Overall Satisfaction

"Overall Satisfaction
Given all the considerations, how satisfied are you with your
consumer directed support program?
How likely would you be to recommend a consumer directed
support program in your county to a friend in a similar situation?
Very
satisfied
Very
likely
i Has the consumer directed support program met the expectations Exceeded
Expectations
that were set for you by your case manager and county social
services department?
Neither satisfied
nor dissatisfied
Very
dissatisfied
• • • • • •
Neither likely
nor unlikely
Very
unlikely
• • • • • • •
Met
Expectations
Failed
Expectations
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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 CHSAGREE 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.
I MOBILITY/CONTROL/PRIVACY Agree Disagree
• { ^ • ^ ^ • • • ^ • • • ^ • • H Strongly Somewhat Neither Somewhat Strongly
1. I CAN (EVEN IF SOMEONE HELPS M E BECAUSE OF M Y DISABILITY) GET
TO WHERE I WANT TO GO
2. I HAVE CONTROL OVER M Y DAILY SCHEDULE.
3." I HAVE PRIVACY TO BE ALONE OR WITH PEOPLE I CHOOSE
4.* ONLY PEOPLE WHO ARE SUPPOSED TO KNOW M Y PERSONAL
i INFORMATION HAVE ACCESS TO I T . . . . . .
5. I can set desired outcomes (goals) for myself.
6. can deniriA ahm it
8
M s a t i s f i e d w
iik'4 'th my current level of independence
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