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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 />

Very<br />

likelv<br />

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

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

services department?<br />

E x p e c t a t l 0 n s<br />

Neither satisfied<br />

nor dissatisfied<br />

Verydissatisfied<br />

• • • • • •<br />

Neither likely<br />

nor unlikely<br />

Met<br />

Expectations<br />

Very<br />

unlikelv<br />

Failed<br />

Expectations<br />

4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed<br />

supports? .jf^gyiGUtf Jtfj/p<br />

i^ 6<br />

-<br />

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

please indicate how much you agree or disagree with each statement. Please complete these sections<br />

from the perspective of the person with a developmental disability. The person who has the<br />

developmental disability should be directly involved in completing this survey as much as possible.<br />

Independence I Mobility/Control/Privacy Agre<br />

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

Disagre<br />

Strongly Somewhat Neither Somewhat Strongly<br />

to where I want to go jSj Q LJ LJ LI<br />

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

3. | have privacy to be alone or with people I choose. .. T2f • • • •<br />

4<br />

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

1<br />

information have access to it • • • •<br />

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

can decide about how I spend my money [2* • • • •<br />

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

am satisfied with my current level of independence .. J A • • • •

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