Appendix 4 – Questionnaire for Persons with Disabilities

Experience in and perception of the institution

For how long have you been living in this institution?
What was the reason for coming to an institution?
Whose decision was it for you to come to an institution?
For how long do you anticipate to stay at this institution? What factors would determine this?
Are you staying in this institution out of your free will? Why?
What do you think of the quality of services you receive at this institution?
How would you describe your relationship with your caregivers? Do they treat you well?
How would you describe your relationship with other residents?
Do you get the autonomy you need in managing your time and space, and to make priorities the way you see fit?
How easy for you is it to move in and out of the institution? How often you do that per month?
Would you like to leave this institution? Why? What do you need to be able to leave and live outside? What is stopping you from doing so?
Where would you like to live and with who?
Do you have any friends inside the institution?
Are you bullied or violated by anyone inside the institution? By who? And how?
Please select which of the following facilities isn’t available at your institution: internet, phone, private bathrooms, garden, physiotherapy, counselling, speech therapy, sports, pool, TV in each room, common areas).
How would you describe the quality of services provided in this institution? – including food, shelter, cleanliness, privacy, attention by caregivers, healthcare, education, opportunity for employment, access to nearby community, etc. - (each can be evaluated as good, fair, or bad).
Is there a daily doctor in the institution? is he/she helpful when you need them?

Relationship with family and community

Are you in contact with your family members? Friends? Colleagues? Outside the institutions? How frequently? By phone? Do they come and visit you here? How often?
Do any of your family members come and visit you?

Who? How often?

Do you visit them at their place?

How often?

How would you describe your relationship with your parents?
Do you experience any discrimination when you are outside the institution? Where? What type of discrimination or harassment?
Are you bullied or violated by anyone outside the institution? By who? And how?

Attitude and expectations / Education and work

Were you at school before coming to this institution? Was it a special school or mainstream?

If yes, what was the highest certification you attained? Did you have any learning difficulties?
If not, why weren’t you enrolled?

Did you drop out at any point before finishing the program/degree? If yes, why?
What kind of activities are you involved in at this time? (Job, school, religious activities, family events, sports and recreation, etc.) PLEASE SPECIFY.
Are you currently receiving any kind of education? please specify grade/degree, formal/informal, vocational/academic, etc.

Are you facing any learning difficulties?
Describe your relationship to your teacher.
Are you intending to continue your higher education?

Have you ever worked before? What type of work was it?

Why did you leave your work?
How would you describe your previous work conditions?

Do you currently work?

Inside or outside the institution?
How would you describe your work conditions?

If they don’t work, are you willing to work in the future?

If yes, are you doing anything in the meantime to reach this end?
If not, why not?

Autonomy and self-determination

Where do you see yourself 5 years from now? where would you be living? Career life? Family life? Community life?
To what extent are you actively making decisions with regards to your own life (accommodation, marriage, education, work)? Why? Why not?
Do you at any point feel overpowered or coerced by an individual or a group to act in certain ways or make certain decisions? If yes, by who? and how
What do you need to be able to be fully independent and to manage your own life?

Any other thoughts or experience you would like to share?