Overall Satisfaction

Overall Satisfaction Neither satisfied
V e r
y
satisfied
nor dissatisfied
s
V e r y
dissatisfied
sausueu y uiaaauan
1. Given all the considerations, how satisfied are you with your ' ^/' ' '
consumer directed support program? LJ LJ LJ LI LJ LJ LJ
Very Neither likely Very
2. How likely would you be to recommend a consumer directed iikefy n»r«niiMy uniikeiy_
support program in your county to a friend in a similar situation? . . _ _\ Q Q Q Q Q
3. Has the consumer directed support program met the expectations Exceeded Met Faued
. . . . , , . . . , Expectations Expectations Expectations
that were set for you by your case manager and county social ~n i / ^ —
services department? • • • 13 • • •
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? -i
Thinking beyond consumer directed supports tayour^overalI quality of life, on the following pages^
please indicate how much you agree or disagree wijf^each statement. Please complete thesesections
from the perspective of the person with a developmental disability. The person who has the"
developmental disability should be directly irivolveUihcbmpleting this survey as much as possible. :
Independence | 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 • • • a
2. I have control over my daily schedule • • a-" • •
3. I have privacy to be alone or with people I choose • • $y • •
4.
5.
Only people who are supposed to know my personal
information have access to it
I can set desired outcomes (goals) for myself •
•
•
• • •
•
7.
I can decide about how I spend my money
I can make decisions that will affect my future
•
•
•
•
a" • •
a • •
8. I am satisfied with my current level of independence • • a • •
CD