Overall Satisfaction

Overall Satisfaction
1. Given all the considerations, how satisfied are you with your
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
Neither satisfied
nor dissatisfied
Very
dissatisfied
• a • • • • •
Very
likely
3. Has the consumer directed support program met the expectations Exceeded
that were set for you I by your case manager and county social
services department?
^Pf* 3
Neither likely
nor unlikely
Very
unlikely
• a • • • • •
^
Met
Expectations
Failed
Expectations
T
• a m • • • •
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
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?
I Independence Mobility/Control/Privacy Agree Disagree
____________________________ Strongly Somewhat Neither Somewhat Strongly
I can (even if someone helps me because of my disability) get
2. I have control over my daily schedule.
3. I have privacy to be alone or with people I choose.
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 rlPPiHo ahnilt hnw I cnonH mw mnnow
8
I can make decisions that will affect my future
- I am satisfied with my current level of independence [__
fa • • a •
• • • a a
• a • a
a • a a
• • • •
• • • •
a • • •
• • • a •