Overall Satisfaction

Overall Satisfaction
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^ nor dissatisfied Very
satisfied """ dissatisfied
1. GIVEN ALL THE CONSIDERATIONS, HOW SATISFIED ARE YOU WITH YOUR ^ - •
CONSUMER DIRECTED SUPPORT PROGRAM? /«J LJ LJ LJ LJ LJ LJ
2. HOW LIKELY WOULD YOU BE TO RECOMMEND A CONSUMER DIRECTED ^p-
Very Neither likely Very
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SUPPORT PROGRAM IN YOUR COUNTY TO A FRIEND IN A SIMILAR SITUATION? . . JGF LJ LJ LJ LJ [J LJ
3. HAS THE CONSUMER DIRECTED SUPPORT PROGRAM MET THE EXPECTATIONS Exceeded Met Failed
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,, . , . . , , • i .Expectations Expectations Expectations
THAT WERE SET FOR YOU BY YOUR CASE MANAGER AND COUNTY SOCIAL \ T 7 • ^ —
SERVICES DEPARTMENT? KJ. CI LJ LJ LJ LJ LJ
4. WHAT IS THE ONE THING THAT WOULD HAVE THE GREATEST IMPACT ON YOUR SATISFACTION WITH CONSUMER DIRECTED
SUPPORTS?
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 DISABILITY SHOULD BE DIRECTLY INVOLVED IN COMPLETING THIS SURVEY AS MUCH AS POSSIBLE.
Independence j Mobility/Control/Privacy Agree Disagree
S ^ S ^ S B B H B H H H ^ H H H B H Strongly Somewhat Neither Somewhat Strongly
1. I CAN (EVEN IF SOMEONE HELPS M E BECAUSE OF MY DISABILITY) GET
TO WHERE I WANT TO GO . £J • • •
2. I HAVE CONTROL OVER MY DAILY SCHEDULE. . . . • • • •
k 3. 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
• • • •
5. I CAN SET DESIRED OUTCOMES (GOALS) FOR MYSELF. • • • •
6. I CAN DECIDE ABOUT HOW I SPEND MY MONEY . . .
• • • •
7. I CAN MAKE DECISIONS THAT WILL AFFECT MY FUTURE • • • •
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I AM SATISFIED WITH MY CURRENT LEVEL OF INDEPENDENCE • • • •