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
V e r y
Neither satisfied
V e r
nor dissatisfied .
^ J
# • • • • • •
Very Neither likely Very
likelv nor unlikely unlikely
satisfied dissatisfied
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 Failed
., . . , . . . . .
that were set for you by your case manager and county social
Expectations
~n—~~~
Expectations
^
Expectatii
services department? Q £2^-1 LI GL Q LI
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? -
PoAihfs oy minor PhilAMm AhmllJ lit aMc fc> ~\
Thinking beyond consumer directed supports to your overall quality of life, on the following pages
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
1. I can (even if someone helps me because of my disability) get
to where I want to go
* • • • •
2. I have control over my daily schedule
CO
• • • •
•
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 • • • •
7.
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 • • • •
CD
CO