Overall Satisfaction

Overall Satisfaction I
m m m _ m _ _ — m m m _ _ m m _ m m _ m m m _ _ m m g m m m m _ _ s m _ m _ \ v Neither satisfied
^ — ^ ^ ^ ^ ^ ^ ^ — ^ ^ ^ — ^ — ^ ^ ^ ^ ^ ^ ^ Very nor dissatisfied
satisfied dissatisfied
1. Given all the considerations, how satisfied are you with your ' ' •
consumer directed support program? LJ j£» LJ LI Li LJ D
2. How likely would you be to recommend a consumer directed -^Z "
V E I
Very Neither likely Very
support program in your county to a friend in a similar situation? .. LJ LJ LJ LJ Q LI
o r u
^'
k e l y
7
unukeiy_
3. Has the consumer directed support program met the expectations Exceeded Met Faued
. . . . - . . . . , Expectations Expectations Expectations
that were set for you by your case manager and county social ~ ^ ^ ^ —
services department? • • • [2 Q Q Q
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? I L_
Thinjdng bpyond consumer directed supports to your overall quality of life, on the following pages
p|e^e^ind{^te^f^ :much you agree or disagree with each sfatement. ;
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 aspdsslble]
fodependerree | Mobility/Control/Privacy Agree Disagree
~^k~^k~^L~lk~^LWLW—~Wk--\ 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.
3. I have privacy to be alone or with people I choose...
4. Only people who are supposed to know my personal
5. I can set desired outcomes (goals) for myself
6. I can decide about how I spend my money
7. I can make decisions that will affect my future
8. I am satisfied with my current level of independence
• • • •
• • • •
• • • •
• • • •
• • • •
• • • •
• • • •
• • • •