Overall Satisfaction

Overall Satisfaction 1
a—i—i i • • 1
V e r y
satisfied
Neither satisfied
nor dissatisfied
V e r
y j
dissatisfied
Given all the considerations, how satisfied are you with your ' ' '
consumer directed support program? Li p} LI LI Li Li Li
Very noru Neither likely Very
How likely would you be to recommend a consumer directed f kely
^f^-
support program in your county to a friend in a similar situation? .. Q Q Q Q Q Q
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 ~nl > / i ^ —
services department? • • L?J • • • •
What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports?.
Thinking beyond consumer directed^supports^tpj^qunbverall quality of life, on the following pajgesj^S
please indicate how much you agleejqr disagre^wftKeach 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.; _ v
Independence]
Mobility / Control / Privacy Agree Disagree
Strongly Somewhat Neither Somewhat Strongly
1 can (even if someone helps mefeecause of my disability) get
to where 1 want to go • T2f • • •
1 have control over my daily schedule.. • • • •
1 have privacy to be alone or with people 1 choose fa a • a •
Only people who are supposed to know my personal
information have access to it.. v..... • • • •
1 can set desired outcomes (goals) for myself... • • • •
1 can decide about how 1 spend my money . a
a • a
1 can make decisions that will affect my future. • • • •
1 am satisfied with my current level of independence • a • •