Overall Satisfaction

Overall Satisfaction Neither satisfied
V e r y
nor dissatisfied f 5
satisfied
! ,
dissatisfied
1. Given all the considerations, how satisfied are you with your
1 1 1
_
consumer directed support program? LI LJ LJ LJ LJ LI LJ
2. How likely would you be to recommend a consumer directed
support program in your county to a friend in a similar situation?
Very Neither likely Very
likely nor unlikely unlikely
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? • GjS • • • • •
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 qualityof Hfe^ on the following pages :
please indicate how much you agree or disagree with each statement. Pfease 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 | Mobility / Control / Privacy Agree Disagree
Strongly Somewhat Neither Somewhat Strongly
1. I can (even if someone helps me because of my disability) get
to where I want to go 0
• • • •
2. I have control over my daily schedule • • • •
3. I have privacy to be alone or with people I choose • • • • •
4.
5.
Only people who are supposed to know my personal
information have access to it
I can set desired outcomes (goals) for myself
•
•
•
•
•
•
•
•
7.
8.
I can decide about how I spend my money
I can make decisions that will affect my future
I am satisfied with my current level of independence
• • •
• •
a •
• •
• •
a •
CD