Service Area Needs Assessment 2019 Survey

Question Title

* 1. What is your relationship to On My Own, Inc.?


Person with a Disability	Person with a Disability
Community Partner	Community Partner
Consumer/Client of OMO or person with a disability	Consumer/Client of OMO or person with a disability
Community Member	Community Member
Family Member/Friend of Consumer/Client	Family Member/Friend of Consumer/Client
Volunteer	Volunteer
OMO Board Member	OMO Board Member
OMO Staff	OMO Staff
Organization or Service Agency	Organization or Service Agency

Other (please specify)

Question Title

* 2. What Missouri County do you live in?

Bates

Cedar

Hickory

St. Clair

Vernon

Other (please specify)

Question Title

* 3. Select the column that you believe best describes the availability of people with disabilities in your community.

	Widely Available	Somewhat Available	Could be Improved	Not available at all
Accessible Transportation	Accessible Transportation Widely Available	Accessible Transportation Somewhat Available	Accessible Transportation Could be Improved	Accessible Transportation Not available at all
Accessible Housing	Accessible Housing Widely Available	Accessible Housing Somewhat Available	Accessible Housing Could be Improved	Accessible Housing Not available at all
Affordable Housing	Affordable Housing Widely Available	Affordable Housing Somewhat Available	Affordable Housing Could be Improved	Affordable Housing Not available at all
Nursing Home Transition	Nursing Home Transition Widely Available	Nursing Home Transition Somewhat Available	Nursing Home Transition Could be Improved	Nursing Home Transition Not available at all
Preventing Unnecessary Institutionalization	Preventing Unnecessary Institutionalization Widely Available	Preventing Unnecessary Institutionalization Somewhat Available	Preventing Unnecessary Institutionalization Could be Improved	Preventing Unnecessary Institutionalization Not available at all
Peer Support Groups	Peer Support Groups Widely Available	Peer Support Groups Somewhat Available	Peer Support Groups Could be Improved	Peer Support Groups Not available at all
Information & Referral Services	Information & Referral Services Widely Available	Information & Referral Services Somewhat Available	Information & Referral Services Could be Improved	Information & Referral Services Not available at all
Independent Living Skills Training	Independent Living Skills Training Widely Available	Independent Living Skills Training Somewhat Available	Independent Living Skills Training Could be Improved	Independent Living Skills Training Not available at all
Emergency Assistance Funds	Emergency Assistance Funds Widely Available	Emergency Assistance Funds Somewhat Available	Emergency Assistance Funds Could be Improved	Emergency Assistance Funds Not available at all
Voting Accessibility	Voting Accessibility Widely Available	Voting Accessibility Somewhat Available	Voting Accessibility Could be Improved	Voting Accessibility Not available at all
ADA Accessibility Compliance	ADA Accessibility Compliance Widely Available	ADA Accessibility Compliance Somewhat Available	ADA Accessibility Compliance Could be Improved	ADA Accessibility Compliance Not available at all
Mo Property Tax Rebate (Circuit Breaker)	Mo Property Tax Rebate (Circuit Breaker) Widely Available	Mo Property Tax Rebate (Circuit Breaker) Somewhat Available	Mo Property Tax Rebate (Circuit Breaker) Could be Improved	Mo Property Tax Rebate (Circuit Breaker) Not available at all
Adaptive Equipment	Adaptive Equipment Widely Available	Adaptive Equipment Somewhat Available	Adaptive Equipment Could be Improved	Adaptive Equipment Not available at all
Adaptive Telephone	Adaptive Telephone Widely Available	Adaptive Telephone Somewhat Available	Adaptive Telephone Could be Improved	Adaptive Telephone Not available at all
Adaptive Internet/Computer	Adaptive Internet/Computer Widely Available	Adaptive Internet/Computer Somewhat Available	Adaptive Internet/Computer Could be Improved	Adaptive Internet/Computer Not available at all
Communication Services (Interpreters/Braille)	Communication Services (Interpreters/Braille) Widely Available	Communication Services (Interpreters/Braille) Somewhat Available	Communication Services (Interpreters/Braille) Could be Improved	Communication Services (Interpreters/Braille) Not available at all
Personal Care Attendant Services	Personal Care Attendant Services Widely Available	Personal Care Attendant Services Somewhat Available	Personal Care Attendant Services Could be Improved	Personal Care Attendant Services Not available at all
Ramps/Home Modifications	Ramps/Home Modifications Widely Available	Ramps/Home Modifications Somewhat Available	Ramps/Home Modifications Could be Improved	Ramps/Home Modifications Not available at all
Youth Services	Youth Services Widely Available	Youth Services Somewhat Available	Youth Services Could be Improved	Youth Services Not available at all
Children’s Services	Children’s Services Widely Available	Children’s Services Somewhat Available	Children’s Services Could be Improved	Children’s Services Not available at all
Recreational Services	Recreational Services Widely Available	Recreational Services Somewhat Available	Recreational Services Could be Improved	Recreational Services Not available at all
Disaster Preparedness	Disaster Preparedness Widely Available	Disaster Preparedness Somewhat Available	Disaster Preparedness Could be Improved	Disaster Preparedness Not available at all
Mental Health Services	Mental Health Services Widely Available	Mental Health Services Somewhat Available	Mental Health Services Could be Improved	Mental Health Services Not available at all
Prescription Services	Prescription Services Widely Available	Prescription Services Somewhat Available	Prescription Services Could be Improved	Prescription Services Not available at all
Assistive Technology	Assistive Technology Widely Available	Assistive Technology Somewhat Available	Assistive Technology Could be Improved	Assistive Technology Not available at all
Advocacy Individual/Systems	Advocacy Individual/Systems Widely Available	Advocacy Individual/Systems Somewhat Available	Advocacy Individual/Systems Could be Improved	Advocacy Individual/Systems Not available at all
Health Care Services	Health Care Services Widely Available	Health Care Services Somewhat Available	Health Care Services Could be Improved	Health Care Services Not available at all
Durable Medical Equipment	Durable Medical Equipment Widely Available	Durable Medical Equipment Somewhat Available	Durable Medical Equipment Could be Improved	Durable Medical Equipment Not available at all

Comments

Question Title

* 4. What services, not listed above, do you believe are needed for people with disabilities in your community?

Question Title

* 5. Optional Contact Information

First and Last Name

Address, State and Zip code

Phone number

Email address