Overall Satisfaction

OVERALL SATISFACTION
1. Given all the considerations, how satisfied are you with your
consumer directed support program?
2. How likely would you be to recommend a consumer directed
support program in your county to a friend in a similar situation?
Very
satisfied
Neither satisfied
nor dissatisfied
Very
dissatisfied
a • • • • • •
Very
likely
Neither likely
nor unlikely
Very
unlikely
a • • • • • •
3. Has the consumer directed support program met the expectations Exceeded
that were set for you by your case manager and county social
Exp tations
f
E x
t i o n s
PT —r
services department? Q • • • • • •
Met FaUed
Expectations
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? < U -FTE^'/oil^Y -h RR^I 01K Q,uU - CJ^ryK y^-aA-
2.
3.
4.
Thinking beyond consumer directed supports to your overall quality of life! on tire following pages^
please indicate how much youagfee or disagree with each statement. Please compteteTthese 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-1 Mobility/Control/Privacy Agree Disagree
Strongly Somewhat Neither Somewhat Strongly
1. I can (even if someone helps me because of my disability) get
have privacy to be alone or with people I choose.
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 • • • •
8. I am satisfied with my current level of independence •
•
•
•