Overall Satisfaction

Overall Satisfaction
1. Given ail the considerations, how satisfied are you with your
consumer directed support program?
2. How likely would you be to recommend a consumer directed
V e r
y
satisfied
Neither satisfied
nor dissatisfied
V e ,
T
dissatisfied
• E ^ A • • • •
Very Neither likely Very
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
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? £GRYC^^F-^R- /U^JB^^J^-^ —F-K*.
:upports? Crryc^^-^R- M^-JU^^JJ^R^^..^ T-J^, —/-4^ - ^ H * ^
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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^ections
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
_____B____________H______| Strongly Somewhat Neither Somewhat Strongly
1. I can (even if someone helps me because of my disability) get
to where I want to go
AR • • • •
2. I have control over my daily schedule....
I have privacy to be alone or with people I choose
•
•
•
AR
A
• •
•
•
CO
4.
5.
Only people who are supposed to know my personal
information have access to it... .
I can set desired outcomes (goals) for myself..
•
•
•
•
A
•
•
•
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
•
A " •
•
•
A
•
A
•
•
•