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Overall Satisfaction

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<strong>Overall</strong> <strong>Satisfaction</strong>"!<br />

1. Given all the considerations, how satisfied are you with your<br />

consumer directed support program?<br />

2. How likely would you be to recommend a consumer directed<br />

support program in your county to a friend in a similar situation?<br />

Very<br />

satisfied<br />

Neither satisfied<br />

nor dissatisfied<br />

Very<br />

dissatisfied 1<br />

a a • a a a a<br />

Very<br />

likely<br />

3. Has the consumer directed support program met the expectations Exceeded<br />

rr r r Expectations<br />

Neither likely<br />

nor unlikelv<br />

1<br />

Very<br />

unlikely<br />

• •••••<br />

Met<br />

Expectations<br />

Failed<br />

Expectations<br />

that were set for you by your case manager and county social *<br />

services department? • • • • • • •<br />

X. What is the one thing that would have the greatest impact on your satisfaction with consumerdirected<br />

supports?<br />

Thinking beyond consumer directed supports to your overall quality of life, on the following pages- *t<br />

please indicate how much you agree ordisagree witlreach^statement. Please complete these sections ,<br />

from the perspective of the person with a development The person who hasthe^ -?>_.'<br />

developmental disability should bedirectiy involved inxoB^eting this survey as much as possible^ "<br />

Independence I Mobility/Control/Privacy<br />

Agre<br />

1. I can (even if someone helps me because of my disability) get<br />

Disagre<br />

Strongly Somewhat Neither Somewhat Strongly<br />

• • • •<br />

2. I have control over my daily schedule • t__ • • •<br />

3. I have privacy to be alone or with people I choose. • J • • •<br />

4.<br />

5.<br />

Only people who are supposed to know my personal<br />

information have access to it<br />

I can set desired outcomes (goals) for myself<br />

•<br />

•<br />

•<br />

•<br />

•<br />

•<br />

•<br />

•<br />

6.<br />

7.<br />

I can decide about how I spend my money<br />

I can make decisions that will affect my future<br />

•<br />

• J •<br />

'xj •<br />

•<br />

•<br />

•<br />

•<br />

CO<br />

I am satisfied with my current level of independence • • • •

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