• • • a 

• • • • 

• 

• 

• 

• 

• 

• 

• 

• 

• a a • 

1






Very 

satisfied 

Very 

likely 

3. Has the consumer directed support program met the expectations Êxceeded 

Expectations 




nor unlikely 

Met 

Expectations 

Very 

dissatisfied 

Very 

unlikely 

Failed 

Expectations 




supports? 


please indicate how much you agree or disagree with each staTelmerit. Please complete these sections 

from the perspective of the person with a developmental disability. The person who hasthe _ 


Independence I Mobility/ Control /Privacy Agree Disagree 

M M ^ M M ^ G L Strongly Somewhat Neither Somewhat Strongly 








8. I am satisfied with mv current level of indeoen 

• • • A 

• • • • m 

• • • • 

• • • • 

• • • • 

A • • • 

• • A • OQ 

• • • •





V e r y 

satisfied 



V e r y 

dissatisfied 

• 



"i 1 r ' 

support program in your county to a friend in a similar situation? . . Q ^ Q G Q Q G 


, . , Expectations Expectations Expectations 

that were set for you by your case manager and county social ~^ ~T~ ^-I 

services department? • • • JSJ • • • 


supports? . _ 

OOF-*- WA.P A^VN CÂJ-CVÂL YJ^V^R^JK VKMJLCT JIG.. IJI DATR^'^CIRFSRIL- 

c • ^ c 

^^ 

Thinking BEYOND CONSUMER DIRECTED SUPPORTS TO YOUR OVERALL QUALITY OF LIFE, on THE FOLLOWINGPAGESIJM 

PLEASE INDICATE how MUCH YOU AGREEOR DISAGREE WITH EACH STATEMENT. Please COMPLETE THESASECTIONS 

FROM the PERSPECTIVE OF THE PERSON WITH A DEVELOPMENTAL DISABILITY. The PERSON WHO HÂS^THE'FF^. 

DEVELOPMENTAL DISABILIVSHDULDLBE DIRECTLY INVOLVED INCOMPLETING this SURVEY AS MUCH ASPOSSTOLE^ ^ - 


F__m______f____________________\ Strongly Somewhat Neither Somewhat Strongly 

1. I 

to where I want to go • • 0 • • 



• 

• 

• 

• 

• 

• 

• 

• ja 

CO 




CD 

I can decide about how I spend my money • • • • B 

7. I can make decisions that will affect my future • • • • M 

CD 

I am satisfied with my current level of independence • • • • OF






Very 

satisfied 





Very 

dissatisfied 

T 

• ••••£_• 


likely 

• • a 

nor unlikely 

• • • 

unlikely 

• 

1— 

1 

1 

Met 

Expectations 

Failed 

Expectations 

services department? • • • |£| • • • 

4. What is the one thing that would have the tneg greatest impact on your satisfaction with consumer directed 

supports? 

i ii ,» * . ,. « i J I 

I : : :—. . ^ . ^ . : 


please indicate how much you agree 6>"disagree"wftr|e^^^tement. Please complete these sections 


developmental disability should be directly involved in TOmpleting this survey as much as possible. 


••••••••••••••^•••••^••J Strongly Somewhat Neither Somewhat Strongly 





5. I can set desired outcomes (goals) for myse 


7. I can make decisions that will affect my futL 

8. I am satisfied with mv current level of indec 

• • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • • • .J 

• • • • 

• • • •








sen/ices 

Very 

satisfied 



Very 

dissatisfied 

• • • Q-Q • • 

Very 

likely 

Exceeded 

Expectations 

3 set for you by your case manager and county social ~n r 


nor unlikely 

Met 

Expectations 

j_ ^ 

Very 

unlikely 

Failed 

Expectations 

department? • • • • • 

4. What is the one thing that would have the greatest impact on your, satisfaction with consumer directed 

supports? m>









Very 

satisfied 

Very 

likely 

Exceeded 

Expectations 



Very 

dissatisfied 

• • • • • 


nor unlikely 

Very 

unlikely 

• • • • • 

Met Failed 


1 3 • • • • • • 

4; What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? 


please indicate how much you agree or disagree with eacl^stetemenVPTee^^cbmplete these sections 



I Independence Mobility / Control / Privacy Agree Disagree 

W m 

MM B 

MM m 

MM aa 

M~ u 

MWM— a 

M—m Strongly Somewhat Neither Somewhat Strongly 

1. I 


I have control over my daily schedule • • • • • 





6. I can decide about how I spend my money • • • • • tar 


8. I am satisfied with my current level of independence • • • • ;


V eT 

y nor dissatisfied Very 


Given all the considerations, how satisfied are you with your ' FA_ ' „ _ 

consumer directed support program? 1—1 LJ LJ LJ LJ LJ 



r 



• • • • • • 

Has the consumer directed support program met the expectations Exceeded Met Failed 

. . . , x , , i . I 


Expectations 

~n 

Expectations 

~r— 

Expectations 

E 

-i 

services department? ., Q CJ Q J3 Q Q Q 


supports? y-o / W / ? -^S£*&/ISK DRTD -PBN CJ- UI )^PH Q-Hw KIDS &N ^ S)P /y? O AJU^ 4-N> 

... •.-:.S:-I1S*EL£SI3:iiBEMaaS: 

Thinking beyond consumer directed supports to your overall quality of life, on the followjng pjges.£ \ 

please indicate how much you agree or disagree" with each statement. Please complete thesejsections j^J^g^:^ 

from the perspective of the person with a developmental disability. The person who 

developmental disability should be Erectly Involved in completing this survey as much as possible:;^ 

Independence I Mobility 


/Control /Privacy Agree Disagre 


to where I want to go LJ PTJF 

2. I have control over my daily schedule LJ • 

3. I have privacy to be alone or with people I choose LJ 


information have access to it Q Q| 

5. I can set desired outcomes (goals) for myself.... • jar 

6. I can decide about how I spend my money Qj 

7. I can make decisions that will affect my future Q| LJ 

8. I am satisfied with my current level of independence LJ 12 

• • • 

• a 

• • a 

• • 

• • a 

• • a 

• 

... •?



VERY 

SATISFIED 

NEITHER SATISFIED 

NOR DISSATISFIED 

VERY 

DISSATISFIED 

consumer directed support program? LI Q J2) LI LI LI LI 



3. Has the consumer directed support program met the expectations EXCEEDED 


VERY 

LIKELY 

1 

NEITHER LIKELY 

NOR UNLIKELY 

VERY 

UNLIKELY 

• TA • • • • • 

E x p c c t a t i o n s 

MET 

EXPECTATIONS 

FAILED 

EXPECTATIONS 

* j j . . — . — . ^ , i i^4 iûui kji ovyuiai i l I 

services department? LI Q Q 0 Q Q Q 

3 

( f y -f ^ ^. _ 5 U o l s ^ ry^s^ 0^ 

An 


supports? Ir^;^/ 

\~a Q>ERV- 

^'^K^VC^ O_ CL< 3- 

U>VV 

1*3 -F 

SO V 

K






Very 

satisfied 

T 



Very 

dissatisfied 

T 

• ^_ • • • • • 

Very 

likely 

—I 


nor unlikely 

1 

Very 

unlikely 

J A • • • • • • 


that were set for you by your case manager and county social EXPECTATIONS EXPECTATIONS 

1 

Failed 

Expectations 

services department? • • • ( 2 • • • 

4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed. 

supports? 

7 



from 1 he perspective of the person with a developmental disability. The person who has the 


Independence | Mobility/Control/Privacy . AGREE DISAGREE 

I^^HHHHIHHBMHHH____ Strongly Somewhat Neither Somewhat Strongly 


to where I want to go LM 









A • • • 

• • • • 

A • • • 

A • • • 

• • • • 

• • • 

• • • • 

• • • • 3





Very 

likely 

r 

Ne 

«ther satisfied 



nor unlikely 

support program in your county to a friend in a similar situation? .. ( uj 


Ex 

that were set for you by your case manager and county social T ations 

î*" 0 

1 

Very 

unlikely 

"* Expectations 

services department? • J3 • • • • • 

A. What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? ,_ ijjvJj^t/)MdÛo^ U) /)/>/*) /7 ~" ' > 

Thinking beyond consumer directed supports to your overall quality of lifeTon the following pages 

i please indicate how much you agree or disagree with each statement. Please complete these sections 

ufrom the perspective of the person with a developmental disability^ ^£perso1rt#ib has the IS 

' ^ e v e l j ^ 

' 'iO^gPSgl Mobility/Control/Privacy 

go. 


I have privacy to be alone or with people I choose... 




»• I can make decisions that will affect my future • 

^ ^ ^ ^ ^ 

| am satisfied with my current level of independence ... • a 

'->'• - 

• • • • 

Overall Satisfaction | 

HWMWW" D N^MMM_______________J| 





Very 

satisfied 

T 



Very 

dissatisfied 

T 

"gf • • • • • • 

Very 

likely 

T 


nor unlikely 

T 

Very 

unlikely 

T 

^ • • • • • I J Failed 

Expectations 


that were set for you by your case manager and county social Expectations—Expectations 

services department? • NK • • • • Q 


_T„O ' 

OWM { M M I^NIJIL R\7o ()R\±, 

on . Pw#") ID TIUDH U OWL JYUIPCMJ- 

A N fa/MI. - *J -tunes . M 

)nsum4r ( 

4 

Thinking beyond consum^ directed supports taypur overall quality of life.T on. the following patjes_ 

please indicate How much you "agree or disagree with each stetsm^l Please c^piete these sections 

2. 

3. 

disability7shouJd from the perspective of the person with a developmental disability "The person who has the 

developmental be^directly involved in completing W^survey as" much as possible. 

j Independence Mobility/Control/Privacy 

AGREE DISAGREE 






5. 

6. 

7. 

8. 





C 

• • • • 

• tar • • 

• • • • 

• • 

a to 

7 

4 

• • • 

• • • 

• ur • • • 

• tar • • • 

• • i§9






Very 

satisfied 



Very 

dissatisfied 

• • Kl • • • • 

Very 

likely 




nor unlikely 

Very 

unlikely 

Met Failed 


services department? • • • El • • • 

4. What is the one thing that would have the .greatest impact on your satisfaction with consumer directed 

supports? JZ QOansJd. flai/e //t&d Vft AOLV*. M?JT< Jfif^DT nâ.H&^ ^ 


please indicate how much you agree or disagree with each statement Please complete these sections 


developmentaldisability should be directly involved in completingthis survey as much ^"possible. 


^^BBBKtkWtkWkWklk^k^k^k^^kWA Strongly Somewhat Neither Somewhat Strongly 



c\i 

CO 



4. 

5. 




• • 

• 

• 

• • 

• 

El 

6. 

7. 




• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

CO








eT 

V C I 

J nor dissatisfied 7 



likely 

3 • • 


— I 

T 

• • • • ~r 

Exceeded 

Expectations 

Met 

Expectations 

Failed 

Expectations 

that were set for you by your case manager and county social , 

services department? • Q Q Q Q 


supports? OTorV, ^y-r.i'.Wftrv^ O n PnaQn* 

_L5L mors If 

Thinking beyond consumer directed supports to your overall quality of tifej on the following pages^ 

please indicate how much you agree ordisagre'e with each stajenientJ Please complete these^sectioris 

from the perspective of the person with a developmental disability .The person who has the~: - ~;-> 

developmental disability should be directly involved in completing this survey as much as possible, r 

Independence I Mobility 

/ Control / Privacy Agree Disagree 


1. 

or 




CO 

I have privacy to be alone or with people I choose. • • a • • 


information have access to it.. • • • • 


6. I can decide about how I spend my money • • • • • 

7. I can make decisions that will affect my future • • • 

8. I am satisfied with my current level of independence .. . •


e r y 

satisfied 



V e r 

y 

dissatisfied 

1. Given all the considerations, how satisfied are you with your i ' 7 1 ' r 

' 

consumer directed support program? LI I2Y LI LI LI LI 




i 7-1 r 

support program in your county to a friend in a similar situation? .. [ ] [ ] JGJ QL LJ LI Q 


. . . . , , . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n i , ^ 

services department? • • • Q F • • • 


supports? , 

— ~ ^ Z 

TT 

•} 

7~7 7=Z ' - , 


please indicate how'much you agree or disagree with each staffieht Please complete miaWseôris 

from the perspective of the person with a developmental disability. The person whof hasihe : : s3 

developmental disability should tje'directly involved in completing this!survey as muchas^p

Overall Satisfaction I 

m m m _ m _ _ — m m m _ _ m m _ m m _ m m m _ _ m m g m m m m _ _ s m _ m _ \ v Neither satisfied 

^ — ^ ^ ^ ^ ^ ^ ^ — ^ ^ ^ — ^ — ^ ^ ^ ^ ^ ^ ^ Very nor dissatisfied 


1. Given all the considerations, how satisfied are you with your ' ' • 

consumer directed support program? LJ j£» LJ LI Li LJ D 

2. How likely would you be to recommend a consumer directed -^Z " 

V E I 


support program in your county to a friend in a similar situation? .. LJ LJ LJ LJ Q LI 

o r u 

^' 

k e l y 

7 

unukeiy_ 


. . . . - . . . . , Expectations Expectations Expectations 

that were set for you by your case manager and county social ~ ^ ^ ^ — 

services department? • • • [2 Q Q Q 


supports? I L_ 

Thinjdng bpyond consumer directed supports to your overall quality of life, on the following pages 

p|eêînd{^te^f^ :much you agree or disagree with each sfatement. ; 

Please complete these sections 

from the perspective of the person with a developmental disability. The person who has the^ 

developmental disability should be directly involved in completing this survey as much aspdsslble] 

fodependerree | Mobility/Control/Privacy Agree Disagree 

~^k~^k~^L~lk~^LWLW—~Wk--\ Strongly Somewhat Neither Somewhat Strongly 









• • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • • •


V e r y 

satisfied 



V e i 

T 

dissatisfied 


1 

^ ^ 

1 

^ 

R 

• 

consumer directed support program? LJ 12 LJ LJ LI LI LJ 




I 1 R 

support program in your county to a friend in a similar situation? .. (3 LI LJ LJ LJ LI LI 


. . . . , , . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n n ^ 

services department? • Q LJ LJ LJ LI LJ 

4. What is the one thingthat would have the greatest impact on your satisfaction withcOnsumer directed 

supports? (jTYKtrU ^rlJUr. PyatiLr/xtiii .ahut tod/Sttv [imoT 

Thinking BEYOND CONSUMER DIRECTED SUPPORTS TO YOUR overall quality of life, ON THE FOLLOWING PAGES 

PLEASE INDICATE HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT. Please COMPLETE THESESECTIDNS 

FROM THE perspective of the person with a developmental disability., The PERSON WHO HAS THE 

DEVELOPMENTAL DISABILITY SHOULD BE DIRECTLY INVOLVED IN COMPFEVNG THIS SURVEY AS MUCH ASPOSSIBLE. 

Independence | Mobility / Control / Privacy A G R E E 

Neither 

DISAGREE 




2. I have control over my daily schedule. • • A • 

3. I have privacy to be alone or with people I choose • • A • 



5. I can set desired outcomes (goals) for myself.... • • • • 

I can decide about how I spend my money ... . • • El • • 

7. I can make decisions that will affect my future • • A • 

CD 

CO 


1; Given all the considerations, how satisfied are you with your 




Very 

satisfied 



services 



Very 

dissatisfied 

)&•••• • • 


likely 

n o r 

unlikely unlikel 

E x p c c V > t i o n s 

e set ror you by your case manager and county social TjKf w r 

Met 

Expectations 

T 'i 

Failed 

Expectations 

department? I M • pj Q Q • • 


supports? 

Thinking beyond consumer directed supports to your overal quality of life, on the folowing 

please indicate how much you agree or disagre with each statement. Please complete thes 

from the perspective of the person with a developmental disability. The person who ha 

developmental disability~should be directly involved in completirig this survey as much as"possib 

jnêP^ndenC^ Mobility /Control /Privacy 


Agree 

Disagre 




I have privacy to be alone or with people I choose • • • • • 

CO 

4. 

5. 




• 

• 

to • 

• 

• • 

6. 

7. 


I can make decisions that will affect my future... . 

• • 

a • 

• 

• 

• 

a 

CO 

I am satisfied with my current level of independence • a • • 

r








Very 

satisfied 



Very 

dissatisfied 

a • • • • • • 

Very 

likely 

Exceeded 

Expectations 


nor unlikely 

Very 

unlikely 

• • • • • • 

Met 

Expectations 

Failed 

Expectations 

services department? B • • • • • • 


supports? /hr?ftfi- CL+aK Psutw s-rAT4*A^T5 j 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages i; 

pleasei indjcate how much you agree or disagree with each statement. Please complete mesexsections 

from the perspective of the person with a developmental disability. The person who has the ; 

developmental disability should be directly involved in completing this survey as much as possible. . 


Agree Disagre 


can (even if someone helps me because of my disability) get 







8. I am satisfied with mv current level of indent? 

a m • • • 

• • • a 

• • • • 

• • • a 

a • • • 

• • • • 

• • • • 

m • • • •






Very 

satisfied 

T 

5Pu 

Very 

likely 



Very 

dissatisfied 

• • • • • 


' nor unlikely unlike!; 

1 

iyh • • • • • 

3. Has the consumer directed support program met the expectations Exceeded s Met 


E x p 

f^? 

Expectations 

— = ^ - 1 = - ^ F 

services department? Ql Q Q • Q Q Q 

4. What is the one thing that would have the g 

supports? -^Tb L^jt inne. i 

ami, 

( Y L a U R N ^ry^^r^â 

Faded 

Expectations 

factiojj with consumer directed 

5 

Thinking beyond consumer directed supports to youroverall quality of life, on the following pages\ 

please indicate how much you agreeor disagree "with each'steterrient. Please compiefethesesertions 

from the perspective of the person with a developmental disability. The person wholhas;the:^:DB? 

developmental disability should be directly involved in completing this survey as much as possible. ; : 

jnd^pendenCi^ Mobility/Control/Privacy 





5. 

6. 

7. 

8. 

can set desired outcomes (goals) for myself, 

can decide about how I spend my money .. 

am satisfied with my current level of independence 

Agree 


• • • 

• • • 

• • • 

• • • 

• • • 

• • • 

• • • 

• • • 

Disagree\ y 

Neither Somewhat Sgoogly 

m • 

p • 

or • 

•








Very 

satisfied 



Very 

• •••aa• 

dissatisfied 

Very 

likely 


nor unlikely 

Very 

unlikely 

• Q • • • • • 

Exceeded 

Expectations 

Met 

Expectations 

Failed 

Expectations 

services department? • • • • EI • • 


supports? ^jtfsfs^rSl^ s^j^yJZ Utti j î^/aj^ /p(/(phzj> 

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v 

n c,.i!fLi s a t f i e d 


1. Given all the considerations, how satisfied are you with your ' _ / 

consumer directed support program? : u w u • • • • 


r u 

k c l y 

2. How likely would you be to recommend a consumer directed -^r^. "° ^' 

support program in your county to a friend in a similar situation? .. • • • • • • • 


. . . . , , . . • 1 Expectations Expectations Expectations 

that were set for you by your case manager and county social ^ • — 

services department? Q Q Ll Q Q Q Q 


supports? T OLW\ Veru CjejY\cjejrY\t°IL ahtuAJ' ~H^> CKARû 

ng in rpMxSh^ wthaf -Hrv^ tore. Willing -/o J a^PRRSJT.. 


please indicate how much you agree or disagree withêadStatement. Please complete these^sections 



uniikeiy 


I^HHHI^Hi^^HHHHIlHHH Strongly Somewhat Neither Somewhat Strongly 


to where I want to go • • • a 

2. I have control over my daily schedule • • a • 

I have privacy to be alone or with people I choose • • • a 

CO 

4. 

5. 




• 

• 

• • 

• 

• 

• 

7. 



• 

• 

• 

• 

• 

• 

• 

• 


CO 

CO 

^ 

0 

o r 

dissatisfied 

V E I 

7 

dissatisfied

1 


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Very 

satisfied 



Very 

a • • • • 

dissatisfied 

• • 

Very 

likely 


nor unlikely 

Very 

unlikely 

1 

• ••••• 



Exp 

f






B. Has the consumer directed support program met the expectations 



Very 

satisfied 



Very 

dissatisfied 

• • • • • • 


likely 

ofa 

nor 

• 

unlikely 

• • 

unlikely 

• • 

Exceeded 

Met 

FaUed 

Expectations 

• • 

Expectations 

• •l 

Expectations 

ofa • 

v 4o 4 o I. What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? Abi'l i 4 IR\A/Kircj 

—for CUJ-FI'4-r(Q RKI(Avers

Overal I Satisfaction Neither satisfied 

f 3 

? J 

satisfied 

1 


V e r 

y 

dissatisfied 



E K 3 • • • • • 

Very y Neither likely Very 

How likely would you be to recommend a consumer directed —" oru 

f kely "*f* 

y 

support program in your county to a friend in a similar situation? .. |T/| [] [] Q [] Q Q 

Has the consumer directed support program met the expectations Exceeded y Met Failed 

. . . . , , i . - i Expectations Expectations Expectations 

that were set for you by your case manager and county social 1 / ^ — 

services department? 5J Q 0) Q Q 0) Q 


supports? nififivAJtOrt D ^ A L F V ) ^ F L 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages :v 


from the perspective of the person with a developmental disability. The person who has^the^, _ i 

developmental disability should be directly involved in[completing this survey as much as POSSIBLES^ 

Independence | Mobility / Control / Privacy A G R E E DISAGREE 



to where I want to go • • • • GBR 

2. I have control over my daily schedule Q Q Q 01 

3. I have privacy to be alone or with people I choose Q Q Q 


information have access to it Q QK' 01 Q Q 



7. I can make decisions that will affect my future • • • / • 


• A • •


V e r 

y 

satisfied 


W e 

_,. ^. _, 

dissatisfied 

. Given all the considerations, how satisfied are you with your r~l Tszl I—I r~l I—I I—I I—I 

consumer directed support program? LI LI LJ LJ LI LJ 


r u k e l y 

I. How likely would you be to recommend a consumer directed "° f' 

__^_Y_ 

support program in your county to a friend in a similar situation? .. T^j Q Q Q [] Q Q 


. . . . , , . r 


that were set for you by your case manager and county social i ~~7 • ^ 

services department? , Q 13 • Q Q Q Q 


supports? Tut -rv/xf-f- in -fft* âres\+S>. j-k&VT. -&U. 

L/da^kjj^CAOA Co. is ultva^ a&NA&r \>#JD\X~









Very 

satisfied 



Very 

dissatisfied 

• a • • • • • 


likely 

a • 

nor 

• 

unlikely 

• 

unlikely 

• • • 

Exceeded 

Met 

Failed 

Expectations 

• • 

Expectations 

a • 

Expectations 

• • • 

What is the one thing ttât would have the greatest impact on, our satisfaction with consumer directed 

supports? t would have the greatest impact on your s 



from the perspective of the person with a developmental disability. The person who has the. 












8. I am satisfied with mv current level of indeDen 



• • • • 

• • • • 

• • • • 

• • • • • 

• • • • 

• El • • • 

• • • • 

• • • •









. 

satisfied 



V e r y 

dissatisfied 

77 1 1 

• • • • • • 





'-. What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? ^ 

7 

Thinking beyond consumer directed supports to your overall quality of life, on the folowing |ages, ^ 

please indicate how much you agree or disagree with each'sYatement. Please complete thesejlections 3 

from the perspective of the person with a developmental disability. The person who haslifc: 

developmental disability should be directly involved in completing^his survey as much as possibles!-M 

I ^dependence Mobility/Control/Privacy Agre Disagre 

•^ •Hi^HI 1. I can (even if someone helps me because of my disability) get 

Strongly 

to where I want to go !2|^ 

2. I have control over my daily schedule ^ 


4. Only people who are supposed to know my personal ^ 

information have access to it fYl 





• • • • 

• • • a 

• • • a 

Somewhat Neither Somewhat Strongly 

• • a • 

• • • • 

• • a a 

• a • • 

• • • •






Very 

satisfied 



Very 

dissatisfied 

a • • • • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 

a • • • • • • 


Met 

Failed 

• a • 

Expectations 

• • • 

Expectations 

• 



|4ruiM- prcpnrin^ 

mnn-P^ -feir What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? )\p\-c, AlWnipj 

Thinking beyond consumer directed jsupports to your overall quality of life, on the following pages I. ^-..^ 

please indicate how much you agreeor disagree with each statement. Please complete these sections /. 

from the perspective of the person with a developmental disability. The person who has the^ _\ ^ 

developmental disability should be directly involved in completing this survey as much as possible." 2 

1. 

j Independence Mobility/ Control / Privacy 

I can (even if someone helps me because of my disability) get Agre Disagre 




• 

• 

• 

• 

• 

• 

• 

• 

CO 



information have access to it m • • • • 



7. I can make decisions that will affect my future • ® • • • 

8. I am satisfied with my current level of independence • ® • • • 

•*--*-.-J


V c r 

> 

satisfied 


dissatisfied 

R 

Given all the considerations, how satisfied are you with your fl F I H ( I S • • 

consumer directed support program? J U U U ^ J U U 

y e r v Neither likely Very 


likely 

n o r 

unlikely unlikelv 

R 

support program in your county to a friend in a similar situation? . . • Q Q Q Q Q Q 


* . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n ^rp 

sen/ices department? • • • /8j • • • 


supports? ' L _ 

'Thinking beyond consumer directed supports to your overall quality of life, on the following pages 




I Independence Mobility /Control /Privacy AGREE DISAGREE 

B B J ^ N ^ ^ ^ ^ ^ ^ ^ ^ M M M L Strongly Somewhat Neither Somewhat Strongly 




3. I have Drivacv to be alone or with Deonle I choose 




6. I can decide about how I spend my money . . . 

7. 



• • • • 

• • • M • 

• • M • • 

• 

• 

• 

• 

• ^sr • 

• JSC • 

• 

• 

• 

• 

• 

• 

• 

• 

• • •






Very 

satisfied 

Very 

likely 

3. Has the consumer directed support program met the expectations E^^^_ 





Very 

dissatisfied 

• ••••• 


nor unlikely 

Very 

unlikely 

1 

1 

• ••••• 

Met 

Expectations 

FaUed 

Expectations 

4. What is the one thing 

mg that 

that 

would 

would 

nave 

have 

tne 

the 

greatest 

greatest impact 

impact 

on your satisfaction with consumer directed 

supports? 






1. 

" Strongly Somewhat Neither Somewhat Strongly 


• n • • • 

2. • m • • • 


4. 

5. 


I can set desired outcomes (goals) for myself n 

• 

• 

• 

• 

• 

• 

• 

• 

6. 

7. 

8. 




• 

n • 

n • 

• 

• 

• 

• 

• 

• 

• 

• 

•


V 

. 


e r y 

satisfied 


^ 

V e r 

y 

dissatisfied 


1 1 

f - 

consumer directed support program? Gl [CjQ Q Ql Ql Q 

2. How likely would you be to recommend a consumer directed "f* ^ 

|Thinking beyond consumer directed supports to your overall quality of life, on the following pages 

^please indicate how much you agree or disagree with each statement. Please complete these sections 

Jrpm the perspective of the person with a developmental disability. The person who has the 

developmental disability should be directly involved in completing this survey as much as possible 

j Independence Mobility/Control/Privacy 



*2. | have control over my daily schedule. 

B ; , Only people who are supposed to know my personal 

fe. information have access to it 



JJ- I can make decisions that will affect my future 



Agree 

Strongly Somewhat 1 

n o r u n l i k e l 

- v u n l i k e l 

y 

support program in your county to a friend in a similar situation? .. Q^Q (~J Q • Q Q 


that were set for you by your case manager and county social ^T"*" Expectations Expectations 

services department? rj Q (j^Q • • • 


supports? = ^ 

Disagree 


• • • • 

• • • 

• • a a 

• • • 

• • • • 

• • • 

• • • 

• • _ y • •

Overall Satisfaction I M H ^ 

NI IT'LT • I HI """ III'IIHUIIIIILLLLLLLLLLIMJUB V . Neither satisfied v 


Given all the considerations, how satisfied are you with your ' r-^/J—j RN R~l R~l 

consumer directed support program? LJ Ll LJ LI LI LI LI 


. . . . . i • , a likelv nor unlikely unlikely 

How likely would you be to recommend a consumer directed —r -p> 1 H~ 

support program in your county to a friend in a similar situation? .. Q QLJ LI LI LI LJ 


, . . . . i Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n i . ^ 

services department? • LJ • [jj LJ • • 


supports? 

w. 

( ^ A X ^ T ? V U X B ^ ] _VA^C ^VWC^V V ^ ^ J R - . 

Thinkinq beyond consumer directed supports to your overall quality of life, on the following pages 





_ ^ _ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ J ' Strongly Somewhat Neither Somewhat Stron 



2. I have control over my daily schedule. LI 

3. I have privacy to be alone or with people I choose. . . . • 




6. I can decide about how I spend my money LJ 

' • I can make decisions that will affect my future • 

I am satisfied with my current level of independence ... • 

a 7 

• • • 

a • of • 

• • • 

• • a 7 

• 

• • • 

• a • a^ 

• • , • a" 

• • a

Overall Satisfaction u 

3 Has the consumer directed support program met the expectations Exceeded Met Failed 

, - , . . Expectations Expectations Expectations 

that were set for you by your case manager and county social -n ^ 

4. 

services department? • • • V] • • • 


supports? -^Tki^ tinonfa /w&Zu^ / W ' .Uu^^y^ •. fi.Ui.-kijA- a/MC'LT 

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I Independence Mobility / Control / Privacy AGREE DISAGREE 



2. I have control over my daily schedule. ^ ' - T ^ A \ ) 

3. I have privacy tqjbe alone or with people I choose 

AC (U^h^S^4U^.r- J- i^tUtj. ZAMA^jfL^ J c 


information have access to it .-A-. 


6. I can decide about how I spend my rhoney-A^v^. 

7. 

8. 

can make decisions that will affect my future 

• W V A I I W H V ^ ^ vviui I i iy ^ U M U I H >o vol ui i| IUCI IUC 

/CV-N^ 2s* J— "-v-i_







Very 

satisfii 

if 

isfied/ 

Very 

likely 

Keiy / 




Very 

dissatisfied 

1 

• ••••• 


nor unlikely 

Very 

unlikely 

1 — 

• ••••• 



services department? Q Of Q Q Q Q Q 

4. What is the one thing that would.-have the greatest impact on your satisfaction! wi h consumer directed 

it would .-nave me greatest impact on your satisractiori witn consul 

supports? & h^rt qf- uSWa-F ?XCLC+l^L ,5 , 

OniKJrdt. Of g± leaî- -Snpaa. Udk— )f • 

toKo toujui &fo^ 4i> dans ^ ^ ^ f ^ ^ j ^ p j 

Thinking beyond consumer directed supports to your overall quality of life,~6nfhe following pages 




I Independence Mobility / Control / Privacy AGREE 

DISAGREE 


mg^gg^g^^^H^g^^^jfl Strongly Som 


to where I want to go Q 

2. I have control over my daily schedule *\?C Q / 

3. I have privacy to be alone or with people I choose Q 

4. Only people who are supposed to know my personal / 

information have access to it |\J Q 

5. I can set desired outcomes (goals) for myself.. . . . li • 

6. I can decide about how I spend my money f~\ 

7. I can make decisions that will affect my future Q LJ 

8. I am satisfied with my current level of independence . Q 

• • • 

• • • 

• • • 

• • • 

• • • 

• • • 

• • • 

• • •






Very 

satisfied 



Very 

dissatisfied 

1 

• • EA • • • • 

Very 

likely 


,, , x . , 3 

, . r 


. . Expectations 


nor unlikely 

Very 

unlikely 

1 ~ 

• •••••• 

Met 

Expectations 

Failed 

Expectations 

services department? • • • • • • A : 

4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed, 

supports? 3 /R\ UÂ^L >5 i/t/w\ '-) (^SFJZCA^-K. £^




Very 

satisfied 

T 



J. I:T RAL.R V 

Very 

likely 


nor unlikely 

R 

2. How likely would you be to recommend a consumer directed —i , , 

t 

Very 

dissatisfied 

support program in your county to a friend in a similar situation? . . pg| Ql Q Ql CI Q Q 

Very 

unlikelv 

3 Has the consumer directed support program met the expectations Exceeded Met 

Failed 

Expectations 

° - 

, , , . . Expectations Expectations 

that were set for you by your case manager and county social ~r— "-i • 

services department? M • • • • • • 


S U P P O R T S ? A ^ K F V ^ O ; . - ^ f*\Q^1 -V^Cs-X RS, /Afr ° A < ; P G R I ^ V . < > 

' « r., • 1 

1 

P p. 





1. 

(ndependenC^j Mobility 

/ Control / Privacy 


A G R E E 


DISAGREE 


• 3 • • • 

2. • p. • • • 

3. • • • • 

4. 

5. 


• 

• 

• 

• 

• 

• 

• 

• 

6. 

7. I can make decisions that will affect my future • 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

CO 

R






Very 

satisfied 





Very 

dissatisfied 


likely 

nor unlikely 

1 

— 

Very 

unlikely 

—t - 

• 

^" 

• • • • • • 

Met 

Expectations 

Failed 

Expectations 

services department? • • • E I • • • 


supports? To -IYRXIN OÂD QDUC^-U. LQunfy 

\SI)O 

RL






Very 

satisfied 



Very 

dissatisfied 

• sf • • • • 

Very 

likely 

T 


nor unlikely 

T 

Very 

unlikely 

• Qtf • • • • 

Met 

Expectations 

Failed 

Expectations 

E w e 

3. Has the consumer directed support program met the expectations ^ A 

Expectations 

• • • a[ • • 

that were set for you by your case manager and county social "~"'"' 


/ 


supports? 





I Agre Disagre 

Independence Mobility/Control/Privacy 



to where I want to go • or • • • 


CO 

I have privacy to be alone or with people I choose • ar • • • 





7. I can make decisions that will affect my future • of • • • 







Very 

satisfied 

Very 

likely 

Has the consumer directed support program met the expectations E^^* [ i s 





Very 

dissatisfied 

• • • • • • 


nor unlikely 

Very 

unlikely 

• ••••• 

Met 

Expectations 

Failed 

Expectations 

• ^ • • • • • 


supports? S^ôTtT^v^ "~TZ^ A ^ x o \ * J(BA4WR*J>— 






Independence Mobility/Control/Privacy 

1. 

1 

• Strongly Somewhat Neither Somewhat Strongly 


• • • • 

2. • • • • & 

3. 

4. 

5. 

6. 

7. 

CO 



• • • • 

• • 

• 

• 

• 

• 

• 

• 

• 





• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

•

^flsfaction 

^derations, how satisfied are you with your 

support program? 

*" ^Vv- _ ' /ou be to recommend a consumer directed 

., n your county to a friend in a similar situation? 

Very 

satisfied 

"T 



Very 

dissatisfied 

caPa • • • • • 

r 

Very 

likelv 

, J / ^ " meone helps me because of my disability) get 

(L. '**ttogo 

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\ j 

1/ 

\, ft 

i, 

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^ s ^ ' ' 

r 

1 

,fj 

, 

over 

*° 

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my daily schedule Qj 

alone or with people I choose... 

ve access to it 

i h o are supposed to know my personal 

,,( 

3d outcomes (goals) for myself. 

''bout how I spend my money .. 

•V isions that will affect my future. 

1 

with my current level of independence 

Agree 


Disagree 


• • • • 

• • • • • 

• • • • 

• • • • 

. • • • • 

• • • 

• S • • 

. • • 0 • 

~






Very 

satisfied 

T 



Very 

dissatisfied 

Very 

• • • • • SI • 

likely 

1 Neither 

likely 

nor unlikely 

T 

1 

• ••••• S 

Met 

Failed 


• • 

Expectations 

• • 

Expectations 

0 • • 



Very 

unlikely 


supports? \^Y)XAs&\P. Îhl rrî+Jhl^ 4-n ,i J^QA-^JrtX^ ~ iM-Z.dS 

' rocs' .c,o 4W^ CCA^\& o£&r suport ^ 





I Agre Independence Mobility/Control/Privacy D 

l" g 

• 1 

?!L IV 

• - - H * Strongly Somewhat Neither Some 



2. I have control over my daily schedule . 








• • • • 

m • • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • (a • •

Overall Satisfaction „ N(liher!iilsM 



e T 

satisfied ^ y nor dissatisfied dissatisfied . - 

2. How likely would you be to recommend a consumer directed 1 —,—i— 

support program in your county to a friend in a similar situation? . . Q Q Q Q Q [Si Q 




likclv 

n o r 

unlikely unlikely 

E x p c t a t l o n s 

1 

Expectations —Expectat.ons 

services department? • Q Q • • • 


supports? 

pUyjfoilUv|- -fWl (.DCS fry-urn I r > v \ 

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Agre Independence § Mobility/Control/Privacy 


Disagre 

^ ^ ^ ^ ^ ^ ^ ^ m m m m m m m ^ ^ n n Strongly Somewhat Neither Somewhat Strongly 




CO 



• • • 

• / 





CD 

CO









Very 

satisfied 



Very 

dissatisfied 

]3 • • • • • 

Very 

likely 

Exceeded 

Expectations" - 


nor unlikely 

T 

Met 

Expectations 

Very 

unlikely 

Failed 

Expectations 

• • • • • 

IWiK^ksS 4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? pipPY^ltcDflc. -f a 1 o-P/Hps 

n\KU ac\ uss 

ma 1 Mî 






Independence Mobility /Control /Privacy 

•MUMJU ^WHpgaBlMlM^MMWffl Strongly Somewhat Neither Somewhat Strongly 


• 0 • • 


CO 

I have privacy to be alone or with people I choose • n • • 


information have access to it • El • • • 


6. I can decide about how I spend my money • • si • • 


8. I am satisfied with my current level of independence • • ja • •

Overal Satisfaction B 

pfl Neither satisfied 

V e r y 



Iven all the considerations, how satisfied are you with your ' „ ' ' 

>nsumer directed support program?

erall Satisfaction 

n all the considerations, how satisfied are you with your 

umer directed support program? 

likely would you be to recommend a consumer directed 

ort program in your county to a friend in a similar situation? 

Very 

satisfied 

the consumer directed support program met the expectations Exceeded 



Very 

dissatisfied 

H'Q • • • • • 


Very 

likely 

Sfa 

nor 

• 

unlikely 

• • 

unlikely 

• • 

T 

Met 

Expectations 

1 

Failed 

Expectations 

, . . Expectations 

were set for you by your case manager and county social ~n 

ces department? • QTQ • • • • 

is the one thing that would have the greatest impact on your satisfaction with consumer directed 

;ing beyond consumer directed supports to your overall quality of life, on the following pages 

e indicate how much you agree or disagree with each statement. Please complete these sections 

the perspective of the person with a developmental disability. The person who has the 

lopmental disability should be directly involved in completing this survey as much as possible. 

idependenCe I Mobility 


/Control /Privacy Agre 

Disagre 

• • • • 


have control over my daily schedule • • • 

have privacy to be alone or with people 1 choose • • JSC • • 

Dnly people who are supposed to know my personal 

nformation have access to it • tar • • • 

can set desired outcomes (goals) for myself • • • a-• 

can decide about how 1 spend my money • • • • Or 

can make decisions that will affect my future • • • • 

am satisfied with my current level of independence • • • fir •






Very 

satisfied 



Very 

dissatisfied 


Met 



services department? „ • • • • Qf • • 

Very 

likely 


nor unlikely 

Very 

unlikely 

• • • a • • • 

Failed 

Expecjations 


supports? 





Independence J Mobility/Control/Privacy 

Agre 




3. DeoDle I have privacv to be alone or with I choose.. .... 







Disagre 


• • • • 

• • • • 

• • • • 

• • • • 

car • • • • 

• • • • 

• • • 

• • • •






Very 

satisfied 



Very 

dissatisfied 

• • ® • • • • 


Very 

likely 

a • 

nor 

• 

unlikely 

• 

unlikely 

• • • 

1 

1 

Met Failed 


Expectations 


services department? • • • • • • S 

Amat is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? 

JPP . : 

vi/ XKG J COWICL^ -JLVRJLTJ. WA,UI









Very 

satisfied 



Very 

dissatisfied 

• • • upiu • 

Very 

likclv 


nor unlikely 

Very 

unlikely 

• • • • • 

Exceeded Met FaUed 


• • • era • • 


supports? _ 

3 

c '23A. 





Independence I Mobility/Control/Privacy Agre 

Disagre 

^ g ^ m m a m ^ g m ^ ^ ^ ^ m m m m M 1. I can (even if someone helps me because of my disability) get Strongly Somewhat Neither Somewhat Strongly 










• • • • 

• • • • 

• • • • 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• • • •






Very 

satisfied 



Very 

dissatisfied 

• Q"tl • • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 

• • • • • 


Failed 


• Of • • 

Expectations 

• • 

Expect,* 



supports? ^hAPXdizdlJU o rd \g> UQCLUMOI . q / 





Agre Disagre 

Independence | Mobility/Control/Privacy 

^BS^ H^HBH 

trongly Somewhat Neither Somewhat Strongly 

1. 

a" 


Strongly Somewhat Neither Somewhat Stron 


• 

• 

• 

• 


CO 

• • • • 

I have privacy to be alone or with people I choose or • • • • 



• • • • 


6. I can decide about how I spend my money . . 

• • • • 

7. I can make decisions that will affect my future • • • 

CO 

I am satisfied with my current level of independence • • • •

'Overall Satisfaction Neither satisfied 

1 

^ 1 

V e r y 

satisfied 


V e r y 

dissatisfied 

consumer directed support program? r Q G{ Q Q Q 

Very / Neither likely 

Q 

• 

• 

V e r y 



ll 

*? y 

" oru 

^ ikely 

uiuikety 

support program in your county to a friend in a similar situation? . . Q Q Q Q Q Q Q 


that were set for you by your case manager and county social Expectations Expectations Expectations 

services department? t l j £ l • • • • • 

m 

ID fiPPfLCmft 

f,g % 

Oft&flCg 4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? S s AfCRS&iB/LlTY PUMPS: 

^CT,ou TT TG P>v joe. TH/N6nS nt? 

fo^- ^ feMftgSfcMftvTi (^ m ose Shipments 

e 

. 

n c N T \KM\IX 

jThinking beyond consumer directed supports to your overall quality of life, on the following pages 

"please indicate how much you agree or disagree with each statement. Please complete these sections 


"developmental disability should be directly involved in completing this survey as much as possible. 



Disagre 


• • • • 

2. I have control over my daily schedule .... • • • • 

3. I have privacy to be alone or with people I choose .... • • • • 

& t 

%. 

4 


information have access to it .... • • • • 

5. I can set desired outcomes (goals) for myself .... • • • • 

6. 

7. 



.... • • 

.ja Id • 

• 

• 

• 

• 

8. 

I am satisfied with my current level of independence .... • • • • 

v-

Overall Satisfaction H Neither satisfied 

V e r 

V e r y 

satisfied 

• 

>' 

••••• 


dissatisfied 

or 


likely 

n o r 

unlikely unlikelv 




- R 1 R 

support program in your county to a friend in a similar situation? . . [][][][] Q Q ffi^ 

3. Has the consumer directed support proqram met the expectations Exceeded Met Failed 

,. , ,


E-3 

G I V E N ALL THE CONSIDERATIONS, H O W SATISFIED ARE YOU WITH YOUR 

C O N S U M E R DIRECTED SUPPORT P R O G R A M ? 

:. H O W LIKELY WOULD YOU B E TO R E C O M M E N D A C O N S U M E R DIRECTED 

SUPPORT PROGRAM IN YOUR COUNTY TO A FRIEND IN A SIMILAR SITUATION? 

VERY 

SATISFIED 

;. H A S THE C O N S U M E R DIRECTED SUPPORT PROGRAM M E T THE EXPECTATIONS DEEDED 

THAT WERE SET FOR YOU BY YOUR C A S E M A N A G E R A N D COUNTY SOCIAL EXPIATIONS 



VERY 

• • • • • • 

DISSATISFIED 

R 

VERY 


VERY 

UKELV 

• t) 

NOR UNLIKELY 

• • • 

UNLIKELY 

• • 

MET 

EXPECTATIONS 

FAILED 

EXPECTATIONS 

SERVICES DEPARTMENT? SI • • • • • • 

W H A T IS THE O N E THING THAT WOULD H A V E THE GREATEST IMPACT O N YOUR SATISFACTION WITH C O N S U M E R DIRECTED 

SUPPORTS? ; 

ô^La^J X > " V T * R L ^ /2ssrru> ^L^. ^fAJ

Overall Satisfaction NEITHER SATISFIED 

VERV V 


SATISFIED DISSA 

1 GIVEN ALL THE CONSIDERATIONS, HOW SATISFIED ARE YOU WITH YOUR ' • . 

CONSUMER DIRECTED SUPPORT PROGRAM? * - J ^ —» -J —« "-I * 

VERY NEITHER LIKELY Y 

2. HOW LIKELY WOULD YOU BE TO RECOMMEND A CONSUMER DIRECTED — R 

"" LLKC 

'- V 

^ 

SUPPORT PROGRAM IN YOUR COUNTY TO A FRIEND IN A SIMILAR SITUATION? . . Q Q Q Q Q I 

3. HAS THE CONSUMER DIRECTED SUPPORT PROGRAM MET THE EXPECTATIONS EXCEEDED MET R- A 

. . . , . . , EXPECTATIONS EXPECTATIONS EXPEI 

THAT WERE SET FOR YOU BY YOUR CASE MANAGER AND COUNTY SOCIAL ~n ^-T 

SERVICES DEPARTMENT? • • • • • • [ 

4. WHAT IS THE ONE THING THAT WOULD HAVE THE GREATEST IMPACT ON YOUR SATISFACTION WITH CONSUMER DIRE 

SUPPORTS? Ac KCIU Vv t/v%- «^L->(>. rmkv 4AI- tv^r Af(-\ûcr\^ 

b:^cd c--> Û; CKUVK tYt'Af> I T \y-,^ hn-r\ reduced ^ n^^VJ cr~ 

cA\o\cC~^. K-'ci- RV..-T'C-.M svftr&ev? J'RU^.F a hti'-Cj p;^v.:: : 

Dverall Satisfaction Neither satisfied 

^ e 

 

satisfied 

nor dissatisfied ^ 

dissatisfied 

liven al the considerations, how satisfied are you with your 

onsumer directed suport program? LJ £J LJ LJ LJ 


ow likely would you be to recomend a consumer directed 

nor 

jport jports? hat is the one thing that would have the greatest impact on your 

program in your county to a friend in a similar situation? . 

iat as were the consumer set for directed you by suport your program case manager met the and expectations county social ~n 

speeded 

,, , - . | Expectations Expectations Expectations 

ervices department? • K] • • LJ • 

linking ase indicate beyond how consumer much directed you agre suports or to disagre your with each statement. on th 

overall quality of life, 

jvelopmental Dm the disability should be directly involved in completing person this who survey has 

perspective 

Agre Disagre 

to 1 can where (even 1 want if someone to go helps me because of my disability) get 

• • • El • 

1 have control over my daily schedule • • • • 

1 have privacy to be alone or with • people • 1 • chose El • 

Only information people have who aces are suposed to it to know my personal 

* • • • • 

1 can set desired outcomes (goals) for • myself • • • 

1 can decide about how 1 spend my • money • • • a 

1 can make decisions that wil afect • my future • • • la 

1 am satisfied with my curent level of • independence • • • 

of the person with a developmental disability. The 


mjmr—h^Baagm^^mmammimiOJtM Strongly Somewhat Neither Somewhat Strongly

Overall Satisfaction i 

HM^^thlroiff^^ 

| Neither satisfied 

v 

«ry nor dissatisfied 

V e r y 


1. Given all the considerations, how satisfied are you with your ' ' 1 

consumer directed support program? LI LJ LI LI LI 123^ 



f ikcl? 

support program in your county to a friend in a similar situation? . . [] [J [j Q LJ Q 


. , , . . . , Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n *—i "-i— 

services department? • • • • • ]g£ • 


supports? 

. Q-J 1A /? ~ ; J y ; A tr> a /)-u*. - L ym/x {ks r 





J Independence Mobility/Control/Privacy Agree Disagree 

l^^—^^^^—^gi Strongly Somewhat Neither Somewhat Strongly 


• • • • 

a • • • • 




• 

• 

ar • 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

. • • •

Overall Satisfaction J3j NEITHER SATISFIED 

Given all the considerations, how satisfied are you with your ' ' ' 

consumer directed support program? LJ Li LJ L_J Li U 


VERV NEITHER LIKELY VERY 

LIKELY "UR UNLIKELY UNLIKELY 

T 

support program in your county to a friend in a similar situation? . . LJ Q LJ LJ LJ LJ 

3. Has the consumer directed support program met the expectations EXCEEDED 

M C T K A I L E D 

. . . . , , , . , KXPCCTATIONS EXPECTATIONS KXPECTATIONS 

that were set for you by your case manager and county social ~n ^r— ^ 

services department? LJ LJ LJ Q£j LJ Q LJ 


supports? _ ^ ^ 

——— - ! — - ; - J-0 






I H!21i!>AMIUTTLM»_. qUflMIMllMi,' ll SLRNNOLV SOMEWHAT NEITHER SOMEWHAT STRONGLY 


to where I want to go • H • • • 

2. I have control over my daily schedule • • • • ja 




5. I can set desired outcomes (goals) for myself. . . . • • • • El 

6. I can decide about how I spend my money . . • • • • 

7. 

CO 

A V O R 

> NOR DISSATISFIED 

V C R 

> 

SATISFIED DISSATISFIED 

I can make decisions that will affect my future • • • • 



y Neither satisfied 

. • , 

satisfied 


V e r 

y 

dissatisfied 

1. Given all the considerations, how satisfied are you with your ^ • • 

consumer directed support program? LJ LI LJ LJ LJ LJ LJ 



n o r u 

" likc Y unlike 

' '- v 

support program in your county to a friend in a similar situation? . . Q Q Ej Q Q Q Q 

Exp 

f that were set for you by your case manager and county social 

ati0 

^ J xp 

jg^ services department? 

Expectations 



ofliTe/onlhe fSiawlng^page^" 

youToveralfqaTity Thinking beyond consumer directed supports to 

the perspective of the person with a developmental disability. please indicate how much you agree or disagree with each statement. Please complete these sections 

from Th 


Independence | Mobility/Control/Privacy Agre 



Neither 

Disagre 


to where I want to go. .. • • • • 



4. 

5. 




• 

• 

• 

• 

• 

• 

• 

• 

6. 

7. 



• 

• 

• • 

• • 

• 

• 


CO

action 

ations, how satisfied are you with your 

port program? 


V e r y 

X e r y 


satisfied 

• a • • 

dissatisfied 

• • • 

Very Neither likely Verv 

>e to recommend a consumer directed ^ nor 

"f kely U 

*L 

ur county to a friend in a similar situation? . . [] Q Q [] Q Q Q 

)cted support program met the expectations Exceeded Met Failed 

. . . . Expectations Expectations Expectations 

)y your case manager and county social ~n ^ — 

pro hat would have the greatest impact on your satisfaction with consumer directed 

The 8 

) fti-q *•~ J 4 'JZ 

lê


Ver 

>' 

satisfied 



V e r y 

dissatisfied 

iven all the considerations, how satisfied are you with your ' - ' ' 

jnsumer directed support program? LJ UK LJ LJ LJ LJ Li 


n o 

i k £ 

3w likely would you be to recommend a consumer directed 

°' ' y 

c l v 

^ 

- i j - I y I I 

jpport program in your county to a friend in a similar situation? . . LJ LJ u LJ LJ LJ LJ 

as the consumer directed support program met the expectations Exceeded Met Faded 

. . . | . . Expectations Expectations Expectations 

at were set for you by your case manager and county social ~n ^ ^ 

?rvices department? • Qj LJ • L J L J L J 

hat is the one thing that would have the greatest impact on your satisfaction with,consumer directed 

ipportS? -fU. fJTO ?,r4^ C A M J — Q & G C 8 f - ^ AMV" ^ J - ^ ^ S 

7J A f 

i i _ i / 

inking beyond consumer directed supports to your overall quality of life, on the following pages 

>ase indicate how much you agree or disagree with each statement. Please complete these sections 

m the perspective of the person with a developmental disability. The person who has the 

velopmental disability should be directly involved in completing this survey as much as possible. 


Strongly Somewhat Neither Somewhat Strongl) 










3t 

• 

• • • • 

• • • • • 

• • • • • • 

• 

• • • • 

• • • • • • 

• • • • • • 

• • • • • • 

• 

•


GIVEN ALL THE CONSIDERATIONS, HOW SATISFIED ARE YOU WITH YOUR 


HOW LIKELY WOULD YOU BE TO RECOMMEND A CONSUMER DIRECTED 

SUPPORT PROGRAM IN YOUR COUNTY TO A FRIEND IN A SIMILAR SITUATION? . . 

Very 

satisfied 

Very 

likelv 




nor unlikely 

T 

Very 

dissatisfied 

1 

Very 

unlikely 

ja • • • • • • 

TT 

3. HAS THE CONSUMER DIRECTED SUPPORT PROGRAM MET THE EXPECTATIONS Exceeded 

Met 

Failed 

Expectations 

• • • 

Expectations 

ja • 

Expectations 

• • 

THAT WERE SET FOR YOU BY YOUR CASE MANAGER AND COUNTY SOCIAL 

SERVICES DEPARTMENT? 

bdkr to îucJioVs *u-\gt iY\T^Jh'p^v^q^n^ 

4. WHAT IS THE ONE THING THAT WOULD HAVE THE GREATEST IMPACT ON YOUR SATISFACTION WITH CONSUMER DIRECTED 

SUPPORTS? 





Independence J Mobility 

/ Control / Privacy AGREE DISAGREE 

B H I H H R I B B ^ H I I H H B B I I ^ H H B Strongly Somewhat Neither Somewhat Strongly 


c\I 

3. 

4. 

5. 

6. 

7. 1 

8. 1 


I HAVE CONTROL OVER MY DAILY SCHEDULE. . . . 

I HAVE PRIVACY TO BE ALONE OR WITH PEOPLE I CHOOSE. 

ONLY PEOPLE WHO ARE SUPPOSED TO KNOW MY PERSONAL 


• • • • 

• • • • 

• • • • 

• • • • 

I CAN SET DESIRED OUTCOMES (GOALS) FOR MYSELF • • • • 

I CAN DECIDE ABOUT HOW I SPEND MY MONEY . . 

• • • • Sac 

CAN MAKE DECISIONS THAT WILL AFFECT MY FUTURE • • • • 

AM SATISFIED WITH MY CURRENT LEVEL OF INDEPENDENCE • • • • •

erall Satisfaction 

"- 3 

^Sfl^MB^H^M^Mli Very nor disatisfied Vcr 

> 

satisfied disatisfied 

Q [] [] Q Q 

likely Neither nor Me' unlikely likely Faued unlikely Very 

T" 

. , i i , • • Expectations Expectations 

3i all the considerations, how satisfied are you with your JL. ' 1 

3umer Dort 

likely would you be to recommend a consumer directed 

. program in your county to a friend in a similar situation? 

Very 

. 

Exceded directed support program? 

the consumer directed support program met the expectations 

were set for you by your case manager and county social ~n ^ ^— 

ices department? 12 • • • • • • 

wo thuvrt cbni un ,VW- i\jfAp /l/u' n,m )D a/->&_. f, as. 

t=^QiCi'.aLL t* /AiAjn uri^L fOJu i>nST) (l&nsiin/enaJJ'nn 

Cut tAjL hcXtuAfi °- (oiAoon toho bo Âjui^t^/Lns^^. WLAA OAJL 

ing beyond consumer directed supports to your overall quality Of life, on the following pages £ 

e indicate how much you agree or disagree with each statement. Please complete these sections/^ 

the perspective of the person with a developmental disability. The person who has the fal 

Sopmental disability should be directly involved in completing this survey as much as possible. 

dependence I Mobility /Control /Privacy Agre 


5 where 1 want to go 

have control over my daily schedule. . . . • 

have privacy to be alone or with people 1 choose.. • 

)nly people who are supposed to know my personal 

iformation have access to it • 

can set desired outcomes (goals) for myself • 

can decide about how 1 spend my money . • 

can make decisions that will affect my future • 

am satisfied with my current level of independence • 

Disagre 

>trongly Somewhat 

• Neither 

• Somewhat 

• StrongI 

• • • 

• • • 

• • • 

• • • 

• • • 

• • • 

• • •






J^gg 3. Has the consumer directed support program met the expectations 



Very 

satisfied 



Very 

dissatisfied 

1 

• • • • • 


•Ta 

nor 

• 

unlikely 

• • 

unlikelv 

T 

r • • 

Very 

likely 

M 

Met 

Expectations 

Failed 

Expectations 

T 

• • • • • • • 


supports? t . 7 ! 

i ' p t- / r u ^ o i C _ j > Oho ixJor/c. 


please indicate how much you agree or disagree With each statement. Please complete these sections 

from the perspective of the person with a developmental disability. The person who hasjhe 

developmental disability should be directly involved in"cVmpleting this survey as much as possible. 

D 

! sagr 

Q!lI " I Strongly Somewhat Neither Somewhat Strongly 


J 



2. I have control over my daily schedule. Q 

3. I have privacy to be alone or with people I choose.... ...... • QK • • • 

4. Only people who are supposed to know my personal • 

information have access to it Q Q Q Q 



7. I can make decisions that will affect my future Q Q| Q ^/Q 

8. I am satisfied with my current level of independence Q Q O L-l 

—


^ er 

!f 

satisfied 

nor dissatisfied f^. . 

dissatisfied 


consumer directed support program? «J LJ LJ LI LI LI LI 



n o r u 

k e l y u n h k e l y 

^' 

support program in your county to a friend in a similar situation? . . Q Q Q [] Q Q 


. . . . , , • . . • Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n "-i ^ 

services department? 0 Q Q Q Q Q Q 


Supports? Mfifc. h,-, rJTl. ^7>«-5^P Tg> /C*r/?^

L>,erall Satisfaction 

k - -e' the directed considerations, suport how program? satisfied are you with Neither U your satisfied • J ' J L 


y would you be to recomend a consumer directed likely 

satisfied disatisfied 

Verv j- .• v consumer directed suport program met the expectations Exceded " 

' "' ' . t i i , • i Expectations Expe 

A V 

, v„ set for you by your case manager and county social ~n 

V department? • 3 • • • • 

rvv.< 

c= :~e one thing that would have the greatest impact on your 

. ,i,Kiuj beyond consumer directed suports to your on 

overall quality of life, 

f , how much you agre or disagre with each statement. 

f 

(do person who 

f 

" (^mental disability should be directly involved in completing this sur 

perspective 

Disagre 

1 .^g^QgS (even ^SB^HBfli if someone helps me because Strongly of Somewhat my disability) Neither Somewhat get 

v, where 1 want to go , /fiii 

• • • • 

control over my daily schedule • • • • 

, 

( t,n\/G 

^ve privacy to be alone or with • people • I LJ chose • • 

s , iy people who are suposed to know • my personal • • • 

,,»/1 ^rmation set desired have aces outcomes to (goals) it for myself • • • • 

/ , ^'i decide about how I spend my • money • • • 

, make decisions that wil afect my • future • • • 

satisfied with my curent level of independence • • • . • 

i JijcJepCndGnCG 

ictl)ao indicate 

1 Mobility 

of the person with a developmental disability. The 

/Control /Privacy Agre








services department? .. .UPhO". gastlS . VO^JSR .SETL 

4. What is the one thing that would have the greatest impact on your 

supports? FTJUJR 6^ y^/xr D§ MRE^NSS 

SKÎ %)$> SySf^, (X)HEA T 

Very 

satisfied 



Very 

dissatisfied 

• ••••0a 

Very 

likely 


nor unlikely 

Very 

unlikely 

• • • • • Q^t 



. . • • • • • ] • • 

satisfaction with consumer directed 

Thinking beyond consumer directed supports to'your overall quality of life; on the following pages w---* 

please indicate how .much you agree or disagree with each statement. Please complete these sections 

from the perspective of the person with a developmental disability. The person who hasthe, 

developmental disability should be directly involved jn completing this survey as much as : possible., jgagf,; 


Independence Mobility / Control / Privacy 

I I ^ ^ H m | ^ h m m J Strongly Somewhat Neither Somewhat Strongly 




I have privacy to be alone or with people I choose...... • • • • 


information have access to it • • El • • 

GO 



• • • • 


CO 



V e r 

y 

satisfied 


V e r y 

„ 

dissatisfied 

1. Given all the considerations, how satisfied are you with your ^ „ 

consumer directed support program? LI LI LI LI LI LJ 

to 2. How likely would you be recommend a consumer directed 

Very Neither likely / Very 

lik 

f y 

— noru fikely 

support program in your county to a friend in a similar situation? .. Q 8j Q Q [) Q Q 


., . . , _ u . , . , 



i. 

services department? * • • • • • • utt 

4. What 

sui Jpdfts?





Ven 

l 


V e r y 

.nor dissatisfied 

satisfied 

• itf 

/\ 

• Q 

dissatisfied 

Q Q 



1 support program in your county to a friend in a similar situation? . . Q Q^Q 1 r 

G G Q G 


. . . . , . . . , Expectations Expectations^ Expectations 

that were set for you by your case manager and county social ~n (J_V ^ 



foprg CcmfX-eX concha nrs. fl\ T\R*-C)IXRPOOREST 

CLV&*0ÛE''TMMIN/ER^., ,


1. Given all the considerations, how satisfied are you with your n 

dissatisfied 

n n HI 

y 

VTS'V~\ r~l 

consumer directed support program? LI LI LJ LI LI LJ 

f 

r . 

satisfied / dissatisfied 

2. How likely would you be to recommend a consumer directed ' lk 

f ly n / 



o r u n U k e 

'y umikeiy 

support program in your county to a friend in a similar situation? .. Qf Q Q [] Q Q [] 

3. Has the consumer directed support program met the expectations F ^ ^ l a 

Expectations 

Met 

Expectations 

Failed 

Expectations 

that were set for you by your case manager and county social y_ " ""X. r—» ,—/ pU 

services department? i £J LI LI LI LI LI Li 


supports? -i- 

Thinking beyond" consumer directed supports tojbuKoverall quality of life, onjtefoltowing pages 

please indicate[hcwû^yû''agfTO*or perepecê^fthe wtrfeaSi disagree statement7Please complete these sections 

from the person with a dewlopm^tal disabilitykTJe^perepn,w^ „ _ 


Independeh^tfliobility/ Control / Privacy^^/^*^ ff*^~' 

1. I can (even if someone helps me because of my disability) get , 

* Strongly Somewhat Neither Somewhat Strongly 

to where I want to go • • CJ LJ 

2. I have control over my daily schedule ID Q Q LJ 



Vei 

7 nor 

information have access to it Q Q G G 

5. I can set desired outcomes (goals) for myself • • ^ • • 

6. I can decide about how I spend my money Qj Q Q Q 

7. I can make decisions that will affect my future LJ LJ /^-^ ^ ^ 

8. I am satisfied with my current level of independence LJ LJ

D vera 1 Satisfaction 

Vel 

7 nor 


V e r y 

dissatisfied . _ ^ 


aiven all the considerations, how satisfied are you with your ' ' _ ' 

onsumer directed support program? .. LJ LJ LJ LI LJ LJ 


low likely would you be to recommend a consumer directed nomnukeiy unlikely 

upport program in your county to a friend in a similar situation? .. Q Q Q Q 3 Q Q 

las the consumer directed support program met the expectations Exceeded Met Failed 

lat were set for you by your case manager and county social 

Exp tatlons E x p e c a t K E x p e c 

f i "" ( a t l 

° 

ervices department? • • • • • • 13 

'hat is the one thing that would have the greatest impact on your satisfaction with consumer directed 

jpports? 

linking beyond consumer directed[supportsto your overall quality of life, on the followingj padesg^j 

ease indicate how much you agree ordisagree with each statement. Please complete these sections ?; 

3m the perspective of the person with a developmental disability. The person who has the . iavelopmental 

disability should be directly involved in completing this survey as much as possible. _ ^jf? 


independence Mobility/Control/Privacy 

^^j^^^^^^^^^^^^M Strongly Somewhat Neither Somewhat Strongly 


to where I want to go • • a • • 

I have control over my daily schedule Q Q Si LI LJ 

I have privacy to be alone or with people I choose . • Q Q \M Q LI 


information have access to it... • • 13 • CJ LI Q 

I can set desired outcomes (goals) for myself • • a • • 

I 

can 

am satisfied 

decide about 

with my 

how 

current 

I spend 

level 

my 

of 

money 

independence ... 

Q 

• 

LJ 

m 

(3- 

• 

LJ 

• 

CJ 

• 

I can make decisions that will affect my future LI D (El Q Q






Very 

satisfied 



Very 

dissatisfied 

• or • • • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 

• of • • • • • 



Exceeded 

Met Failed 

services department? Q Q Gl Of Q Q Q 



supports? 

IT ô,-vVKU. bucQr,^- .^K-oAcS hgJl-PxJc-VW^ A\-*>. ^5 

>-e^,r-T- h,-**- & 

beyond cliFected^ Thinking consumer. supports to you^wrajh|ijality' of - life,- on the following page 

please indicate how much you agree or disagre^wftf^ Please complete 7 

of the with these"sectjons 

from the perspective person a developmental disability. The person who has the 


I Independence Mobility/Control/Privacy 













or • • • • 

• • • a-• 

• • • • Or 

• • • • 

• • • • 

• • • • a 

• • • • a* 

• • • or •


e r 

^ 

!f nor dissatisfied .. e 

f^ , 


1. Given all the considerations, how satisfied are you with your I ' 1 ' 

1 


2. How 

consumer 

likely would 

directed 

you 

support 

be to recommend 

program? 

a consumer directed 

O 

—1 

LI LJ LI 

1 

LI LI LI 

1 

support program in your county to a friend in a similar situation? .. LJ LJ LJ LJ CJ LJ 



,, . r i . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~H 

services department? • O • • • • • 

k What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? i 

\ ^ i t f x . » I^KIAQA ts^fia^J- 


please indicate how much you agree or disagree - 

with: eachstatement. Please complete these sections 

from the perspective of the person with a developmental disability. The person who has the ' 

developmental disabilityshould be directly involved in completing this survey as much as possible. -_if 0 

U?d£P®ndenCe I Mobility / Control / Privacy Agree Disagree 

^gmi^^g^^^mJ Strongly 


to where 1 want to go • • 3 • • 


3. 1 have privacy to be alone or with people 1 choose. • • • • 




• • 

• 

• 

• 

• 

• 

6. 

7. 

8. 


1 can make decisions that will affect my future. 

1 am satisfied with my current level of independence ... 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

cn

Overall Satisfaction^! 



V e r 

y 

satisfied 



y e r 

_,. * _, 

dissatisfied 

•••••da 


2. How likely would you be to recommend a consumer directed ""f^ w 

support program in your county to a friend in a similar situation? .. Q Q Q Q • ^ Q 



that were set for you by your case manager and county social ~n • . ' 

services department? Q Q Q Q Qfij Q 

A^Â cat*. 4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? / / l o Z e c - o s i J - a s J i , A U v ^ - k U * »T»SL 

T.S.p, ^ tr>o furti^'for^^ "fp^ w^ f.W -fp r/ 

r 

overal Thinking beyond consumer directed supports to your quality, of life; onithp iojfpV^fpageSiK F 

please indicate how much you agfee^rdisagree" with each statement. Please complete^s^sjcuons 

from the perspective of the person with a developmental disability. The persorf wlro hasfihe i i ~ - 

developmental disability should be directly involved in completing this survey as much as possibles 

I Agre independenpeS Mobility/Control/Privacy 


. _____ _____ C»-.«U, C-i—-au/Kot N7_i#f*-M> QrkffVwhat .^tmi 

" f 

Disagre 


2. 



• ' 

• as 

• 

• 

• 

• 

• 

• 



information have access to it h • • • • 


6. 

• • m • • 

7. I can make decisions that will affect my future • • w • • 

8. I am satisfied with my current level of independence • • • • 

a j

Overall Satisfaction"! Neither satisfied 

s, now sausnea are you 

^ 

wun your r—» i—i 

r 

consumer directed support 


er 

y nor dissatisfied .. e 

TL . 


program? U U Qi U U U 


.... .. , j- * j likely nor unlikely unlikely 

2. How likely would you be to recommend a consumer directed — —-—i 1— 

q Has the consumer directed support program met the expectations Exceeded Met Failed 

J 

- 1 1 

, , r-r r a r- Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n ~ _ r T J ~ 

support services program department? in your county to a friend in a similar situation? . . [_j • Qj • £y • 1J1 Q Q| • Q • Q • 

4. What is the one thing that would have the.greatest impact on your satisfaction with consumer directed 

supports? ^ i> 

I/?/. AtMh MouJ ^7WxiU^Mmdj^ nm, 

-fcfC./rf. . NOfjA^^ hil'niitA c 

/HA//JJV ///IJAAM, Vnh/iVr A J 

uMJTR 

-HAM foajU)AM)LI/t7. 

Thinking beyond consumer directed supports to your overall quality of life, on the f_lowing_pag§§g|9i 



developmental disabihty should be directly involved in joompjeting this survey as much as possible. _.jr,r 

Neither Disagre 

1 can (even if someone helps me because of my disability) get Strongly Somewhat 

to where 1 want to go • 


• • • 

Independence | Mobility / Control / Privacy Agre 


3. 1 have privacy to be alone or with people 1 choose.......... • w • • • 


• • • a 

5. 1 can set desired outcomes (goals) for myself • • a 


CD 

7. 1 can make decisions that will affect my future • • • • 

• • 

?8- 1 am satisfied with my current level of independence ....... a' 

•





Very 

satisfied 

—I 



Very 

dissatisfied 

• P • • • • • 

1 

Very 

likely 



nor unlikely 

Very 

unlikely 

IS • • • • • 

Expectations 

Met 

Expectations 

Failed 

Expectations 


services department? Q §1 • Q (~J Q Q 

^p^LOOffc 

i. What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? Feto^r TC

gVerall Satisfaction ^ 

3iven all the considerations, how satisfied are you with your 


Very 

satisfied 

T 

Very 

likely 



Very 

dissatisfied 

T 

• • • • • • 


nor unlikely 

Very 

unlikely 

tow likely would you be to recommend a consumer directed 1 r- 

,upport program in your county to a friend in a similar situation? .. J ) Q Q Q Q Q Q 

-2*g^ 

tes the consumer directed support program met the expectations E Exceeds Met Faued 

hat were set for you by your case manager and county social 

Expectations 


4- upports? . Y& A WOff VYOTFER-K) jprmid^ JMCTP VTA \\NI^ 

/hat is the one thing that would have the greatest impact on your satisfaction with consumer directed 


% e r y 

satisfied . 


V e r 

y 

dissatisfied 

1. Given all the considerations, how satisfied are you with your ry / 

r\ n n n n fl 

consumer directed support program? LJ LJ LI LI LJ LJ 

2. How likely would you be to recommend a consumer directed "f y y 


tmeu 

f aaiy unl 

f ly 

support program in your county to a friend in a similar situation? . . (^XJ • Q Q Q Q 


that were set for you by your case manager and county social — 

E x p 

T 

t i o n s EsE££ 

f^ 

services department? [jj • Q Q Q Q Q 

4. What is the one thing that would f have the greatest impact on your satisfaction with consumer directed 

supports? ~ duvs__VV-V- Uvvk^\rsU^M 

4**- ÎT 

JsLng 

Tnln 

beyond consumer directed sup_prts.to/yo^r6veMj cjliallty 

pleaie indicate how much you "agreor'disagre wrtrfea^Tstetement. of life, on th 

from the perspective of the personjwitha developmental disability. The compl 

Please 

developmental disability should'be directly involved inTOmpTeting survey much 

this 

!.n.-^!SPSJ?,^®nce | Mobility /Control /Privacy Agre 



as 

Disagre 


_r • • • 


. 

LJ 

[_K 

[_f LJ 

• 

LJ 

• 

LJ 

• • 


4. Only people who are supposed to know my personal , 

information have access to it.... . [_f LJ LJ LJ LJ 


6- I can decide about how I spend my money Q LJ LJ LJ 

I can make decisions that will affect my future ar^ a a a a 

o- I am satisfied with my current level of independence ... a car a • •



consumer directed 

V e r 

y 

satisfied 



V c c 

? 

dissatisfied 

lerauons, now satistied are you with your ' W ) 

support program? LJ LI'DSP U U LI LJ 



likely 

T— 

nor unlikely 

1— 

unlikely 

1 

support program in your county to a friend in a similar situation? .. Q Q LJ LJ Q L) 

3. Has the consumer directed support program met the expectations E*«*eded Met Failed 


that were set for you by your case manager and county social ~^ ^ — ~ Z ^ 

services department? • • • • T^J • • 


supports? NRIOJ\\U) F 1 lx)rl^^lrO W\R(L CN 1 DFFRFEM>U^J£_, 

- P K ^ COSKAUZT. fctUQFvJj) H(L*LCXL^^fo $ < J ~ CJ ^ W ^ ^ ^ F F ^ 

Thinking beyond consumer directedsupports to your overall quality of life, on the following pagesd^-a 11 

please jndicate how much you agree or disagree with eacfrâfement. Please completerthese sections 

from the perspective of the person with a developmental disability. The person who has the , 

developmental disability should be^directly involved in^compjetihg this survey as much as possible. 

LND©P£PdenCe | Mobility / Control / Privacy AGREE 


Neither 

DISAGREE 


to where I want to go ; • • • • 

2. I have control over my daily schedule • 

I have privacy to be alone or with people I choose.......... • 

BP • 

• 

• 

• 

• 

• 

CO 

4. 

5. 




• 

• 

• 

• 

• 

• 

• 

• 

6. 

7. 




• 

• 

• 

• 

• 

B P 

JAR 

• 

• 

• 

• 

• 

• 

CO 

T v ~~i R



1. Given al the considerations, how satisfied 

Very 

are you with your 

Very 


satisfied 

dissatisfied 

2. suport How likely program would in you your be county to to recomend a friend a consumer in a similar directed 


Very 

situation? 

likely 

• • 

nor 

Ma 

unlikely 

• 

unlikely 

• • 

Has the j consumer directed suport program met the 

Met 

expectations 

Faded 

department? set Tor you Dy your case manager ana county social ~~ 


Exceeded 

What that services were is the set one for thing you by that your would case have manager the greatest and county impact social on you 

Expectations 

VfMv rfQturVujM" 'is auHionzed -for*ftaymenf ^Mvr AWin .seMto 

ydeint^ 4hf boatd rums 1 

- tlnK ^kV mnte 4k^y m^f. d-^c 

consumer directed suport program? • • • • ity • 

suports? mOftf. TOJtbiliUl m loaton (IT fnrh Specific SV 

nwalâuicM.ne*;,. KarYK-W rMinW e Pi.fn ftcmW^




c r y 

^ 

satisfied 


nor dissatisfied * _ , 

dissatisfied 


2. How likely would you be to recommend a consumer directed nomniikeiy unuke__ 

support program in your county to a friend in a similar situation? . . jjf _ [ ] [ ) [ ] [ ] [ ) 


. . . . r , • . . • Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n "ÎR 1 

i 

services department? • • • J3 • • • 


supports? ., 

r ttf'lfl fl&fsr- MMCK- s?r leaser 

r»n fnlnu/in Thinking hinl/inn beyond hai;r\nH consumer nnncumnr directed Hi motor! supports otinnnrtp to tAi/niirmiarall your overall quality iniiali'h/ of nf life, lifts on the foltowjng tho pages naflfifi " _ 

please indicate how much you agree" or disagreewith each statement. Please complete these'sections" 

from the perspective of the person with a developmental disability. The person who has the " •- = 

developmental disability should be directly invorved in completing this survey as much as possible. 

1 Independence Agre 

Mobility/Control/Privacy 

1. 1 can (even if someone helps me because of my disability) get 





2. 1 have control over my daily schedule H • • • • 

3. 1 have privacy to be alone or with people 1 choose. M • • • • 




6. 1 can decide about how 1 spend my money • ® • • • 


8. 1 am satisfied with my current level of independence • • • •

Overall Satisfaction"! 





Very 

satisfied 



Very 

dissatisfied 1 

a a • a a a a 

Very 

likely 


rr r r Expectations 


nor unlikelv 

1 

Very 

unlikely 

• ••••• 

Met 

Expectations 

Failed 

Expectations 

that were set for you by your case manager and county social * 


X. What is the one thing that would have the greatest impact on your satisfaction with consumerdirected 

supports? 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages- *t 

please indicate how much you agree ordisagree witlreach^statement. Please complete these sections , 

from the perspective of the person with a development The person who hasthe^ -?>_.' 

developmental disability should bedirectiy involved inxoBêting this survey as much as possible^ " 


Agre 


Disagre 


• • • • 

2. I have control over my daily schedule • t__ • • • 

3. I have privacy to be alone or with people I choose. • J • • • 

4. 

5. 




• 

• 

• 

• 

• 

• 

• 

• 

6. 

7. 



• 

• J • 

'xj • 

• 

• 

• 

• 

CO 







Very 

satisfied 

Very 

likely 


. i . ~. i Expectations 

• that were set for you by your case manager and county social ~n 




Neittii 

Very 

dissatisfied 

1 

• •••••• 

ier likely 

nor unlikely 

Very 

unlikely 

1 

• • t^Q • • • 

• • a • • • 

Met 

Expectations 

Failed 

Expectations 


supports? 



from the perspective of the person with a developmental disability. The person who has the^ 



Independence Mobility / Control / Privacy 

_ _ _ _ _ _ B H H H — 

_ | Strongly Somewhat Neither Somewhat Strongly 

1. I can (even if someone helps me because of my disability) get ^V— 

to where I want to go Q • Q Q \) 




5. I can set desired outcomes (goals) for myself • • a • • 

6. 

7. 

• • • • 

• • • • 

• • • • 

• • • • 

• • • 

a • • 

• • • 

• • • 

o. I am satisfied with my current level of independence .. . • • • • • 

• 

•





V e r y 

satisfied 



V e r 

y 

dissatisfied 



—r 1 1— 

support program in your county to a friend in a similar situation? . . ffl • Q Q Q Q Q 


... t r i , . . , Expectations Expectations Expectatii 

that were set for you by your case manager and county social ~n t 

-r— 

4L, 


5t




Neither satisfied . 

V e r 

y 

satisfied 

nor dissatisfied V 

V e 

. fy j 

dissatisfied 


n l k £ 

2. How likely would you be to recommend a consumer directed nomnhkeiy " '| ' y 

support program in your county to a friend in a similar situation? .. jy [ ] [ ] [ ] [ ] Q Q 


. . . , , , , r 


that were set for you by your case manager and county social ~T_ * 

services 

department? El • • • • • • 

4. What is the one thing that^wputerlTavethe greatest impact on your satisfaction with consumerxjireeded 

supports? ) / L W / LdMa 

tfy iTliosj^ rjH -T^CA LÔAJ^pi&AA^ , 

pages4|p^g 

Thinking beyond consumer directed supports to youroverall quality of life, on the following 

please indicate how much you acjreeVr disagree with each statement. Please complete these sections 

from the perspective of the person with a developmental disability. The person whohas^toe^^ 

developmental disability shouldbe directly involved in completing this survey as much as possible. 

I Agre Independence Mobility/Control/Privacy 











Disagre 


& • • • • 

CI • • • • 

® • • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • • •


1. consumer Given al directed l the considerations, suport program? how satisfied are you with your 

2. suport How likely program would in you your be county to to recomend a friend a consumer in a similar directed situation? 

T 

Very 

satisfied 

T 

Very 

likely 

T 




nor unlikely 

Very 

dissatisfied 

Very 

unlikely 

m • • • • • • 

the consumer directed suport program met the expectations Exceeded 

Failed 

Expectations 

Has 3. 

4. What is the one thing that would have the greatest impact on yo 

suports? that were set l.utvw for you by -fo your case manager cu^ and county social E 

^Qrc±3ty*v>






Very 

satisfied 

Very 

likely 


°' , , . . Expectations 




nor unlikely 

Very 

dissatisfied 

Very 

unlikely 

• • • • • • • 

Met 

Expectations 

FaUed 

Expectations 



sr^rfre 

4 What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

" '•-> • t —- ^-Xj 1 

supports? — i M j rhaA^JL- &^ QUA OIAJXS 1 

0u\-& s-jrri 

I






Very 

satisfied 

Very 

likely 




4. What is the one thing that would have 

supports? 

?atest impact on your sati 



Very 

dissatisfied 

1 

• • • • • • 


nor unlikely 

Very 

unlikely 

% • • • • • • 

Expectations 

\âM






Very 

satisfied 



Very 

dissatisfied 

• _rti • • • • 

Very 

likelv 


nor unlikelv 

Very 

unlikelv 

_t) • • • • • 


Met 

Failed 

. . . , , , , . , Expectations 

• ofa 

Expectations 

• • 

Expectations 

• • 

that were set for you by your case manager and county social ""• 



supports? f O ' X v - V tv* j 

1 

C>. b '' 





Independence | Mobility/Control/Privacy Agre 



3. I have privacy to be alone or with people I choose.. . 






Disagre 


• • • • 

• • • • 

• • • • 

• 

• 

• 

• 

• 

• 

• 

• 

• • J 

• • 

• a 

• 

• 

• 

• 

7 

• • •


Very 

satisfied 



Very 

dissatisfied 

1 Given all the considerations, how satisfied are you with your rS ^ !~S HI Fl HI 







Very 

satisfied 

Very 

likelv 




E x p e c t a t l 0 n s 



Verydissatisfied 

• • • • • • 


nor unlikely 

Met 

Expectations 

Very 

unlikelv 

Failed 

Expectations 


supports? .jf^gyiGUtf Jtfj/p 

i^ 6 

- 






1 • I can (even if someone helps me because of my disability) get ^ 

Disagre 


to where I want to go jSj Q LJ LJ LI 

2. I have control over my daily schedule £AC • • • • 

3. | have privacy to be alone or with people I choose. .. T2f • • • • 

4 

- Only people who are supposed to know my personal 

1 


I can set desired outcomes (goals) for myself ^ • • • • 

can decide about how I spend my money [2* • • • • 

• can make decisions that will affect my future M • • • • 

am satisfied with my current level of independence .. J A • • • •






Very 

satisfied 

T 

Very 

likely 

T 



Very 

dissatisfied 

• • • • • 


nor unlikely unlike!; 

BTQ • • • • • 


Met 

Failed 

E x p s c t a t o n s 


I 

' 

-Jtnectai 

Expectations 


• Of • • • • 

Expectations 


SUpOrtS? 0 O F . , ^ . ^ ^ r » ^ ~ ^ r ^ ~ . . A ^ A^JT 

*J++~. A&ffeJZJ, A^. -HKT^^y AÂ^J**. UCKFUIJ SU.meP 3*> AX*Lu£j OUL3~- 

**** A 

"" rr 

'*— '" ^"y'^J Frit|






, 


e 

|7 . 

satisfied 

nor dissatisfied ^ 

diss: 

— | 1 

Very 

likely 


nor unlikely un 

• ^ • • • • 


Met 

that were set for you by your case manager and county social ^T* 

Expectations 

3 

" 0 

" 5 

services department? Q Q Q Q 

4. What is the one thing that would have the greatest impact on your satisfaction with consumer dire 

supports? ObC'S ^Gu*u«jtj?. t* IMJ^M/LU^. &



' consumer directed support program? 


; 




- services department? 

Very 

satisfied 

"T 



Very 

dissatisfied 

• Ja • • • • • 

Very 

likely 


nor unlikely 

T 

Very 

unlikely 

r Failed 

Expectations 

&Q Q Q Q Q Q 

Met 

Q • 

Expectations 

• • • • • 

Exceeded 

Expectations 

-nU ^ p6^( M'^yv flil/l 4 What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

' supports? . VofJUJA RWL.r&r / y H 

\\- R/IY.FV 

J 

.Myidr 

! 

Mcny J 

riflVif -tV ) 

I N L -t.\H-ft









Very 

satisfied 

Exceeded 

Expectations 



Very 

dissatisfied 

• ••••• 


nor unlikelv 

Met 

Expectations 

Very 

unlikelv 

Failed 

Expectations 

jtf • • • • • 


supports? 

A M) m CM- A- / TF Aia; / r\7 £ 0 N THR PFAGFARN IT FH/.









Very 

satisfied 



Very 

dissatisfied 

1 

• • • • • A • 

Very 

likely 


nor unlikely 

Very 

unlikely 

• • • A • • • 

Exceeded 

Expectations 

Met 

Expectations 

• ••••• 

Failed 

Expecjations 


supports? 




"developmental disability should be directly involved in completing this survey as much as possible. 

Agre Disagre 

Independence 1 Mobility/Control/Privacy 

' B Strongly Somewhat Neither Somewhat Strongly 







can set desired outcomes (goals) for myself 

can decide about how I spend my money 



• • • • 

• • • • 

• • El • • 

• X] • • • 

• • El • • 

• • B' • • 

• • A • • 

• • S I • •


V e r 

* 

satisfied 


W e r 

* J 

dissatisfied 


consumer directed support program? —I —I U LI LI LI 



noru kely unli 

f' | kely 

support program in your county to a friend in a similar situation? . . ^ _) Q Q __ __ Q 

3. Has the consumer directed support program met the expectations Met Failed 

, . , , r CJ r Expectations Expectations Expectations 

that were set for you by your case manager and county social « ^ • 

services department? • _ • • • • Q 

4. What is the one thing that wouJd have the greatest impact on your satisfaction with consumer directed 

supports? fl^vx .( i,n d#'cr»(tf A^tf , i WQ 1 

^ ^Jfl^tiK 

Thinking beyond consumer directed supports to your overall quality of life, on the foltow|ngj^ges^_ye 

please indicate how much you agree or disagree with each statement. Please complete thes£S^)t|orjs 

from the perspective of the person with a developmental disability. The person who h^the^; z=-£r 

developmental disability should be directly involved in completing this survey as much as possible. _= 

INDEPENDENCE \ Mobility /Control /Privacy 


2. I have control over rm, 

3. I have privacy to be a 



5. I can set desired outcomes (goals) for myself Jmv^y. Pw*< 

6. I can decide about how I spend my money. 

7. I can make decisions that will affect my future. .(.^$U^). 

8. 

Agre 



• • • • 


• • • • a 

• • • • 

• J • • • • 

• • • 

• • • a 

• • • • 

. • m • • •





Very 

satisfied 



Very 

• at) • • • 

dissatisfied 

• 

Very 

likely 


nor unlikely 

Very 

unlikely 

~ j j — I / I R I " 

3. Has support the consumer program in directed your county support to a program friend in met a similar the expectations situation? . . Q (7^Q Q Q Q Q 

Exceeded 


Exp 

^ c 

' at,ons 

• • uyu 

Met 

• • 

Failed 

• 




supports? VnkQ.-m m a I i -tic. .- a ^ a j : J U a ^ j L > * f ^ . f t / * : ^ 

CL jk^ 

\ I \ J V< H TO . ^ 1 -. A \ k t ; y t ; A U c Hp VUX i M\/T?4


V e r y 


V e 

f y 


Given all the considerations, how satisfied are you with your ' S ' ' 

T 7 1 r 

consumer directed support program? '—I « "—I • • I ' 


How likely would you be to recommend a consumer directed j*eiy 

n o r u i k c > y 

f 

"""^ 

support program in your county to a friend in a similar situation? .. ^ G G D G G G 




that were set for you I 

that were set for you by your case manager and county social ~y ^ ^ 



supports? ^^JJCWJO C*UA m, ^trs/Yt bÔ****- ci CouL*. e^^^fcy- UJUJU^ 

eLw't -LuLtsi^ \U^L+t*jj ^tjgA-r*- ooiHt t W j . Sfn. . fle. ^ccid Ur r's sift c*Aobex{j 

WWevery/t. rf c 1 

^ ^ ^ - 

^ ^ ^ ^ ^ p/«v a»ri*-o I 

QyJMgilûality ilfliiUlV^- _i '-i:^^^. 

Thinking beyond consumer directed supports to your of life, ojijigjoto^^ _ 

please indicate how muî'y^'^^^^sagree with eau^âfement Please'compietejhese'sections 

from the perspective of the person with a developmental disability. The person who J^ÔW^ : 

developmental disability should.be dlrecînvblved in completing this survey as" much asppssible. 




to where I want to go .•••>_.•'• Of 

2. I have control over my daily schedule Q 

3. I have privacy to be alone or with people I choose.......... Q 


information have access to it... Q 



7. I can make decisions that will affect my future Q 


• • • • 

• • a 

• • a 

• or • • 

• a • 

• ef a • 

• • • 

• a •








services department? ; 

Very 

satisfied 



Very 

dissatisfied 

• _ • • • • • 

Very 

likely 


nor unlikely 

!_!•••••• 

Very 

unlikely 

Exceeded 

Met 

Failed 

Expectations 

• a • 

Expectations 

• • • 

Expectations 

• 

//^^^y •^W^ 4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? a-T^JL- ,^>^îeîJ^rJb^ ^n^









Very 

satisfied 



Very 

dissatisfied 

•f • • • • • • 

Very 

likeiv 


nor unlikely 

Very 

unlikely 

•fa • • • • • 

Exceeded 

Expectations 

Met 

Expectations 

Failed 

Expectations 

• • • • • • • 


supports? (X P-rum -h^> 4HW, ^ I>m//IYWR'*VRI rTK/i,() 

3 


please indicate how much you agTee or disagree with each statement. Please complete these sections 

from the perspective of the person^ yyjth a developmental disability. The person who has the 

developmental disability should b^directly involved in completing this survey as much as possible. • 

Independence I Mobility/ Control / Privacy AGREE Disagree 

^^^^^^^^^^^^^^^^^^J Strongly Somewhat Neither Somewhat Strongly 






information have access to it • • Ef- • • 




8. I am satisfied with my current level of independence . • • • of •


V e r 

y 

satisfied 


V e r y 

dissatisfied 


consumer directed support program? Lid LJ LJ LI LI LI LI 



2. How likely would you be to recommend a consumer directed 1 1 1 

support program in your county to a friend in a similar situation? . . \ ^ LI LI LI LI LI L) 


.. . . , , . . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~T ~ ^ ^ 

services department? LI QT LI LI LI LI LI 


supports? 

rt/MbiJi-hj, - *jT dowjjh hww v^wc Jrvrnd^ OK Oom h> 

nttAiA xurxbX ^QY S~ mmAh5 info ^JU JjOM- # W i^tnAJJ SMUS 






Very 

satisfied 



Very 

dissatisfied 

• "_f • • • • • 

Very 

likely 


nor unlikelv 


, , , , . . Expectations , Expectations 

• that were set for you by your case manager and county social 


Very 

unlikely 

• • • • • 

Failed 

Expectations 

_f • •I • • • 


supports? 

Thj AtaAAtm u)ki±kcr or not ir aMcncr UJah/c 






^ h m h m b h m J Strongly Somewhat Neither Somewhat Strongly 







6. I can decide about how I spend my money . .. 


8. I am satisfied with mv current level of inrienent 

of • • • • 

• • • • 

• • • • 

• or • • • 

• or • • 

• • • 

• oaf • • • 

• • • •

Overall Satisfaction NEITHER SATISFIED 

V T T V 

V E R Y 

NOR DISSATISFIED SATISFIED DISSATISFIED 

1. GIVEN ALL THE CONSIDERATIONS, HOW SATISFIED ARE YOU WITH YOUR N N 5 6 N N N F L 

CONSUMER DIRECTED SUPPORT PROGRAM? —* —1 _J L J L J L J L J 

VERV NEITHER LIKELY VERY 

2. HOW LIKELY WOULD YOU BE TO RECOMMEND A CONSUMER DIRECTED 

LIKELY 

N O R 

UNLIKELY 

-I 

UNLIKELV 

R 

SUPPORT PROGRAM IN YOUR COUNTY TO A FRIEND IN A SIMILAR SITUATION? . . [ ] [ ] [ ] fjj |~j p| 

3. HAS THE CONSUMER DIRECTED SUPPORT PROQRAM MET THE EXPECTATIONS r^^d MET FADED 

, , KXPECTATIONS EXPECTATIONS EXPECTATIONS 

THAT WERE SET FOR YOU BY YOUR CASE MANAGER AND COUNTY SOCIAL — I _ ^ I 

SERVICES DEPARTMENT? • J J • ^ • • 


SUPPORTS? 





Independence I Mobility/Control/Privacy AGREE Disagree 

M B H M O I I _ _ _ _ 1 _ _ _ B M | J STRONGLY SOMEWHAT NEITHER SOMEWHAT STRONGLY 



2. I HAVE CONTROL OVER MY DAILY SCHEDULE 


4. ONLY PEOPLE WHO ARE SUPPOSED TO KNOW M Y PERSONAL 


5. I CAN SET DESIRED OUTCOMES (GOALS) FOR MYS< 

6. I CAN DECIDE ABOUT HOW I SPEND MY MONEY 

8. 

• • • • 

• • • • 

• • • 

• • • • 

• • • • 

• • • • 

• • • • 

• • • •






Very 

satisfied 



Very 

dissatisfied 

r 

• fru • • • • 

Very 

likely 


nor unlikely 

T 

Very 

unlikely 

r 

&r/a • • • • • 

Failed 

Expectations 



mat were set iur you uy yuui case manager ana county social 

Exceeded 

Expectations 

• . i 

Met 

Expectations 

• 1 

services department? Q ST Q Q Q Q Q 

4. What is the one thing that wouldtiave the greatest impact on your satisfaction with consumer directed 

supports? i A.U-/e. V^


V c r 

y nor dissatisfied ,. f\. . 

satisfied 

• cat • • • • 

dissatisfied 

• 




2. How likely would you be to recommend a consumer directed noruniikeiv 

support program in your county to a friend in a similar situation? . . (~J fj^ • Q L_ Gl L_ 


• • • 0 • • • 

, . , Expectations Expectations Expectations 

that were set for you by your case manager and county social ^ ^ 



supports? . - 

Thinking beyond consumer directed supports to you? overall quality of life, on the following pages ^ 

please indicate how much you agree or disagree witfTeach statement. Please complete these sections 




• : I Strnnplv Somewhat Neither Somewhat Stron 


• R • • • 

2. • • • • 


CO 

4. 

5. 


• 

• 

• 

• 

• 

• 

• 

• 

6. 

7. 




• 

0k • 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

CO 

u n l l 

l 

k e 

' v






Very 

satisfied 

1 

Very 

likely 

—I 

3. Has the consumer directed support program met the expectations Reeded 






nor unlikely 

1 — 

Very 

dissatisfied 

1 

Very 

unlikely 

1 

A • • • • • • 

Expectations 

Met 

Expectations 

Failed 

Expectations 


supports? '< •' Q •.: :,.! 0 ' j - f f ' 

: 

. ^ , 

Thinking beyond consumer directed supports to your overall quality of life, on'the following pages 




I Independence | Mobility / Control / Privacy Agree Disagree 

^TlHiHHHÎ^^^^HHHI^^HMfl Strongly Somewhat Neither Somewhat Strongly 



I have control over my daily schedule • • • ® • 

3. I have privacy to be alone or with people I choose .. • • • • 

e\i 




6. 

I can decide about how I spend my money a 

7. I can make decisions that will affect my future a 

8. 

I am satisfied with my current level of independence a 

f 

• • • 

• • • 

• a •







V e r y 

.*? * nor dissatisfied 

satisfied 

• • • • £f • 

dissatisfied 

• 




... . , . i . • , Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n ^-i \^ 

services department? • Q • • • Q CJ 

4. What mat is tne the one tning thing tnat that wouia would nave have the greatest impact onyourâtisfaction with consumer dsrecl directed 

supRorts? 


please indicate how much you agree or disagree with each statement. Please complete thesesections 



^ndepende^C^ Mobility/Control/Privacy 







6. 

7. 

8. 

Li 

am satisfied with my current level of independence Q £^ 



• • • • 

• • • • 

• a • • 

• • 

• 

• 

• 

• 

• • 

• 

• 

• 

• • • 

a • 

• • 

• 

•

, Overall Satisfaction _ Neither satisfied 

hW^r^W/fr,) 1f______m^Llf-^ MÎM^fl Very nor dissatisfied Ver 

7 


1. Given all the considerations, 

>, now 

how 

sansnea 

satisfied 

are 

are 

you 

you 

wnn 

with 

your 

your 

— 

^-.i ^ 

, r 

consumer directed support program? -"xj - U U U U 


2. How likely would you be to recommend a consumer directed norunhkeh 

support program in your county to a friend in a similar situation? .. Q frj Q [] [] Q [] 


., . , , . , . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n—~~ ^ ^ 

services 

department? • • • • • • 

4. What is the one thing that would have the.greatest impacton your satisfaction with consumer directed 

supports? twl a^g^, AJÛL- 

7 t 


please indicate how much you agree or disagree with each statement. Please complete thesesections 


developmental disability should bVdirectly involved in completing this survey as much as possible. 


— 

H 

u n l l 

| 

k e l y 


1. I can (even if someone helps me because of my disability) get^_^ 

to where I want to go j^t • • • • 

cvi 

CO 

• • • 

I have privacy to be alone or with people I choose • • • • • 





• • • • • 


.cat 

• • • • • 


CO



consumer directed support program? .- 


V c r 

y 

satisfied 



V e r 

? 

dissatisfied 

• • • • • J^F • 



support program in your county to a friend in a similar situation? .. Q Q Q Q D Q 


. . . , , . . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n ^ — 7 — — ^ — 

services department? • • • • • Q 


supports? ~ 

Thinking beyond consumer directed supports to your^yerall quality of life, on the following pages 

please indicate how much you agree or disagree with eaclvstatement. Please complete these sections 












8. 

• • • • 

• • a a 

• • • • 

• • • • 

• • • O R • 

• • • • 

• • • • 

• • • a









Very 

satisfied 

Very 

likely 

Exceeded 

Expectations 




nor unlikely 

Met 

Expectations 

/ 

Very 

dissatisfied 

Very 

unlikely 

Failed 

Expectations 

• • • - • • • • 


supports? 

Thinking beyond consumer directed supports to your overajlI quality of life, on the following pages 

please indicate how much you agree or disagree with eachjstatement. Please complete these sections 



Independence- [ Mobility /Control /Privacy Agree Disagree 

JBIH^HHH^^lri Strongly Somewhat Neither Somewhat Strongly 





• 

a- • 

• 

• 

• 

• 

• 

• 

CO 



or 5. I can set desired outcomes (goals) for myself • • • • 

or I can decide about how I spend my money • • • • 

CD 

7. I can make decisions that will affect my future. .. & • • • • 

CO 



Ver 

>' 

satisfied 



V e r y 

dissatisfied 


nîvwii «.•» N IW VVMWIWVIMUWLW, LL^/VV JULLJILWU )FUU WILLI JTUUI 

— R ~ 

\~7\ I W I K 

I 

I K I K J K | 

1 — 

K 

consumer directed support program? Al L-* L J L J L J L J L J 






. . . . , , • . . • Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n K 

i "-i— 

services department? • • S • Q Q Q 


supports? F I E V I B I I R F Y — HT, I N A NJOIIB -F-C A A & - H I I / » Q . S D I X V F *^TQ 

U J G - T Y > T / W / I H ? ^ C A G ^ Y S 0 N C A _ I / \ AUJVWJOS L p'









Very 

satisfied 



Very 

dissatisfied 

• a • • • • • 

Very 

likelv 


nor unlikely 

Very 

unlikely 

• ••••• 

Exceeded 

Met 

FaUed 

Expectations 

• a • 

Expectations 

• • • 

Expectations 

• 


supports? > 

VAJVICL-V cifj"uhiK ^ O N , r-P U- u)0(jLld V^W a Jnh • 

Onmmuîu please- IAV\P\






Very 

satisfied 

( 



Very 

dissatisfied 

1 

a • • • • • • 

Very 

likely 

-T 


. .. , , x. • i Expectations 



nor unlikely 

T 

Very 

unlikelv 

T ' 

SF Q Q Q • Q • 

Met 

Expectations 

Failed 

Expectations 

services department? • EF • • • • • 


supports? •• 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages . _ : 


from the perspective of the person with a developmental disability. The person who has the _ y_ : 

developmental disability should bedirectly involved in completing this survey as much as possible. 


^^^^^^^^^^^^^^^^^M Strongly Somewhat Neither Somewhat Strongly 


to where I want to go • J a • • 

2. I have control over my daily schedule • si • • • 

CO 






7. I can make decisions that will affect my future • si • a • 

CO 

I am satisfied with my current level of independence a 

• £1 • •








Very 

dissatisfied 

• • SKQ • • • 


fior unlikely 

T 

Very 

unlikelv 

Failed 

Expectations 


• • • a • • • 

Expectations 




supports? 







trongly Sc [either Son lewhat 

mewhat r> 


CO 



• 

• • • 



• 

• • • • 


8. I am satisfied with my current level of independence • • • 

• 

Strongly 

•






Very 

satisfied 



Very 

dissatisfied 

a • • • • • • 

Very 

likely 



services 


nor unlikely 

, — 

Very 

unlikely 

1 

• ••••• 

Met 

Expectations 

Failed 

Expectations 

department? • • • H • • • 


supports? TVvt doU0X (XmOgnj- oa\DC.odsed. 




developmental disability should be directly involved in completing ttiis survey as much as possible. 


^H^^^^^^^^^^^^^^^^^l Strongly Somewhat Neither Somewhat Strongly 





c\i 

4. 

5. 




• 

• • 

• 

• 

• • 

• 

6. 

7. 



• 

• 

• 

• 

• 

• 

• 

• 


CO


V e r y 

nor dissatisfied f 5 

satisfied 

! , 

dissatisfied 


1 1 1 

_ 

consumer directed support program? LI LJ LJ LJ LJ LI LJ 






,, . , , . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n ^ ^ 

services department? • GjS • • • • • 


supports? 

Thinking beyond consumer directed supports to your overall qualityof Hfe^ on the following pages : 

please indicate how much you agree or disagree with each statement. Pfease complete these sections 

from the perspective of the person with a developmental disability. The person who has'the 





to where I want to go 0 

• • • • 


3. I have privacy to be alone or with people I choose • • • • • 

4. 

5. 




• 

• 

• 

• 

• 

• 

• 

• 

7. 

8. 




• • • 

• • 

a • 

• • 

• • 

a • 

CD






Very 

satisfied 

—I 



Very 

dissatisfied 

S • • • • • • 

Very 

likely 

—I 


. . . Expectations 


nor unlikely 

1 ~ 

1 

Very 

unlikely 

21 • • • • • • 

Met 

Expectations 


services department? • _J • • • • • 

1 

Failed 

Expectations 


supports? 

hÂ)/7Usri^ -~l/yi#->^V ^ cJZfjsU^yxX^ £fry?l^rz&*ii£^ O^Z 

developmental disability should be directly involved in completing this survey as much as possible. . 


^ M _ B S _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ | Strongly Somewhat Neither Somewhat Strongly 



• 

• • 

2. I have control over my daily schedule • • _ • • 

CO 



• _ • • • 

5. I can set desired outcomes (goals) for myself . • _ • • • 


• • • _ • 

7. I can make decisions that will affect my future • _ • • • 

8. I am satisfied with my current level of independence . • _ • • •


• _ Neither satisfied 

— — ^ I H W » I W W B W •IIIHIM'LL Very nor dissatisfied 

V e , 

T 




• • &u • • • 




•— r T 

support program in your county to a friend in a similar situation? .. Q^fQ Q Q Q _ _ 

3. Has the consumer directed support program met the expectations „„__ M 

/!L_- ^ J . ! " ^ . 

that wen 


services 

department? 

~T \_y ^— 

• • • Qf • • • 

. i , _ , , , . . . . Expectations Expectations Expectations 


supports? Sfr&a^SL^p f^f QA 

- (Xc^cV







Very 

satisfied 



Very 

dissatisfied 

—I 

• 

1 

• • • • • 


Very 

likely 

afj • 

nor unlikely 

• • • 

unlikelv 

• 

7 

T 

R ' 

Expectations 

Met 

Expectations 

that were set for you by your case manager and county social —i—IT/*—' 1 

Failed 

Expectations 

services department? Q t a U Q Q Q Q 


supports? mcrTgdoi\4n






Very 

satisfied 

T 



Very 

dissatisfied 

• • fcjf Q • Q • 

Very 

likely 



Exceeded 

services department? ".. 

Expectations 

/ Neither likely 

nor unlikely 

Met 

Expectations 

Very 

unlikelv 

Failed 

Expectations 

^mp • • • • • 

4. What is the one thing that would have theoreatest impact on yojîr satisfaction with consumer directed 

Supports? «h>y>€_JiCu\ " ' *--\ rr 


please indicate how much you agree or disagree with each statement'Please complete these sections 


developmental disabilityshduld be directly involved in completing this survey as much as possible. 



1. I can (even if someone helps me because of my disability) gel t 

2. 1 have control over my daily schedule 

• • • • 

• • • • • 

3. 1 have privacy to be alone or with people 1 choose • • • • 



K • • • • 

5. 1 can set desired outcomes (goals) for myself M • • • • 

6. 1 can decide about how 1 spend my money 

• • • • 


CO 







Very 

satisfied 

Very 

likely 




Very 

dissatisfied 

• • • • • 


nor unlikely 

T 

Met 

Expectations 

Very 

unlikely 

Failed 

Expectations 

i • i Expectations 

that were set for you by your case manager and county social «/ - • 

services department? __ • • U LI Li LI 


ports? 

v y^ '— 

' M h o o i F " o n o y i K i S VT^ 

Thinking beyond consumer directed.supports to your overall quality of life, on the follo^g pjges. 

please indicate how^much you[agree or disagree with each statement. Please completethesejections 

from the perspective ofthe pejsdn^hadevelopmental disability. J h e person w ^ ^ h e 

developmental disability should be directly involved in completing this survey as much as^pgssible. 


• • ' . . I ' " ' ' " 1 Strongly Somewhat Neither Somewhat Strongly 



2. I have control over my daily schedule. LJ 

3. I have privacy to be alone or with people I choose.... • 





7. I can make decisions that will affect my future • 


4 • • 

• 

• 

• 

i • 

• 

• 

i 

• • • 

• • • 

• • a 

• • a 

• a •






Very 

satisfied 



Very 

dissatisfied 

m • • • • • • 

Very 

likely 


that were set for you by your case manager and county social Expiations 


nor unlikely 

Very 

unlikely 

Met Failed 


services department? fjy • • • • • • 


supports? 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages 7 

i 

please indicate how much you agree or disagree with each statement. Please complete these'sections 

from the perspective of the person with a developmental disability. The person who has the"*** > 

developmental disability should bedirectly involved in completing this survey as much as possible.* 

2. 

3. 

5. 

6. 

7. 

8. 

jndepepdenC^j Mobility/Control/Privacy 

7 







• • • 

• • • 

a • • • 

si • • • 

• • • 

• • to 

• • 

• • 

•


C 

"7 , 

satisfied 


nor dissatisfied "^T 

dissatisfied 

Given all the considerations, how satisfied are you with your ^ ' _ _ ' 

consumer directed support program? L J L J L J L J L J L J 


o r u 

k e 

How likely would you be to recommend a consumer directed " "'' ' y 

support program in your county to a friend in a similar situation? . . Q Q Q [] Q Q Q 

"n»j*'y 

Has the consumer directed support program met the expectations Exceeded Met FAUED 

,, . , . . . , Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n n ^ 

services department? Q Q • • • • • 

What IS the one thing that would have the greatest impact O N your satisfaction with consumer directed 

S U P P O R T S ? ''VW^V I Y R W 

c 

-SK-TU^ JJC^ 

!


Very Neither satisfied 

.,/!-_. 

satisfied 


Given all the considerations, 5, how satisfied are you with your •/ _ i dissatisfied H 

consumer directed support program? • • • Q Q 

V E 

"7 


How likely would you be to recommend a consumer directed "" >ru 

f ke 

' y 

support program in your county to a friend in a similar situation? .. Q Q Q Q Q Q 



E 

t i o P S 

^T/ 

E x p c c a t i < > > s 

i ' 

Expet 

f t 

" )ns 


What is the one thing that, would have the greatest impact on your satisfaction with consumer directed 

supports? 

Thinking beyond consumer directs 

P L E A S E indicate how much ^SSPSt^^Sl^'^^ 

from the P E R S P E C T I V E of T H E P J * ^ 

jgdependence | Mobility /Control /Privacy Agree Disagree 

**** 



to where I want to go Q Vj Q Q Q 

!. I have control over my daily schedule. Q Dl Q Q 

I have privacy to be alone or with people I choose L I Q Q O 

Only people who are supposed to know my personal • / 

information have access to it.,'-TV . . ] 2 K Q Q Q Q 

I can set desired outcomes (goals) for myself • ^ • • • 

I can decide about how I spend my money "J^C [] Q Q Q 

I can make decisions that will affect my future Q Q Q Q 

I am satisfied with my current level of independence Q

O V E R A L L Satisfaction 

Very 

satisfied 

R 



Very 

dissatisfied 

.^Given all the considerations, how satisfied are you with your • ^ • * 

fconsumer directed support program? L J l_l • • • • • 

|How likely would you be to recommend a consumer directed 

R 

•r ' ' , i i i 

Very 

likely 


nor unlikely 

upport program in your county to a friend in a similar situation? .. G G Q G Q 

.

pverall Satisfaction | 

| '& • - ________—___—____ Neither satisfied 

..^7 - 

satisfied 

nor dissatisfied Very 

dissatisfied 



H O W likely would you be TO recommend a consumer directed B 

. • • • • • 


f y 

° o r u 

^ 

i k c l y 

""w? 

support program in your county TO a friend in a similar situation? .. N_F Q Q Q Q Q Q 

Has the consumer directed support program M E T the expectations Exceeded Met Failed 


E x 

T^ o n s E 

t i 

'P"f ° n s 


1/ 

Expectations 

What is the one thing that would have T H E GREATEST impact on your satisfaction with consumer directed 

supports? vc? OA ^ 0 ^JO^4- HR,L* HO*A SDRFP 4N




rlow likely would you be to recommend a consumer directed 


Very 

satisfied 

"T 



Very 

dissatisfied 

Q'H • • • • • 

Very 

likely 


. , . . i Expectations 


nor unlikely 

Very 

unlikely 

IKB • • • • • 

Met 

Expectations 

Failed 

Expectations 

I act iui yvju uy yuui oaac 11 icii layci ai iu ouui uy suuiai > ^ 

that were set for you by your case manager and county social ~T 

services 

1 

• 

department? \3TU • • • • • 

l/Vhat is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? , CiUhXA/LK


Given ail the considerations, how satisfied are you with your 


Very 

satisfied 

7 

Very 

likely 

RR 




nor unlikely 

T 

Very 

dissatisfied 

How likely would you be to recommend a consumer directed —^- r- r- 

support program in your county to a friend in a similar situation? .. gj^ Q Q Q Q Q Q 



Exp 

f tatl0 

Very 

unlikely 

Failed 

Expectations 

' ' i ~\y—"T" 



supports? " 

ma/X O N V \ A B U ^ A M D ^ C U V O A / V \ . D (WudA\'jA 

< ^ " ^ - > ^ T V X V A , ^ I ^ - J Y » A [\XAJVV I _ 

mh W I R T Mttôm A I Y O U I M ^ m ^ a t J T ^ U M i ^ ^ . 

i\ftiK RATOU to D O - F F U F L I T M . I L ^ 

1 ^ I L < H I / J ? ) O T D A L M ^ \AF 

I L L ' A A J ^ I R J P ^ Y L A / V U L 

rhinking beyond consumer directed supports to your overall quality of life, on the following pages 

)lease indicate how much you agree or disagree with each statement. Please complete these sections 

rom the perspective of the person with a developmental disability. The person who has the 

ievelopmental disability should be directly involved in completing this survey as much as possible. 

^ J T E P ^ Mobility/Control/Privacy Agree 


Disagree 


1 can (even if someone helps me because of my disability) get \ 

to where 1 want to go J~~^( • • • • 

1 have control over my daily schedule... • • • • • 

1 have privacy to be alone or with people 1 choose.. • • • • 


information have access to it • a • • 

1 can set desired outcomes (goals) for myself . • * • • • 


1 can make decisions that will affect my future • • • • 

1 am satisfied with my current level of independence . • • • a

OveâN^3atis^tlonj 





Very 

satisfied 



Very 

dissatisfied 

m • • • • • • 

Very 

likely 



r 

services department? _ 


nor unlikely 

Very 

unlikely 

o • • • • • • 

Met 

Failed 

Expectations 

I 

Expectations 

' j . 

Expectations 

^.Aim.uiu 

B J Q Q Q Q Q Q 

WhaHs the one thing thatwould have the greatest impact on your satisfaction with consumer directed 

supports? 777AkcA

Overall Satisfaction g 





V e r y 

satisfied 



V e r 

y 

dissatisfied 

_tf_ • • • • • 

Very 

likely 



nor unlikely 

T 

Very 

unlikely 

T 

• c_ro • • • • 

Met Failed 


Expectations 

1 

Expectations 

^_ 

services department? G_TU • • • • • 


supports? 

rfeifidh Ho {/Qv'\ous ca-f&nnrie.^ of fund's /Jr>f ha^Vi.-; -hi bf. 

c? c 

JmLMn~' •a +c a. rVfVr-; dollar am^.tnt f.mecion s^m£ r^/jcfrr? 

/'•'.as loJ rUx- ach>o f iutidôf -ri^. con'MMs- af- ar 

Wi^n Only fa /\f_C£o^^L -ffô ti u 


)lease indicate how much you agree or disagree with each statement. Please complete these'sections 




Neither 

Q 

Disagree 


1 can (even if someone helps me because of my disability) get 

to where 1 want to go • • a • 

1 have control over my daily schedule 

Only 1 have people privacy who to are be supposed alone or with to know people my 1 personal choose 

• • • • 

a a a a 

information have access to it. • of • • a 





• • • a 

• •r a • • 

• • • • 

• • • •

V 

"7 J 





consumer directed support program? la U Li LI U U U 

How likely would you be to recommend a consumer directed -^p- 

V e r 

y 


n o r u l k e l y 

^ 

support program in your county to a friend in a similar situation? .. *Q Q C_ L_ Q LJ LJ 


. , , , , . i Expectations Expectations Expectations 

that were set for you by your case manager and county social ~~r: ^ n — 

services department? Qh • • • • • • 

[vVhat is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? "ITAF, CbS HF! .SONNE, 

sb;\te, bji-V rmV Wls J 

"""f^ 

(jpopaUv^ sfcUs M -FTUR incurs DDI Vv, WXft^ 

•to do'4Vvxnas hui himseU-, T W . Cbs has Qlio^RL me. (JGFDUSF/ 

and ma\nVa\r> fWia\i-£cj gguipmenl anr) ajfflifr 1 

*; 4VIQJT roik.^ 

h& F,\WJDA^ ff^ lf rfsf> of a enlarge /• " • _ 

"hinking beyond consumer directed supports to your overall quality of life, on the following pages 

jlease indicate how much you agree or disagree with each statement. Please complete these sections 

rom the perspective of the person with a developmental disability, the person who has the 

fevelopmental disability should be directly involved in completing this survey as much as possible. 



Disagree 

Somewhat Stronelv 


to where 1 want to go • • a • 

1 have control over my daily schedule • a _ • • 

1 have privacy to be alone or with people 1 choose • • _ a a 


information have access to it _ • • • • 

1 can set desired outcomes (goals) for myself • • _ • • 

1 can decide about how 1 spend my money • a _ • • 

1 can make decisions that will affect my future • • _ • • 

1 am satisfied with my current level of independence • • • a


V e r y 

satisfied 



V e r y 

dissatisfied 

iven all the considerations, how satisfied are you with your ' ' ' 

consumer directed support program? «-l L1 D LJ LJ LJ U 


services department? • BO • • • • • 

is the one thing tha| would have the greatest impact on your satisfaction with con 

What 

Worts? -hfohh- Cfnm4y


V c r 

> nor dissatisfied 

V e r y 


Given all the considerations, how satisfied are you with your ' ^ ' „ ' 

consumer directed support program? —J I—I L J L J L J L J L J 


How likely would you be to recommend a consumer directed nomniikeiy 

support program in your county to a friend in a similar situation? .. ^ Q Q [] Q Q Q 


u n l k e l y 

' | 

. , , . . . i Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n *n ^ 



supports? FKIY d^MÛb< A-rrc









Very 

satisfied 

"T 



Very 

dissatisfied 

oâ • • • • • 

Very 

likely 


nor unlikely 

Exceeded Met 


I 7 | 

Very 

unlikely 

• • • • • 

Failed 

Expectations 

O F • • • • • • 


S U 

PP° 

R T S ? 

^~ ' 

V 

* L ^ A . C W . - X W L Y ^ S I - ~ R . B , K R I - F S 

. V / Q Y U U W V - s^QX | ' A TO C\,rc\jâ A^RV. 

~ £ — N Y > \ _ - C C ^ N U c^k \>-e G;_,\-E -RX> U ^ Y I RVI G S U > P P T > R W ^ 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages % 

please indicate how much you agree or disagree with each statement. Please complete these sections^ 

from the perspective of the person with a developmental disability. The person who has the - " " 


JLFE 

Independence | Mobility/Control/Privacv Agree 



Disagree 

Somewhat Srmnclv 

to where I want to go... Q • • • 

2. I have control over my daily schedule... Ef • • • • 




• • • • 

EC • • • • 

5. I can set desired outcomes (goals) for myself A R • • • • 



8. I am satisfied with my current level of independence z 

• • _ R 

z V • 

• • 

• • • 

• • •






y Neither satisfied 

. C 

"7 . nor dissatisfied Very 


_>•••••• 

Very 

likely 

T 


nor unlikely 

T 

(_•••••• 

Very 

unlikely 



Exp 

f tations 

services department? Q f^j [~j r~j| Q r~j r—| 

Met FaUed 



supports? _ 

f° oaf ^ movies DINNT^j hhlria Ms 

Thinking beyond consumer directed supports to your overall quality of life, on the following paqes • 



developmental disability should be directly involved in completing this survey as much as possible 




to where I want to go ^ Q Q Q [_ 

I have control over my daily schedule Q Q Q Q Q 

I have privacy to be alone or with people I choose Q Q [_ Q Q 


information have access to it.. "Q Q Q Q Q 

5. I can set desired outcomes (goals) for myself • • e • • 

6. I can decide about how I spend my money .. TK.. %. W*M ... f~\ • Q _j Q 

7. I can make decisions that will affect my future Q Q Q • • 

o- I am satisfied with my current level of independence ... "Q • • • •








Very 

satisfied 



Very 

dissatisfied 

• • • y • • • 

Very 

likely 

Ncithi 

nor 

• • • 

Exceeded 

Expectations 

services department? Q Q| Q 

Expe 

ikely 

kely 

Very 

unlikely 

• • • 

FaUed 

Expectations 

• • • 


supports? 

Thinking beyond consumer directed supports TO your overall quality of life, on the following pages 




Independence I Mobility / Control / Privacy Agree 

Neither 

Disagree 









6. I can decide about how I spend my money m • • • • 



J! Overall Satisfaction 



2. 



Very 

satisfied 

T 

Very 

likely 

~r 


. . . • . • i Expectations 

that were set for you by your case manager and county social ~n 





nor unlikely 

J J J B J J G 

Met 

Expectations 

Very 

dissatisfied 

T 

Very 

unlikely 

T 

Failed 

Expectations 

4 What is the one thing that would have the greatest impacbon your satisfaction) with consumer directec 

supports? WFN^| Qn T(UA -fr^np Job wffh 



ffrom the perspective of the person with a developmental disability. The person who has the 

-developmental disability should be directly involved in completing this survey as much as possible. 

Independence I Mobility/ Control / Privacy Agree Disagree 


T1. 1 can (even if someone helps me because of my disability) get 

to where 1 want to go • 1 B • • • 

22. 1 have control over my daily schedule • I I • • • 

33. 1 have privacy to be alone or with people 1 choose • 1 B • • • 


information have access to it. • 1 B • • • 

£5. 1 can set desired outcomes (goals) for myself • 1 • • • 

£33. 


• 1 B • • • 

77. 1 can make decisions that will affect my future • V B • • • 

§B. 

1 am satisfied with my current level of independence • E 1 • • •


Very 

satisfied 

—I 



1/ 

Very 

dissatisfied 

T 

> Given all the considerations, how satisfied are you with your ^ 

~ consumer directed support program? (__ _] _J —1 _] _] 

Very 

likely 


nor unlikely 

>. How likely would you be to recommend a consumer directed , 

support program in your county to a friend in a similar situation? .. [ ) _ • • • • • • 


Very 

unlikely 

Met 

Failed 

Jphat were set for you by your case manager and county social Expectations 

Expectations 

__ r„ 

Expectations 

^'services department? JJ| Q Q _J Q —J Q 

^ What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

& P RRVP*Y\///II4Y ufnri^ R FYF^ 

BEYOND CONSUMER DIRECTED SUPPORTS TOYPVQVERALL QUALITY OF LIFE, on the FOLLOWING PAGV 

TEASE.IND.CATE how much YOU AGREE OR DISAGRER WITH"EACH STATEMENT. Please c o r n ^ 

JBMTH^PERSPECTIVE OF THE PERSON WITH A DEYELOPMJNTAL DISABILITY. The PERSON WHO HASYH 

GVELOPMENTAL DISABILITY SHOULD BE DIRECTLYINVOLVED Trfcompfetihg this SURVEY AS MUCFAFPBSLIB^ 

dependence j Mobility / Control / Privacy 

dean (even if someone helps me because of my disability) get 

|to where I want to go . 

.have Privacy to be alone or with people I choose... 

PP|Y people who are supposed to know my personal 

Agree 


T 

Disagree 


A • • 

KL • A • • 

B • • • • 

& • • A A 

a • A • • 

• C_ A • • 

• ® • • A 

p • • • •








services department? : 

Very 

satisfied 



i/ Very 

dissatisfied 

• • • • • 


likely 

10 • 

nor unlikely 

• • 

unlikely 

• • 

T 

Exceeded 

Expectations 

Met 

Expectations 

Failed 

Expectations 

4. What is the one thing âtwoiuW have the greatest impact on your satisfaction with consumer directed 

supports? 

A 

overal quality of life, Thinking beyond consumer direct^ supports toydur on the following 

perspective^ the agre person or with wflfeach a developmental disability. please indicate how much you disagree statement. PleasecompTeM 

Jrom the The pe 

"developmental disability should ledjredtly involved m completing this survey mmSSPuSap^^^ 


— 

~BH——i••——————_B___ Strongly Somewhat Neither Somewhat Strongly 


to where I want to go • h • • a 

a 2. I have control over my daily schedule.. • a • 

3. I have privacy to be alone or with people I choose... • • • • 


information have access to it...... • • • a 

5. I can set desired outcomes (goals) for myself... • • • • 

CD 

I can decide about how I spend my money . . • • • • • 

7. I can make decisions that will affect my future.. -El 

8. 

• • a a 

I am satisfied with my current level of independence • • a •


Very 

satisfied 



Very 

dissatisfied 

1. Given all the considerations, how satisfied are you with your ' ^ ' ' 

consumer directed support program? —J y(j LI U U LI U 



Very 

likely 

T 



E 

_^£__ 


nor unlikely 

T 

Very 

unlikely 

T 

Q • • • • • • 

Met 

Expectations 

Failed 

Expectations 

services department? • • GJ • • • • 


supports? Pnij IN^rnDPrl rî n (T^R-y & £ \\ê . 

Thinking beyond consumer directed supports to your overall quality of life, on the following pages^ ---J 1 

. 

please indicate how much you agree or disagree with* each statement. Please complete these sections 

from the perspective of the person with a developmental disability. The person who has the : v 

developmental disability should be directly involved in completing this survey as much as possible;!?* I# 

I.H d e p e n d e n C e I Mobility /Control /Privacy Agree Disagree 

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Strongly Somewhat Neither Somewhat Strongly 



a 2. I have control over my daily schedule. 

• • • • 

CO 




cn 

• • • • 

I can set desired outcomes (goals) for myself . • _ • • • 

• _ a a 

• 


7. I can make decisions that will affect my future • • 

a 

• • 

a 

8. I am satisfied with my current level of independence • •









Very 

satisfied 

Very 

likely 

T 

Exceeded 

Expectations 



Neithcr likely 

nor unlikely 

Met 

Expectations 

Very 

dissatisfied 

Very 

unlikely 

Failed 

Expectations 


supports? | 

junlina, h>r et\Strerun?«Lh riltthbcrJi cli


Given all the considerations, how satisfied are you wrn your 


How likely would you be to recommend a consumer drected 

support program in your county to a friend in a simila- situation? 

Very 

satisfied 



Very 

dissatisfied 

• )_J • • • • • 

Very 

likely 

T 

Has the consumer directed support program met the sêctations Exceeded 

that were set for you by your case manager and court 1 

/ social 



nor unlikely 

T 

Very 

unlikely 

r 

• )_!••••• 

Met 


Failed 

Expectations 

• KI • • • • • 

What is the one thing that would have the greatest irrcsct on your satisfaction with consumer directed 

supports? , n , . 

Thinking beyond consumer directed supports to youro*erall quality of life, on the following pages 

please indicate how much you agree or disagree with SECT, statement. Please complete these sections 


developmental disability should be directly involved in zmpieting this survey as much as possible 

jndependenC^J Mobility/ Control /Privacy 

I can (even if someone helps me because of my dKbility) get 

to where I want to go Q*l 

I have control over my daily schedule ~j 

I have privacy to be alone or with people I choose. ^ 

Only people who are supposed to know my persora 


I can set desired outcomes (goals) for myself.... Q 

I can decide about how I spend my money [—j 

I can make decisions that will affect my future... Q 

I am satisfied with my current level of independent Q 



• • • • 

• • • 

• • • • 

• • • • 

• • • 

• • • 

• • • 

PI • • •


, 

satisfied 


V e r y 

dissatisfied 

' I 1 

Given all T H E considerations, how satisfied are you with your 

consumer directed support program? —I UI LJ LJ LJ LJ LJ 

How likely would you B E to recommend a consumer directed " 


support program in your county TO a friend in a similar situation? . . 0 Q Q Q Q Q Q 


... . x • i . • i Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n— n "-i— 

services department? • /_f • • • • • 

What is the one thing that would have the greatest impact on your satisfaction with, consumer directed 

S U P P O R T S ?






Very 

satisfied 

Very 

likely 


that were set for you by your case manager and county social "^T 3 

" 0 1 





nor unlikely 

Met 

Expectations 

Very 

dissatisfied 

Very 

unlikely 

FaUed 

Expectations 

" 1 —f 


supports? 

- 4- OjJe-crx. 


Dlease indicate how much you agree or disagree with each statement. Please complete these sections 


developmental disability should be directly involved in completing this survey as much as possible 7 

. 


B_________HH~~~~_H_ Strongly Somewhat Neither Somewhat Strongly 



1 have control over my daily schedule. . . • • • • 

1 have privacy to be alone or with people 1 choose ® • • • • 


information have access to it —' Jwaco CO • • • • 

1 can set desired outcomes (goals) for myself • • • • 


1 can make decisions that will affect my future. . • • • • 







Very 

satisfied 

1 

Very 

likely 

"T 






Very 

dissatisfied 

r 

Q Q • • Q 


nor unlikely 

Very 

unlikely 

r 

^Sf • • • • • • 

Met 

Expectations 

Failed 

Expectations 

JS^Q • • • • • 

A/hat is the one thing that would have the greatest impact on your satisfaction with consumer directed 

upports? 

"hinking beyond consumer directed supports to your overall quality of life, on the following pages 

ilease indicate how much you agree or disagree with each statement. Please complete these sections 

om the perspective of the person with a developmental disability. The person who has the 

levelopmental disability should be directly involved in completing this survey as much as possible. 

Independence J Mobility/Control/Privacy Agree 

Disagree 


•O__B____HH_______ Strongly Som 



1 have control over my daily schedule • • • • • 

1 have privacy to be alone or with people 1 choose • • • • 


information have access to it • • • 

1 can set desired outcomes (goals) for myself • • • 


1 can make decisions that will affect my future • • • • 



iJmumuLJun i IIW m**mtmmmmmmM+mum*um. 





Very 

satisfied 

Very 

likely 






nor unlikely 

Very 

dissatisfied 

Very 

unlikely 

• • • • • • 

Met Failed 




supports? r-foos? Yoo p~r>q QAÂ 















m • • • • 

• • • • 

® • • • • 

• • • • 

• • • • 

® • • • • 

• • • • 

• • • • •


iven all the considerations, how satisfied are you with your 

bonsumer directed support program? 



Very 

satisfied 

Very 

likely 

— N R 




E x p y t a t i o n s 



/ 

Very 

dissatisfied 

• • • • • 


nor unlikely 

Very 

unlikely 

1 

• ••••• 

Met 

Expectations 

FaUed 

Expectations 

ft • • • • • • 

Vhat is the one thing that would have the greatest impact on your satisfaction with consumer directed 

Wports? Qi-W ( Y O ^ V * W \ ? A ^ o






Very 

satisfied 

T 



Very 

dissatisfied 

• J2 • • • • • 

Very 

likely 

1 



< t f • 


nor unlikely 

T 

Very 

unlikely 

• • Q • • 

Met 

Expectations 

FaUed 

Expectations 

T 

services department? (_C_ Q Q Q Q Q 


s u 

r t s ? 

PP° M9 h - f / m ^ K»odrt,,*D}L, 




developmental disability should be directly involved in completing this survey as"much as possible. 

Independence J Mobility / Control / Privacy Agree Disagree 

BBHIHBBHBBi Strongly Somewhat Neither Somewhat Strongly 


to where 1 want to go Q 

1 have control over my daily schedule 

1 have privacy to be alone or with people 1 choose 



• • • 

• • • • 

• • • • 

& • • • • 

1 can set desired outcomes (goals) for myself '. • • • • 

1 can decide about how i spend my money 


• • • • 

• • • • 







Very 

satisfied 

—I 



Very 

dissatisfied 

p(Q • • • • • 

Very 

likely 

T 


nor unlikely 

T 

Very 

unlikely 

OF • • • • • • 

Has the consumer directed support program met the expectations Exceed M e t 



6 THIN9 W 

SUPPORTS? ° U,D 9 R E A T 6 S T I M P A C T 

OUR ((v^ VY\c*Lr\aMr jr- \


^ er 

y 

satisfied 

nor dissatisfied ,. ,. V- . 

dissatisfied 

Given all the considerations, how satisfied are you with your VY 7 

• • • • • • 

consumer directed support program? ^ 


likely 

n o r 


How likely would you be to recommend a consumer directed ' y X ^- • 

support program in your county to a friend in a similar situation? . . Q 

Has the consumer directed support program met the expectations V%£%L 

Q 

E x 

Q 

e 

a t i n n s 

• Q L| 

ExPectations 

that were set for you by your case manager and county social O/ r-» r-* n r~i ri 

services department? ^ • • LI LI U LI 

.— : : ^TU'RIITYTI:^ • 






1 

- - - 1 Strongly Somt 

1. I can (even if someone helps me because /of my disability) 

JIJJS IIIB UCUOUac Ul Illy uuaumiji; a^'v _ _ ^ » 

2. I have control over my daily sche^te^^ • • Q LJ 

to where I want to go. frfcd&lpfafiOff '^p^f^ 

mory\ 

3. 4. I Only have people privacy who to be are alone supposed or with to people know my I choose personal

Overall Satisfaction § 








Very 

satisfied 



• • • • • 

Very 

likely 

Exceeded 

Expectations 


nor unlikely 

1 

Met 

Expectations 

Very 

dissatisfied 

Very 

unlikely 

1 

Failed 

Expectations 

^/Vhat is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? "THE qieri-W.S.J i -Vbiny iiy^M VV> RYVURM FLY— 


alease indicate how much you agree or disagree with each statement. Please complete these sections 



^ n 

^ e 

P? n 

- e n C I © Mobility/Control/Privacy Agree Disagree 

n _ g ^ ^ m ^ ^ ^ ^ ^ H H j Strongly Somewhat Neither Somewhat Strongly 


to where 1 want to go • • • _ 

1 have control over my daily schedule • • • 

1 have privacy to be alone or with people 1 choose • • EL • • 


information have access to it • _ • • 

1 can set desired outcomes (goals) for myself . • • ® • 


~7 

3 

• • j • 

1 can make decisions that will affect my future • _ • • 

1 am satisfied with my current level of independence • • •









Very 

satisfied 

1 

J 



Very 

dissatisfied 

T 

• m • • • • • 


likely 

• a • 

nor unlikely 

• • • 

unlikely 

• 

T 

Exceeded 

Expectations 

Met 

Expectations 

Failed 

Expectations 

• SI • • • • • 

What is the 

one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? 

•teLrPrSr h y *—« - SUPOrtS 

'° y0U r 

° vera 

" 

£ ualit 

y o n 

° ' «» 

foll 

°«i"g 

from . hr^^ ,°l y 

° U 

a 9 f e e 

° r d i S a 9 r e e w i , h e a c h s t a t e m e n t 

- Please complete these 

pbsS 

SCIONS 

from the perepeotive of the person with a developmental disability. The person who HAS the 

developmental disability should be directly involved in completing this survey ^smuch AS 

Independence | Mobility, Control, Prjvacy Agree D. sagree 

1. I can (even if someone helps me because of my disability) qet 






5. 

6. 

7. 

8. 

can decide about how I spend my money ..... 




a a • • 

• 3 ® • • • 

• • • a 

• a • • 

• • • • 

m • • • • 

• • • • 

• a • •









Very 

satisfied 

Very 

likely 

T 




nor unlikely 

J 

Very 

dissatisfied 

Very 

unlikely 

£ • Q • Q • Q 



fa • • • • • • 


Supports? , IT Ce~J)Lt±*-{^ Sa^r^M 

A r~ r 

^ y;«,sv/Cv_ 

hinking beyond consumer directed supports to your overall quality of life, on the following pages 

lease indicate how much you agree or disagree with each statement. Please complete these sections 

om the perspective of the person with a developmental disability. The person who has the 

evelopmental disability should be directly involved in completing this survey as much as possible. 

Independence"! 

Mobility / Control / Privacy 





sa • • - 

I have control over my daily schedule ... Q Q _1 _) 

I have privacy to be alone or with people I choose.... . . . . . . . • • a • 


information have access to it Q • |_J Q _1 

I can set desired outcomes (goals) for myself • • • ® • 

I can decide about how I spend my money Q Q Q (_| 21 

I am satisfied with my current level of independence ... 


• • (_r • •









Very 

satisfied 



Very 

dissatisfied 

p.u • • • • • 

Very 

likely 


nor unlikely 

T 

Very 

unlikely 

S| • • • • • • 

Exceeded 

Expectations 

Met Faded 


a • • • • • • 


supports? 

•dtp. GSa.oQ_ ^.PcA \/S MJM/Ui^b^jjc^s

Overall Satisfaction y Neither satisfied 

. E 

*7 nor dissatisfied Very 


1 1 1 


Donsumer directed support program? ^ LJ LJ LJ LJ LJ LJ 



likelv nor unlikelv unlikely 

—I 1 1 

support program in your county to a friend in a similar situation? . . LJ LJ LJ LJ LJ LI 


,. . , . i , • • Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n tL 

- t 

r 1 

"-i— 

services department? • Q( LJ • • • • 


upports? 

ftW)\IVY >Q C^PPLY -PT.Âs 

~TH 

thsroO^ S t UWA - L I I I A I'S ft-RT-K r,r NN b^/^rs 

F>W COPR-My- , /V








Very 

satisfied 



Very 

dissatisfied 

a,a • • • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 



® • • • • • • 

What is the one thing thatwouldJiave the .greatest impact oh your satisfaction with consumer 

supports? ^ y^hnlihl - ^ rn*f ~FP, Cm?


a—i—i i • • 1 

V e r y 

satisfied 



V e r 

y j 

dissatisfied 


consumer directed support program? Li p} LI LI Li Li Li 

Very noru Neither likely Very 

How likely would you be to recommend a consumer directed f kely 

^f^- 



.. . . , , . . . , Expectations Expectations Expectations 

that were set for you by your case manager and county social ~nl > / i ^ — 

services department? • • L?J • • • • 


supports?. 

Thinking beyond consumer directed^supports^tpj^qunbverall quality of life, on the following pajgesj^S 

please indicate how much you agleejqr disagre^wftKeach statement."Please complete these sections ^ 

from the perspective of the person with a developmental disability. The person who has'the " v * 

developmental disability should be directly involved in completing this survey as much as possible.; _ v 

Independence] 



1 can (even if someone helps mefeecause of my disability) get 

to where 1 want to go • T2f • • • 

1 have control over my daily schedule.. • • • • 

1 have privacy to be alone or with people 1 choose fa a • a • 


information have access to it.. v..... • • • • 

1 can set desired outcomes (goals) for myself... • • • • 

1 can decide about how 1 spend my money . a 

a • a 

1 can make decisions that will affect my future. • • • • 

1 am satisfied with my current level of independence • a • •






satisfied 



V e r 

y 

dissatisfied 

T T 

® • • • • • • 

Very 

likely 




nor unlikely 

T 

Very 

unlikely 

21 • • • • • • 

E x p 

" t a t i o n s 

Met Failed 


services department? §Q [Jj Q Q Q Q Q 


supports? 


alease indicate how much you agree or disagree with each statement. Please complete these sections 


developmental disability should beTdirectly involved in completing this survey as'much as possible. 

hidepend^ncej Mobility / Control / Privacy Agree Disagree 



to where I want to go*. 






a m 

satisfied with my current level of independence 

• • • • 

m • • • • 

• • • • 

a • • • • 

• • • • 

• • • • 

• • • • 

• • • •








Very 

satisfied 



Very 

dissatisfied 

• (2 • • • • • 



• a 



• • !Sl • • • • 


supports? 

nr 

Thinking beyond consumer directed supports to your overall quality of life, on the folowing pages 





MBWffl^MWBBHJ Strongly Somewhat Neither Somewhat Strongly 


to where 1 want to go. . . • • • • 

2. 1 have control over my daily schedule. . • • • • 

1 have privacy to be alone or with people 1 choose • • • • 

CO 

4. 

5. 




• 

• 

• 

ja 

• 

• 

• 

• 

7. 


1 can make decisions that wil affect my future 

• 

• 

• 

• 

• 

• 

• 

• 

1 am satisfied with my current level of independence • • • • 

CD 

CO






Very 

satisfied 



Very 

dissatisfied 

JA • • • • • • 

Very 

likely 



E x p 

- c t a t i o n s 


nor unlikely 

Very 

unlikely 

• • • • • 

Met Failed 


services department? jgH Q Q • Q Q Q 


Supports? T££ A£>H_









Very 

satisfied 



Very 

dissatisfied 

r 

• s/a • • • • 

Very 

likely / 


nor unlikely 

T 

Very 

unlikely 

r 

oaaa • • • 

Met 

Failed 


Expectations 

•a••••• 

/ 


supports? jpportsr , -ft \\~>\- un ck M.vyn' approve*. t^m$û)Ka^ 

vv 

-"v \ ^ — — w . r - *—_ 

j —— iTj — 

COu^tS h> -rvu_ 5>^^- ^ 4^(m5 ^ -HvoÊ- ITAAMS. 








to where I want to go Ql LI 

2. 

3. 

have control over my daily schedule 

have privacy to be alone or with people I choose. Q • 

• 

• 

• 

• 

• 

• 

• 

• 

•








Very 

satisfied 



Very 

dissatisfied 

• & • • • Q • 

Very 

likely 


nor unlikely 

Very 

unlikely 

*Q • • • • • • 

Exceeded 

Expectations 

Met 

Expectations 

Failed 

Expectations 

services department? • J5l Q • • • • 


supports? 

(^^L^TIIYUK^ H& NA^ KRIFAD WRITS!D'RII'AIUMHiJU CII'AIURIHM IN^&M


7* y 

satisfied 


V c r y 

dissatisfied 




Very 

U U U LI LI D 


" oru 

f kely 

uM 

f el 

support program in your county to a friend in a similar situation? . . 0 Q Q Q Q [] Q 



E 

- ^ ^ ms^ss 



supports? 





^nêpendenC^ Mobility / Control / Privacy Agree Disagree 





3. I have DrivaCV tr> he> alnno nr mith 







~1 1 1 

• • • • 

• • • • 

• • • • 

• • • • 

• • • • 

• a • • • 

• • • • 

• • • •






Very 

satisfied 



Very 

dissatisfied 

• • a • • • • 

Very 

likely 





nor unlikely 

Very 

unlikely 

1 

• ••••• 

Met 

Failed 


T 

• • • Q • • • 


supports? 

7 





Independence Mobility / Control / Privacy Agree Disagree 











• • • • • 

• • • • 

• • • • 

• • • (2 • 

• • • J • 

• • • y • 

• • • • 

• • • •







v 

.."J!? . 



V e r y 


qa • • • 


likely 


T 

R 

Met Failed 



' ' T " " Expectations Expectations ^ 

Q Qjgj Q Q Q Q 


supports?. 

/ IA A/1 A./A /(j. 


please indicate how much you agree or disagree with each statement. Please complete these sections' 

1 t h e 

OT Perspective of the person with a developmental disability. The person who has the 

developmental disability should be directly involved in completing this survey as much aVpossible 

MependenC^ Mobility 




/ Control / Privacy 

to where I want to go Q Q Ql Q 

2. I have control over my daily schedule .. ^ Q Q Q Q 

3. I have privacy to be alone or with people I choose Ql Q Q Q 


information have access to it Q ^ Q Ql Ql 


6. I can decide about how I spend my money [ ] [ ] [ ] 

7. i can make decisions that will affect my future Q) j$ Q Ql Q 

8. I am satisfied with my current level of independence ... . . . . . . . J2 • • •


c r } 

^ nor dissatisfied Very 

satisfied """ dissatisfied 

1. GIVEN ALL THE CONSIDERATIONS, HOW SATISFIED ARE YOU WITH YOUR ^ - • 

CONSUMER DIRECTED SUPPORT PROGRAM? /«J LJ LJ LJ LJ LJ LJ 

2. HOW LIKELY WOULD YOU BE TO RECOMMEND A CONSUMER DIRECTED ^p- 


n o r 

""'' k>: 

' v 

SUPPORT PROGRAM IN YOUR COUNTY TO A FRIEND IN A SIMILAR SITUATION? . . JGF LJ LJ LJ LJ [J LJ 

3. HAS THE CONSUMER DIRECTED SUPPORT PROGRAM MET THE EXPECTATIONS Exceeded Met Failed 

umikeiy 

,, . , . . , , • i .Expectations Expectations Expectations 

THAT WERE SET FOR YOU BY YOUR CASE MANAGER AND COUNTY SOCIAL \ T 7 • ^ — 

SERVICES DEPARTMENT? KJ. CI LJ LJ LJ LJ LJ 


SUPPORTS? 





Independence j Mobility/Control/Privacy Agree Disagree 

S ^ S ^ S B B H B H H H ^ H H H B H Strongly Somewhat Neither Somewhat Strongly 


TO WHERE I WANT TO GO . £J • • • 

2. I HAVE CONTROL OVER MY DAILY SCHEDULE. . . . • • • • 

k 3. I HAVE PRIVACY TO BE ALONE OR WITH PEOPLE I CHOOSE • • • • 



• • • • 

5. I CAN SET DESIRED OUTCOMES (GOALS) FOR MYSELF. • • • • 

6. I CAN DECIDE ABOUT HOW I SPEND MY MONEY . . . 

• • • • 

7. I CAN MAKE DECISIONS THAT WILL AFFECT MY FUTURE • • • • 

CO 

•I 

I AM SATISFIED WITH MY CURRENT LEVEL OF INDEPENDENCE • • • •


1. GIVEN ALL THE CONSIDERATIONS, HOW SATISFIED ARE YOU WITH YOUR 




VERY 

SATISFIED 

3. HAS THE CONSUMER DIRECTED SUPPORT PROGRAM MET THE EXPECTATIONS Exceeded 


VERY 

LIKELY 




NOR UNLIKELV 

VERY 

DISSATISFIED 

VERY 

UNLIKELV 

M • • • • • • 

L X P < C T A T I O N S 

I 

SERVICES DEPARTMENT? • Q£J Q Q Q • Q 

MET 

KXPECTATIONS 

FAILED 

KXPECTATIONS 


SUPPORTS? _ _ _ _ _ _ _ 

TOE ci. 





Independence j Mobility / Control / Privacy Agree Disagree 

^B^^BHHHBHHBHBFHI^HHFL STRONGLY SOMEWHAT NEITHER SOMEWHAT STRONGLY 



2. I HAVE CONTROL OVER MY DAILY SCHEDULE. . 

CO 

E F • • • • 

® • • • • 

I HAVE PRIVACY TO BE ALONE OR WITH PEOPLE I CHOOSE B • • • • 


INFORMATION HAVE ACCESS TO IT • • • • 

5. I CAN SET DESIRED OUTCOMES (GOALS) FOR MYSELF. . . . . . . • • • • • 

6. I CAN DECIDE ABOUT HOW I SPEND MY MONEY • • • • 

7. I CAN MAKE DECISIONS THAT WILL AFFECT MY FUTURE • • • • 

8. I AM SATISFIED WITH MY CURRENT LEVEL OF INDEPENDENCE • • • •






Very 

satisfii 

Very 

likely 




cpecîi 

Expectations 



Very 

dissatisfied 

1 

• ••••• 


nor unlikely unlikel 

• •••••• 

Met 

Expectations 

Failed 

Expectations 

• ••••• 

4. What is the one thing that would have the greatest impaction youp-satisfaction with consumer directed 

supports? 

V 

NR\^ SRRV> RLWX)

Overall Satisfaction „ 





Independence | Mobility / Control / Privacy Agree 




Disagree 

Somewhat Stmnplv 

• • • 


3. I have privacy to be alone or with people I choose • or • • • 


information have access to it... • _ • • • 

5. I can set desired outcomes (goals) for myself a 




1. Given all the considerations, how satisfied are you with your JLs ' ' 

consumer directed support program? 1 LJ LJ LI LI LI LI 

• • • 


7. I can make decisions that will affect my future • a • • 

8. I am satisfied with my current level of independence • 0 • • • 

V c r > 

V e r y 

„ J 

Verj' Neither likely Very 


f kely 

support program in your county to a friend in a similar situation? .. Jg( [][][][]_ [| 


. . . . , . . . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social -71 :— ^ — 

services department? • • / ) ^ _ • • • • 


supports? &gf>i/Vj /viy -KEEAONN. by u^/hj tW. CJITC-'KBOP LC 5\J^K-M ,


1 GIVEN ALL THE CONSIDERATIONS, HOW SATISFIED ARE YOU WITH YOUR 




VERY 

SATISFIED 



VERY 

DISSATISFIED 

1 

• Q L • • • • • 

VERY 

LIKELY 


NOR UNLIKELY 

VERY 

UNLIKELY 

R ' 

• •••••• 

3 HAS THE CONSUMER DIRECTED SUPPORT PROGRAM MET THE EXPECTATIONS EXCEEDED 

MET 

, , . . , EXPECTATIONS EXPECTATIONS . . 

THAT WERE SET FOR YOU BY YOUR CASE MANAGER AND COUNTY SOCIAL ~N I ^ 

FAILED 

EXPECTATIONS 

SERVICES DEPARTMENT? • • • • • 


SUPPORTS? , • , 

\>AUP,. '° 





Independence | Mobility / Control / Privacy 



2. I HAVE CONTROL OVER MY DAILY SCHEDULE 



5. I CAN SET DESIRED OUTCOMES (GOALS) FOR MYSELF. 

6. I NAN RLPNIRLP AHMIT HNW I SNPNH M\/ MNNPV 

7. 

CAN MAKE DECISIONS THAT WILL AFFECT MY FUTURE. 

8- I AM SATISFIED WITH MY CURRENT LEVEL OF INDEPENDENCE 


STRONGLY SOMEWHAT Neither SOMEWHAT STRONGLY 

• • • • 

• • • • 

• • • • 

• • • • 

• • • 

• • • • 

• • • • 

• • a. • •

——••—-I / 

Overall Satisfaction I Neither satisfied 

;^_7 . nor dissatisfied 


1. Given all the considerations, how satisfied are you with your _ __ ' * 

consumer directed support program? y-* LJ LJ LJ U LJ LJ 

V e r 

y 


. How likely would you be to recommend a consumer directed 

nor lkely 

"f 

u l U i k e l y 

support program in your county to a friend in a similar situation? .. ^ [] Q Q [] Q [] 

. Has the consumer directed support program met the expectations Exceeded Met Failed 

, , , , . . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n "î i— 

services department? r^j Q Q Q • Q Q 


supports? lAtL /Z3f)j?sJ g m jlJA&YZ^H- /thaji/jl. rf\JL^ 

bfateaf/&ASAJ>/)U^ sstt^J^y-rtjOML. &}-JUAJL £>t6A OUfYl ^ jp^fiLAsJclt/?^ 

Thinking BEYOND CONSUMER DIRECTED^SUPORTS TO YOUR overall QUALITY of life, ON THE FOLOWING 

PLEASE INDICATE HOW MUCH YOU AGRE OR DISAGRE WITHEACFSTEITEMENT . Please COMPLETE THES 

FROM ^PERSPECTIVE of the PERSON with a DEVELOPMENTAL DISABILITY. The PERSON WHO HASTFIE 

DEVELOPMENTAL DISABILITY SHOULD be DIRECTLY INVOLVED IN'COMPFETIN G THIS SURVEY AS MUCH AS P 

J nC 

i e 

P^ n 

dence | Mobility /Control /Privacy Agree Disagree 





3. I have Drivacv to be alone or with neni 




6. I can decide about how I spend my money . .7 

a • • • 

• _ a a a 

• • • • 

• • • a 

• "51 • • • 

• • • • 

• • • • 

a • • a

_ _ _ _ _ _ _ v 7 


: 

- • • • • B Neither satisfied 

B 

^ ^ ^ 

B H H M 

^ 1 

H 

 

V e f 

y nor dissatisfied . 

V t r 

* 



consumer directed support program? 2_ LJ LJ LI LI LI LI 


How likely would you be to recommend a consumer directed 2fL noruniikeiy ^f^- 

support program in your county to a friend in a similar situation? .. 8 Q Q Q Q Q Q 



E x p t i o n s 

T 

services department? J_* • • • • • • 

What is the one thing that would have the greatest impact on your satisfaction with copsumer directed 

„.w w.io i...ny men WWUIU NAVE MT? YITJCTIESI impaci on your sansraction witn consumer directed 

supports? If fy_s q'\\j/^ M I DSSGJ- 4O pvnqraYnS nÂ T^^RNI/VVRS 

ROULD hot KOdh CJtteruJtSZ. T UOCLS CihlJUhD tâJCe. \^\ 

h/fitd up hAXJ -h/^-L- to -bauclss yvu^ U/JS S/IRHS T muMr 

Qithr^Jtri +n \pi-loSt> T W hWa^\CAbJ s-toOu'n has 

^nppiOYid 

rhinkinq beyond consumer directed supports to your overall quality of life, on the following pages^, _ 

)lease indicate how much you agree or disagree witiveach statement. Please complete these sections 

rom the perspective of the person with a developmental disability. iThe person 

ievelopmental disability should be directly involved in completing this survey as much as possible. ;: ,j 

Independence | Mobility/ Control /Privacy Agree 

itroogly Somewhat Neither 

Disagree 

Somewhat Strooelv 


to where 1 want to go • _ • • • 

a 1 have control over my daily schedule... _ a • • 

1 have privacy to be alone or with people 1 choose • _ • • • 


information have access to it • _ a • • 

1 can set desired outcomes (goals) for myself • _ • a • 

1 can decide about how 1 spend my money . _ a • • • 

1 can make decisions that will affect my future • _ • • • 

1 am satisfied with my current level of independence • m • • •



consumer directed S U D D O I I D R O A R A M ? 






V e r y 

7** nor dissatisfied 


• _ • • • • • 



_• • • • • • 




supports? 

Thinking beyond consumer directed supports to your overall quality of life, ori the following pages-, ?~please 

indicate how much you agree or disagreewith each statement. Please complete these sections 

from the perspective of the person with a developmental disability. The person who has ttieT^ 

developmental disability should be directly involved in^mpleting this survey as much as possible^lS^ 






I have privacy to be alone or with people I choose... 






• • • • a 

a • • a 

• • _ a • 

• _ • • • 

a • _ • • 

a a _ a a 

• • • • a 

a a a









Very 

satisfied 

Very 

Likely 




nor unlikely 

T 

Very 

dissatisfied 

Very 

unlikely 

• Q • • • • • 

Exceeded 

Expectations 

Met 

Expectations 

Failed 

Expectations 


supports? 

f/U * «... • - ' 

— 

ASSUSS ' OF 9u«J:+Y ____ A 

Tn 

! n 

i_i n 

9 beyohdcohsumer directed supports to your "OVERALL QUALITY OF LIFE^bri the following pages: 

please indicate^how'much you agree'or disagree^with each statement Plea^ „mpiete these sections 

from the PERSP^JIVE PI$IE^PERSON WITH A DEWLOPMENTAL DISABILITY.. JJIE person who has the 

developmental disability srtoukj BTdirectly involved inWpletir^^ possible?" 

| ! N ^ P M | | Q P ^ Mobility / Control / Privacy Agree Disagree 



to where 1 want to go a 

1 have control over my daily schedule. 

1 have privacy to be alone or with people 1 choose • a 



• 

• a 

• • 

a 

• 

• 

• • 

• • • • • 

1 can set desired outcomes (goals) for myself.. • • • • 

1 can decide about how 1 spend my money. 

1 can make decisions that will affect my future... 

1 am satisfied with my current level of independence • a 

• • • • 

• • . • • 

_ • •


J 

V e r y 



J 

V e r y 

_ J 


Given all the considerations, how satisfied are you with your ' ^ ' _^ _ ' 

consumer directed support program? L_J__ LI LI U LI LI 


How likely would you be to recommend a consumer directed ""'"f^ !^f— 

support program in your county to a friend in a similar situation? .. Q Q Q Q Q [] 

Has the consumer directed support program met the expectations Exceeded Met FaBed 

. . . . . , . . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~rr- ^ 

services department? j_J • LI Q L_ LI LI 

^/Vhat is the one thing that would have the.greatest impact on your satisfaction with consumer, directed 

supports? 4V_ c^rkJuhr 10 ^\A/\ |yr HUK daxjfjMtih) ruuLdJy dJ\Ci 

rhinking beyond consumer directed supports to your overall quality of life, on the following pages~ 5 

Dlease indicate how much you agree or disagree with each statement. Please complete these sections 

from the perspective of the person with a developmental disability. The person who has the r KS 

developmental disability should be directly involved in completing this survey as much as possibler 

^dependence | Mobility /Control /Privacy Agree Disagree 

•_____•__________________! Strongly Somewhat Neither Somewhat 

Stroi Strongly 

a 



• • 

I have control over my daily schedule • • • a 

I have privacy to be alone or with people I choose • • _ • a 


information have access to it. • • • a 

I can set desired outcomes (goals) for myself a 

• a & 


I can make decisions that will affect my future • • • a 


OveralTSa^ 

V e r y 

satisfied 



e r y 

dissatisfied 

Given all the considerations, how satisfied are you with your ' ^ ' ' 



• 

: 

' : _ Neither satisfied 

^ ^ • • " • • • • • I ^ — - — ] V 

« 7 nor dissatisfied 

V e r 

y 

satisfied / dissatisfied 

Given all the considerations, how satisfied are you with your K a / R I 

consumer directed support program? J * * L J L I L J L J L J L I 


PORL 

"^ IKELY 

—"J" 1 


support program in your county to a friend in a similar situation? .. £i Q Q Q Q) Q Ql 


. . . . . . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social


GIVEN ALL THE CONSIDERATIONS, HOW SATISFIED ARE YOU WITH YOUR 


HOW LIKELY WOULD YOU BE TO RECOMMEND A CONSUMER DIRECTED 

SUPPORT PROGRAM IN YOUR COUNTY TO A FRIEND IN A SIMILAR SITUATION? .. 

HAS THE CONSUMER DIRECTED SUPPORT PROGRAM MET THE EXPECTATIONS 


^ . 



V e r 

y 


T T 

B • • • • • • 

Very 

likely 

T 


nor unlikely 

_ ] • • • • • • 

Exceeded 

Expectations 

SERVICES DEPARTMENT? J _ Q Q Q Q Q Q 

Very 

unlikely 

Met Failed 


WHAT IS THE ONE THING THAT WOULD HAVE THE GREATEST IMPACT ON YOUR SATISFACTION WITH CONSUMER DIRECTED 

SUPPORTS? 

QRTHFL hem. )r jk.


v 


satisfied nor dissatisfied Very 

Given all the considerations, how satisfied are you with your 1 —f"" 

consumer directed support program? *QT Q Q Q Q Q Q 

What is the one thing that would have the greatest impact on your satisfaction with consumer direi 

supports? ^ , it; ^ UJ 

pnsumer,directed 

A ^


v 


satisfied nor dissatisfied 

s a n s t l e d 

Given all the considerations, JERAUONS, now how satisfied are you with your r- 

consumer directed 

support program? _ f U • • • Q 


V c r 

* 

dissatisfied 

T 

• 


lik 

f Iy 

norunukeiy 

support program in your county to a friend in a similar situation? .. Of • • • Q • • 


. , . . . . • 

Exceeded 

Expectations 

Met 

Expectations 

Faded 

Expectations 

that were set for you by your case manager and county social \ / — 



supports? 

^ _ " ~~ -p 

m U 

ROMFTP^R^L,7 

relol^N£^ 3 

TO YOUR OVERALL QUALFTY OF LIFE, ON THE FOLLOWING PAGES : 

^ * £ ~ 

o r d l s a r e e w i t h e 

9 

a c h 

^ n e h t P L E A W C O M ^ 

D 

?YJ*'PPNIENTAL DISABILITY. THE PERSON WHO HAS THE. t 

LEVELOPMENTAL DISABILITY SHOULD BE DIRECTLY INVOLVED IN COMPLETING T^SURVEY &m33R&~afflEBr 

independence I Mobility /Control /Privacy Agree Disagree 

•———— Strongly Somewhat Neither Somewhat Strongly 

I CAN (EVEN IF SOMEONE HELPS M E BECAUSE OF M Y DISABILITY) GET 

TO WHERE I WANT TO GO. .\A.\S. S.f.S££tt. yCr\pftVf?n£^T 

I S ft PFZ-OSL^FA VA_L^_, 

I u — • 

J1 HAVE PRIVACY TO BE ALONE OR WITH PEOPLE I CHOOSE. 

I ONLY PEOPLE WHO ARE SUPPOSED TO KNOW MY PERSONAL 

j I can decide about how I spend my money ?£gSw*T- 


y* m 

satisfied with my current level of independence Q 

• • • • 

ar • • • • 

a a • a 

or a a • • 

• • • • 

• a • a 

• •r • • • 

• • • 

j






Very 

satisfied 

Very 

likely 

T 






Very 

dissatisfied 

T 

• ril^ • • • • 

Expectations 

/ Ne Neither likely 

nor unlikely 

Met 

Expectations 

Very 

unlikely 

sJ 

Failed 

Expectations 

• • • • • • 


supports? 


please indicate how much you agreeor disagree with each statement Please complete these sections 



Independence | Mobility/ Control / Privacy Agree Disagree 

*~* _ 

BBBBJBBBBBBBBBBBB Strongly Somewhat Neither Somewhat Strongly 



I. I have control over my daily schedule Q 


\. Only people who are supposed to know my personal 


can decide about how I spend my money 



• a a • 

• • AT • • 

a • • • 

• • • • 

• • a • 

a • > • 

a • • a 

• • • •






Very 

satisfied 

Very 

likely 




nor unlikely 

•j 

V e i 

T 

dissatisfied 

Very 

unlikely 

3 • • • • • • 


that were set for you by your case manager and county social ^T 3 

'' 01 

" 

services department? FJ Q r~j Q J—J r~j Q 

Met 

Failed 

Expectations -j Expectations 


supports? ^ 

Thinking beyond consumer directe^ your overall quality of life/on the folowing pages 

please indicate how much you agree ondisagree with each statementf-pie^ 

from the perspective of the person with a developmental disability. The person who hasTthe 

developmental disability should be directly involved in completing thbVurvey as much as p^shle' ~ 

JJJ^Pênc^ Mobillty, Control, Privacy Agree 

T 


Disagree 



to where 1 want to go... 

El 

1 have control over my daily schedule. • 

1 have privacy to be alone or with people 1 choose • 

• • 

_ • 

_ • 

• 

• 

• 

• 

• 

• 


information have access to it • • • a 

1 can set desired outcomes (goals) for myself a 

a • a 

1 can decide about how 1 spend my money • _ • • • 

1 can make decisions that wil affect my future • • • • 







Very 

satisfied 



Very 

dissatisfied 

• j_f • • • • • Very 

unlikely 

Very 

likely 

T 



nor unlikely 

T 

Met 

Failed 


Expectations 

( 

Expectations 

^ 

services department? Q J__ • • • • • 


supports? 

T 

& n 

9 beyond consumer directed supports to your overall quality of life, on the following pages - 

please indicate how much you agree or disagreewlth each'slafem^ 

f 

J£ m 

the perspective of the person with a developmental disability. The person who has the*!- % " 

developmental disability should be' directly involved in completing this survey as much as po1slWe^?r 

j£__£^C^^ Mobility/Control/Privacy Agree 


Disagree 



to where 1 want to go.. • • • a 

1 have control over my daily schedule • • • a 

1 have privacy to be alone or with people 1 choose i-t • • • a 

* Only people who are supposed to know my personal 

* information have access to it j-f a • a a 

1 can set desired outcomes (goals) for myself • a • • 


1 can make decisions that will affect my future • a • • 



v 

satisfied 


n 0 r d i s s a t i s f i e d V e r y 

Given all the considerations, how satisfied are you with your • ^f"- 

consumer directed support program? O Q Q Q Q Q Q 


;Sfe 

your overall quality of life, on the following pages.. 

e 

= jndlcate h o w m u c n 

y° u 

agree or disagree with each statement. Please cdmptetethese s¥ctidris 

Sjl^P^'v 9 o f t h e e r s 

P °n w]th> developmental disability. The person Who has^the^ 

developmental disability should beUirectly involved incompleting this survey as* muchas^ssiBle?^ - 

|Jjji®P6ndenCe I Mobility /Control /Privacy Agree Disagree 

WtKKKtKKBtKtKKtKKtKMm Strongly Somewhat Neither Somewhat Strongly 

.... I can (even if someone helps me because of my disability) get 

• .'to where I want to go 

h a v e 

jTJ 

r i v 

P acy to be alone or with people I choose... 

fcOnly people who are supposed to know my personal 


lu 

f' y 

nomniikeiy 

support program in your county to a friend in a similar situation? .. Q Q Q Q Q Q Q 

Has the consumer directed support program met the expectations Exceeded M e t Faued 

that were set for you by your case manager and county social Expectations Expiations Emotion. 

services department? Q r—| Q Q J—J Q 


supports? — . ..... 

*f ^ rL:U .fairrf* ,;>û>^ 

• • • • 

• • a • 

• a • • 

• • • • 

• El • • • 

• • • • 

• • • • 

• 13 • • a








Very 

satisfied 

—I 

Very 

likely 

— I 




nor unlikely 

T 

Very 

dissatisfied 

Very 

unlikely 

13 • • • • • • 

Exceeded 

Expectations 

Met 

Expectations 

Failed 

Expectations 

services department? Q Q Q Q Q Q 


supports? rg do THE Thwf 77 /,*»#r TA Jd 4- 

HJNKMG BEYOND CONSUMER DIRECTED supports to YOUR overall quality of life, ON THE FOLLOWING PAGES*'? i £ 

LEASE INDICATE HOW MUCH YOU AGREE OR DISAGREE WITH EACH statemerirPlekse COMPLETETHE^RS^tio1,rf 

OM THE Perspective of the person with a developmental disability. The PERSON WHO HAS'theiÂ 

LEVELOPMENTAL DISABILITY SHOULD BE DIRECTLY INVOLVED IN COMPLETING THISVURVEY AS MUCHTS-STBLL?^- 




to where I want to go m • • • u 


I have privacy to be alone or with people I choose.... a 

• 

• 

IS 

• • • 

Only people who are supposed to know my personal __ _ 

information have access to it ................. 12 • • • • 

I can set desired outcomes (goals) for myself ..a • • • • 

I can decide about how I spend my money Q Gl Q Q 

I can make decisions that will affect my future • l_ • • • 

I am satisfied with my current level of independence (_ Q Q Q ^ 

/NRT





."7, 

satisfied 



V e i 

T 

dissatisfied 

. • • • A J K F A • 


nor keIy unl 

"f f >y 

support program in your county to a friend in a similar situation? .. [][][][][] Q 

Has the consumer directed support program met the expectations Exceeded Met FAUED 

. . . . . . , , . , Expectations Expectations Expectations 

3 set for you by your case manager and county social ~n n I 

that were set for you by your case manager and county social —* — 

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services 


supports? 

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I can decide about how I spend my money.. 


• • • • jar 

• • • • 

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a • • • 

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satisfied 

1 



Very 

dissatisfied 

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likely 

Has the consumer directed support program met the expectations EXCEEDED 


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Very 

unlikely 

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from THP 7 « C 

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* M E H T ! ^^M^Mônz 

from the perspective of the person with a developmental disabilitVfhe person who has the 

developmental disability should be directly involved In completing tt^^SS^^S^ 

Independence Mobility / Control / Privacy Agree 










Disagree 


a • • • 

• • • • 

• • • a • 

a si • • • 

• • • • 

a a • • 

• • a • 

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satisfied 

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• • i • r i_ . . . . Expectations 

that were set for you by your case manager and county social ~T 

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dissatisfied 

• • • • • • 


nor unlikely 

Very 

unlikely 

• • • • • • 

Met 

Expectations 

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supports? To O&T-xU-RTAS









Very 

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Very 

dissatisfied 

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unlikely 

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Expectations 

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• • • • • 


supports? 

MID. 

fhinking beyond consumer directed supports to your overall quality of life, on the following pages 

alease indicate how much yolj agree or disagree'with each statement. Pleasecol^^ 

from the perspective of,the person with a developmental disability. The person who has the 


Independency J Mobility/Control/Privacy Agree Disagree 


I can (evenjf^someone helps me because of my disability) get / 

to where I want to go J2J* 

I have control over my daily c~hedule. Q 



information have access to it ^Rj 

I can set desired outcomes (goals) for myself Q 

I can decide about how I spend my money Q 

I can make decisions that will affect my future Q 

I am satisfied with my current level of independence ........ Q ^ 

• a • a 

a • • 

a • • • 

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Very 

satisfied 

Very 

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• • • • • • 


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Very 

unlikely 

• ••••• 

Met 

Expectations 

Failed 

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supports? - 

Thinking beyond consumer directed supports to your overall quality of life,on theJoljowjng pages *i 

please indicate how much you aglree^rdisagrei with each statement. Please completeTthese sections 

from the perspective of the person with a developmental disability. The person who hasthe ^ 

developmental disability should b'edirectiy involved in completing this survey as much"aVpo^sibte^r^ 

^^©P^ndeêJ Mobility / Control / Privacy Agree Disagree 


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How likely would you be to recommend a consumer directed norunhkeiy unhkeiy_ 

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. . . . , , • . • • Expectations Expectations Expectations 

that were set for you by your case manager and county social ~T ^ i — ~ *— 

services department? Q Q Q Q fij • Q 

What is the one thing that would have the greatest impact on your satisfaction withconsumer directed 

supports? Y P ^ X > 1 J U ^ \ ^ cryt ^ a-jZfyi&V~£- 

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SS!I?i?9 beyond ronsumer; DIRECTED supports to your overall quality of life, on the following pages ~T_5 

please indicate how much you agree or disagree wUffeach statement. Please COMPFETE thes^se^TIOLS 

t!HP. th 

© perspective of the person with a developmental disability. The person who has "THE]"- %~ - 

developmental disability should be directiy involved in completing this SURVEY as MUCHTS'po^^ 

Independence | Mobility / Control / Privacy Agree 

Disagree 

E**BBSBBBSSSSSSS9BHBSBL Strongly Som Somewhat Neither Somewhat Strongly 

I can (even if someone helps me because of my disability) get / 

to where I want to go \. 

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I have control over my daily schedule .. Q Q j^t Q Q 

I have privacy to be alone or with people I choose. Q Q O 

Only people who are supposed to; know my personal 

information have access to it Q Qf Q Q Q 

I can set desired outcomes (goals) for myself..... 

I can decide about how I spend my money Q Q Q| Q| 

I am satisfied with my current level of independence ... • • ^ • • 

I can make decisions that will affect my future Q Q

Overall' Satisfaction 



rlow likely would you be to recommend a consumer directed 



(that were set for you by your case manager and county social 


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satisfied 



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SUPPORTS? ^ E W T C G ^ A^R&ÔI: Â^F PG^T^C^,

Overall Satisfaction i 








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What is the one thingjhat would have the greatest impact on your satisfaction with consumer directed 

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&Sfc!09 bey° consumer directed supports to your overall quality of life, on the following pages 

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î 1 

? the perspective of the person with a developmental disability. The person who has the ?i 

developmental disability should be directly involved incompleting this survey as much^pSssiblet" f^f 

Independence | Mobility/Control/Privacy 




n , 

h. P y people who are supposed to know my personal 

înformation have access to it 



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support program? 

how satisfied are you with 

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IFVEN AL THE CONSIDERATIONS , HOW SATISFIED ARE YOU WITH YOUR - 

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Very 

likely 

—I 


nor unlikely 

LOWLIKEIY WOULD YOU BE TO RECOMMEND A CONSUMER DIRECTED 

1 

J SORT PROGRAM IN YOUR COUNTY TO A FRIEND IN A SIMILAR SITUATION? 

Very 

unlikely 

• • M • • • • 

IAS'THE CONSUMER DIRECTED SUPORT PROGRAM MET THE EXPECTATIONS Exceeded Met 

Expectations LAFWERE SET FOR YOU BY YOUR CASE MANAGER AND COUNTY SOCIAL Expectations 

*"*1CES DEPARTMENT? 

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JFHAI IS THE ONE THING THAT : WOILDHAVE THE PREATE^MPACT ON YOUR SATISFACTIPN WITH CONSUMER 

supports? _ 

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MPPorts to YOUR overall quality of life, ON THE Mowing[PAGES 5 

INDICATE how MUCH YOU AGRE OR DISAGRE with EACH STATEMENT. Please COMPLETETHESE SE 

jrfimperspectiye of the person with a developmental disability. The PERSON who haVtfie * 

TBSRNJENTAL DISABILITY SHOULD BE DIRECTLY INVOLVED IN COMPLETING this SURVEY AS MUCH aTR38sfte 

ydependence | 

Mobility / Control / Privacy 

AN (EVEN IF SOMEONE HELPS ME BECAUSE OF MY DISABILITY) GET 

LAVE 

>??P ,E 

WHO ARE SUPOSED TO KNOW MY PERSONAL 

ITORMATION HAVE ACCES TO IT... 

IN 

(.DECIDE ABOUT HOW I SPEND MY MONEY 

Agree 


Disagree 


• a • • 

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• a • • 

• • a • 

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How likely would you be to recommend a consumer directed noruniikely ^fflL. 

support program in your county to a friend in a similar situation? .. Q jgf Q Q Q Q Q 

Has the consumer directed support program met the expectations Met Failed 

.. . j. i , r 


that were set for you by your case manager and county social -nr—— ^ — 

services department? • JEf • • • • • 

What is the one thing that would have th§ greatest impact on your satisfaction with consumer directed 

Supports? /Vfcv U4y -fr> -CA//, £J 0v\ ^^VIW^L s*~p0*St~ IS+K& 

hinking beyond consumer directed supports to your overall quality of life, on the following pages. J 

lease indicate how much you agree or disagree with each statement Please complete these sections " 

om the perspective of the person with a developmental disability. The person who has the_ 

evelopmental disability should bedirectly involved in completing this survey as muchas possible!^ 

Independence | Mobility/ Control/ Privacy Agree Disagree 

•••^'••••••••••••••••B Strongly Somewhat Neither Somewhat Strongly 


to where 1 want to go 

1 have control over my daily schedule • 

1 have privacy to be alone or with people 1 choose • 

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a • 

a • 

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• 

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noru 

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f* ly 





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f ^ Expectations 

services department? O^Q • • • • • 

^/Vhat is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? 


>lease indicate how much you agree or disagree with each statement. PleaseTcomplete these sections 

ram the perspective of Jthe person with a developmental disability. The person who has the 

leyelopmental disability should be directly involved in completing this survey as much as possible" ' 

J09!gpendence:| Mobility /Control /Privacy 




£1 have privacy to be alone or with people I choose....... 

•"• Only people who are supposed to know my personal 

r 

Agree 


Disagree 


• a • • 

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a- • a • a 

a • a a 

• • • • 

• • a • 

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satisfied nor dissatisfied 

Given all the considerations, how satisfied are YOU with your "~T" •—• ^JF^ 

consumer directed support program? N£J Q Q Q Q Q Q 

V e r 

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support program in your county to a friend in a similar situation? .. • • • • • • 

ttk 

f* "orunnkeiy , mi i k e| V 

Has the consumer directed support program met the expectations Exceeded M e t Fatted 

that were set for you by your case manager and county social Expectations Expectations Expectation 

services department? ^ Q Q Q Q Q Q 

RPPORTS 1 

? t h i n 9 t h a t W O U l d h a V e t h e 

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pverall quality of Hfe^ bnjhe following pages 

jcate how much you agreeor disagree withêach statemenrpiel^complete sections 

. P^Pe^tei* % personwith a developmental disability. .The person who has the 

developmental disability should be directly involved in completing this smveyâs* much as possible. *" 

pnaependencei Mobility/Control/Privacy Agree D 

S A 9 L 

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WOrily people who are supposed to know my personal \r-/C 

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: I can set desired outcomes (goals) for myself • 

5 I can decide about how I spend my money 

-"Mean make decisions that will affect my future 

TARN satisfied with my current level of independence 

• a • a 

• • 

• • a 

• • • • 

• • • 

• a a • 

• • • • 

• • • a








V 


9 

* nor dissatisfied 

V e r 

y 

satisfied 

• a • • • • 

dissatisfied 

• 

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likely 


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services department? g| Q • • • Q Q 


supports? -jh C&U^j p~ IJLP "TAe srr^nMo tuUt^ // JJL. 

SBl n 

9 beyond consumer directed supports to your overall quality of life, on the following pages \ 

•lease indicate how much you agree or disagree with each statement. Please complete "theseTectionsT* 

•SSUfe perspective of the person with a developmental disability. The person who has the 

leyeiopmentai disability should be directly involved in competmg ths survey as much as possible. 

JjJ^PP 

e r | 

denCe | Mobility / Control / Privacy Agree Disagree 



to where I want to go Q Q Q Q| 

I have control over my daily schedule a • • • 

t 

......a • • • • 

I have privacy to be alone or with people I choose.... 

fi"Only people who are supposed to know my personal 

si 

înformation have access to it Qfr Q CI Ql Ul 

I can set desired outcomes (goals) for myself • a Q Q Q 

I can decide about how I spend my money Q Q Ql Ql 

I can make decisions that will affect my future • • a • • 

j am satisfied with my current level of independence ... • a • • •



.._7. nor dissatisfied 


Given all the considerations, how satisfied are you with your ~JT „ _ - 

consumer directed support program? y\ LI LI LJ LJ LA LJ 

V E L 

7 


How likely would you be to recommend a consumer directed " F Y \j— NORU 

F KELY 

£ L Y 

" " T 

support program in your county to a friend in a similar situation? .. [] ft Q [][][] [] 


that were set for you by your case manager and county social *&*m< Expectations ___tauons 

services department? • Q Q Q Q Q 


supports? 

rhinking beyond consumer directed supports to your overall quality of life, on the following pages" t 

)lease indicate how much you agreeôr disagree with eaxl^stetement. Please complete these sections * 

rom the perspective of the person1 with a developmentardisability. The person who has T H E Z - ; V - 

levelopmental disability should be directly involved INWRNêting this survey at much" as ffsslble^?^: 

êp^denC^ Mobility/Control/Privacy 

I can (even if someone helps me because of my disability) get / 

to where I want to go |VJ 

I have control over my daily schedule Qj| 

I have privacy to be alone or with people I choose ...... |^ 


information have access to it.......... 






— 

J 

• • • • 

• a • • 

• • • • 

ft • a a 

• • • 

a a • 

• • • a 

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y nor dissatisfied _ 

— 

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• satisfied dissatisfied 

Given all the considerations, how satisfied are you with your • Q l_f Q Q Q Q 

consumer directed support program? ^ J 

^ ^ 


likely 

n o r 


How likely would you be to recommend a consumer directed —i——7 1 r 

support program in your county to a friend in a similar situation? .. Q M Q Q Q Q Q 

Has the consumer directed support program met the expectations £Z£L EX^ ANS Ex^lons 

that were set for you by your case manager and county social "L. r~i Fl fcrf r~l HI 

services Apartment? LI LI LJ LI ]4' LI LJ 

What is the one thing that would have, the greatest impact on your satisfaction with consumer directed 

supports? ^ Mmju tftWrJjubf L)/ ûUiihA^ OK, 

Thinking fcgyond consumer djrected supports to your overall quality of life, on the following pages 

please indicate how much you agree or disagree with each stefiientj Please'completethesej|îpns 

from the perspective of the person with a developmental disability. The person who has the_ 

developmental disability should be directly involved in completing trite survey a¥much as pdssfojeV^ 


1. I can feven if someon 

to wr% e | w a n t to go. 

2. I hav$ control over my daily schedule 

3. I hav§ privacy to be alone or with people I choose... 


inforo&ti on have access to it 

5. I can 3^ desired outcomes (goals) for myself. 

6. I can rSecide about how I spend my money ... 

I can^ke decisions that will affect my future. 

Agree 


Disagree 


• • • • 

• • • a 

a & • • • 

a a • • 

• • • • 

a • • • 

• • • 

. • • • •

T h 









Very 

satisfied 

Very 

likely 

tqrj 

Exceeded 

Expectations 



dissatisfied 

• • • • • 


nor unlikely 

Very 

unlikely 

• • • • Q 

Met FaUed 


..D_(a • • • •"• 


supports? / Qh\ prOUf\ SOO^ficd > ifh'nLi^toj?, b 

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9 .bjy^cawmer directed supports to your overall quality of life, on the following pages I*:.. 

please indicate how much you agree o> disagree Withea^ 

from the perspective of the person with a developmental disability The person who has the ~ 

developmental disability should be directly involved in completing this survey as much as^possiBte^-tk> 

^ ^ ^ ^ C ^ Mobility/Control/Privacy Agree 


Disagree 



to where 1 want to go... rj| • • a 

1 have control over my daily schedule. • • a • • 

1 have privacy to be alone or with people 1 choose • • • a a 


information have access to it • • • • a 

1 can set desired outcomes (goals) for myself . • • • a 


• • • • 

1 can make decisions that will affect my future • _ a • • 

1 am satisfied with my current level of independence a 

• a a









Very 

satisfied 

—i— 

• 

Very 

likely 



Very 

dissatisfied 

• • • • • 


nor unlikely 

Exceeded Met 


Very 

unlikely 

Failed 

Expectations 

1 t I 

• J^Q • • • • 


supports? 

supports to your overall quality of life, on the following pages 

please indicate how much you agree or disagree with'eac1?s^FEMENR Please complete these sections 


developmental disability should be directly involved in completing this survey as much as possible. - V 




1 have control over my daily schedule • • • • 

1 have privacy to be alone or with people 1 choose • • a a 


information have access to it. • • • • 

1 can set desired outcomes (goals) for myself • a • • 


1 can make decisions that will affect my future • & • • • 





V e r y 



V e r y 



2. How likely would you be to recommend a consumer directed " oru kely u n U k e I y 

f . 

support program in your county to a friend in a similar situation? . . Q [] [] [| Q 



E 

^*s__^ Expectations ____jay_s 

services 

3 set for you by your case manager and county social ~% ^ i 

department? UXU • • • • • 


supports? c 

u 






^ ^ h j j ^ ^ ^ ^ ^ ^ ^ ^ h J Strongly Somewhat Neither Somewhat Strongly 



2. I have control over my daily schedule. . jOJfi 

3. I have privacy to be alone or with people I choose.. 


information have access to it.. 

5. I can set desired outcomes (goals) for myself. . M/. f:.. 

6. I can decide about how I spend my money . 

7. 

8. 

• • • • 

• • • A • • 

• MI? • • 

m • • • • 

• • • • 

• • • • 

• • • • 

• • 3 • •









Very 

satisfied 



J 

Very 

dissatisfied 

1 


likely nor unlikely unlike! 

fV" 

1 

r- 

pLu • • • • • 

Exceeded 

Expectations 

Met 

Expectations 

Failed 

Expectations 

• •••••• 


supports? 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

( J .. -> n \ la 

i - -t 

U 




developmental disability should be directly involved in completing this survey as much as possible: 

Independence I Mobility/ 

Control / Privacy Agree Disagree 






can decide about how 

I am satisfied with my current level of independence Q 

• • • • 

• Br • • • 

• • • • 

Of • 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• • • •


satisfied 



e r y 

dissatisfied 


consumer directed support program? LI L* LI LI LI LI 


How likely would you be to recommend a consumer directed -^p- noruniikeiy mihkeiy 

support program in your county to a friend in a similar situation? .. Q Q Q Q Q Q Q 


, • • . ~. i Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n ^ 

services department? • • J2 • • • • 


supports? _ 

(c 

Thinking beyond consumer directed jsupports to your overall[quality of life, on the following pages 

please indicate how^much you agree or disagree with each sta^êrt. PleasexJomplete these sections 

from the perspective of the person with a developmental disability. The person who has the i, 

developmental disability should be directly involved in completing this survey as much as possible. ; is 








I can decide about how I spend my money .. 


• a • • • 

• • • • 

• • ® • • 

• • • • 

• a • • a 

a • • a 

• • ® • • 

a • • a

VERATL Satisfaction ] Very 

satisfied 



Very 

dissatisfied 

•Given all the considerations, how satisfied are you with your • , > i 

^consumer directed support program? • QF • • • • • 

>w likely would you be to recommend a consumer directed 

[support program in your county to a friend in a similar situation? 

TOT 

Very 

likely 

—I— 

[as the consumer directed support program met the expectations Exceeds 

lat were set for you by your case manager and county social Expectations 


nor unlikely 

Very 

unlikely 

• 

R 

S P A • • • • 

Met 

FaUed 


services ^—department? QF • • • • • • 

1% • 

HAT IS THE ONE THING THAT WOULD HAVE THE GREATEST IMPACT ON YOUR SATISFACTION WITH CONSUMER DIRECTED 

SUPPORTS? S RV.^RHM^^4^T ,A V^N >DA (A^JJYLAX R* NTXA 

^P-4fr, , : 1>~——: n 

J^g beyond consumer directed supports toyouroverall quality of life, on the following pages O U ^ 

H 

M U 

F h 

y° u 

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9?F 

r 

djsagrîth each statement. Please c6mplete the^s&tioÎR^ 

r s e c t , v e 

SSFJ^ P 

o f 

the pereon with a developmental disability. The person who has thei*^ 

vgiopmental disability should be directly involved in completing this survey asTmuch 'upossfte^ ^ 

SILPJR^ndenCe I Mobility/Control/Privacy Agree Disagree 

— • — • Strongly Somewhat Neither Somewhat Strongly 

[can (even if someone helps me because of my disability) get 

'vwhere I want to go D£| Q 

e control over my daily schedule Q 

3 privacy to be alone or with people I choose ...... • 

SIS. ' * 

^ 'people who are supposed to know my personal 

jobation have access to it £/jf Q 

set 

'IT. 

desired outcomes (goals) for myself jv/TT-Q fc=R 

^decide about how I spend my money Y Q 

GNMATE decisions that will affect my future j£F Q 

GJJG*| with my current level of independence • 

• 

• 

• 

• 

• 

• 

• 

a 

• • • 

JQ Q — Q 

• • • 

• • • 

• • •


3iven all the considerations, how satisfied are you with your 




Very 

satisfied 



Very 

dissatisfied 

• • TJR • • • • 

Very 

likely 

[Has the consumer directed support program met the expectations Exceeded 



nor unlikely 

Very 

unlikely 

• • • • • • 

Met 

EXP TATIONS E 

F *P EC 

F ATI 

° PS 

FaUed 

Expectations 

services department? Q Q Q Q Q Q 

Vhat is the one thing thatwould have the greatest impact on your satisfaction with consumer directed 

iupports? 

——" . —. 1 ' ^ ' sxfiTixjrS) ' — ^?U.VY\e • y i ^ v i \ x i r iyî /LIFE t~~> 

4 V 

^-1 far, V Or!n?r\G,\ fl P^zrYY\ 

L 



om the perspective of the person with a developmental disability. The person who has the r. 

svelopmental disability should be directly involved in completing this survey as much as possible. 


NIBB9BMBHBLBLBBILBLBI| Strongly Somewhat Neither Somewhat Strongly 


to where I want to go Q E( Q Q Q 

I have control over my daily schedule Q ~$ Q CI Q 

I have privacy to be alone or with people I choose.... • 13 • • • 


information have access to it Q Q Q Q • 

I can set desired outcomes (goals) for myself • • U • • 

I can decide about how I spend my money Q (H| Q Q 

I can make decisions that will affect my future Q Q 13[ O Q 

I am satisfied with my current level of independence .. • • • U • 

—F


^ J 

satisfied 



V e r 

y 

dissatisfied 

Given all the considerations, how satisfied are you with your ' r 

consumer directed support program? Q LI LI Q Q G 


Very * Neither likely Very 

noru 

f kcly 

support program in your county to a friend in a similar situation? ..

Overall Satisfaction « 

^ ^ ^ ^ ^ V Neither satisfied ^ 

satisfied rdiss tisfied dissatisfied 

Given ail the considerations, how satisfied are you with your ' - ' ' 

consumer directed support program? £3 Qj M Ql QJ W UJ 


How likely would you be to recommend a consumer directed "° r k e l y ulUi 

"f' | ke 

' y 

support program in your county to a friend in a similar situation? .. 81 Q E) SI 13 3 Q 

Has the consumer directed suppbrt program met the expectations Exceeded Met Failed 

. . . . . . • Expectations Expectations Expectations 

that were set for you by your case manager and county social ^ — 

services department? .V; @| (v| (3 01 13 13 13 


supports? V Z A A I ^ ^ ^ ^ F ^ ^ X F V F R J 

WIDE » JHIIRTTAJ 4 CFEJ&R VI*/JH *F 

Thinking beyond consumer directed supports to your OVERALL QUALITY OF LIFE, on the fo lowing P ^ F 


from the PERSPECTIVE OF THE PERSON WITH A DEVELOPMENTAL DISABILITY, The person who has the 


1. 

Independent MOBILITY/ CONTROL / PRIVACY ^ N E I T H E R J S T T - * 


(3 • 

2. m M 13 

3. SI • M ul 

4. 


_I • SI 

5. IS 13 13 

6. IS M J 

7. • 13 J 13 

8. I am satisfied with my current level of independence 13 (3 13






Very 

satisfied 

Very 

likely 






nor unlikely 

Very 

dissatisfied 

Very 

unlikely 

of • • • • • • 

Met 

Expectations 

Failed 

Expectations 

services department? _ _ ( • • • • • • 

/Vhat is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? 

Pfl US TP 

our 

"hinking 

ilease indicate 

beyond 

how 

consumer 

much 

directed 

you agree 

supports 

or disagre 

to your 

with 

overal 

each 

quality 

statement. 

of life, on the fol 

Please 

rom the perspective of the person with a developmental disability. The person 

compl 

levelopmenta l disability should be directly involved in completing this survey as much 

w 

JH^PQHdenCe I Mobility / Control / Privacy Agree Disagree 




I have control over my daily schedule Nfe. (^PVP... 





• or • a a 

• • ef • • 

• a a • 

J • a • a 

• • • • a 

• • • a 

• • a a 

• a • •









Very 

satisfied 



Very 

dissatisfied 

liaf • • • • • • 

Very 

likely 


nor unlikely 

T 

Very 

unlikely 

;a,a • • • • • 

Exceeded 

Expectations 

Met 

Expectations 

FaUed 

Expectations 

• ••••• 


supports? $*U*U 



om the perspective of the person with a developmental disability. The person who has the f 

evelopmental disability should be directly involved in completing this survey as much as possible. 


_^_~_^_^_^____^__J ' Strongly Somewhat Neither Somewhat Strongly 

I can (even if someone helps me because of my disability) get RI R"l 

to where I want to go • • J2_L LI LI 


I have privacy to be alone or with people I choose.... ....... x • • • 

Only people who are supposed to know my personal . , 

information have access to it Ql ]__. L J LJ LI 

I can set desired outcomes (goals) for myself..... 

I can decide about how I spend my money Q Ll Q L_ 

I can make decisions that will affect my future • • • • 

I am satisfied with my current level of independence ... • • • •

Te1ra¥SaTlsfaction 1 

-. ---- H Neither satisfied 

••^•^••l^^^*^^^**'^^^^ ..^?'. nor dissatisfied 

»>=,*' - ' satisfied dissatisfied 

3iven all the considerations, how satisfied are you with your ' • • 

consumer directed support program? LJ U LI U LI LJ . 

• — 

" - . Very *" Neither likely Very 

tow likely would you be to recommend a consumer directed 

n o r M k e 

^ ' y 

"""^ 

support program in your county to a friend in a similar situation? .. £

Qyerail Satisfaction I v 

• • ~ • — • Very nor dissatisfied 


GIVEN ALL THE CONSIDERATIONS, HOW SATISFIED ARE YOU WITH YOUR ' > ,—* RU «—» R-| A 

CONSUMER DIRECTED SUPPORT PROGRAM? LI LL U LI U U LI 

V e r >. Neither likely Very 

HOW LIKELY WOULD YOU BE TO RECOMMEND A CONSUMER DIRECTED , 

likel'v 

^F 5 

n o r 


1 1— 

SUPPORT PROGRAM IN YOUR COUNTY TO A FRIEND IN A SIMILAR SITUATION? .. [] Q Q Q Q Q G 

HAS THE CONSUMER DIRECTED SUPPORT PROGRAM MET THE EXPECTATIONS Exceeded Met 

* 

R 

° R 

Failed 

FMK-fations Expectations Expectations 

THAT WERE SET FOR YOU BY YOUR CASE MANAGER AND COUNTY SOCIAL -N ' ' 

SERVICES DEPARTMENT? • • • 13 • • • 

WHAT IS THE ONE THING THAT WOULD HAVE THE GREATEST IMPACT ON YOUR SATISFACTION WITH CONSUMER DIRECTED 

SUPPORTS? 

iV\GR-






V e r 

y 

satisfied 



V e r 

T 

dissatisfied 

• • • • • • • 

Very 

likely 

3. Has the consumer directed support program met the expectations ^"fjf 1 



Expectations 


nor unlikely 

Very 

unlikely 

• ••••• 

MET 

Expectations 

Failed 

Expectations 


Supports? /*\Q&-£- P-U/*0 S C,TJOUS? />"S)JDJEL AUA/L/TSL^ 


please indicate how much you agree or disagree with each statement. Please complete thesejsections 


developmental 

jlnd^p^Td^jl^J 

disability should be directly involved in completing this survey as much as possible. 

Agree Mobility/Control/Privacy 

Disagree 



to where I want to go _ • • • • 

2. I have control over my daily schedule. • • a • • 

CO 

I have privacy to be alone or with people I choose _ • • • • 


information have access to it _ • • • • 

5. I can set desired outcomes (goals) for myself _ • • a • 

6. I can decide about how I spend my money .. • • a • • 

7. I can make decisions that will affect my future.. • a a a • 

I am satisfied with my current level of independence _ a a a • 

CO 

?2. V

Ôverall Satisfaction 








Very 

satisfied 



Very 

dissatisfied 

• J^Q • • • rj 

Very 

likely 

Exceeded 

Expectations 


nor unlikely 

Very 

unlikely 

• • • • • 

Met 

Expectations 

FaUed 

Expectations 

•

^^ral^îtisfactiorj 



1 

V e r 

y 

satisfied 


V e r 

* 

dissatisfied 

i 1 r 

consumer directed support program? Q Q H Q Q Q [] 

_. How likely would you be to recommend a consumer directed 

Very Neither likelv Very 

Uk 

f ly 

nomniikeiy u ni i k e ly 

support program in your county to a friend in a similar situation? .. Q Q Q Q Q 

3. Has the consumer directed support program met the expectations Exceeded M et F a i l e d 

that were set for you by your case manager and county social Expectations Expectations Expectations 

services department? j—| —j j—j Q ~j ^ rj~~ 

l 

6 t h i n g t h a t w o u l d h a v e t h e 

' supports? greatest impact on your satisfaction with consumer directed 

Thinking beyond consumer directed supports to your overall quality of life'on the following pages 










4.r Only people who are supposed to know my personal 



6. I can decide ahm 


8 

a m s a t i s f i e d w i t n m 

"«L.' 

Y current level of independence 

a • • • 

• • a • 

• _ • • a 

a • • • 

• or • • • 

• a _ • • 

a • • • a 

• • • •

Overall Satisfaction Very 

satisfied 






• a 


• • • 

nor dissatisfied *^ j 

dissatisfied 

• ja 

Very 


• • • 

Very 

likely 


T 

R 

Met FaUed 


. • • • • EXPECTATIONS 

that were set for you by your case manager and county social ~ n • 

services department? J% • • • • • • 


supports?^ _ ___ .o, 3 ,— = — - ; ^ ^ ^ 

Thinking beyond consumer directed supports to your 

P|^5^ 

OVERAH ^^5AW^^^SSS^^S^»î 

SB. fndicke how much you ag^rWsigre^'each statement. Please COMPTETEJ^.^chops., 

frbm the PERSPECTIVE of THE P E R ^ V ^ E ^ ^ N T E L DISABUITY^The 

developmental disability should be directly involved in completing this survey as much AS possroie. 

1. 

Indepertd^nc^j / CONTROL / PRIVACY Agree 

MOBILITY 



to where I want to go ^ • 

2. I have control over my daily s 

3. I have privacy to be alone or 

5. 

6. 

7. 

'tit?'-- 5 

* -' 


information have access to it.. .; 


I can decide about how I spend my money ... 



Disagree 


• • • • 

• ja • • • 

• El • a • 

• a • • • 

a _ • • • 

• • a • 

• • o • • 

• • • •






Very 

satisfied 

Very 

likely 

i Has the consumer directed support program met the expectations Exceeded 

Expectations 





Very 

dissatisfied 

• • • • • • 


nor unlikely 

Very 

unlikely 

• • • • • • • 

Met 

Expectations 

Failed 

Expectations 

• • • • • • 

What is the,one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? 

THINKING BEYOND CONSUMER DIRECTED SUPPORTS TO YOUR OVERALL QUALITY OF LIFE, ON THE FOLLOWING PAGES 

PLEASE INDICATE HOW MUCH YOU AGREE OR CHSAGREE WITH EACH STATEMENT: PLEASE COMPLETE :THESE SECTIONS 

FROM THE PERSPECTIVE OF THE PERSON WITH A DEVELOPMENTAL DISABILITY. THE PERSON WHO HAS THE 


I MOBILITY/CONTROL/PRIVACY Agree Disagree 

• { ^ • ^ ^ • • • ^ • • • ^ • • H Strongly Somewhat Neither Somewhat Strongly 

1. I CAN (EVEN IF SOMEONE HELPS M E BECAUSE OF M Y DISABILITY) GET 


2. I HAVE CONTROL OVER M Y DAILY SCHEDULE. 

3." I HAVE PRIVACY TO BE ALONE OR WITH PEOPLE I CHOOSE 

4.* ONLY PEOPLE WHO ARE SUPPOSED TO KNOW M Y PERSONAL 

i INFORMATION HAVE ACCESS TO I T . . . . . . 


6. can deniriA ahm it 

8 

M s a t i s f i e d w 

iik'4 'th my current level of independence 

• 3 • • • 

• • a • 

• EL • a • 

a • • • • 

• • • • 

• a • • 

• • a • 

• • • • •






Very 

satisfied 

Very 

likely 

1 




dissatisfied 


nor unlikely 

T 

Met 

Expectations 

Very 

unlikely 

Failed 

Expectations 

. R L • • Expectations 

that were set for you by your case manager and county social \_y • —-—r— 

services department? ( • • • • • • • 

%. What is the one thing that would have the greatest impact on your satisfaction with consumer directed 

supports? i 


please indicate how much you agree or disagree with each statement/ Please complete these, sections 

from the perspective of the person with a developmental disability. The person who hasjh^^^ 

developmental disability should be directly involved in completing this survey as much as pbssible.^*PR 

1. 

3. 

4. 

5. 

6. 

7. 


Y - 

Neither 

Disagree 




I have control over my daily schedule • 

I have privacy to be alone or with people I choose • 

a" a a • 

a -a • 

_ a • a 




• 

• 

• 

or • 

• 

• 

a 

• 


I can make decisions that will affect my future a • ar • • 

I am satisfied with my current level of independence • • •






Very 

satisfied 

5 T 

Very 

likely 



Exp

Overall Satisfaction „ 




y nor dissatisfied 

V e r 

V e r y 

satisfied " dissatisfied 


noru 

f k£ly 

support program in your county to a friend in a similar situation? .. ^ [] Q Q Q [) Q 


. . . . , i_ _ • , Expectations Expectations Expectations 

that were set for you by your case manager and county social H_ XI ^ JL— 

services department? • • 3 • • • • 


supports? . . 

Thinking beyond consumer directed supports to your overall quality of life, on the^follgwing pages ^ 


from the perspective of the person with a developmental disability. The personjffibhas the .J 

developmental disability should be directly involved in completing this survey as" much as possible. 

c\i 


• • • ^ • • • ^ • • • ^ ^ • • J Strongly Somewhat Neither Somewhat Strongly 

to where 1 want to go • a 

• a • • 

1 have control over my daily schedule • a • a 

3. 1 have privacy to be alone or with people 1 choose • a • • 

4. 

5. 




• 

• 

• • 

a • 

• 

• 

6. 

7. 




• 

• 

• 

• • • 

a a • 

a a • 

CO


• • • • • • W M M W I I I I MIIM 

. Given all the considerations, how satisfied are you with your 




Very 

satisfied 



Very 

dissatisfied 

T 

[p • • • • • • 

Very 

likely 


. , . , Expectations 


nor unlikely 

T 

Met 

Expectations 

that were set for you by your case manager and county social ~~rr • 

Very 

unlikely 

R 

Failed 

Expectations 

services department? : sj • • • • • • 


supports? :£ -tt^TNK ut m aA-ttjt -MJL ôb 





2. 

3. 


^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ J Strongly Somewhat Neither Somewhat Strongly 






6. I can decide about how I spend my money .. . 


8. I am satisfied with my current level of indepen< 

• • • • 

a" a • • • 

• • a • 

• • • • 

• • • • 

• or • a • 

• • • • 

• • • •




Very 

satisfied 

Very 

likely 

T 




nor unlikely 

T 

2. How likely would you be to recommend a consumer directed —, r r 

support program in your county to a friend in a similar situation? .. ^ 

Very 

dissatisfied 

T 

Very 

unlikely 

r 


FaUed 

Expectations 

that were set for you by your case manager and county social Expectations —Expectations ja,^ 

services department? • M • • • • • 


supports? 

Thinking beyond consumer directed supports to your overall quality of life, pn^jfollowing page? 


-from the perspective of the person with a developmental disability. The person who has the 


Independence 1 Mobility / Control / Privacy Agree Disagree 




• • • • 

• o • • 

• • • 

• • • • 

• • • • 

• • • • 

1 can make decisions that will affect my future • • a • 

1 am satisfied with my current level of independence . _ pi • • •




~> How likely would you be to recommend a consumer directed 


Very 

satisfied 

Very 

likely 

—, 


, . . . . Expectations 




nor unlikely 

1 

Very 

dissatisfied 

Very 

unlikely 

• • • • • • • 

Met 

Expectations 

FaUed 

Expectations 

that were set for you by your case manager and county social ~n "-i ^-r 


What is the one thing that would have the greatesHmpactpn your satisfaction with consumer directed 

Supports? 1 êoag^r/Tî Q-£ -fAa. < 

^\QtAA' 1 

> T. Vud~






Very 

satisfied 

T 



Very 

dissatisfied 

• Y F A • • • • 

Very 

likely 


. , , . . Expectations 


nor unlikely 

T 

Met 

Expectations 

Very 

unlikely 

Failed 

Expectations 

that were set for you by your case manager and county social ~n \ y * ^ 

services department? • • • Of • • • 


Supports? C S\rrs

Overail Satisfaction 



satisfied 



V e r 

y 

dissatisfied 


2. How likely would you be to recommend a consumer directed -^p nomniikeiy u oi i k ei y 

support program in your county to a friend in a similar situation? . . Q ^ Q Q [] Q [] 



Exp 

tations E x p c c t a t i o n s 

f i 

E__c«2_ns 

services department? • U M • • • • 


supports? ) ^ , 

P/YiCtnij*^ O^FW C^DJW^ UMHTS* (AT1A*S< J 

0alios, U /yÂ^) UFLJBFA,A>UA/^/U





Very 

satisfied 

T 



Very 

dissatisfied 


noru 

f kely 

^, support program in your county to a friend in a similar situation? .. jjj Q Q Q Q Q Q 


lions 

. , . , . . , Expectations Expectations Expectati 

3- that were set for you by your case manager and county social ~n — — 

services department? • • • • £ } • • 

4. What is the one thing tfja,t would have the greatest inTpact on youcsatisfactiori with consumer directed 

: supports? 3orts? A 7\*KovL^/ C^^Jzp 

^ > e - r^-z*ÂSAAJ*>^ JZ^YA-F. 

#*•*-»•' ' -j. _ - _ : ,. .„..-., , ., : i. , • _ _ j .... . .......... ...... . ~ 

f!lW n 

9 beyond consumer directed supports to your overall quality of life, on the fpllowing pages\. 

|please indicatehpw much you agree or disagree with each statement. Please complete theselsectidns 

|frpm the perspective of the person with a developmental disability. The person who has the 

^developmental disability should be directly involved in completing this survey as much as posslblef ' 

Jnd^perênce I Mobility/Control/Privacy Agree Disagree 


1. I can (even if someone helps me because of my disability) get \V 

^ " to where I want to go Q Q LI LJ 

^2. I have control over my daily schedule. .. Q • fo d Q 

|3- I have privacy to be alone or with people I choose Q Q &) I—1 Q 

-a 


information have access to it..... Q (3 Q Q Q 

I can set desired outcomes (goals) for myself • ^ • • • 

I can decide about how I spend my money • • • Q • Q ^ Q 


' °- I am satisfied with my current level of independence ... • Q Q Q 

^ 

2*

Bêrall Satisfaction 



Very 

satisfied 



Very 

dissatisfied 

1 

era • • • • • 

Very 

likely 


, , . . . Expectations 

) set tor you Dy your case manager ana couniy social 


department? 

services 


nor unlikely 

T" 

Very 

unlikelv 

r ' 

afo • • • • • 

Met 

Expectations 

1 1 

FaUed 

Expectations 


supports?. . 

I 


2. 

pjease indicate how much you agree or disagree with each statement. Please complete these sections 

from the perspective of the person with a developmental disability.. The person who has the 


3.** 

• * 

5. 

6? 

i 



[Independence | Mobility /Control /Privacy Agree Disagree 




1 have control over my daily schedule a a • • a 

1 have privacy to be alone or with people 1 choose • • a • 



1 can set desired outcomes (goals) for myself • si • • • 

1 can decide about how 1 spend my money si • • • • 

1 can make decisions that will affect my future • • a • a 


O V E R A L L Satisfaction § 

• _ _ _ _ _ B _ _ B B H B — • • M M M A M M M M A D M v Neither satisfied 

satisfied nor dissatisfied Very 

. Given all the considerations, how satisfied are you with your ~~ « 

consumer directed support program? Q _ Q Q Q Q Q 

Very Neither likely v 

. How likely would you be to recommend a consumer DIRECTED noruniikeiy u n l i k e 

support program in your county to a friend in a similar situation? .. Q Q Q fj Q Q Q ~ 

. Has the consumer directed support program met the expectations Exceeded Met F a i i e d 


E ; ? t a t i o n s 

Pf 

Expectations Expectation. 

services department? rj Q rj Q Q [_ 

6 , h i 

• Tpports? " 9 h a t W 

' 

At/ 

° U l d h a V S 

' 

h e 9 r e a t e s t i m p a c l o n 

^ 

u r 

satisfaction with consumer directed 

—: ; ~; : .. - - z... 

T ^ M &-> "ÛL- SÂl A . ^ ' ^ j . - I A ^ - ^ . tk/ - ^ . ^ ; 

|jhinking beyond consumer, directed supports to your overall quality of life, onJteJoHowing pages 

fpldase indicate how much you agree or disagree with each statement. Please COMPLETE these sections 



Independence I Mobility/Control/Privacy Agree D 

! sag 

'!L , 

* I * Strongly Somewhat Neither Somewhat Strongly 




"3. I have privacy to be alone or with people I choose. 






I am satisfied with my current level of indepen< 

• • a • • 

a • • • 

• • y • • 

• a • 

• • • • • 

• a • 

• • • • 

a • • a 

y 

l y






Very 

satisfied 



Very 

dissatisfied 

• • af • • • • 

Very 

likely 


norunlikely 

• • Ef • • • • 

Exceeded 

Expectations 

Met 

Expectations 

services department? Q Qj Q Q Q 

Very 

unlikely 

Failed 

Expectations 

Kxpeci 

r 

. What is the one thing that would have the greatest impact on your satisfaction with consumer directed • 

supports? TtfF CetSA/Ti/ /X /J*T r/P^sr/A^ /st/?^7? 7? JXAJCC^ 

Thinking 

please indicate 

beyond 

how 

consumer 

much 

directed 

you agree 

jsupports 

or disagre 

to your 

with 

overal 

each 

quality 

statement. 

of life, 

Please 

on the 

com 

fo 

from 

developmental 

the perspective 

disability 

of 

should 

the 

be 

person 

directly 

with 

involved 

a developmental 

in completing 

disability. 

this survey 

The 

as 

person 

much 

w 

Independence 1 Mobility/Control/Privacy Agree Disagree 



to where I want to go :. • • a • • 


CO 



I have privacy to be alone or with people I choose of 

• • • • 

4. 

5. 




• 

• 

• 

• 

a • 

_r • 

6. 

7. 

8. 




• 

• 

• • 

• 

2- 

• 

• 

• 

• 

a






Very 

satisfied 



Very 

dissatisfied 

• ^ • • • • • 


Met 



services department? • • • 13 • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 

• am • • • • 

Failed 

Expectations 


supports? A-^rvj f*./fîV»r

Overall Satisfaction Neither satisfied v^ 

^ er 

y nor dissatisfied er 

v_ 


1 1 r 

1. Given all the considerations, how satisfied are you with your JL« • _ • 

consumer directed support program? LJ U LJ LJ LJ LJ 


I. How likely would you be to recommend a consumer directed ^p- noru lkely u n h k d y 

f 

support program in your county to a friend in a similar situation? .. I2f Q Q CJ Q Q Q 


. . . . . . . Expectations Expectations Expectations 

that were set for you by your case manager and county social ~n—— "-i n 

services department? • J2 • • • • • 


supports? 

TKe. C a f f y Q r \ C . e r h m r A ^ o n ^ P . ' ; ViWf-Krtu.-f- y v y g O r Y ^ pa— 

y\ croLs—or fyyOe nf q ( r q c f i . ' L / T \ / . 5 ^ A f FCFTFRJOL 

•FKE p e r n o r w > rh

Overall Satisfaction H 

m Neither satisfied 

V e r 

y nor dissatisfied 



consumer directed support program? '—I I—I '—I I—I 

V e r y 


2. How likely would you be to recommend a consumer directed nomni.keiy unhkeiy_ 

support program in your county to a friend in a similar situation? . . ^. Q [] Q [] [] [] 


. . . . r * , . . , Expectations Expectations Expectations 

that were set for you by your case manager and county social ~ T T ' *— 



supports? . 

VOtJ/J // fu* ~k Ar^r^ "kith* AS.*' -In SU**TIU






Very 

satisfied 

1 

Very 

likely 

1 



Very 

dissatisfied 

1 

• ••••• 


nor unlikelv 

Very 

unlikely 

1 

Met 

Failed 

, . . . . 

Expectations 


or • a a a a 


a that were set for you by your case manager and county social ~T ^ 



supports? 

pf N A0R>RLS V - FIERCE* ?H F ^ A F~ 

W (" I ( 





j^ên3|nce^ Mobility / Control / Privacy Agree 


Disagree 


to where 1 want to go 9 • • • • 

2. 1 have control over my daily schedule • or • • • 

1 have privacy to be alone or with people 1 choose • a • • 

CO 




6. 1 can decide about how 1 spend my money • • m • • 


CO 







Very 

satisfied 



l/ 

Very 

dissatisfied 

r 

j2 • • Neither • likely • • Very • 

Very 

likely 

T 


, . , . . . . Expectations 

nor unlikelv 

Met 

Expectations 

unlikelv 

—r - 

^ - 

Failed 

Expectations 


services department? J3 • • • • • • 


supports? < vlcOfe^ A ^ U %m\Vv\ c.is^cX \^€mW^ -••(< n\C









Very 

satisfied 



Very 

dissatisfied 

ura • • • • • 

Very 

likely 


nor unlikely 

Very 

unlikely 

•fa a • a a a 

Exceeded Met 


Failed 

Expectations 

ati • • • • • 


supports? . 1— 





Independence I Mobility/ Control /Privacy Agree Disagree 

•^H^^^n^^^^^l^l^ll^^J Strongly Somewhat Neither Somewhat Strongly 


to where I want to go • • • • a' 

2. I have control over my daily schedule • • • • or 

3. I have privacy to be alone or with people I choose • • • • a- 




6. I can decide about how I spend my money • • • • a" 


CO 







Very 

satisfied 

—I 



Q Q Q P Q Q 

Very 

likely 

—I 


nor unlikely 

T 

Very 

dissatisfied 

1 

Very 

unlikely 

T 

a • • • • • • 



Exceeded 

^T 3 

" 01 

* 

services department? • • • ^ • • • 

Met Failed 



, J with c 

supports? To V Y ^ I P P iTKt 'pnjy-zuw m6v-c ô^t^rw^ -p6usca . THiS 

4 

Sftndiw Caps 

Btd- ky dbity iW$ l'tte~] 

Car fomascy 6)un-fy S^ms to be Putting Sfitrvbw Caps drî \\m

^g^fall Satisfaction 

1 


' consumer directed support program? 

2/ How likely would you be to recommend a consumer directed 

-» support program in your county to a friend in a similar situation? . . 

AI 


\ * that were set for you by your case manager and county social 

- services department? 

"H 5 

(A »/ 

Very 

satisfied 

Very 

likely 



Very 

dissatisfied 

1 

• • • • • 


nor unlikely 

T 

Very 

unlikelv 

r " 

ofrj •.• • • • 

Exceeded 

Expectations 

Met 

Expectations 

Failed 

Expectations 

• • Ef • • • • 

4 What is the one thing that would have the greatest Impact on your satisfaction with consumer directed 

supports? ~ H ^ > , JFÛU^^ oJr >• (\n\AJ^y^ (QY^^ / U W ^ I 

$£ 

4- 

(Thinking beyond consumer directed supports to your OVERALL QUALITY OF LIFE, on the following pages 

f please indicate how much you agree or disagree with each statement. Please complete these sections 

Jrom the PERSPECTIVE OF THE PERSON WITH A DEVELOPMENTAL DISABILITY. The person who has the 


Independence I MOBILITY/CONTROL/PRIVACY Agree Disagree 

23£B5HHHHHHHBBHH^^NIL Strongly Somewhat Neither Somewhat Strongly 


to where I want to go Q Gl Q LJ Ll 

"'2. I have control over my daily schedule 

%&. I have privacy to be alone or with people I choose.. . 

Only people who are supposed to know my personal , 

o- I can set desired outcomes (goals) for myself • • • • 

can decide about how I spend my money Q Q Q Ql 



• • • 

• • • 

• • • 

• 

• 

or • 

• • 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• • •

Overall Satisfaction

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