Overall Satisfaction

Overall Satisfaction |
1. Given all the considerations, how satisfied are you with your n
dissatisfied
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y
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consumer directed support program? LI LI LJ LI LI LJ
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satisfied / dissatisfied
2. How likely would you be to recommend a consumer directed ' lk
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Neither satisfied
Very Neither likely Very
o r u n U k e
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support program in your county to a friend in a similar situation? .. Qf Q Q [] Q Q []
3. Has the consumer directed support program met the expectations F ^ ^ l a
Expectations
Met
Expectations
Failed
Expectations
that were set for you by your case manager and county social y_ " ""X. r—» ,—/ pU
services department? i £J LI LI LI LI LI Li
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? -i-
Thinking beyond" consumer directed supports tojbuKoverall quality of life, onjtefoltowing pages
please indicate[hcw^u^y^u''agfTO*or perepec^e^fthe wtrfeaSi disagree statement7Please complete these sections
from the person with a dewlopm^tal disabilitykTJe^perepn,w^ „ _
developmental disability should be directly involved in completing this survey as much as possible.
Independeh^tfliobility/ Control / Privacy^^/^*^ ff*^~'
1. I can (even if someone helps me because of my disability) get ,
* Strongly Somewhat Neither Somewhat Strongly
to where I want to go • • CJ LJ
2. I have control over my daily schedule ID Q Q LJ
3. I have privacy to be alone or with people I choose...
4. Only people who are supposed to know my personal
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7 nor
information have access to it Q Q G G
5. I can set desired outcomes (goals) for myself • • ^ • •
6. I can decide about how I spend my money Qj Q Q Q
7. I can make decisions that will affect my future LJ LJ /^-^ ^ ^
8. I am satisfied with my current level of independence LJ LJ