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
support program in your county to a friend in a similar situation? .
3. Has the consumer directed support program met the expectations
that were set for you by your case manager and county social
services department? .. .UPhO". gastlS . VO^JSR .SETL
4. What is the one thing that would have the greatest impact on your
supports? FTJUJR 6^ y^/xr D§ MRE^NSS
SK^I %)$> SySf^, (X)HEA T
Very
satisfied
Neither satisfied
nor dissatisfied
Very
dissatisfied
• ••••0a
Very
likely
Neither likely
nor unlikely
Very
unlikely
• • • • • Q^t
Exceeded Met Failed
Expectations Expectations Expectations
. . • • • • • ] • •
satisfaction with consumer directed
Thinking beyond consumer directed supports to'your overall quality of life; on the following pages w---*
please indicate how .much you agree or disagree with each statement. Please complete these sections
from the perspective of the person with a developmental disability. The person who hasthe,
developmental disability should be directly involved jn completing this survey as much as : possible., jgagf,;
I Agre Disagre
Independence Mobility / Control / Privacy
I I ^ ^ H m | ^ h m m J 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 • • • •
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 • • El • •
GO
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 • • • •
CO
I am satisfied with my current level of independence . • • • •