Aspire of WNY- Satisfaction Survey 2020 Question Title * 1. Date Completed Date / Time Date OK Question Title * 2. What is the age range of the person who receives services? 17 & Under 18 - 27 28-37 38 - 47 48 - 57 58 - 67 68+ OK Question Title * 3. Survey completed by: Individual Family Advocate Staff Individual with support from staff Individual with support from family Other (please specify) OK Question Title * 4. Was the communication from Aspire regarding the agency’s operational and safety plans during COVID-19 timely and informative? Yes No Other (please specify) OK Question Title * 5. Were you satisfied with the frequency of communication from Aspire in general during COVID-19? Yes No Other (please specify) OK Question Title * 6. What is the best way for you to receive information or updates from Aspire? (Please check all that apply and provide phone number and/or email). *Please note, by providing your phone number and/or email address, you consent to receive communication from Aspire via this method* Phone (please provide best contact number below) Email (please provide email address below) I do not want phone or email communication, I only wish to receive written communication Other (please specify) OK Question Title * 7. Which service(s) do you receive from Aspire of WNY? (Please check all that apply) Residential Habilitation Site-Based Day Habilitation Day Habilitation Without Walls (SVLE, Tech Today or CoOp) Community Habilitation Free-Standing Respite In-Home Respite Saturday Respite After-School Respite Community-Based Prevocational Service (ADAPT) Pathways to Employment Supported Employment Self-Directed Services (Fiscal Intermediary, Support Broker) Environmental or Vehicle Modifications (EMOD VMOD Adaptive Technology) Family Education & Training (FET) Health Center Primary Care, OBGYN, Podiatry Health Center PT, Speech Therapy Health Center Counseling Center for Learning- School Aged Program Center for Learning- Daycare Program Center for Learning- Preschool Program or Off-site preschool program Center for Learning- Other Other (please specify) OK Question Title * 8. Regarding the specific service(s) you receive from Aspire, were you satisfied with the frequency that your service team(s) contacted you regarding your safety and well-being during COVID-19? Yes No Other (please specify) OK Question Title * 9. Did you continue to receive services from Aspire during COVID-19? Yes (please continue to Question 10) No (please skip to Question 15) Other (please specify) OK Question Title * 10. Did you receive services in person or virtually? In Person Virtually (via phone, tablet, computer, etc.) Both Other (please specify) OK Question Title * 11. If you received services virtually, how did these services meet your needs as compared to the services you received before? Virtual services met my needs more than in-person services Virtual services met my needs the same as in-person services Virtual services did not meet my needs more than in-person services Other (please specify) OK Question Title * 12. If you received services virtually, would you want the option to continue receiving services this way? Yes No Other (please specify) OK Question Title * 13. If you continued to receive services in person, did you feel safe with the precautions taken by staff? Yes No Other (please specify) OK Question Title * 14. If you continued to receive services in person, did the services meet your needs? Why/why not? Yes No Why/why not? OK Question Title * 15. If you have not received your normal services during COVID-19, do you feel that Aspire is taking adequate safety measure to keep you safe upon the reopening of that service? Yes No Other (please specify) OK Question Title * 16. Please indicate any concerns you have with returning to programs. OK Question Title * 17. When returning to services, will wearing a mask present any difficulties for you? Yes No Other (please specify) OK Question Title * 18. Was there anything that changed with the service(s) you receive from Aspire during COVID-19 that you liked? Yes (please continue to Question 19) No (please skip to Question 21) Other (please specify) OK Question Title * 19. If you answered Yes to Question 18, please tell us what the changes were that you liked. OK Question Title * 20. Would you like these changes to continue? Yes No Other (please specify) OK Question Title * 21. Are there areas that you have discovered you need more assistance with due to not receiving services or receiving limited services during COVID-19? Yes (please continue to Question 22) No (please skip to Question 23) Other (please specify) OK Question Title * 22. If you answered Yes to Question 21, please share with us the areas you feel you need more support? OK Question Title * 23. What did you miss most about your Aspire services during COVID-19? OK Question Title * 24. What could Aspire have done differently to support you during COVID-19? OK Question Title * 25. Is there something that we can do to help you navigate this new environment? OK Question Title * 26. If you or your loved one lives in an Aspire IRA Group Home, how safe do you feel you/they were kept during the pandemic? Very safe Somewhat safe Not safe/not unsafe Somewhat unsafe Very unsafe N/A Other (please specify) OK Question Title * 27. If you or your loved one lives in an Aspire IRA Group Home, do you feel you received good communication from Aspire during the pandemic? Yes No N/A Other (please specify) OK Question Title * 28. If you or your loved one lives in an Aspire IRA Group Home, was there anything more Aspire could have done to support you/your family member during the pandemic? OK Question Title * 29. If you or your loved one receives any Day Service from Aspire, what type of community outings or activities would you feel safe/confident participating in? The same activities I participated in before Whatever activities are scheduled Only places/events where social distancing is possible Only events that occur outdoors Prefer that activities are brought into the program N/A Nothing that exceeds ___ number of people (please share number below) OK Question Title * 30. If you or your loved one receives any Day Service from Aspire, was there anything more Aspire could have done to support you/your family member during the pandemic? OK Question Title * 31. Would you like a personal response to your survey feedback? Yes (continue to Question 32) No OK Question Title * 32. If you answered yes to question 31, please provide us your name and contact information so we may contact you. Name Email Address Phone Number OK DONE