Overall Satisfaction

Overall Satisfaction NEITHER SATISFIED
V T T V
V E R Y
NOR DISSATISFIED SATISFIED DISSATISFIED
1. GIVEN ALL THE CONSIDERATIONS, HOW SATISFIED ARE YOU WITH YOUR N N 5 6 N N N F L
CONSUMER DIRECTED SUPPORT PROGRAM? —* —1 _J L J L J L J L J
VERV NEITHER LIKELY VERY
2. HOW LIKELY WOULD YOU BE TO RECOMMEND A CONSUMER DIRECTED
LIKELY
N O R
UNLIKELY
-I
UNLIKELV
R
SUPPORT PROGRAM IN YOUR COUNTY TO A FRIEND IN A SIMILAR SITUATION? . . [ ] [ ] [ ] fjj |~j p|
3. HAS THE CONSUMER DIRECTED SUPPORT PROQRAM MET THE EXPECTATIONS r^^d MET FADED
, , KXPECTATIONS EXPECTATIONS EXPECTATIONS
THAT WERE SET FOR YOU BY YOUR CASE MANAGER AND COUNTY SOCIAL — I _ ^ I
SERVICES DEPARTMENT? • J J • ^ • •
4. WHAT IS THE ONE THING THAT WOULD HAVE THE GREATEST IMPACT ON YOUR SATISFACTION WITH CONSUMER DIRECTED
SUPPORTS?
THINKING BEYOND CONSUMER DIRECTED SUPPORTS TO YOUR overall quality of life, ON THE FOLLOWING PAGES
PLEASE INDICATE HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT. PLEASE COMPLETE THESE SECTIONS
FROM THE perspective of the person with a developmental disability. THE PERSON WHO HAS THE
DEVELOPMENTAL DISABILITY SHOULD BE DIRECTLY INVOLVED IN COMPLETING THIS SURVEY AS MUCH AS POSSIBLE.
Independence I Mobility/Control/Privacy AGREE Disagree
M B H M O I I _ _ _ _ 1 _ _ _ B M | J STRONGLY SOMEWHAT NEITHER SOMEWHAT STRONGLY
1. I CAN (EVEN IF SOMEONE HELPS M E BECAUSE OF MY DISABILITY) GET
TO WHERE I WANT TO GO
2. I HAVE CONTROL OVER MY DAILY SCHEDULE
3. I HAVE PRIVACY TO BE ALONE OR WITH PEOPLE I CHOOSE
4. ONLY PEOPLE WHO ARE SUPPOSED TO KNOW M Y PERSONAL
INFORMATION HAVE ACCESS TO IT
5. I CAN SET DESIRED OUTCOMES (GOALS) FOR MYS<
6. I CAN DECIDE ABOUT HOW I SPEND MY MONEY
8.
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