Family and Guardian Survey -  The Moore Center - Fall 2021

The New Hampshire Bureau of Developmental Services (BDS) is conducting a redesignation review of your Area Agency. This process reviews the quality of services provided over the last five years.     

We would like your opinion about services that you and/or your family member(s) receive from the Area Agency.

Your input is crucial, and we appreciate you taking the time to answer this 14 question survey. If you are not able to complete this online survey, a paper copy can be requested from the Area Agency.

Your responses will be anonymous and the input you provide will not affect your services.

Thank you for your help as your input is very important to us!

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* 1. Do you or your family member(s) receive the information you need from the Area Agency to make decisions about services and resources?

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* 2. Do you get the information you need about:

  Yes Sometimes No Not Applicable
Family Support services (such as respite, home/vehicle modifications, advocacy)?
Family Support Council?
Employment Services?
Waiting lists?
Transition from high school to adult services?
Support and information at age 14 years and older regarding options available upon graduation?

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* 3. Are the Area Agency staff responsive? For example, do they return your calls in a reasonable amount of time?

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* 4. Are you, your family member(s), and/or other family members and friends encouraged and supported to exercise choice and control over:

  Yes Sometimes No Not Applicable
The planning of services?
Implementation of Services?
Managing financial resources?

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* 5. Do you feel that the Area Agency considers the unique concerns, priorities, and resources of your family in providing services?

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* 6. Do you think that staff and providers respect your family member’s choices regarding:

  Yes Sometimes No
The services they receive?
Who provides the service?
Where the services are provided?
What goals are pursued in the service agreement?

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* 7. Are you satisfied with the services you and your family member are receiving from the Area Agency?

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* 8. Are you satisfied with the health related supports that are provided to your family member by the Area Agency (such as assistance in locating health care providers, specialists and supporting healthy living activities)?

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* 9. Are you satisfied with the safety related supports that are provided to your family member by the Area Agency (such as appropriate supervision supports, environmental modifications and assistive technology)?

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* 10. Do you know whom to call if your family members’ rights have been violated or they are not receiving the services they need and want?

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* 11. Is your family member supported to form and maintain relationships and become an active member of the community, doing work/leisure activities of his/her choice?

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* 12. Does the Area Agency ask the individual and or guardian receiving services if they are satisfied with the quality of services received from them?

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* 13. If you have made suggestions regarding improving the quality of services, did the Area Agency follow-up with you?

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* 14. Would you like to offer any additional comments?

Thank you for taking time to complete this survey.



 

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