Overall Satisfaction

Neither satisfied
V e r
y nor dissatisfied V<
satisfied
T* J
dissatisfied
1. Given all the considerations, how satisfied are you with your JL. r— _ -' 1 / _ ' r
consumer directed support program? ....... I J LJ LJ Uj. LJ LJ L J
Very Neither likely Very
_ , , . . •• x i likely n o r
n o r
unlikely unlikely unlikeli
2. How likely would you be to recommend a consumer directed —r—
—i rr-
1 1—
r—
support program in your county to a friend in a similar situation? .. Q QJ LG LL O LG Q
3. Has the consumer directed support program met the expectations Exceeded Met Failed
. . . ., . , . . Expectations Expectations Expectations
that were set for you by your case manager and county social ~i • . • „
services department? r • • • • • •
• I ' '
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? s
-V-)L^)h>i / ' 4-U rL\ fr\^sC) tX\LLi\\ TT\ a^>-\ • b * ? • - ' / ^
Thinking beyond consumer directed supports to your ov^ifquality of life, on the following pages .;_«
_ ib*** ... _ _ ."J. - - -' __ff__??*_**_*__»^_^ -,. . .u ^^X'l^
Iplease indicate how much you agree or disagree with eacrrStatement. Please complete these sections
from the perspective of the person with a developmental disability. The person who has the^f^ss?
.developmental disability shouldbedirectly involved in^^^teting this survey as much as possible^^ggs
|hdepend®DS® \ Mobility/Control/Privacy" Agree Disagree
Strongly Somewhat Neither Somewhat Strongly
1. I can (even if someone helps me because of my disability) get _
to where I want to go • LJ 7
• • •
2. I have control over my daily schedule ... fW^.'.... Q EG LG LG LG
3. I have privacy to be alone or with people I choose.
__£_
4. Only people who are supposed to know my personal ^,
information have access to it.. J\J [LI LG LG CG
5. I can set desired outcomes (goals) for myself..
6. I can decide about how I spend my money ... Q Q LG Q Q
7. I can make decisions that will affect my future .IFF..... LG T_l LG LG LG
8. I am satisfied with my current level of independence^" Q LG 1 3 Q LG