Consumer Satisfaction Survey

A survey for people who have received services from a Center for Independent Living in the past twelve months. It asks what they received, whether they were treated as the person in charge of their own goals, what changed for them, and what the center could do better. It uses one agreement scale throughout so results pool across centers and years, and it gives a SILC the consumer satisfaction results its State Plan commits to reviewing.

At a glance

7minutes, about
5sections
20questions2 required
1.0.0version

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The preview saves nothing. Hosted copies are reached by a coded link for your state.

Who it is for

People who received services from a Center for Independent Living in the past 12 months. A family member or support person may help, but the answers should be the consumer's own.

What respondents are told first

It takes about 7 minutes.
You may skip any question except the first one.
Your answers are confidential. The center sees counts and comments, never your name, unless you choose to give it at the end.
Nothing you say here changes the services you receive.
You can stop at any time. What you have answered so far still counts.

The questions

Every question has a stable identifier, shown in brackets, that stays the same across versions and matches the question bank. Hints appear under the labels on screen and are read as descriptions.

The services you received

Which services did you receive from the center in the past 12 months? [cs_services], required
Check all that apply.
- Information and referral: Answers to a question, or being pointed to another program [info_referral]
- Independent living skills training: Learning to do things for yourself, like cooking, budgeting or using transit [il_skills]
- Peer support: Time with another person with a disability who has been there [peer_support]
- Help with my own advocacy: Help speaking up for yourself with a landlord, agency, school or employer [advocacy_individual]
- Systems advocacy: Working with the center to change a policy, law or practice [advocacy_systems]
- Moving out of a nursing home or institution: Or help staying out of one [transition_institution]
- Youth transition: Moving from school to adult life [transition_youth]
- Assistive technology [assistive_tech]
- Housing [housing]
- Employment [employment]
- Benefits: SSI, SSDI, Medicaid, food assistance and similar [benefits]
- Personal assistance services [personal_assistance]
- Transportation [transportation]
- Something else [other] (write-in follows)
- I am not sure [unsure]
How long have you been receiving services from the center? [cs_duration]
- Less than 3 months [lt_3m]
- 3 to 12 months [3_12m]
- 1 to 3 years [1_3y]
- More than 3 years [gt_3y]
- I am not sure [unsure]
How did you work with the center? [cs_mode]
Check all that apply.
- In person at the center [in_person_office]
- In person at my home or in my community [in_person_home]
- By phone [phone]
- By video call [video]
- By email or text [email_text]

Your experience

For each statement, choose how much you agree. Choose "Does not apply" if a statement is not about something you experienced.

Staff treated me with respect. [cs_agree_respect]
- Strongly agree [strongly_agree]
- Agree [agree]
- Neither agree nor disagree [neutral]
- Disagree [disagree]
- Strongly disagree [strongly_disagree]
- Does not apply [not_applicable]
Staff listened to what I wanted. [cs_agree_listened]
- Strongly agree [strongly_agree]
- Agree [agree]
- Neither agree nor disagree [neutral]
- Disagree [disagree]
- Strongly disagree [strongly_disagree]
- Does not apply [not_applicable]
I set my own goals, and the center worked toward them. [cs_agree_goals]
- Strongly agree [strongly_agree]
- Agree [agree]
- Neither agree nor disagree [neutral]
- Disagree [disagree]
- Strongly disagree [strongly_disagree]
- Does not apply [not_applicable]
I got information in a format I can use. [cs_agree_format]
For example large print, braille, plain language, my language, or a format my screen reader can read.
- Strongly agree [strongly_agree]
- Agree [agree]
- Neither agree nor disagree [neutral]
- Disagree [disagree]
- Strongly disagree [strongly_disagree]
- Does not apply [not_applicable]
Help was available when I needed it. [cs_agree_timely]
- Strongly agree [strongly_agree]
- Agree [agree]
- Neither agree nor disagree [neutral]
- Disagree [disagree]
- Strongly disagree [strongly_disagree]
- Does not apply [not_applicable]
The center's office, phone line and website were accessible to me. [cs_agree_access]
- Strongly agree [strongly_agree]
- Agree [agree]
- Neither agree nor disagree [neutral]
- Disagree [disagree]
- Strongly disagree [strongly_disagree]
- Does not apply [not_applicable]
I know how to reach the center if I need help again. [cs_agree_reach]
- Strongly agree [strongly_agree]
- Agree [agree]
- Neither agree nor disagree [neutral]
- Disagree [disagree]
- Strongly disagree [strongly_disagree]
- Does not apply [not_applicable]

What changed

Did the center's services help you reach what you wanted? [cs_helped]
- Yes, a lot [a_lot]
- Yes, somewhat [somewhat]
- Not yet: We are still working on it [not_yet]
- No [no]
What changed for you because of the center? [cs_changes]
Check all that apply.
- I do more for myself at home [more_independent]
- I take part in my community more [more_involved]
- I found or kept a place to live [housing]
- I found or kept a job, or started school or training [job]
- I got benefits or health coverage I did not have [benefits]
- I moved out of a nursing home or institution, or stayed out of one [left_facility]
- I learned a skill I use [skills]
- I know my rights and how to use them [rights]
- I have equipment or technology that helps me [tech]
- I feel less alone [connected]
- Something else [other] (write-in follows)
- Nothing has changed yet [nothing]
Overall, how satisfied are you with the center? [cs_overall]
- Very satisfied [very_satisfied]
- Satisfied [satisfied]
- Neither satisfied nor dissatisfied [neutral]
- Dissatisfied [dissatisfied]
- Very dissatisfied [very_dissatisfied]
Would you recommend the center to another person with a disability? [cs_recommend]
- Yes [yes]
- Maybe [maybe]
- No [no]

In your own words

Was there anything you needed that the center could not help with? [cs_unmet]
Free text.
What could the center do better? [cs_improve]
Free text.
Is there anything the center did especially well? [cs_praise]
Free text.

About you (optional)

These questions are optional. They help the center see whether it serves everyone in its area equally well.

Which county in your state do you live in? [cs_county]
A list of your state's counties, plus "I do not live in your state".
What is your age? [cs_age]
- Under 18 [under_18]
- 18 to 24 [18_24]
- 25 to 59 [25_59]
- 60 or older [60_plus]
- Prefer not to say [prefer_not]
Would you like someone from the center to contact you? [cs_followup]
Optional. Fill this in only if you want a call or an email about something you said here. Your contact details are stored separately from your answers.
Name, Email, Phone. Stored separately from the answers.

What you get back

For each Center: which services consumers say they received, agreement with seven statements about respect, consumer control, format, timeliness, accessibility and knowing how to come back, the outcomes consumers report, overall satisfaction, and whether they would recommend the Center, each as counts, plus the three free-text questions for the Center to read.

The seven agreement statements use the same six-point scale, so a Center's result can be compared with its previous year or with another Center using the same instrument. The outcomes question maps to the goal categories in the federal Program Performance Report (community living, employment, benefits, skills, rights, technology, social participation, moving out of an institution), so a SILC can set consumer-reported outcomes beside the Center's reported goal counts.

The survey deliberately asks about the past twelve months and not about a single visit, and it tells respondents nothing they say changes the services they get.

Testing status

Automated structure and axe-core checks: pass on every built page.
Browser pass for contrast, focus and reflow at 320 pixels: done for the preview, repeated for each hosted state page before a channel opens.
Screen reader pass by a daily screen reader user with a task list: not yet. The first Center to field it gates its channel on this pass.

If you find something a screen reader reads badly, tell us which screen reader and browser you used and what you heard.

Versions

Version 1.0.0 is the first published version. A new version adds question identifiers and never reuses one. Changes are listed in the repository.