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

Very<br />

satisfied<br />

Neither satisfied<br />

nor dissatisfied<br />

Very<br />

dissatisfied<br />

• • af • • • •<br />

Very<br />

likely<br />

Neither likely<br />

norunlikely<br />

• • Ef • • • •<br />

Exceeded<br />

Expectations<br />

Met<br />

Expectations<br />

services department? Q Qj Q Q Q<br />

Very<br />

unlikely<br />

Failed<br />

Expectations<br />

Kxpeci<br />

r<br />

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

supports? TtfF CetSA/Ti/ /X /J*T r/P^sr/A^ /st/?^7? 7? JXAJCC^<br />

Thinking<br />

please indicate<br />

beyond<br />

how<br />

consumer<br />

much<br />

directed<br />

you agree<br />

jsupports<br />

or disagre<br />

to your<br />

with<br />

overal<br />

each<br />

quality<br />

statement.<br />

of life,<br />

Please<br />

on the<br />

com<br />

fo<br />

from<br />

developmental<br />

the perspective<br />

disability<br />

of<br />

should<br />

the<br />

be<br />

person<br />

directly<br />

with<br />

involved<br />

a developmental<br />

in completing<br />

disability.<br />

this survey<br />

The<br />

as<br />

person<br />

much<br />

w<br />

Independence 1 Mobility/Control/Privacy Agree Disagree<br />

Strongly Somewhat Neither Somewhat Strongly<br />

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

to where I want to go :. • • a • •<br />

2. I have control over my daily schedule • • • •<br />

CO<br />

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

consumer directed support program?<br />

I have privacy to be alone or with people I choose of<br />

• • • •<br />

4.<br />

5.<br />

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

information have access to it.....<br />

I can set desired outcomes (goals) for myself •<br />

•<br />

•<br />

•<br />

•<br />

a •<br />

_r •<br />

6.<br />

7.<br />

8.<br />

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

I can make decisions that will affect my future<br />

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

•<br />

•<br />

• •<br />

•<br />

2-<br />

•<br />

•<br />

•<br />

•<br />

a

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