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Overall Satisfaction

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T h<br />

<strong>Overall</strong> <strong>Satisfaction</strong><br />

Given all the considerations, how satisfied are you with your<br />

consumer directed support program?<br />

How likely would you be to recommend a consumer directed<br />

support program in your county to a friend in a similar situation? ..<br />

Has the consumer directed support program met the expectations<br />

that were set for you by your case manager and county social<br />

services department?<br />

Very<br />

satisfied<br />

Very<br />

likely<br />

tqrj<br />

Exceeded<br />

Expectations<br />

Neither satisfied<br />

nor dissatisfied Very<br />

dissatisfied<br />

• • • • •<br />

Neither likely<br />

nor unlikely<br />

Very<br />

unlikely<br />

• • • • Q<br />

Met FaUed<br />

Expectations Expectations<br />

..D_(a • • • •"•<br />

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

supports? / Qh\ prOUf\ SOO^ficd > ifh'nLi^toj?, b<br />

n k<br />

L<br />

L n<br />

9 .bjy^cawmer directed supports to your overall quality of life, on the following pages I*:..<br />

please indicate how much you agree o> disagree Withea^<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^possiBte^-tk><br />

^ ^ ^ ^ C ^ Mobility/Control/Privacy Agree<br />

Strongly Somewhat Neither<br />

Disagree<br />

Somewhat Strongly<br />

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

to where 1 want to go... rj| • • a<br />

1 have control over my daily schedule. • • a • •<br />

1 have privacy to be alone or with people 1 choose • • • a a<br />

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

information have access to it • • • • a<br />

1 can set desired outcomes (goals) for myself . • • • a<br />

1 can decide about how 1 spend my money<br />

• • • •<br />

1 can make decisions that will affect my future • _ a • •<br />

1 am satisfied with my current level of independence a<br />

• a a

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