Overall Satisfaction

D vera 1 Satisfaction
Vel
7 nor
Neither satisfied
V e r y
dissatisfied . _ ^
satisfied dissatisfied
aiven all the considerations, how satisfied are you with your ' ' _ '
onsumer directed support program? .. LJ LJ LJ LI LJ LJ
Very Neither likely Very
low likely would you be to recommend a consumer directed nomnukeiy unlikely
upport program in your county to a friend in a similar situation? .. Q Q Q Q 3 Q Q
las the consumer directed support program met the expectations Exceeded Met Failed
lat were set for you by your case manager and county social
Exp tatlons E x p e c a t K E x p e c
f i "" ( a t l
°
ervices department? • • • • • • 13
'hat is the one thing that would have the greatest impact on your satisfaction with consumer directed
jpports?
linking beyond consumer directed[supportsto your overall quality of life, on the followingj padesg^j
ease indicate how much you agree ordisagree with each statement. Please complete these sections ?;
3m the perspective of the person with a developmental disability. The person who has the . iavelopmental
disability should be directly involved in completing this survey as much as possible. _ ^jf?
I Agre Disagre
independence Mobility/Control/Privacy
^^j^^^^^^^^^^^^M Strongly Somewhat Neither Somewhat Strongly
I can (even if someone helps me because of my disability) get
to where I want to go • • a • •
I have control over my daily schedule Q Q Si LI LJ
I have privacy to be alone or with people I choose . • Q Q \M Q LI
Only people who are supposed to know my personal
information have access to it... • • 13 • CJ LI Q
I can set desired outcomes (goals) for myself • • a • •
I
can
am satisfied
decide about
with my
how
current
I spend
level
my
of
money
independence ...
Q
•
LJ
m
(3-
•
LJ
•
CJ
•
I can make decisions that will affect my future LI D (El Q Q