Overall Satisfaction

Overall Satisfaction
Very
satisfied
Neither satisfied
nor dissatisfied
Very
dissatisfied
1. Given all the considerations, how satisfied are you with your ' ^ ' '
consumer directed support program? —J y(j LI U U LI U
2. How likely would you be to recommend a consumer directed
support program in your county to a friend in a similar situation? .
Very
likely
T
3. Has the consumer directed support program met the expectations Exceeded
that were set for you by your case manager and county social
E
_^£__
Neither likely
nor unlikely
T
Very
unlikely
T
Q • • • • • •
Met
Expectations
Failed
Expectations
services department? • • GJ • • • •
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? Pnij IN^rnDPrl r^i n (T^R-y & £ \\^e .
Thinking beyond consumer directed supports to your overall quality of life, on the following pages^ ---J 1
.
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 : v
developmental disability should be directly involved in completing this survey as much as possible;!?* I#
I.H d e p e n d e n C e I 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 • • • •
a 2. I have control over my daily schedule.
• • • •
CO
I have privacy to be alone or with people I choose • • • •
4. Only people who are supposed to know my personal
information have access to it
cn
• • • •
I can set desired outcomes (goals) for myself . • _ • • •
• _ a a
•
6. I can decide about how I spend my money
7. I can make decisions that will affect my future • •
a
• •
a
8. I am satisfied with my current level of independence • •