Overall Satisfaction

Overall Satisfaction
y Neither satisfied
. • ,
satisfied
nor dissatisfied
V e r
y
dissatisfied
1. Given all the considerations, how satisfied are you with your ^ • •
consumer directed support program? LJ LI LJ LJ LJ LJ LJ
2. How likely would you be to recommend a consumer directed
Very Neither likely Very
n o r u
" likc Y unlike
' '- v
support program in your county to a friend in a similar situation? . . Q Q Ej Q Q Q Q
Exp
f that were set for you by your case manager and county social
ati0
^ J xp
jg^ services department?
Expectations
3. Has the consumer directed support program met the expectations Exceeded Met Faded
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
ofliTe/onlhe fSiawlng^page^"
youToveralfqaTity Thinking beyond consumer directed supports to
the perspective of the person with a developmental disability. please indicate how much you agree or disagree with each statement. Please complete these sections
from Th
developmental disability should be directly involved in completing this survey as much as possible.
Independence | Mobility/Control/Privacy Agre
1. I can (even if someone helps me because of my disability) get
Strongly Somewhat
Neither
Disagre
Somewhat Strongly
to where I want to go. .. • • • •
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
•
•
•
•
•
•
•
•
6.
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