Group Home Consumer's Barriers to Independent Living Survey

CAREER OPPORTUNITY DEVELOPMENT, INC. (CODI)
901 Atlantic Ave, Egg Harbor City, NJ 08210

Dear Residential Customer,

The purpose of this survey is to gauge the readiness or willingness of consumers to move from group homes into supported apartments. In order to do this, we need your input. You do not have to identify yourself, but you may if you wish.

 If you have any questions please call Paul D’Acunto, Quality Improvement Specialist, at (609) 965-6871.

Thank you,

Linda Carney        Taran Winchester                             Sarai Southrey
President / CEO    Quality Improvement Coordinator    Vice President of Residential Services 

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* 1. I have never lived on my own and don't know how.

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* 2. I fear living on my own.

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* 3. I fear unfamiliar places and/or people.

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* 4. I fear missing my peers and of being lonely and bored.

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* 5. I can't afford rent or security on my own.

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* 6. I fear not being able to afford utilities.

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* 7. I fear I may have a mental illness or substance use relapse.

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* 8. My family does not support or consent to me living on my own.

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* 9. I fear CODI services will be reduced or stopped.

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* 10. I am unable to independently take medication as prescribed.

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* 11. I fear not being able to perform personal hygiene, budgeting, meal planning and preparation, laundry, or house cleaning duties.

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* 12. I am comfortable in my current house and don't wish to leave.

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* 13. I require 24 hour staff support for my medical issues.

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* 14. I fear becoming a victim of crime or abuse.

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* 15. If a Rental Voucher becomes available, would you be interested in moving into an apartment?

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* 16. Comments

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* 17. Consumer's Name (optional)

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