Overall Satisfaction

Overall Satisfaction •
V e r
y
Neither satisfied
nor dissatisfied
V e r
y
satisfied dissatisfied
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
Very Neither likely Very
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
3. Has the consumer directed support program met the expectations Exceeded Met Failed
. . . . 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
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
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
Independence | Mobility/Control/Privacy AGREE DISAGREE
H^^BH^HL^HLLIHHI^^HRIL Strongly Somewhat Neither Somewhat Strongly
1.
2.
I can (even if someone helps me because of my disability) get
to where I want to go •
•r 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
•
•
•
•
•
•
•
•
7.
I can decide about how I spend my money
I can make decisions that will affect my future
or
•
• •
•
•
•
•
•
CO
CO
I am satisfied with my current level of independence or • • • •