Overall Satisfaction

Overall Satisfaction
1. Given all the considerations, how satisfied are you with your
consumer directed support program?
2. How likely would you be to recommend a consumer directed
support program in your county to a friend in a similar situation?
Very
satisfied
T
Neither satisfied
nor dissatisfied
Very
dissatisfied
• • fcjf Q • Q •
Very
likely
3. Has the consumer directed support program met the expectations
that were set for you by your case manager and county social
Exceeded
services department? "..
Expectations
/ Neither likely
nor unlikely
Met
Expectations
Very
unlikelv
Failed
Expectations
^mp • • • • •
4. What is the one thing that would have theoreatest impact on yoj^ir satisfaction with consumer directed
Supports? «h>y>€_JiCu\ " ' *--\ rr
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 disabilityshduld be directly involved in completing this survey as much as possible.
Independence I Mobility/Control/Privacy Agree Disagree
Strongly Somewhat Neither Somewhat Strongly
1. I can (even if someone helps me because of my disability) gel t
2. 1 have control over my daily schedule
• • • •
• • • • •
3. 1 have privacy to be alone or with people 1 choose • • • •
4. Only people who are supposed to know my personal
information have access to it
K • • • •
5. 1 can set desired outcomes (goals) for myself M • • • •
6. 1 can decide about how 1 spend my money
• • • •
7. 1 can make decisions that will affect my future • • • •
CO
1 am satisfied with my current level of independence • • • •