2018 Service Area Needs Assessment

Question Title

* 1. Have you heard of On My Own, Inc.?

Yes

Question Title

* 2. 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

* 3. Select the following services that you are aware of On My Own, Inc. offering.


Individual and Systems Advocacy	Individual and Systems Advocacy
Peer Support	Peer Support
Independent Living Skills Training	Independent Living Skills Training
Information and Referral	Information and Referral
Youth Transition	Youth Transition
Nursing Home Transition	Nursing Home Transition
Adaptive Telephones	Adaptive Telephones
Home Modifications/Ramps	Home Modifications/Ramps
Assistive Technology	Assistive Technology
Equipment Loan Program	Equipment Loan Program
Air Conditioner Loan Program	Air Conditioner Loan Program
Consumer Directed Services (CDS)	Consumer Directed Services (CDS)
In Home Services (IHS)	In Home Services (IHS)
Disability Awareness	Disability Awareness
RISE Speakers	RISE Speakers
BINGO	BINGO
Pre Employment Transition Services	Pre Employment Transition Services

Other (please specify)

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* 4. What is your age range?

17 or under

18-25

26-54

55-64

65-74

74 +

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* 5. What is your gender?

Male

Female

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* 6. What is your race?

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Other (please specify)

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* 7. Are you a person with a disability?

Yes

Question Title

* 8. If yes, what is your disability type? (choose all that apply)


Cognitive	Cognitive
Physical	Physical
Hearing	Hearing
Vision	Vision
Mental/Emotional	Mental/Emotional

Other (please specify)

Question Title

* 9. As an Organization or Service Agency have you ever collaborated on Services with On My Own, Inc?

Yes

If yes, please explain

Question Title

* 10. What Missouri County do you live in?

Bates

Cedar

Hickory

St. Clair

Vernon

Other (please specify)

Question Title

* 11. Are there unmet needs in your community for persons with disabilities?

Yes

Comments

Question Title

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

	Available	Not Available
Accessible Transportation	Accessible Transportation Available	Accessible Transportation Not Available
Accessible Housing	Accessible Housing Available	Accessible Housing Not Available
Affordable Housing	Affordable Housing Available	Affordable Housing Not Available
Nursing Home Transition	Nursing Home Transition Available	Nursing Home Transition Not Available
Preventing Unnecessary Institutionalization	Preventing Unnecessary Institutionalization Available	Preventing Unnecessary Institutionalization Not Available
Employment Services	Employment Services Available	Employment Services Not Available
Individual Peer Support	Individual Peer Support Available	Individual Peer Support Not Available
Group Peer Support	Group Peer Support Available	Group Peer Support Not Available
Information	Information Available	Information Not Available
Referral	Referral Available	Referral Not Available
Independent Living Skills Training	Independent Living Skills Training Available	Independent Living Skills Training Not Available
Emergency Assistance	Emergency Assistance Available	Emergency Assistance Not Available
Voting Accessibility	Voting Accessibility Available	Voting Accessibility Not Available
ADA Accessibility Compliance	ADA Accessibility Compliance Available	ADA Accessibility Compliance Not Available
Mo Property Tax Rebate (Circuit Breaker)	Mo Property Tax Rebate (Circuit Breaker) Available	Mo Property Tax Rebate (Circuit Breaker) Not Available
Benefits Planning/Counseling	Benefits Planning/Counseling Available	Benefits Planning/Counseling Not Available
Adaptive Equipment	Adaptive Equipment Available	Adaptive Equipment Not Available
Adaptive Telephone	Adaptive Telephone Available	Adaptive Telephone Not Available
Adaptive Internet/Computer	Adaptive Internet/Computer Available	Adaptive Internet/Computer Not Available
Communication Services (Interpreters/Braille)	Communication Services (Interpreters/Braille) Available	Communication Services (Interpreters/Braille) Not Available
Personal Care Attendant Services	Personal Care Attendant Services Available	Personal Care Attendant Services Not Available
Ramps/Home Modifications	Ramps/Home Modifications Available	Ramps/Home Modifications Not Available
Youth Services	Youth Services Available	Youth Services Not Available
Children’s Services	Children’s Services Available	Children’s Services Not Available
Recreational Services	Recreational Services Available	Recreational Services Not Available
Disaster Preparedness	Disaster Preparedness Available	Disaster Preparedness Not Available
Mental Health Services	Mental Health Services Available	Mental Health Services Not Available
Prescription Services	Prescription Services Available	Prescription Services Not Available
Post Secondary Education	Post Secondary Education Available	Post Secondary Education Not Available
Assistive Technology	Assistive Technology Available	Assistive Technology Not Available
Systems Advocacy	Systems Advocacy Available	Systems Advocacy Not Available
Individual Advocacy	Individual Advocacy Available	Individual Advocacy Not Available

Comments

Question Title

* 13. Rate the most significant barriers for people with disabilities in your community?

	Major	Moderate	Minor	No Barriers	Unknown
Awareness of Disability Programs	Awareness of Disability Programs Major	Awareness of Disability Programs Moderate	Awareness of Disability Programs Minor	Awareness of Disability Programs No Barriers	Awareness of Disability Programs Unknown
Financial Need	Financial Need Major	Financial Need Moderate	Financial Need Minor	Financial Need No Barriers	Financial Need Unknown
Healthcare	Healthcare Major	Healthcare Moderate	Healthcare Minor	Healthcare No Barriers	Healthcare Unknown
Housing ( a lack of accessible, affordable, independent housing)	Housing ( a lack of accessible, affordable, independent housing) Major	Housing ( a lack of accessible, affordable, independent housing) Moderate	Housing ( a lack of accessible, affordable, independent housing) Minor	Housing ( a lack of accessible, affordable, independent housing) No Barriers	Housing ( a lack of accessible, affordable, independent housing) Unknown
Employment ( a lack of assistance, health issues, lack of reasonable accommodations)	Employment ( a lack of assistance, health issues, lack of reasonable accommodations) Major	Employment ( a lack of assistance, health issues, lack of reasonable accommodations) Moderate	Employment ( a lack of assistance, health issues, lack of reasonable accommodations) Minor	Employment ( a lack of assistance, health issues, lack of reasonable accommodations) No Barriers	Employment ( a lack of assistance, health issues, lack of reasonable accommodations) Unknown
Attitudinal (stereotyping or stigma, prejudice and discrimination)	Attitudinal (stereotyping or stigma, prejudice and discrimination) Major	Attitudinal (stereotyping or stigma, prejudice and discrimination) Moderate	Attitudinal (stereotyping or stigma, prejudice and discrimination) Minor	Attitudinal (stereotyping or stigma, prejudice and discrimination) No Barriers	Attitudinal (stereotyping or stigma, prejudice and discrimination) Unknown
Communication (experienced by people who have disabilities that affect hearing, speaking, reading, writing, and or understanding, and who use different ways to communicate than people who do not have a disability)	Communication (experienced by people who have disabilities that affect hearing, speaking, reading, writing, and or understanding, and who use different ways to communicate than people who do not have a disability) Major	Communication (experienced by people who have disabilities that affect hearing, speaking, reading, writing, and or understanding, and who use different ways to communicate than people who do not have a disability) Moderate	Communication (experienced by people who have disabilities that affect hearing, speaking, reading, writing, and or understanding, and who use different ways to communicate than people who do not have a disability) Minor	Communication (experienced by people who have disabilities that affect hearing, speaking, reading, writing, and or understanding, and who use different ways to communicate than people who do not have a disability) No Barriers	Communication (experienced by people who have disabilities that affect hearing, speaking, reading, writing, and or understanding, and who use different ways to communicate than people who do not have a disability) Unknown
Physical (structural obstacles in natural or man made environments that prevent or block mobility)	Physical (structural obstacles in natural or man made environments that prevent or block mobility) Major	Physical (structural obstacles in natural or man made environments that prevent or block mobility) Moderate	Physical (structural obstacles in natural or man made environments that prevent or block mobility) Minor	Physical (structural obstacles in natural or man made environments that prevent or block mobility) No Barriers	Physical (structural obstacles in natural or man made environments that prevent or block mobility) Unknown
Policy ( lack of awareness or enforcement of existing laws and regulations that require programs and activities be accessible to people with disabilities)	Policy ( lack of awareness or enforcement of existing laws and regulations that require programs and activities be accessible to people with disabilities) Major	Policy ( lack of awareness or enforcement of existing laws and regulations that require programs and activities be accessible to people with disabilities) Moderate	Policy ( lack of awareness or enforcement of existing laws and regulations that require programs and activities be accessible to people with disabilities) Minor	Policy ( lack of awareness or enforcement of existing laws and regulations that require programs and activities be accessible to people with disabilities) No Barriers	Policy ( lack of awareness or enforcement of existing laws and regulations that require programs and activities be accessible to people with disabilities) Unknown
Programmatic (limit the effective delivery of a public health or healthcare program for people with different types of impairments)	Programmatic (limit the effective delivery of a public health or healthcare program for people with different types of impairments) Major	Programmatic (limit the effective delivery of a public health or healthcare program for people with different types of impairments) Moderate	Programmatic (limit the effective delivery of a public health or healthcare program for people with different types of impairments) Minor	Programmatic (limit the effective delivery of a public health or healthcare program for people with different types of impairments) No Barriers	Programmatic (limit the effective delivery of a public health or healthcare program for people with different types of impairments) Unknown
Social (conditions in which people are born, grow, live, learn, work and age)	Social (conditions in which people are born, grow, live, learn, work and age) Major	Social (conditions in which people are born, grow, live, learn, work and age) Moderate	Social (conditions in which people are born, grow, live, learn, work and age) Minor	Social (conditions in which people are born, grow, live, learn, work and age) No Barriers	Social (conditions in which people are born, grow, live, learn, work and age) Unknown

Comments

Question Title

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

	Available	Not Available
Accessible Transportation	Accessible Transportation Available	Accessible Transportation Not Available
Accessible Housing	Accessible Housing Available	Accessible Housing Not Available
Affordable Housing	Affordable Housing Available	Affordable Housing Not Available
Nursing Home Transition	Nursing Home Transition Available	Nursing Home Transition Not Available
Preventing Unnecessary Institutionalization	Preventing Unnecessary Institutionalization Available	Preventing Unnecessary Institutionalization Not Available
Employment Services	Employment Services Available	Employment Services Not Available
Individual Peer Support	Individual Peer Support Available	Individual Peer Support Not Available
Group Peer Support	Group Peer Support Available	Group Peer Support Not Available
Information	Information Available	Information Not Available
Referral	Referral Available	Referral Not Available
Independent Living Skills Training	Independent Living Skills Training Available	Independent Living Skills Training Not Available
Emergency Assistance	Emergency Assistance Available	Emergency Assistance Not Available
Voting Accessibility	Voting Accessibility Available	Voting Accessibility Not Available
ADA Accessibility Compliance	ADA Accessibility Compliance Available	ADA Accessibility Compliance Not Available
Mo Property Tax Rebate (Circuit Breaker)	Mo Property Tax Rebate (Circuit Breaker) Available	Mo Property Tax Rebate (Circuit Breaker) Not Available
Benefits Planning/Counseling	Benefits Planning/Counseling Available	Benefits Planning/Counseling Not Available
Adaptive Equipment	Adaptive Equipment Available	Adaptive Equipment Not Available
Adaptive Telephone	Adaptive Telephone Available	Adaptive Telephone Not Available
Adaptive Internet/Computer	Adaptive Internet/Computer Available	Adaptive Internet/Computer Not Available
Communication Services (Interpreters/Braille)	Communication Services (Interpreters/Braille) Available	Communication Services (Interpreters/Braille) Not Available
Personal Care Attendant Services	Personal Care Attendant Services Available	Personal Care Attendant Services Not Available
Ramps/Home Modifications	Ramps/Home Modifications Available	Ramps/Home Modifications Not Available
Youth Services	Youth Services Available	Youth Services Not Available
Children’s Services	Children’s Services Available	Children’s Services Not Available
Recreational Services	Recreational Services Available	Recreational Services Not Available
Disaster Preparedness	Disaster Preparedness Available	Disaster Preparedness Not Available
Mental Health Services	Mental Health Services Available	Mental Health Services Not Available
Prescription Services	Prescription Services Available	Prescription Services Not Available
Post Secondary Education	Post Secondary Education Available	Post Secondary Education Not Available
Assistive Technology	Assistive Technology Available	Assistive Technology Not Available
Systems Advocacy	Systems Advocacy Available	Systems Advocacy Not Available
Individual Advocacy	Individual Advocacy Available	Individual Advocacy Not Available

Comments

Question Title

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

Question Title

* 16. Optional Contact Information

First and Last Name

Address, State and Zip code

Phone number

Email address