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
Very
likely
1—
3 Has the consumer directed support program met the expectations Exceeded
i • i Expectations
that were set for you by your case manager and county social
Neither satisfied
nor dissatisfied
Very
dissatisfied
T
• • • • • •
Neither likely
nor unlikely
Very
unlikely
1
• • • • • •
Met
Expectations
Failed
Expectations
services department? 21 • • • • • •
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
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
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
^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ J Strongly Somewhat Neither Somewhat Strongly
1. I can (even if someone helps me because of my disability) get
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 • • • • _
4. Only people who are supposed to know my personal
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