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?
Very
satisfied
1
Neither satisfied
nor dissatisfied
Very
dissatisfied
• f_j • • • • •
Very
likely
T
Neither likely
nor unlikely
T
Very
unlikely
• 0 • • • • •
3. Has the consumer directed support program met the expectations Exceeded
that were set for you by your case manager and county social
Ex
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' 0
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department? • £i • W| • • •
Met
Failed
Expectations Expectations
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
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Thinking beyond consumer directed supports to your overall quality of life, on the following pages
please indicate how much you agree or disagree with each stafenfpnt. f
Please complete these sections
from the perspective oUhe person with a developmental disability. The person who has the
developmental disability should bedirectiy involved in completing this survey as muchaspossible.
Independence I Mobility/Control/Privacy A G R E E
^m^^mi^^GL Strongly Som
1. I can (even if someone helps me because of my disability) get
to where I want to go
2. I have control over my daily schedule
3. I have privacy to be alone or with people I choose
4. Only people who are supposed to know my personal
5. I can set desired outcomes (goals) for myself.
6. I can decide about how I spend my money ..
8. I am satisfied with my current level of independence
DISAGREE
Strongly Somewhat Neither Somewhat Strongly
a • • •
• a • •
a • • •
•
• •
• •
•
•
•
a • • •
a
a
•
•
TV
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•
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