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
Neither satisfied
nor dissatisfied
Very
dissatisfied
• • • • • • •
Very
likely
1
i. Has the consumer directed support program met the expectations Exceeded
2.
3.
4.
5.
6.
7.
8.
that were set for you by your case manager and county social
E ,
Neither likely
nor unlikely
1
Very
unlikely
• • • • • • •
T
M w
Met
Expectations
' 1 =--t
Failed
Expectations
services department? gj • • Q Q Q •
What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports?
Thinking beyondconsumer directed supports to your overall quality of life, on the following pages
please indicate how much you ag>ee*or disagree with~e¥ch's^ complete these^lections
from the perspective ofthe person with a developmental disability. The person who has the- 7
developmental disability should be directly involved in completing thissurvey as much as possible.
INDEPENDENCE I Mobility/Control/Privacy Agree
Strongly Somewhat
I can (even if someone helps me because of my disability) get
to where I want to go. CI
I have control over my daily schedule [_|
I have privacy to be alone or with people I choose Q
Only people who are supposed to know my personal
information have access to it
I can set desired outcomes (goals) for myself
I can decide about how I spend my money
I can make decisions that will affect my future
I am satisfied with my current level of independence
•
•
•
•
__
Disagree
Neither Somewhat Strongly
•
•
•
• •
• •
• •