Overall Satisfaction

V
"7 J
Neither satisfied
nor dissatisfied
satisfied dissatisfied
Given all the considerations, how satisfied are you with your ' ' '
consumer directed support program? la U Li LI U U U
How likely would you be to recommend a consumer directed -^p-
V e r
y
Very Neither likely Very
n o r u l k e l y
^
support program in your county to a friend in a similar situation? .. *Q Q C_ L_ Q LJ LJ
Has the consumer directed support program met the expectations Exceeded Met Failed
. , , , , . i Expectations Expectations Expectations
that were set for you by your case manager and county social ~~r: ^ n —
services department? Qh • • • • • •
[vVhat is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? "ITAF, CbS HF! .SONNE,
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"hinking beyond consumer directed supports to your overall quality of life, on the following pages
jlease indicate how much you agree or disagree with each statement. Please complete these sections
rom the perspective of the person with a developmental disability, the person who has the
fevelopmental disability should be directly involved in completing this survey as much as possible.
Independence | Mobility/Control/Privacy Agree
Strongly Somewhat Neither
Disagree
Somewhat Stronelv
1 can (even if someone helps me because of my disability) get
to where 1 want to go • • a •
1 have control over my daily schedule • a _ • •
1 have privacy to be alone or with people 1 choose • • _ a a
Only people who are supposed to know my personal
information have access to it _ • • • •
1 can set desired outcomes (goals) for myself • • _ • •
1 can decide about how 1 spend my money • a _ • •
1 can make decisions that will affect my future • • _ • •
1 am satisfied with my current level of independence • • • a