Consumer and Case Manager Perceptions of Important Case Manager Characteristics.

Historical research in the rehabilitation profession reveals that the discipline has changed dramatically in the last 10 years (Tower, 1994, Balcazar, Mathews, Francisco, Fawcett, & Seekins, 1994; Pfeiffer, 1993; Zola, 1993). Today, backed with federal legislation, people with disabilities are working to become empowered and gain control over their lives. This movement has largely been associated with the implementation of the Americans with Disabilities Act (ADA) of 1990. Now more than ever in U.S. history, according to Zola (1993), "people with disabilities are taking an active role and an active voice in their rehabilitation process"(p. 803).

The term "consumer" is said to empower people with disabilities by involving them in choices and decisions related to social independence and productivity (Nosek, 1993). Further, this term demands that professionals consult with the person with the disability before making recommendations that will affect the life of that person. According to Nosek (1993), "Respect for the right and responsibility to make judgements for oneself is the cornerstone of the new, enlightened field of rehabilitation" (p. 101).

Some rehabilitation professionals argue that the term "client" refers to one who is cared for, protected, and served, while the term "consumer" implies one who purchases a commodity or service (Patterson & Marks, 1992). The era of consumerism in the field of rehabilitation has led to a search for factors related to the provision of quality services within the discipline of rehabilitation. This is important regardless of agreement on the use of the term "consumer" or "client."

One of the most frequently cited factors considered by consumers to be important is their participation in the decision making process of rehabilitation (Itzhaky & York, 1994). It is believed that a higher level of self-determination can be achieved if professionals seek greater consumer input and control (Tower, 1994). Another factor important to consumers is whether the services being provided meet their perceived needs and expectations (Asbury, 1994). Other factors viewed as important to consumers include: allowing the consumer to be self-directed in the rehabilitation process (Rowland, Gilliland, & Moxley, 1993); being treated with respect and dignity by the rehabilitation staff (Anderson, Wang, & Houser, 1993); and having needs listened to, appointments scheduled promptly, and telephone calls returned (Schwab, Smith, & DiNitto, 1993).

Some authors stress the importance of "involving" consumers in the process of rehabilitation and "respecting" their support of one another (Rowland, Gilliland, & Moxley, 1993). Tower (1994) stated that, "If practitioners align themselves with the interest of consumers, including consumer input and control, the result will be greater self-determination among clients and less ethical discord regarding paternalism within the helping professions" (p. 196). Ultimately, consumer choice will likely be the key that directs the future of the rehabilitation profession. Once the characteristics and behaviors desired from rehabilitation case managers are known, service agencies can act accordingly and develop strategies to improve services to individuals with disabilities.

Purpose

The present study investigated the characteristics important for rehabilitation case managers as perceived by consumers and compared them with characteristics perceived as important by rehabilitation case managers. As the rehabilitation profession is shaped more and more by consumer choice, it becomes necessary for service agencies to develop a greater level of consumer expectations. Furthermore, the field of rehabilitation is confronted by rising consumer complaints, many of which are related to a lack of clear understanding of expectations for the consumer-professional relationship.

Research Questions

The following three research questions were examined:

1. What are the most important rehabilitation profession case manager characteristics identified by consumers and case managers?

2. Are there differences in the importance ratings between rehabilitation case managers and consumers within a homogeneous community (an agency that only serves those individuals with a psychiatric disability) versus those within a heterogeneous community (those agencies that serve consumers with a variety of disabilities)?

3. Do the rating of these characteristics vary significantly according to the consumers' and rehabilitation case managers' age, sex, ethnicity, level of education, and/or length of time receiving or providing services?

Method

Participants

Table 1 presents the age, gender, level of education, and ethnicity of the consumers and rehabilitation case managers. These data were included in the instruments completed by both groups.

Table 1
Age, Gender, Level of Education, and Ethnicity of the Consumers

                Consumers         Managers
Variable        n      %        n         %

Age
 under 29       34    45.9      3       13.0
 30-39          16    21.6      6       26.1
 40-49          19    25.7      9       39.1
 50+             5     6.8      5       21.7
 Total          74   100.0     23       99.9

Gender
 Male           40    54.1     10       45.5
 Female         34    45.9     12       54.5
 Total          74   100.0     22      100.0

Level of
Education
 Not HS Grad.   15    20.8      0        0.0
 HS Grad.       24    33.3      0        0.0
 Some College   12    16.7      2        8.7
 College Grad.  21    29.2     21       91.3
 Total          72   100.0     23      100.0

Ethnicity
 Hispanic       30    40.5      6       27.3
 AfAm/Hait/
 other          13    17.6      1        4.5
 White
 Non-Hisp.      22    29.7     12       54.5
 Asian/Other     9    12.2      3       13.6
 Total          74    77.1     22        9.9

Two groups of rehabilitation agencies participated in the research. One group specialized in the area of mental health by working only with people with psychiatric disabilities. The other agencies served people who have one or more disabilities such as physical, sensory, and/or mental disabilities.

Rehabilitation case managers (n = 23) and consumers (n = 75) within the participating agencies were given the survey. The consumers were individuals with psychiatric disabilities who have been receiving services from the agency for a minimum of two months. The rehabilitation case mangers surveyed were individuals who were employed by the agency, and served in a professional capacity by providing services that assist people with disabilities to obtain employment.

The rehabilitation case managers coordinate services for the consumer. These services are generally provided by several agencies such as the Office of Vocational Rehabilitation, Social Security Administration, State Employment Services, and Department of Public Health. The case manager assists the consumer by arranging conferences with her/his vocational rehabilitation counselor, arranging for .job interviews, housing, medical appointments, and so forth.

Instrumentation

This study included the development and administration of a survey instrument for measuring important characteristics of rehabilitation case managers. Development of the instrument involved the opinions of rehabilitation case managers (N=8) currently working in the field and consumers (N=8) currently receiving rehabilitation services. Two separate focus groups, one with case managers and a second with consumers, were conducted in order to gather data in preparation for the development of the instrument.

The factors identified as "important characteristics of rehabilitation case managers" by the two focus groups were combined with those factors revealed in the professional rehabilitation literature. Through this process, content validity was established with a total of 18 items.

The instrument was piloted at three of the agencies that participated in the focus groups, but did not participate in the actual study. Each of the 18 factors was rated on a five point scale, from least important (1) to most important (5) by case managers and consumers. The correlational analysis for reliability of the instrument produced a Cronback alpha coefficient for the 18 items of .93. The alpha for each item, if deleted, ranged from .92 to .93, indicating a high degree of internal consistency among all of the items.

Procedure

Both consumers and case managers were surveyed, as in the pilot study, and asked to give their ratings of the case manager characteristics they believed were important with respect to the provision of services in the rehabilitation process. The entire sample for both groups in this study rated each characteristic on a five point scale, from not important (1) to most important (5).

Results

The overall multivariate analysis of variance (MANOVA) of the 18 items on the survey conducted by group (consumer and case managers) and class (homogeneous & heterogeneous) revealed no significant differences in the mean importance ratings by the survey group (consumers and case managers caseloads), [T.sup.2] (1, 18)=.31, p [is greater than] .05, and class by group, [T.sup.2] (1, 18)=.24, g [is greater than] .05. All groups rated the characteristics of case managers as important or very important. However, for the effect of class (homogeneous and heterogeneous), significant differences on the importance ratings were found, [T.sup.2] (1, 18)=.55, p [is less than] .05.

In response to research questions #1 and #2 the mean importance ratings and standard deviations were calculated for all of the 18 survey items. These questions asked if any differences were found between the groups (consumers and case managers) or between the classes (homogeneous or heterogeneous) in the way they rated the 18 items. These items are included with results from the univariate analysis of variance by group and class in Table 3 (consumer and case managers) and Table 4 (homogeneous and heterogeneous). A ranking of the top five items, based on the mean of each item is also presented in Table 2 and Table 3.

Table 2 Importance Survey for Characteristics of Rehabilitation Case Managers, with Means, Standard Deviations, Ranks, and Analysis of Variance on Level of Importance by Group (Consumers vs. Rehabilitation Case Managers)

The Rehabilitation Case Manager
Should:                                   Rank    M      SD       n

1.  Be able to allocate sufficient
    time for speaking with consumers.
        Consumers                                4.12   1.30      75
        Case Managers                      3     4.65   0.49      23
2.  Be a good listener.
        Consumers                          5     4.33   1.25      73
        Case Managers                      2     4.83    0.3      23
3.  Be sensitive to consumer's needs.
        Consumers                          4     4.36   1.10      73
        Case Managers                      4     4.65   0.49      23
4.  Demonstrate concern for consumer's
    desires and not have a preconceived
    view of the rehabilitation plan.
        Consumers                                4.13   1.21      73
        Case Managers                      5     4.64   0.49      22
5.  Be thoughtful and considerate.
        Consumers                                4.27   1.12      74
        Case Managers                            4.35    .71      23
6.  Return phone calls promptly.
        Consumers                                4.17   1.10      72
        Case Managers                            4.26   0.69      23
7.  Schedule appointments promptly.
        Consumers                                4.32   0.86      71
        Case Managers                            4.22   0.74      23
8.  Treat consumers with respect and
    dignity.
        Consumers                          1     4.65   0.88      74
        Case Managers                      1     4.87   0.34      23
9.  Be trustworthy and dependable.
        Consumers                          2     4.51   0.95      72
        Case Managers                            4.78   0.52      23
10. Be knowledgeable about the
    area of disability services
    he/she is providing.
        Consumers                          3     4.37   0.92      73
        Case Managers                            4.61   0.58      23
11. Know the job market.
        Consumers                                4.03   1.20      74
        Case Managers                            4.26   0.86      23
12. Follow-up on consumer progress.
        Consumers                                4.04   1.20      71
        Case Managers                            4.39   0.72      23

13. Assist a consumer to feel
    confident.
        Consumers                                4.18   1.10      71
        Case Managers                            4.45   0.74      22
14. Demonstrate motivation in the
    rehabilitation process.
        Consumers                                4.30   0.99      74
        Case Managers                            4.26   0.86      23
15. Explain how the rehabilitation
    process will proceed.
        Consumers                                4.19   1.04      74
        Case Managers                            4.22   0.80      23
16. Assist in building family and
    community supports for consumers.
        Consumers                                3.88   1.25      73
        Case Managers                            4.43   0.79      23
17. Schedule appointments that are
    convenient and accessible to
    consumers.
        Consumers                                4.07   1.08      72
        Case Managers                            4.39   0.58      23
18. Have a small enough case load to
    allow her/him to spend sufficient
    time with consumers.
         Consumers                               4.27   1.04      74
         Case Managers                           4.30   0.82      23

The Rehabilitation Case Manager
Should:                                   SS        F       P

1.  Be able to allocate sufficient
    time for speaking with consumers.
        Consumers                        125.92    2.61    .110
        Case Managers                      5.22
2.  Be a good listener.
        Consumers                        112.11    3.34    .072
        Case Managers                      3.30
3.  Be sensitive to consumer's needs.
        Consumers                         86.74    0.80    .374
        Case Managers                      5.22
4.  Demonstrate concern for consumer's
    desires and not have a preconceived
    view of the rehabilitation plan.
        Consumers                        105.89    3.64    .060
        Case Managers                      5.09
5.  Be thoughtful and considerate.
        Consumers                         92.59    0.04    .836
        Case Managers                     11.22
6.  Return phone calls promptly.
        Consumers                         86.00    0.54    .466
        Case Managers                     10.43
7.  Schedule appointments promptly.
        Consumers                         51.55    0.00    .956
        Case Managers                     11.91
8.  Treat consumers with respect and
    dignity.
        Consumers                         56.8    61.19    .278
        Case Managers                      2.61
9.  Be trustworthy and dependable.
        Consumers                         63.99    1.71    .195
        Case Managers                      5.91
10. Be knowledgeable about the
    area of disability services
    he/she is providing.
        Consumers                         61.01    0.39    .533
        Case Managers                      7.48
11. Know the job market.
        Consumers                        105.95    0.31    .579
        Case Managers                     16.43
12. Follow-up on consumer progress.
        Consumers                        100.87    1.64    .204
        Case Managers                     11.48
13. Assist a consumer to feel
    confident.
        Consumers                         84.62    0.73    .397
        Case Managers                     11.45
14. Demonstrate motivation in the
    rehabilitation process.
        Consumers                         71.46    0.37    .547
        Case Managers                     16.43
15. Explain how the rehabilitation
    process will proceed.
        Consumers                         79.35    0.48    .826
        Case Managers                     13.91
16. Assist in building family and
    community supports for consumers.
        Consumers                        111.89    2.38    .127
        Case Managers                     13.65
17. Schedule appointments that are
    convenient and accessible to
    consumers.
        Consumers                         82.65    1.32    .254
        Case Managers                      7.48
18. Have a small enough case load to
    allow her/him to spend sufficient
    time with consumers.
         Consumers                        78.59    0.03    .867
         Case Managers                    14.87

The choice of responses were:

1 - of Least Importance, 2 - of Little Importance, 3 - Undecided, 4 - Somewhat Important, 5 - Most Important

Table 3 Means, Standard Deviations, Ranks, and Analysis of Variance on Level of Importance by Class (Heterogeneous vs. Homogeneous)

        Item               Rank     M      SD     n     SS

1. Allocate Time
     Heterogeneous                4.24   1.16   46   60.37
     Homogeneous                  4.25   1.22   52   75.75
2. Good Listener
     Heterogeneous                4.36   1.25   45   68.31
     Homogeneous            3     4.53   1.00   51   50.70
3. Sensitiv./consum.
     Heterogeneous                4.33   1.13   45   56.00
     Homogeneous            4     4.51   0.86   51   36.74
4. Concern/consum.
     Heterogeneous                4.36   0.94   44   38.18
     Homogeneous                  4.13   1.23   51   76.04
5. Thoughtful
     Heterogeneous                4.27   1.07   45   50.80
     Homogeneous                  4.31   1.02   52   53.08
6. Return Calls
     Heterogeneous                4.13   1.18   45   61.20
     Homogeneous                  4.24   0.85   50   35.12
7. Schedule Appts.
     Heterogeneous                4.29   0.92   45   37.24
     Homogeneous                  4.31   0.74   49   26.40
8. Respect/Dignity
     Heterogeneous          1     4.67   0.92   46   38.11
     Homogeneous            1     4.72   0.67   51   22.16
9. Trustworthy
     Heterogeneous          2     4.61   0.97   44   40.43
     Homogeneous            2     4.50   0.78   51   30.63
10.Know Service
     Heterogeneous          3     4.51   0.87   45   33.24
     Homogeneous            5     4.3    0.84   51   35.65
11.Know Jobs
     Heterogeneous          4     4.44   0.99   45   43.11
     Homogeneous                  3.77   1.17   52   69.23
12.Follow-Up
     Heterogeneous                4.25   1.01   44   44.25
     Homogeneous                  4.02   1.19   50   68.98
13.Confidence
     Heterogeneous                4.35   1.07   43   47.77
     Homogeneous                  4.16   1.00   50   48.72
14.Motivation
     Heterogeneous           5    4.44   0.89   45   35.11
     Homogeneous                  4.15   0.99   52   50.77
15.Explanation
     Heterogeneous                4.40   0.91   45   36.80
     Homogeneous                  4.02   1.02   52   52.98
16.Build Support
     Heterogeneous                4.00   1.28   45   72.00
     Homogeneous                  4.02   1.09   51   58.98
17.Sched. Appts.
    Heterogeneous                 4.30   0.94   43   37.07
    Homogeneous                   4.02   1.02   52   52.98
18.Case Load
    Heterogeneous                 4.27   1.05   45   48.80
    Homogeneous                   4.29   0.94   52   44.67

        Item               F       P

1. Allocate Time
     Heterogeneous        0.08   .775
     Homogeneous
2. Good Listener
     Heterogeneous        0.01   .915
     Homogeneous
3. Sensitiv./consum.
     Heterogeneous        0.01   .913
     Homogeneous
4. Concern/consum.
     Heterogeneous        1.40   .241
     Homogeneous
5. Thoughtful
     Heterogeneous        0.07   .796
     Homogeneous
6. Return Calls
     Heterogeneous        0.19   .664
     Homogeneous
7. Schedule Appts.
     Heterogeneous        0.40   .527
     Homogeneous
8. Respect/Dignity
     Heterogeneous        0.03   .861
     Homogeneous
9. Trustworthy
     Heterogeneous        0.17   .681
     Homogeneous
10.Know Service
     Heterogeneous        2.67    .106
     Homogeneous
11.Know Jobs
     Heterogeneous        10.67   .002(**)
     Homogeneous
12.Follow-Up
     Heterogeneous        1.29    .260
     Homogeneous
13.Confidence
     Heterogeneous        2.31    .132
     Homogeneous
14.Motivation
     Heterogeneous        3.58    .062
     Homogeneous
15.Explanation
     Heterogeneous        4.71    .033(*)
     Homogeneous
16.Build Support
     Heterogeneous        0.20    .656
     Homogeneous
17.Sched. Appts.
    Heterogeneous         1.29    .260
    Homogeneous
18.Case Load
    Heterogeneous         0.02    .887
    Homogeneous

(*) p<.05

(**) p<.01

Table 4 Significant Results of Univariate ANOVAs of Class (Homogeneous and Heterogeneous) by Demographic Characteristics for item 11 "know the job market" and item 15 "provide an explanation"

     Effect                 Heterogeneous    Homogeneous

                    Item     M      SD      M       SD       P

Age                  11                                   .025(*)
 <29                        4.22   1.24     4.31    .86
 30-39                      4.67    .52     3.94   1.12
 40-49                      4.62    .65     3.73   1.16
 50+                        5.00    .00     2.71   1.11

Race                  5                                   .002(**)
 Hispanic                   4.56    .63     4.47    .77
 African American           4.30   1.06     2.50   1.92
 White                      4.54    .78     3.71    .72
 Asian (Other)              3.80   1.64     4.71    .49

Gender                      Male            Female
Item                 11     3.86   1.28     4.40    .84   .017(*)
Item                 15     3.84   1.13     4.62    .58   .001(***)

(*) p<.05, (**) p<.01, (***) p<.001

The first research question looked at the relationship between rating of importance among the two groups, the consumers and the rehabilitation case managers. Table 2 indicates that while all of the items were rated highly by consumers and case managers, no significant differences were found in the respondents' (consumers and case managers) perception of the important characteristics of rehabilitation case managers. This finding is consistent with the overall MANOVA test for the survey group, discussed above. This test revealed no significant differences in the overall responses by consumers or case managers.

The second research question asked, "Are there differences in the ratings of rehabilitation case managers and consumers within a homogeneous community and those within a heterogeneous community." Table 3 does indicate two differences. Item 11, "the rehabilitation case manager should know the job market," was rated significantly different by the two classes. The heterogeneous respondents rated the item significantly higher (n=45, M=4.44, SD=0.99), than did the homogeneous respondents (n=52, M=3.77, SD=1.17), F(1, 95) = 10.67, p [is less than] .01. The second item rated significantly different by the two groups of case managers was item 15 which states that the rehabilitation case manager should explain how the rehabilitation process will proceed. The heterogeneous respondents rated the item significantly higher (n=45, M=4.40, SD=0.91) than did the homogeneous respondents (n=52, M=4.02, SD=1.02), F(1,95)=4.71, p [is less than] .05. All of the other items were rated similarly high by the two groups of managers, with the means above four on the 5-point scale.

Further analysis of the means by consumer and by case managers revealed the top five items ranked by each of these groups. These can be found in Table 2 for consumers and case managers, and Table 3 for homogeneous and heterogeneous groups.

The highest rated item by all respondents was the item that states, "The rehabilitation case manager should treat consumers with respect and dignity." Other items rated similarly high by all respondents stated, "The rehabilitation case manager should be trustworthy, be a good listener, and be sensitive to consumers' needs." Several other items were rated among the top five, but did not receive equally high ratings by all the respondents. These included items that stated, "The rehabilitation case manager should demonstrate concern for consumers' desires," rated highly by case managers; "Know the job market and demonstrate motivation in the rehabilitation process," rated highly by the heterogeneous group; and "Know the area of disability services being provided," rated highly by the homogeneous group.

The third research question asked, "Do the ratings of these characteristics vary significantly according to the consumers' and case managers' age, sex, ethnicity, level of education, and/or length of time receiving or providing services?" The data revealed no significant differences in the mean ratings of the consumers and case managers based on the Multivariate Analysis of Variance discussed above. However, the demographic characteristics of case managers (Table 4), were found to be significant factors with two items (Item 11, "to know the job market," and Item 15, "to explain how the rehabilitation process will proceed.")

A univariate analysis of variance of class by age, race, and gender, presented in Table 4, revealed no main effect due to age for item 11, which states, "The rehabilitation case manager should know the job market." Significant differences also were not found due to the age factor alone. However, a significant interaction of class by age (p [is less than] .05) was found. Looking at Table 4, it can be seen that as age increases the differences in rating on level of importance on this item becomes greater. While younger individuals in both groups rated the item similarly, the heterogeneous older group (50+) rated the item to be highly important (M=5.00), the homogeneous older group (50+) rated the item to be only of minimal importance (M=2.71).

The univariate analysis of variance of case managers by race showed a significant interaction of race by case managers (p [is less than] .01) for item 15, which states, "The rehabilitation case manager should explain how the rehabilitation process will proceed." The group of African American respondents and to a lesser extent white respondents from the homogeneous community rated item 15 to be significantly lower on level of importance (M=2.50) than those from the heterogeneous community (M=4.30). The mean was also lower than any of the other means found for the other categories by race regardless of homogeneity of the group.

The univariate analysis of variance of class by gender yielded a main effect due to gender for both items 11, "should know the job market", (p [is less than] .05) and item 15, "should provide an explanation of how the rehabilitation process should proceed," (p [is less than] =.05). In both cases the females rated the importance of the items significantly higher than did the males.

There were no significant differences found for the effect of education. This was also true for the interaction of class by education.

Discussion

In answer to the first research question, the 18 items found in the survey instrument were the key issues mentioned by the literature, the consumers, and the case managers. The consistently high rating for all of the items on the survey, by consumers and case managers, is an indication that these characteristics are, in fact, all highly important in the provision of rehabilitation services to consumers.

As the data were analyzed, it became apparent that rehabilitation case managers are expected to provide services that are timely, are adequate for the needs and desires of the consumers, are provided with enthusiasm and motivation, are comprehensive so as to meet the needs of the individuals receiving services, and provided in a thoughtful and respectful manner. Another item stressed the need to provide aid beyond employment by assisting the consumers in building family and community supports. A final item of importance centered around the need to have a manageable case load to allow sufficient time for each consumer.

It is important to note that the rehabilitation case managers rated almost all of the 18 items higher on level of importance than the consumers. This finding strongly suggests that case managers who work in the service agencies have strong opinions about the way they should be performing their jobs. In this case, both consumers and case managers agree that case managers should possess all 18 characteristics presented in the survey instrument.

The second research question related to differences in the ratings between rehabilitation case managers and consumers within a homogeneous agency, versus those within a heterogeneous agency. As indicated in the Results, two items were rated significantly higher (p [is greater than] .001) by the heterogeneous agency: "The rehabilitation case manager should know the job market," and "The rehabilitation case manager should explain how the rehabilitation process will proceed." This finding is consistent with the distinct functioning of these two agencies. The heterogeneous agency tends to be specifically concerned with employment, and to have less time for addressing other potential needs of the consumer. The homogeneous agency, on the other hand, tends to provide a variety of programs for the consumers along with employment assistance.

Moreover, it is apparent that the participants of the homogeneous community are less concerned with the explanation of services than those of the heterogeneous community. This may also be a factor in the way these agencies function. The greater amount of time spent by the consumers of the homogeneous community at the agency may lead them to obtain a greater understanding of the agency.

Implications for Rehabilitation Practice and Training

Quality of and satisfaction with services has become a key issue for all agencies providing services to consumers. However, if the perception of what constitutes quality to consumers is not clearly understood, it becomes difficult for rehabilitation agencies to make attempts at providing quality services (Parasuranam, et al, 1985).

Professionals in the field of rehabilitation should emphasize characteristics deemed the most important for case managers. Those items rated to be of highest importance by all the respondents include: treat consumers with respect and dignity, be trustworthy, know the area of disability services being provided, be sensitive to consumers' needs, be a good listener, allocate sufficient time for speaking with consumers, demonstrate concern for consumers desires, know the job market, and demonstrate motivation in the rehabilitation process.

Rehabilitation agencies would also do well to include these issues as part of the overall assessment of individuals applying for employment as rehabilitation case managers. Finally, these issues should be included in the performance evaluation process of these professionals.

At another level, these issues should be emphasized in formal professional rehabilitation education programs found at colleges and universities. Once students understand the needs and expectations of the consumer, they can focus their learning on those aspects of rehabilitation which will make them more successful.

Recommendations for Further Research

The survey instrument and present research revealed the important case manager characteristics as perceived by the consumers and rehabilitation case managers. Subsequent research should survey a similar population with the intent of deriving the level of satisfaction of the consumers and the perceived level of satisfaction of the rehabilitation case managers. A comparison of the perceptions of these groups would reveal the accuracy of the perceptions that rehabilitation case managers have relating to the satisfaction of their consumers. This research will be invaluable to the agencies that are assessing the satisfaction of their consumers and working to improve the quality of services.

This study focused on a specific consumer population. Further research with individuals with a variety of disabilities is encouraged. Such research could provide support for applying these findings to other agencies and groups of consumers.

Consumer choice is becoming the key that drives the design and implementation of services for individuals with disabilities (Tower, 1994). As the term "consumer" implies, the person with the disability must now be offered a choice among the services that will be provided in the process of reintegrating into the community. Rehabilitation agencies would be wise to create an environment where consumer choices and needs are top priority in the planning and provision of services.

Acknowledgement

The authors want to acknowledge the contribution of Dr. Loraine Gay to this research and paper. Dr. Gay died in July 1997 from a prolonged illness.

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Rowland, R.R., Gilliland, C., & Moxley, D.P. (1993). A consumer initiated job search training program. Journal of Rehabilitation. 59 (O/D), 61-65.

Schwab, A.J., Smith, T.W., & DiNito, D., (1993). Client satisfaction an quality vocational rehabilitation. Journal of Rehabilitation, 59 (O/D), 17-23.

Tower, K.D. (1994). Consumer-centered social work practice: restoring client self-determination. Social Work, 39(2). 191-196.

Zola, I.K. (1993). In the active voice: a reflective review essay on three books. Policy Studies Journal, 21 (4), 802-805.

Howard Rosenberg Douglas H. Smith

Florida International University

Yolanda Nufer, Ed.D., Executive Director, Abilities of Florida, 6602 S.W. 57th Avenue, Miami, FL 33143.