Community Needs Assessment- Imperial Valley

We want to identify some of the challenges that people with disabilities face in the cities they live in. In particular, we would like to identify barriers in accessing services and any gaps in our current services provides. This survey is anonymous, but we will be using the summarized information we collect to improve services in the local area. The survey contains questions about who you are, the services you use, and how you feel living in your city. We are asking lots of questions to get a detailed picture that looks at lots of different aspects of life for people with disabilities in California and Hawaii.

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* 1. In what city do you live?

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* 2. What is your age?

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* 3. What describes you best as a member of our community?

Current consumer

Person with a disability

Service provider

Caregiver for a person with a disability

Family member/friend of a person with a disability

Other (please specify)

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* 4. How would you describe your disability?

Developmental disability

Learning disability

Mental health or emotional disability

Unseen disability

Physical disability

Sensory disability

Vision disability

Multiple or more than 1 disability

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* 5. What is your current employment situation

Full time employed

Part time employed

Full time education or training

Self employed

Looking after home/family

Volunteering/interning

Not working due to health or disability

Retired

Unemployed

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* 6. What are the best/worst parts of living in San Diego as a person with a disability?

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* 7. Please rate the column that you believe best describes the need for the service in your community.

	High Priority	Priority	Neutral	Low Priority	Not a Priority
Systems advocacy	Systems advocacy High Priority	Systems advocacy Priority	Systems advocacy Neutral	Systems advocacy Low Priority	Systems advocacy Not a Priority
Individual advocacy (coordinators working with consumers to advocate)	Individual advocacy (coordinators working with consumers to advocate) High Priority	Individual advocacy (coordinators working with consumers to advocate) Priority	Individual advocacy (coordinators working with consumers to advocate) Neutral	Individual advocacy (coordinators working with consumers to advocate) Low Priority	Individual advocacy (coordinators working with consumers to advocate) Not a Priority
Accessible Transportation	Accessible Transportation High Priority	Accessible Transportation Priority	Accessible Transportation Neutral	Accessible Transportation Low Priority	Accessible Transportation Not a Priority
Affordable Transportation	Affordable Transportation High Priority	Affordable Transportation Priority	Affordable Transportation Neutral	Affordable Transportation Low Priority	Affordable Transportation Not a Priority
Accessible Housing	Accessible Housing High Priority	Accessible Housing Priority	Accessible Housing Neutral	Accessible Housing Low Priority	Accessible Housing Not a Priority
Nursing home transition	Nursing home transition High Priority	Nursing home transition Priority	Nursing home transition Neutral	Nursing home transition Low Priority	Nursing home transition Not a Priority
Preventing unnecessary institutionalization	Preventing unnecessary institutionalization High Priority	Preventing unnecessary institutionalization Priority	Preventing unnecessary institutionalization Neutral	Preventing unnecessary institutionalization Low Priority	Preventing unnecessary institutionalization Not a Priority
Employment services for adults	Employment services for adults High Priority	Employment services for adults Priority	Employment services for adults Neutral	Employment services for adults Low Priority	Employment services for adults Not a Priority
Employment services for youth	Employment services for youth High Priority	Employment services for youth Priority	Employment services for youth Neutral	Employment services for youth Low Priority	Employment services for youth Not a Priority
Individual (one-on-one) Peer Support	Individual (one-on-one) Peer Support High Priority	Individual (one-on-one) Peer Support Priority	Individual (one-on-one) Peer Support Neutral	Individual (one-on-one) Peer Support Low Priority	Individual (one-on-one) Peer Support Not a Priority
Peer support groups	Peer support groups High Priority	Peer support groups Priority	Peer support groups Neutral	Peer support groups Low Priority	Peer support groups Not a Priority
Information regarding services, disability issues, etc.	Information regarding services, disability issues, etc. High Priority	Information regarding services, disability issues, etc. Priority	Information regarding services, disability issues, etc. Neutral	Information regarding services, disability issues, etc. Low Priority	Information regarding services, disability issues, etc. Not a Priority
Referral to needed programs and services	Referral to needed programs and services High Priority	Referral to needed programs and services Priority	Referral to needed programs and services Neutral	Referral to needed programs and services Low Priority	Referral to needed programs and services Not a Priority
One-on-one Independent Living Skills Training	One-on-one Independent Living Skills Training High Priority	One-on-one Independent Living Skills Training Priority	One-on-one Independent Living Skills Training Neutral	One-on-one Independent Living Skills Training Low Priority	One-on-one Independent Living Skills Training Not a Priority
Emergency financial assistance	Emergency financial assistance High Priority	Emergency financial assistance Priority	Emergency financial assistance Neutral	Emergency financial assistance Low Priority	Emergency financial assistance Not a Priority
Voting accessibility	Voting accessibility High Priority	Voting accessibility Priority	Voting accessibility Neutral	Voting accessibility Low Priority	Voting accessibility Not a Priority
ADA Compliance	ADA Compliance High Priority	ADA Compliance Priority	ADA Compliance Neutral	ADA Compliance Low Priority	ADA Compliance Not a Priority
Benefits Planning Counseling	Benefits Planning Counseling High Priority	Benefits Planning Counseling Priority	Benefits Planning Counseling Neutral	Benefits Planning Counseling Low Priority	Benefits Planning Counseling Not a Priority
Assistive technology	Assistive technology High Priority	Assistive technology Priority	Assistive technology Neutral	Assistive technology Low Priority	Assistive technology Not a Priority
Durable medical equipment	Durable medical equipment High Priority	Durable medical equipment Priority	Durable medical equipment Neutral	Durable medical equipment Low Priority	Durable medical equipment Not a Priority
Communication services (interpreters, Braille, and alternative formats)	Communication services (interpreters, Braille, and alternative formats) High Priority	Communication services (interpreters, Braille, and alternative formats) Priority	Communication services (interpreters, Braille, and alternative formats) Neutral	Communication services (interpreters, Braille, and alternative formats) Low Priority	Communication services (interpreters, Braille, and alternative formats) Not a Priority
Personal Care Attendant Services	Personal Care Attendant Services High Priority	Personal Care Attendant Services Priority	Personal Care Attendant Services Neutral	Personal Care Attendant Services Low Priority	Personal Care Attendant Services Not a Priority
Ramps and Home modifications	Ramps and Home modifications High Priority	Ramps and Home modifications Priority	Ramps and Home modifications Neutral	Ramps and Home modifications Low Priority	Ramps and Home modifications Not a Priority
Youth Services	Youth Services High Priority	Youth Services Priority	Youth Services Neutral	Youth Services Low Priority	Youth Services Not a Priority
Recreational Opportunities	Recreational Opportunities High Priority	Recreational Opportunities Priority	Recreational Opportunities Neutral	Recreational Opportunities Low Priority	Recreational Opportunities Not a Priority
Disaster Preparedness	Disaster Preparedness High Priority	Disaster Preparedness Priority	Disaster Preparedness Neutral	Disaster Preparedness Low Priority	Disaster Preparedness Not a Priority
Mental Health Services	Mental Health Services High Priority	Mental Health Services Priority	Mental Health Services Neutral	Mental Health Services Low Priority	Mental Health Services Not a Priority
Prescription Assistance	Prescription Assistance High Priority	Prescription Assistance Priority	Prescription Assistance Neutral	Prescription Assistance Low Priority	Prescription Assistance Not a Priority

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* 8. Are you able to meet your daily needs in the following areas? Please answer Yes/No

	Yes	No
Device Repair	Device Repair Yes menu	Device Repair No menu
Medical Supplies	Medical Supplies Yes menu	Medical Supplies No menu
Paying bills	Paying bills Yes menu	Paying bills No menu
Having enough food	Having enough food Yes menu	Having enough food No menu
Pet or service animal care	Pet or service animal care Yes menu	Pet or service animal care No menu
Transportation	Transportation Yes menu	Transportation No menu
Having enough medicine	Having enough medicine Yes menu	Having enough medicine No menu
Keeping doctors and/or therapy appointments	Keeping doctors and/or therapy appointments Yes menu	Keeping doctors and/or therapy appointments No menu
Home Repair	Home Repair Yes menu	Home Repair No menu
Recreation or health related activities	Recreation or health related activities Yes menu	Recreation or health related activities No menu

Other (please specify)

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* 9. o you find the following useful? Please choose all that apply

Access to Independence Newsletter

Access to Independence Facebook Page

Access to Independence Website

Access to Independence Instagram

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* 10. What types of events DO/WOULD YOU LIKE to attend sponsored by Access to Independence? Choose all that apply.

Crafts

Peer support groups

Recreational opportunities

Holiday parties

Other (please specify)

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* 11. What type of workshops or trainings would you like to see at Access to independence? Choose all that apply

Disability Awareness

How to self advocate

Emergency Preparedness

Legislative Education Programs

Money management/Life Skills training

Nutrition and Cooking

Community Involvement

Other (please specify)

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* 12. What types of fundraisers would you like to see Access to Independence host?

Restaurant night

Dinner/entertainment

Arts

Walk/Run

Trivia night

Other (please specify)

Community Needs Assessment- Imperial Valley

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* 1. In what city do you live?

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* 2. What is your age?

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* 3. What describes you best as a member of our community?

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* 4. How would you describe your disability?

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* 5. What is your current employment situation

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* 6. What are the best/worst parts of living in San Diego as a person with a disability?

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* 7. Please rate the column that you believe best describes the need for the service in your community.

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* 8. Are you able to meet your daily needs in the following areas? Please answer Yes/No

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* 9. o you find the following useful? Please choose all that apply

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* 10. What types of events DO/WOULD YOU LIKE to attend sponsored by Access to Independence? Choose all that apply.

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* 11. What type of workshops or trainings would you like to see at Access to independence? Choose all that apply

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* 12. What types of fundraisers would you like to see Access to Independence host?

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* 13. Legislative Priorities: Please rate the following legislative priorities 1 - 7, 1 being the most important and 7 being the least important

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* 14. What legislative issues would you like to see us advocating?

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* 15. Please provide any information not asked in this survey that you think we should know.