Client Satisfaction Survey

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This survey is to be completed by the individual receiving services from Barrowman Case Management, assisted, if necessary, by a family member/legal guardian or residential provider staff. The results of this survey are confidential. Please complete and return by August 16, 2022.

The survey is written as if it is being answered by the individual, regardless of who reads the statements to the individual or assists them in responding. If you are assisting the individual, please think in terms of the individual’s reaction, not your own experience or from your point of view.

To the individual:

There are several ways that your case manager works for and with you. This survey lists ways that you and your case manager interact. Please circle the answer for each statement that is the closest to your experience with your case manager. NOT ALL INTERACTIONS ARE REQUIRED; some case managers go beyond the required interactions with their clients, and this survey includes these interactions as well.
1. My case manager contacts me monthly.
- Yes
- No
- I don't know
2. My case manager listens to me when we are together.
- Yes
- No
- I don't know
3. I participate in my Plan of Care.
- Yes
- No
- I don't know
3A. If you answered “no”, please explain why:
4. My case manager encourages me to make decisions about my services and my life.
- Yes
- No
- I don't know
5. My case manager talks with me about my rights.
- Yes
- No
- I don't know
6. My case manager assists me if I need to change providers.
- Yes
- No
- I don't know
7. I can call my case manager during normal business hours and he/she will answer or call back.
- Yes
- No
- I don't know
8. My case manager is helping me reach my goals.
- Yes
- No
- I don't know
9. I currently have a job.
- Yes
- No
9A. I would like to have a job.
- Yes
- No
- I don't know
9B. If yes, my case manager helped me explore job opportunities.
- Yes
- No
- I don't know
10. Are you happy with the friends you have?
- Yes
- No
- I don't know
11. Do you want to have more friends?
- Yes
- No
- I don't know
12. Do you get to participate in activities of your choice?
- Yes
- No
- I don't know
13. My case manager talks with me about how to be healthy, including medications, diet, exercise.
- Yes
- No
- I don't know
14. My case manager talks to me about having annual physical and dental examinations.
- Yes
- No
- I don't know
15. I understand what abuse, neglect and exploitation is.
- Yes
- No
- I don't know
16. If I have been abused, neglected or exploited in the past year, I have told my case manager.
- Yes
- No
- I don't know
17. I would like my case manager to be involved in the following concerns:
Thank you for completing the survey. If someone assisted you with this survey, please include their role or relationship to you (guardian, DSP, friend, etc.,).
_________________ helped me complete the survey. (please print role/relationship):
18. I am in the _________ waiver program:
- SCL
- Michelle P
- ABI
19. I live:
- alone
- with family
- in a staffed residence
- in an AFC/FHP
20. I have been a Barrowman Case Management client for:
- under 1 year
- 1 - 3 years
- 3 - 5 years
- over 5 years
For additional comments or questions, please contact Kaleena Miller at [email protected] or Carla Barrowman Clevenger at [email protected].

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Lexington, KY 40517

(859) 271-4246

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