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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 />

y Neither satisfied<br />

. C<br />

"7 . nor dissatisfied Very<br />

satisfied dissatisfied<br />

_>••••••<br />

Very<br />

likely<br />

T<br />

Neither likely<br />

nor unlikely<br />

T<br />

(_••••••<br />

Very<br />

unlikely<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 />

Exp<br />

f tations<br />

services department? Q f^j [~j r~j| Q r~j r—|<br />

Met FaUed<br />

Expectations Expectations<br />

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

supports? _<br />

f° oaf ^ movies DINNT^j hhlria Ms<br />

Thinking beyond consumer directed supports to your overall quality of life, on the following paqes •<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 Agree Disagree<br />

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

Strongly Somewhat Neither Somewhat Strongly<br />

to where I want to go ^ Q Q Q [_<br />

I have control over my daily schedule Q Q Q Q Q<br />

I have privacy to be alone or with people I choose Q Q [_ Q Q<br />

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

information have access to it.. "Q Q Q Q Q<br />

5. I can set desired outcomes (goals) for myself • • e • •<br />

6. I can decide about how I spend my money .. TK.. %. W*M ... f~\ • Q _j Q<br />

7. I can make decisions that will affect my future Q Q Q • •<br />

o- I am satisfied with my current level of independence ... "Q • • • •

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