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?
Neither satisfied
nor dissatisfied
Very
dissatisfied
• • • • • •
Neither likely
nor unlikely
T
Very
unlikely
fiu • • • • •
3. Has the consumer directed support program met the expectations Exceeded Met
E
t e t i
*pf °°s
Expectations
that were set for you by your case manager and county social
Failed
Expectations
services department? J 3 • • • • • •
4. What is the one thing^at would have the greatest impact on your satisfaction with cqnsumerdjrected
supports? ( Jj\MYU\ h W y T " ~
Thinking beyond consumer^irecte^ ypuroverall quality of life, on the following pages" -
please indicate how much you agreeTor 'disagree with each statement Please compiete these sections
from the perspective of th^geng^th'a^d^Iopmental disability. The person who has the^
developmental disability should be ftirecflylnvoivffi incompleting this survey as much as'pbsslbieT*^--
1.
2.
3.
4.
5.
6.
7.
8.
Independence | Mobility/ Control / Privacy Agree Disagree
Strongly Somewhat Neither Somewhat Strongly
I can (even if someone helps me because of my disability) get
to where I want to go
I have control over my daily schedule.
I have privacy to be alone or with people I choose
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
• a • •
• • • •
• • a •
• • • •
• a • •
• • • a
• • a a
a • • •