Overall Satisfaction

Overall Satisfaction^!
1. Given all the considerations, how satisfied are you with your
consumer directed support program?
V e r
y
satisfied
Neither satisfied
nor dissatisfied
y e r
_,. * _,
dissatisfied
•••••da
Very Neither likely Very
2. How likely would you be to recommend a consumer directed ""f^ w
support program in your county to a friend in a similar situation? .. Q Q Q Q • ^ Q
3. Has the consumer directed support program met the expectations Exceeded Met Failed
. . . . , , . . . . Expectations Expectations Expectations
that were set for you by your case manager and county social ~n • . '
services department? Q Q Q Q Qfij Q
A^^A cat*. 4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? / / l o Z e c - o s i J - a s J i , A U v ^ - k U * »T»SL
T.S.p, ^ tr>o furti^'for^^ "fp^ w^ f.W -fp r/
r
overal Thinking beyond consumer directed supports to your quality, of life; onithp iojfpV^fpageSiK F
please indicate how much you agfee^rdisagree" with each statement. Please complete^s^sjcuons
from the perspective of the person with a developmental disability. The persorf wlro hasfihe i i ~ -
developmental disability should be directly involved in completing this survey as much as possibles
I Agre independenpeS Mobility/Control/Privacy
Strongly Somewhat Neither Somewhat Strongly
. _____ _____ C»-.«U, C-i—-au/Kot N7_i#f*-M> QrkffVwhat .^tmi
" f
Disagre
1. I can (even if someone helps me because of my disability) get
2.
to where I want to go
I have control over my daily schedule
• '
• as
•
•
•
•
•
•
3. 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 h • • • •
5. I can set desired outcomes (goals) for myself • • •
6.
• • m • •
7. I can make decisions that will affect my future • • w • •
8. I am satisfied with my current level of independence • • • •
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