From: Disability Rights Florida [mailto:noreply@xxxxxxxxxxxxxxxxxxxxxxxxxxx] Sent: Tuesday, June 19, 2012 12:30 PM 2013 Planning Survey: Disability Rights Florida requests your input into its goals and objectives for 2013 and beyond. Please share your opinion with us by answering our planning survey. The survey will be open until July 15, 2012. There are many different ways to submit your survey answers. Visit our 2013 Planning Survey page to access on-line, print and translated surveys as well as a phone number to call if you need assistance. The survey is below and the website is: http://www.disabilityrightsflorida.org/our_work/planning_survey/ Disability Rights Florida Planning Survey Disability Rights Florida, Florida’s protection and advocacy system, is developing its goals and objectives for the upcoming 2013 fiscal year that starts October 1, 2012. Please help us by taking a few minutes to complete the survey questions that follow. We depend on the people we serve, their families, supporters, and other stakeholders to tell us what disability issues they find most important. The survey provides a simple, direct way for us to learn what you have on your mind. We analyze these survey results and then incorporate the information you provide into our work plans. The more responses we receive, the better able we are to make sure we are directing our efforts in the areas of greatest interest. You can complete this survey online at www.disabilityrightsflorida.org/survey If you choose to print out the survey and complete it by hand, please either: · Fax it to 850-488-8640 · Mail it to: Disability Rights Florida - Survey 2728 Centerview Dr., Suite 102 Tallahassee, FL 32301 If you want to call us to leave comments or request accommodations, please call 1-800-342-0823. We need your comments by July 15, 2012. Disability Topics Important to You 1. Pick up to five (5) disability topics that are most important to you: ¨ Abuse ¨ Accessible Communities ¨ Access to Voting ¨ Aging ¨ Benefits ¨ Civil Rights ¨ Community Living ¨ Community Integration ¨ Developmental Disabilities ¨ Discrimination ¨ Education ¨ Employment ¨ Homelessness ¨ Housing ¨ Health Care ¨ Independence ¨ Mental Health ¨ Neglect ¨ Peer and Self-Advocacy Services ¨ Personal Safety ¨ Physical Disabilities ¨ Poverty ¨ Psychiatric Disabilities ¨ Self-Determination ¨ Service Animals ¨ Transportation ¨ Veterans with Disabilities ¨ None of the Above ¨ Other (please specify): Specific Disability Issues Based on your experience, pick the items under each priority that need the most attention. 2. Abuse or Neglect in Facilities - select up to three (3): ¨ Injuries or Death in Facilities ¨ Diet ¨ Discharge Planning ¨ Education ¨ Lack of Proper Medical Treatment ¨ Lack of Proper Mental Health Treatment ¨ Overmedication ¨ Personal Safety ¨ Physical Conditions ¨ Recreation ¨ Restraint or Seclusion ¨ Staff Training ¨ Verbal Abuse or Threats ¨ Other (please specify): 3. Disability Rights - select up to three (3): ¨ Access to Legal Services ¨ Children with Disabilities in State Care ¨ Commitments to Facilities ¨ Confidentiality ¨ Criminal Penalties ¨ Discrimination ¨ Forced treatment ¨ Informed Consent ¨ Individual Choice ¨ Mental Health Services ¨ Misuse of Money or Personal Belongings ¨ Outpatient Commitments ¨ Protecting Legal Rights ¨ Voting Rights ¨ Other (please specify): 4. Education - select up to three (3): ¨ Adult Education ¨ Bullying & Assaults ¨ College Preparation ¨ Early Identification of Disabilities ¨ Inclusion ¨ Increasing Knowledge of Mental Illness ¨ Parent Friendly Dispute Resolution ¨ Quality of Learning Experience ¨ Restraint or Seclusion ¨ Teacher Special Ed Certification ¨ Transition Planning for Students with Disabilities ¨ Testing Accommodations ¨ Training in Self-Advocacy ¨ Other (please specify): 5. Employment - select up to three (3): ¨ Assistive Technology ¨ Disability Discrimination in the Workplace ¨ Educating Employers ¨ Integrated Employment Settings ¨ Job Opportunities ¨ School to Work Transition ¨ Self-Employment ¨ Skills Training ¨ Supported Employment ¨ Vocational Rehabilitation Services ¨ Wages ¨ Other (please specify): 6. Empowerment - select up to three (3): ¨ Advance Directives ¨ Alternatives to Guardianship ¨ Communication ¨ Developing Leaders ¨ Ideas for Financial Independence ¨ Making Your Own Decisions ¨ Making Policy ¨ Mentors ¨ Representative Payees ¨ Other (please specify): 7. Community Living - select up to three (3): ¨ Affordable Housing ¨ Assistance & Care ¨ Continuing Education ¨ Shelters ¨ Health Care Services ¨ Homelessness ¨ Public Programs & Services ¨ Outdoor Activity and Recreation ¨ Service Animals ¨ Transportation ¨ Victimization & Violence ¨ Other (please specify): 8. Community Participation and Integration - select up to three (3): ¨ Affordable Programs ¨ Case Management ¨ Getting Resources Where They Are Needed ¨ Inclusive Housing ¨ Increasing State Revenue ¨ Long Term Care ¨ Managed Health Care Services ¨ Quality of Care ¨ Rebalancing Funds ¨ Transition to Community ¨ Voting and Voters Registration ¨ Other (please specify): 9. Please share any other priorities or topics we should consider. Additional Survey Questions 10. Every few years, Disability Rights Florida develops its long range plans to guide the organization over the next 3-5 years. What three (3) things would you most want us to accomplish by October 1, 2018? Please limit yourself to three (3) topics. 1. ____________________________________________________________ 2. ____________________________________________________________ 3. ____________________________________________________________ 11. Do you know our services are free and confidential? ¨ Yes ¨ No 12. Over the next 3-5 years, check the ONE activity from the list below that you think Disability Rights Florida staff should make its number 1 priority. ¨ Information and Referral ¨ Training and Assistance ¨ Investigations and Monitoring ¨ Individual Advocacy Services ¨ Legal Services and Complex Litigation ¨ Other (please specify): 13. Do you think of Disability Rights Florida as an organization that helps: (Check any that apply) ¨ People with developmental disabilities ¨ People with mental illness ¨ People with physical disabilities ¨ People with any disability About You 14. What best describes your job? (check all that apply) ¨ Advocate ¨ Attorney ¨ Caregiver ¨ Courts ¨ Direct Service Provider ¨ Human Services Professional (Social Worker, Case Manager, etc.) ¨ Investigator ¨ Law Enforcement or Criminal Justice ¨ Medical Services (Physician, Nurse, Paramedic, etc.) ¨ Peer Specialist ¨ Private Employer ¨ State Agency Administration ¨ Student ¨ Teacher ¨ Unemployed or Retired ¨ Other (please specify): 15. I am a person diagnosed with a disability: ¨ Yes ¨ No 16. I am close to someone with a disability: ¨ Yes ¨ No 17. If you answered "Yes" to either Question 15 or 16, please check all disabilities that apply: ¨ ADD / ADHD ¨ AIDS / HIV ¨ Autism ¨ Autism Spectrum Disorder ¨ Auto-Immune ¨ Cancer ¨ Cerebral Palsy ¨ Deaf / Blind ¨ Developmental Disability ¨ Diabetes ¨ Down Syndrome ¨ Emotional / Behavioral ¨ Epilepsy ¨ Hard of Hearing / Deaf ¨ In Recovery ¨ Intellectual Disability ¨ Multiple Sclerosis ¨ Muscular Dystrophy ¨ Mental Illness ¨ Mental Retardation ¨ Neurological Disorder ¨ Physical / Orthopedic ¨ Respiratory Disorder ¨ Specific Learning Disability (SLD) ¨ Speech Impairment ¨ Spina Bifida ¨ Substance Abuse ¨ Tourette Syndrome ¨ Traumatic Brain Injury ¨ Visual Impairment / Blind ¨ Other (please specify): 18. My age is: ¨ 21 and Younger ¨ 22 - 59 ¨ 60 and Older ¨ Prefer Not to Answer 19. My race/ethnicity is: 20. What best describes your interest in Disability Rights Florida? (check all that apply) ¨ Current Client ¨ Former Client ¨ Caregiver ¨ Disability Advocate ¨ Parent ¨ Peer Specialist ¨ Personal Reasons ¨ Professional Reasons ¨ Legislative ¨ State Employee ¨ Employee or Board Member of Private Service Provider ¨ Employee or Board Member of Private Community Partner ¨ Disability Rights Florida Board Member ¨ Disability Rights Florida Staff ¨ Disability Rights Florida PAIMI Advisory Council Member ¨ None of the Above ¨ Other (please specify) Demographics 21. Have you ever received services from Disability Rights Florida, formerly the Advocacy Center for Persons with Disabilities, Inc.? Check any that apply: ¨ Advocacy ¨ Brochures ¨ Education ¨ Help with Personal Matter ¨ Help with Larger Systemic Problem Affecting Others ¨ Information ¨ Investigation ¨ Legal Help for Myself or Someone I Know ¨ Monitoring ¨ Outreach ¨ Referral ¨ Representation at a Hearing (Court or Administrative) ¨ Representation at a Mediation ¨ Representation at a Meeting ¨ Training ¨ None of the Above ¨ Other (please specify): 22. My county is (Florida residents only): 23. If you would like to join our electronic mailing list, please print your email address below. May We Contact You? If you do not want us to contact you, you may stop here and you do not need to provide any additional information. 24. Please provide your contact information below: Name: Company: Address: Address 2: City/Town: State: ZIP: Email Address: Phone Number: Survey Complete! Thank you for completing the survey! 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