2019 Individual and Family Survey

2019 Individual and Family Satisfaction Survey

We value your feedback! Please take a moment and give us your feedback and thoughts regarding services received in 2019.

1. Which of the below best describes you?

Individual served by Catholic Charities Parent of an individual served by Catholic Charities Family Member of an individual served by Catholic Charities

Other:

2. Which service(s) do you or your family member(s) receive? (Select as many as appropriate)

Residential Services Community Habilitation/Waiver Respite Services Self-Directed Services (previously CSS) Family Support Services (FSS) Traumatic Brain Injury (TBI) Service Coordination HARP Don't know/Unsure

3. On a scale of 1 to 10 (with 10 being Extremely Satisfied and 1 being Not at all Satisfied), how would you rate the services and supports provided by Catholic Charities Disabilities Services (CCDS).

3. On a scale of 1 to 10 (with 10 being Extremely Satisfied and 1 being Not at all Satisfied), how would you rate the services and supports provided by Catholic Charities Disabilities Services (CCDS).
	1 (Not at all Satisfied)	2	3	4	5	6	7	8	9	10 (Extremely Satisfied)
Scale	3. On a scale of 1 to 10 (with 10 being Extremely Satisfied and 1 being Not at all Satisfied), how would you rate the services and supports provided by Catholic Charities Disabilities Services (CCDS).: Scale (1 (Not at all Satisfied))	Scale (2)	Scale (3)	Scale (4)	Scale (5)	Scale (6)	Scale (7)	Scale (8)	Scale (9)	Scale (10 (Extremely Satisfied))

4. In previous surveys regarding services provided by CCDS, there were areas of concern identified, how do you think we have been doing in these areas this year?

4. In previous surveys regarding services provided by CCDS, there were areas of concern identified, how do you think we have been doing in these areas this year?
	Significant Improvement	Progress made but Improvements still needed	Significant Improvement needed	N/A
Staff Turnover	4. In previous surveys regarding services provided by CCDS, there were areas of concern identified, how do you think we have been doing in these areas this year?: Staff Turnover (Significant Improvement)	Staff Turnover (Progress made but Improvements still needed)	Staff Turnover (Significant Improvement needed)	Staff Turnover (N/A)
Communication with individual and family	Communication with individual and family (Significant Improvement)	Communication with individual and family (Progress made but Improvements still needed)	Communication with individual and family (Significant Improvement needed)	Communication with individual and family (N/A)
Variety of Services offered by CCDS	Variety of Services offered by CCDS (Significant Improvement)	Variety of Services offered by CCDS (Progress made but Improvements still needed)	Variety of Services offered by CCDS (Significant Improvement needed)	Variety of Services offered by CCDS (N/A)
Quality of Service (i.e. Staff Involvement, Care & Concern for Individual)	Quality of Service (i.e. Staff Involvement, Care & Concern for Individual) (Significant Improvement)	Quality of Service (i.e. Staff Involvement, Care & Concern for Individual) (Progress made but Improvements still needed)	Quality of Service (i.e. Staff Involvement, Care & Concern for Individual) (Significant Improvement needed)	Quality of Service (i.e. Staff Involvement, Care & Concern for Individual) (N/A)
Staff appropriately trained to provide services	Staff appropriately trained to provide services (Significant Improvement)	Staff appropriately trained to provide services (Progress made but Improvements still needed)	Staff appropriately trained to provide services (Significant Improvement needed)	Staff appropriately trained to provide services (N/A)
Ability for individual and family to provide feedback regarding services provided	Ability for individual and family to provide feedback regarding services provided (Significant Improvement)	Ability for individual and family to provide feedback regarding services provided (Progress made but Improvements still needed)	Ability for individual and family to provide feedback regarding services provided (Significant Improvement needed)	Ability for individual and family to provide feedback regarding services provided (N/A)
Agency/Staff Advocacy for individuals	Agency/Staff Advocacy for individuals (Significant Improvement)	Agency/Staff Advocacy for individuals (Progress made but Improvements still needed)	Agency/Staff Advocacy for individuals (Significant Improvement needed)	Agency/Staff Advocacy for individuals (N/A)

5. In 2014 and again in 2018, we received accreditation from Council on Quality Leadership, as an agency which is focused on providing person-centered services and supports. As part of our accreditation we have developed a plan on Person Centered Excellence. How do you think we did in 2019 in achieving these goals?

5. In 2014 and again in 2018, we received accreditation from Council on Quality Leadership, as an agency which is focused on providing person-centered services and supports. As part of our accreditation we have developed a plan on Person Centered Excellence. How do you think we did in 2019 in achieving these goals?
	Strongly Disagree	Disagree	Agree	Strongly Agree	N/A
People have authority to plan and pursue their own vision	5. In 2014 and again in 2018, we received accreditation from Council on Quality Leadership, as an agency which is focused on providing person-centered services and supports. As part of our accreditation we have developed a plan on Person Centered Excellence. How do you think we did in 2019 in achieving these goals?: People have authority to plan and pursue their own vision (Strongly Disagree)	People have authority to plan and pursue their own vision (Disagree)	People have authority to plan and pursue their own vision (Agree)	People have authority to plan and pursue their own vision (Strongly Agree)	People have authority to plan and pursue their own vision (N/A)
The Catholic Charities workforce is stable and qualified	The Catholic Charities workforce is stable and qualified (Strongly Disagree)	The Catholic Charities workforce is stable and qualified (Disagree)	The Catholic Charities workforce is stable and qualified (Agree)	The Catholic Charities workforce is stable and qualified (Strongly Agree)	The Catholic Charities workforce is stable and qualified (N/A)
People and families play meaningful leadership roles	People and families play meaningful leadership roles (Strongly Disagree)	People and families play meaningful leadership roles (Disagree)	People and families play meaningful leadership roles (Agree)	People and families play meaningful leadership roles (Strongly Agree)	People and families play meaningful leadership roles (N/A)

6. Thinking about the services and supports you or your family member receive, how could we improve as an agency?

7. What does our agency do well, and should not change?

Would you agree or disagree with the statements below: The use of "me" and "i" in the statements below refers to the individual who receives support and services from CCDS

Would you agree or disagree with the statements below: The use of "me" and "i" in the statements below refers to the individual who receives support and services from CCDS
	Strongly Disagree	Disagree	Agree	Strongly Agree	N/A
CCDS staff are responsive to requests, questions or concerns I express	Would you agree or disagree with the statements below: The use of "me" and "i" in the statements below refers to the individual who receives support and services from CCDS: CCDS staff are responsive to requests, questions or concerns I express (Strongly Disagree)	CCDS staff are responsive to requests, questions or concerns I express (Disagree)	CCDS staff are responsive to requests, questions or concerns I express (Agree)	CCDS staff are responsive to requests, questions or concerns I express (Strongly Agree)	CCDS staff are responsive to requests, questions or concerns I express (N/A)
CCDS staff are available and accessible	CCDS staff are available and accessible (Strongly Disagree)	CCDS staff are available and accessible (Disagree)	CCDS staff are available and accessible (Agree)	CCDS staff are available and accessible (Strongly Agree)	CCDS staff are available and accessible (N/A)
I know who to contact if I have a concern or problem with my services	I know who to contact if I have a concern or problem with my services (Strongly Disagree)	I know who to contact if I have a concern or problem with my services (Disagree)	I know who to contact if I have a concern or problem with my services (Agree)	I know who to contact if I have a concern or problem with my services (Strongly Agree)	I know who to contact if I have a concern or problem with my services (N/A)
I visit the CCDS website to get information	I visit the CCDS website to get information (Strongly Disagree)	I visit the CCDS website to get information (Disagree)	I visit the CCDS website to get information (Agree)	I visit the CCDS website to get information (Strongly Agree)	I visit the CCDS website to get information (N/A)
CCDS staff respect me	CCDS staff respect me (Strongly Disagree)	CCDS staff respect me (Disagree)	CCDS staff respect me (Agree)	CCDS staff respect me (Strongly Agree)	CCDS staff respect me (N/A)
I would recommend CCDS to other families or individuals	I would recommend CCDS to other families or individuals (Strongly Disagree)	I would recommend CCDS to other families or individuals (Disagree)	I would recommend CCDS to other families or individuals (Agree)	I would recommend CCDS to other families or individuals (Strongly Agree)	I would recommend CCDS to other families or individuals (N/A)
CCDS staff knows what is important to me and help me achieve my goals	CCDS staff knows what is important to me and help me achieve my goals (Strongly Disagree)	CCDS staff knows what is important to me and help me achieve my goals (Disagree)	CCDS staff knows what is important to me and help me achieve my goals (Agree)	CCDS staff knows what is important to me and help me achieve my goals (Strongly Agree)	CCDS staff knows what is important to me and help me achieve my goals (N/A)

Additional comments:

Do you receive IHBS (In Home Behavior Services)

Yes No

Do you receive FSS (Family Support Services)

Yes No

IHBS

Catholic Charities Disabilities Services (CCDS) Family Support Services (FSS) Satisfaction Survey for In-Home Behavior Support Services (IHBS)

Please answer the following questions about the IHBS Program offered under CCDS' FSS Grant. Please explain your answers.

1. Was the Behavior Specialist Helpful and Knowledgeable?

2. Was the Behavior Plan easy to follow?

3. Was your Behavior Specialist accessible to you at a convenient time for you?

4. Did this program teach you how to manage the behavior problems identified?

5. Were you satisfied with the number of hours approved under the program?

6. How did you hear about the program?

7. What did you like about the program?

8. How can this program be improved?

9. Additional comments about this program

Thank you for taking the time to complete this survey! We truly appreciate your feedback.

FSS

Catholic Charities Disabilities Services (CCDS) Family Support Services (FSS) Satisfaction Survey

Please answer the following questions about the FSS Program offered by CCDS

1. Did this program provide reimbursement for Respite and/or a Good/Service, i.e. camp, piano lessions, swim therapy, etc.?

2. Was your request an emergency need, a one-time situation, or an ongoing need?

3. How did you hear about the program?

4.A. Did you complete/submit the application yourself or did you receive assistance with the application process?

4.B. If you received assistance, who provided this help?

5. Have you ever received Family Support Services (FSS) funds from CCDS in the past?

6. Were your needs met in a timely manner? If no, please explain.

7. What did you like about this program?

8. How can this program be improved?

9. Are you approved for any Waiver Services?

Yes No

9.B. If yes, which service(s) are you approved for and are you currently receiving the service(s)?*

10. Additional comments about this program:

Thank you for taking the time to complete this survey! We truly appreciate your feedback