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Pennsylvania Statewide Needs Assessment - Private Sector & Vendor Survey

1. What organization do you work for?

2. What is the ZIP code of the office you work in?

3. Define the type of organization you belong to.

Please enter an 'other' value for this selection.

4. Please describe your work experience in working with those with disabilities.

5. What are the barriers to employment your customers face? (Check all that apply)

Disability is too significant
Lack of education
Lack of training
Mobility/Transportation
Stereotypes of abilities
Support services (room, board, tools, licenses, home modification, job accomodations, personal care assistance)
Other Please enter an 'other' value for this selection.

6. What are the barriers to independence your customers face? (Check all that apply)

Disability is too significant
Education (or lack of)
Mobility/Transportation
Stereotypes of abilities
Support services (room, board, tools, licenses, home modification, job accomodations, personal care assistance)
Other Please enter an 'other' value for this selection.

7. Which of these services do you provide, and how frequently do you recommend them?

Assistive technology (e.g., screen reader, scanning software)
Counseling
Education/Training
Evaluation
Vocational Placement
Vocational Planning
Other

If you selected "Other", please describe the service.

8. How successful is each service for the customers?

Assistive technology
Counseling services
Education/Training
Evaluation
Vocational Placement
Vocational Planning

9. What service gaps exist in your organization?

Lack of knowledge to deal with specific disabilities
Limited money to serve everyone who needs help
Too few staff to serve everyone who needs help
Other Please enter an 'other' value for this selection.

10. How are these gaps being addressed?

11. How do customers access or refer themselves for services through your agency? (Check all that apply)

Call-in process
Court referral
Electronic referral process (CWDS, Compass, website)
Medical referral
Private sector referral
Public sector referral
Walk-in process
Other Please enter an 'other' value for this selection.

12. How do you coordinate ancillary services with other private sector counterparts?

13. How do you coordinate ancillary services with public sector agencies?

14. How do your customers find out about your services, and how effective is each method at reaching the customer base?

Internet search
Media spots (TV/radio)
Medical professional referral
Private sector referral
Public sector referral
Self (customer) referral
Told by another customer
Other

If you selected "Other", please describe how your customers learn of your services.

15. What criteria are in place to determine eligibility for services?

Financial need
Functional limitations to employment
Geographic location/Residency
Previous services received
Severity of disability
Type of disability
Other Please enter an 'other' value for this selection.

16. What are your reasons for denials of service? Please rank your answers in the order of frequency. Order the items from the following list. First select an item with the spacebar to show a menu of possible ranking positions. Next, click a ranking position to order it in the ranked list. Note the menu will display more ordering options as you add items to the ranked list.

Does not meet eligibility requirements
Not a resident of PA
Not willing to work
Did not follow through on rehabilitation plan
Cannot be located
Other

If you'd like, please describe what reasons for service denial fall under the "Other" category in the previous question.

17. Are you aware of any groups of people with disabilities who, because of their membership in the group (e.g., race, age, nature of disability, geographic location), have a harder time receiving services?

Please identify and list the group you are referring to in question 18.

Age
Geographic location
Multiple disabilities
Nature of disability
Race
Other

18. Please describe your organization's staff training program.

19. Are staff required to participate in continued education/training programs?

How many hours are required in a year?

20. Does your staff have unmet training needs?

Please describe.

21. Are there any upcoming changes in your organization (funding base, available services, new laws and regulations) that may affect other organizations or providers?

How are those changes being addressed?

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