Overall Satisfaction

Overall Satisfaction
v
n c,.i!fLi s a t f i e d
Neither satisfied
1. Given all the considerations, how satisfied are you with your ' _ /
consumer directed support program? : u w u • • • •
Very Neither likely Very
r u
k c l y
2. How likely would you be to recommend a consumer directed -^r^. "° ^'
support program in your county to a friend in a similar situation? .. • • • • • • •
3. Has the consumer directed support program met the expectations Exceeded Met Failed
. . . . , , . . • 1 Expectations Expectations Expectations
that were set for you by your case manager and county social ^ • —
services department? Q Q Ll Q Q Q Q
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? T OLW\ Veru CjejY\cjejrY\t°IL ahtuAJ' ~H^> CKAR^u
ng in rpMxSh^ wthaf -Hrv^ tore. Willing -/o J a^PRRSJT..
Thinking beyond consumer directed supports to your overall quality of life, on the following pages
please indicate how much you agree or disagree with^eadStatement. 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.
uniikeiy
Independence | Mobility/Control/Privacy Agree Disagree
I^HHHI^Hi^^HHHHIlHHH Strongly Somewhat Neither Somewhat Strongly
1. I can (even if someone helps me because of my disability) get
to where I want to go • • • a
2. I have control over my daily schedule • • a •
I have privacy to be alone or with people I choose • • • a
CO
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
•
•
•
•
•
•
•
•
I am satisfied with my current level of independence • • • •
CO
CO
^
0
o r
dissatisfied
V E I
7
dissatisfied