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
Very
satisfied
Neither satisfied
nor dissatisfied
Very
dissatisfied
g Q Q Q Q Q Q
Very
likely
Neither likely
nor unlikely
support program in your county to a friend in a similar situation? .. "gj [J [] [] G Q Q
3. Has the consumer directed support program met the expectations Exceeded
that were set for you by your case manager and county social Expectations
1
Very
unlikely
Met
Failed
Expectations Expectations
services department? £J • Q • Q • •
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? ( Urn A RKSU] BTSU& A^YW OMd nw (rjAllxi!^ ^'IXJUJ H> \rd6b
Thinking beyond consumer directed supports to your overall quality of life, on the folowjngpagesj
please indicate how much you agree or disagYl^ complete these^ections
from the perspective of the person wjth a developmental disability. The person who hasYhe
developmental disability should be 7
directly involved in^mpieting this survey as much as p^pfblel
Independence | Mobility / Control / Privacy Agree Disagree
Strongly Somewhat Neither Somewhat Strongly
1. I can (even if someone helps me because of my disability) get
2. I have control over my daily schedule.. .Tte UAOWP.
3. I have privacy to be alone or with people I choosje--...
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 decide about how I spend my money .TO •^j £
^^-
7. I can make decisions that will affect my futureHw .Ljcu-i^
8. I am satisfied with my current level of independence ...
• a • •
• • • a
• • • • •
• • • a
• • • •
•
•
•
•
•
•
•
•
• a a •
1