http://www.jstor.org/stable/27503233 .

Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at .
http://www.jstor.org/page/info/about/policies/terms.jsp

.
JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of
content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms
of scholarship. For more information about JSTOR, please contact support@jstor.org.

Springer is collaborating with JSTOR to digitize, preserve and extend access to Population and Environment.

http://www.jstor.org

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

Client Satisfaction with Developmental

Disabilities Services
Bob Weiler
Florida State University

Data
from a representative
disabled
clients of
sample of 312 developmentally
to discover
Services are analyzed
of Health and Rehabilitative
Florida's Department
the char
and to determine
to which
acteristics
of the clients
the extent
the clients are satisfied with
reasons for any dissatisfaction
are related to
various services,
that exists, and the factors which
are least likely to be satisfied with
Clients
services.
satisfaction
with
the caregiver
support
services
and rehabilitative
services
and the vocational
all categories,
they receive. Across
are inappropriateness
reasons most often given for dissatisfaction
services
with
and insuffi
are age,
cient amount.
The factors most
related to client
satisfaction
with
services
strongly
are less likely than per
and number of services
received.
Adolescents
living arrangements,
sons at other ages to be satisfied with
the services
persons
they receive,
living in a family
in nonfamily
and the
setting are less likely than persons
settings to be satisfied with services,

ABSTRACT:

the lower the likelihood

received
of client satisfaction.
Com
greater the number of services
information
that most of the clients have multiple
bined with
these data
disabilities,
showing
some services
that the service delivery
than
system does a better job of delivering
suggest
to the
such as that in Florida may pay insufficient
others. A "slot" oriented
attention
program
of multiple
existence
needs among persons who are developmental
and to provid
ly disabled
to the networks which
form the client's economic
and social support system.
ing services

INTRODUCTION
In 1989, as part of a national effort
Assistance
of the Disabilities
and
the Florida Developmental
Disabilities
The Center for the Study of Population

ment

to Dr. Weiler,
Please address correspondence
FL 32306-4063.
State University,
Tallahassee,

enact
mandated
by Congressional
Bill of Rights Act (P.L. 100-146),
contracted with
Planning Council
at Florida State University
to con
Center

A Journal of Interdisciplinary
and Environment:
Population
1991
Volume
2, Winter
13, Number
?
Inc.
1991 Human
121
Sciences
Press,

for the Study of Population,

Studies

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

Florida

122
POPULATIONAND ENVIRONMENT

the service needs of clients of the state who are

duct a survey to determine
the extent to which
these needs are being met
disabled,
developmentally
in a satisfactory manner,
and the reasons lying behind any discontent.
To
in face-to-face
interviews, with emphasis
help do this, data were collected
of the clients rather than upon clinical
being placed upon the perceptions
of need.
determinations
In addition to providing a descriptive
profile of the service needs of
consumers
disabilities
of developmental
information on several
services,
were
of the clients and their situation
characteristics
also collected.
This
it possible to determine differentials
in client satisfaction,
makes
thus gain
inwhich
the service
ing insights into service gaps that may exist and ways
delivery system may be changed to provide needed services more satisfac
the methods by which
the data were collected,
torily. This paper describes
the
the characteristics
of
clients, their degree of satisfaction with the serv
ices they receive, and the reasons for any dissatisfaction
which exists.

METHODS AND SOURCE OF DATA

The Florida Department
of Health and Rehabilitative
Services
(HRS)
and the Epilepsy Foundation provided the investigators with a list of clients
and their addresses. A sample of clients residing in three counties, Dade,
and Leon, was generated
Hillsborough
randomly. These counties were se
on the part of
lected because of their geographic
location, a willingness
to facilitate the study, and the ease of finding quali
local HRS personnel
in each site. Together,
fied interviewers
these counties contain about 23%
In each county, 600 persons were selected
of the state's population.
ini
100
with
the
in
of
of
them
each
county.
goal
actually
interviewing
tially,
to trained
Each name and address selected was printed and distributed
interviewers.

11 interviewers were used in conducting

the survey: three
Altogether,
in Dade County,
in Leon County.
three in Hillsborough
and
five
County,
in Dade County were bilingual.
In Hills
Two of the three interviewers
was
for
made
who
persons
borough County provision
spoke only Spanish
to be interviewed at HRS facilities where bilingual personnel were avail
interviewers were provided with a Spanish language ver
able. In addition,
sion of a preliminary draft of the instrument. Several training sessions were
held for interviewers. At these sessions, a rationale for the survey was pres
of the organization
of the instrument.
ented, along with a discussion
list of names, addresses and
Each interviewer was given a randomized
possible,
suggested phone numbers (when available). Whenever
they were
For persons
also given the name of the client's social worker.
living in

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

123
BOBWELLER

numbers of the
group or institutional quarters, the names and telephone
client's social worker and of the institution's operator were also provided
Each interviewer was
instructed to begin with the first
whenever
possible.
name on the list and to make up to three attempts to contact the person by
on to the next name on the list. If the initial
before moving
telephone
contact was made by telephone,
interviewers were
instructed to explain
the purpose of the survey (in general terms), conduct the first portion of the
to screen the respondents
sure the person
to make
interview designed
an appoint
to
if
would qualify as developmental
make
so,
ly disabled, and,
ment to conduct the rest of the interview personally
in a face-to-face
fash
ion. If no telephone number was provided,
the interviewer was
instructed
to go to the address listed and to try an interview if the client (or a suitable
forms were completed
and signed at
surrogate) could be located. Consent
interview.
the beginning of the face-to-face
clients posed special in the sense that they were very
Institutionalized
a
some of the ques
to
need
surrogate to respond to the questions,
likely
some
re
tions were
and
of
the
institutional
operators were
inappropriate,
luctant to grant access because of an (unfounded) fear that their particular
or because provid
institution would
somehow
be evaluated
unfavorably,
serve
as
was
to
sufficient
difficult.
This was espe
surrogates
ing
personnel
case
were
in
the
for
institutions
those
which
several
clients
included
cially
in the sample. Nevertheless,
institutional clients may be slightly overrepre
sented in the sample because of the ease with which they could be located.
The National Association
of Developmental
Disabilities
Councils
de
was
to
the
used
interviews.
conduct
the
It
in
used
veloped
questionnaire
54 states and territories as part of the national effort mandated
by Congress
are perfect. This one had several
1990). Few questionnaires
not
Pretests
it
showed
did
do well with children and persons
shortcomings.
use
who are mentally
The
of parallel
instruments (for surro
handicapped.
was
and
considered
the
instrument's
but re
clients)
gates
by
designers
(NADDC,

the designers
be unwieldy. Most of the
jected because
thought itwould
in Florida involved the help of surrogates. Unfor
interviews conducted
in the
tunately, one cannot ascertain the extent of surrogate participation
was also rather long and sometimes
interview process. The questionnaire
contained difficult language. These shortcomings were
largely offset by in
terviewer

training.

CHARACTERISTICSOF RESPONDENTS
statistics of the respondents.
Table 1 presents descriptive
than 10% are preschool ages, and 19.7% are ages 0-14. This

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

Slightly less
is very close

124
POPULATIONAND ENVIRONMENT

TABLE 1
Selected

Sociodemographic

Characteristic

Characteristics

of Respondents

No.

Current Age

31
15
17
20
55
58
38
33
33
19
319

0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-49

50 +
Total
Gender
Male

178
132
310

Female

Total
Race/Ethnicity
White
Black

183
89
40
1
313

Hispanic
Other
Total

Percent

9.7%
4.7%
5.3%
6.3%
17.2%
18.2%
11.9%
10.3%
10.3%
6.0%

100.0%
57.4%
42.6%

100.0%
58.5%
28.4%
12.8%
0.3%

100.0%

Marital Status
Never

302
4
6
0
312

married

Married
divorced

Sep.,

Widowed
Total
Surrogate's Relationship
Relative
Service

prov.

Other
No

surrogate

Total
Current

Place

1.3%
1.9%
0.0%

100.0%

to Client
137
149
15
9
310

44.2%
48.1%
4.8%
2.9%
100.0%

of Residence

Single family home

Multifamily home
Rooming house
Congregate

96.8%

care

Nursing home

125
28
1
96
2

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

41.3%
9.2%
0.3%
31.7%
0.7%

125
BOBWELLER

TABLE 1 (Continued)
Characteristic

No.

Institution 51
Total 303
Number
None
One
Two
Three
Four+
Total

16.8%

100.0%

of times moved

in past five years

189
66
28

12
10
305

59.1%
22.3%
7.3%

11.3%
100.0%
79
146

Don't know 45
Total 270
moved

Health,

29.3%
54.1%
16.7%

100.0%
to Florida

Economic 9
Family 18
Environment

9.2%
3.3%

No

Services

21.6%

100.0%

Ever lived outside Florida

Yes

reason

62.0%

3.9%

Place of birth
Florida 162
US, not Florida 61
Outside US 20
Don't know 31
Total 274

Major

Percent

13.6%
27.3%

12.1%

5
retirement

7.6%
1

Other 13
Don't know 12
Total 66

1.5%
19.7%
18.2%

100.0%

to the 20.7% ages 0-14 projected

for 1990 in these three counties
by
Ahmed
and
Sincich
The
(1988).
Smith,
(57%)
sample is disproportionately
male. By contrast, only 48% of the 1990 population of these three counties
re
(combined)
projected by Smith et al. is male. This is consistent with
search suggesting
that males may have higher prevalence
rates than fe
males or that potentially disabling conditions may be more severe inmales
than in females (LaPlante, 1988; & Verbrugge,
12% of the
1982). About
as Hispanic,
identified themselves
28% identified themselves
respondents
as black, and almost 60% identified themselves
as white. The proportion

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

126
POPULATIONAND ENVIRONMENT

TABLE 2
Educational

Experience

Characteristic

of Respondents
No.

Percent

Received
Early

43
45
67
29
23
20
3
20
150
13

intervention

Preschool
school

Elementary

Junior high/middle
High school

school

Vocational

College
Homebound
Special school
Unknown

Most of education received in

Special school (residential)
Special school (day)
Special

class,

regular

school

Regular

class,

regular

school

Homebound
Residential facility for disabled
Residential facility for mentally
Other

il

7
126
38
19
13
29
11
77

13.4%
14.1%
20.9%
9.1%
7.2%
6.3%
0.9%
6.3%
46.9%
4.1%

2.2%
39.4%
11.9%
5.9%
4.1%
9.1%
3.4%
10.5%

in 1990 has been

three counties
that was Hispanic
(combined)
projected as 30.4% (Center, 1987). Smith et al. (1988) project the propor
as 20.5%. These
tion black in 1990 in these three counties
(combined)
figures are included merely to provide a general notion of how the popula
tion of respondents
the general population.
Prevalence
compares with
rates are not random but tend to vary by age, sex, and ethnicity. Thus the

of these

of the sample and the general population will not

distributions
be the same.
necessarily
have ever been married. Only 2.9% of
Very few of the respondents
In over
the interviews were conducted
without
the help of a surrogate.
90% of the cases, the surrogate was either a relative or a service provider.
As may be seen in Table 1, slightly more than half of the sample live in a
live in a single family
family home. Most of these (41.3% of the sample)
a
in
9.2%
of
the
live
home.
home;
sample
multifamily
Slightly less than
live in some sort of group facility. This breaks down
half of the respondents
as 31.7%
care facility and 16.8% in an institution. The
in a congregate
percent

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

127
BOBWELLER

live in a nursing home (0.7%) or rooming

remaining 1% of the respondents
house (0.3%).
Persons born outside of Florida are 29.6% of the sample. The propor
is 7.3%. The four leading reasons given for
tion born outside
the U.S.
are:
"Services" is not
economic
and environment.
family, other,
migration
a
as
reason
to
7.6%
the
Florida
of
for
migration
respondents.
by only
given
in an earlier study of applicants
to
This finding is similar to that obtained
HRS Developmental
Services.
in Table
of the respondents
is presented
The educational
experience
2. They have been educated
in a variety of settings. Only
13.4% have
received early intervention and only 14.1% have attended preschool.
Early
is critical to prevent further problems
intervention
and to achieve maxi
mum development.
Yet waiting
lists are long and programs may have in
sufficient resources, especially
trained professionals.
Many day care pro
viders do not accept children with special needs (NADDC,
1990). Almost
half of the respondents have attended a special school or program with no
it impossible to compute
the highest grade completed.
grades. This makes
is calculated by combining
number of years of schooling
When
number of
an
in
each
the
have
average of 7.2
years spent
type,
spent
respondents
in
A
school.
the
considerable
of
years
report that most
portion
respondents
of their schooling
took place in a special setting, either a special school or
a special class in a regular school. Only 5.9% report they have received
most of their schooling
in a regular class in a regular school.
in the
This shows segregation
of developmental
persons
ly disabled
a
educational
It
is
consistent
with
federal
system.
report that, de
public
a
to
federal
law
that
students
with
be served in
disabilities
spite
requires
some states exclude more than two
the "least restrictive" settings possible,
thirds of certain disability groups from regular schools (U.S. Department
of
as
38%
the
of
children
interviewed
1985).
Education,
part of
Nationally,
in
the consumer
either
survey were completely
separate build
segregated
education
1990).
(NADDC,
ings, residential schools or in homebound
are presented
Selected disability characteristics
of the respondents
in
Table 3. Mental
is the major primary disability,
retardation
followed
by
cerebral palsy. The high proportion who give mental
retardation as the
primary disability may be due to a tendency of other persons to label de
disabled persons as "retarded," either because
velopmentally
they are "dif
ferent" or are physically
the portions of
unable to perform satisfactorily
intelligence tests that require manual dexterity. Also, persons who are clas
sified as mentally
retarded may qualify for federally or state financed serv
ices more easily than persons with other developmental
ly disabling condi
even when
are taken into account,
tions. However,
secondary disabilities

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

c
0>
Ui?
CD
?

rsi i? rsi m

rj- <y>
O

(N lo -^ rr cx> in m
LO COK COO lOK
ld lo r\ m cx>o^ cr>

LO Lo ^D rsj c\ m tj
K CO^t M CO LO LO
t? t? <N *? CN (N (N

O
Z

c
"o
c
Vi
eu
-L CLO
03^ _
C ro nj C .2 C c o
tu .t;
fO

'<"
? t?5: ?Q

C?
<

03
U

IS<u

03 03
2 "2
o.
3 2
<y

g"?

? Q
?
O CL?

eu
_
q; o> 03? ?;
_J
0? to
Q- U <

^ CU't a^

5.

2?

go

03
CU CD
DOC
U
? "3 O
O Qj
? ?
gi-S
wu ?
E c t= E 00 e
U

-j

?? ?1 ?1 ?

c/i
c
CD
u

vDO<Nror\imcNromomo

in^ffi'-O'-rni-r-inoi
t?
ro
rsi

O
Z

Mr

: jz
5 s: O

0) 03
c

coco^onLnincr>ror-cO'

-3

i <

</> .=-,
>-'c

C? *
c?U?

Lul4

-?

mm^-i-vOCOfNC^'-v?tNrtOO^tNOO
CNO
C\| CN 1? r- v?> (N

<
1
DO03
S03 "2
<^

3 &
Q- Q-X =5
o<

ex.

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

vu O^ COO

(NO

vu

129
BOBWELLER

is very
retardation
the proportion with mental
The high proportion that is classified
conditions.
to
to a tendency
also be partially attributable
retarded, even though they
persons as mentally

high relative to the other

as mentally
retarded may
classify severely disabled
may not actually be men

tally retarded.
Most
have multiple disabilities
(56.9%) of the respondents
(Jacobson
re
368 secondary disabling conditions were
& Janicki, 1983). Altogether,
condition
could be recorded as the primary
ported. Only one disabling
to have more than one secondary
but itwas possible
disabling condition,
condition.
the suggestion
disabling
Following
were classified as physical or emotional/mental
was developed:
1.
2.
3.
4.

of the DDPC,
disabilities
and the following typology

if it is
physical only (this includes persons with only one disability
physical);
that is
physical primary and at least one secondary disabling condition
emotional/mental;
emotional/mental
primary and at least one secondary disabling condi
tion that is physical; and
emotional/mental
if
only (this includes persons with only one disability
it is emotional/mental).1

The distribution of cases across this typology may be seen in Table 3.

One-seventh
of the respondents have only physical disabilities.
About half
of these persons have multiple physical disabling conditions.
By contrast,
37.2% have only emotional/mental
most
and
of these
conditions,
disabling
persons had only one such condition. Almost 49% had both physical and
emotional/mental

conditions.
these persons,
the emo
disabling
Among
is over 6 times as likely as the physical condition
tional/mental
condition
to be reported as the "primary" disabling condition.
on
Slightly more than 10% of the clients answer yes to a question
to a consumer/advocacy
whether
16.8% report that
they belong
group,
someone
in their home is a member of a consumer/advocacy
group, and
9.8% report that someone
in their immediate family is a member of such a
22.2% of the respondents
answer positively
to at least
group. Altogether,
one of the preceding
consumer advocacy
items concerning
group member
ship.

the suggestions
were classified
of the DDPC,
as emo
the following
conditions
following
tional/mental
emotional
mental
chronic
autism,
impairments:
illness), epilepsy/
(including
seizure disorder,
head
other neurological
and behav
retardation,
injury, mental
impairment,
ior problems.
All other primary or secondary
as physical.
were classified
conditions
disabling

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

130
POPULATIONAND ENVIRONMENT

FIGURE 1. Independence,

Integration and Productivity

Scales.

Self Perception

INDEPENDENCE

Mi
INTEGRATION

PRODUCnVTTY

100.0%

0.0%

(1)TOTALLY
gg (2)

(3)^

(4)

ATALL
(5)NOT

INDEPENDENCE, INTEGRATION AND PRODUCTIVITY

The respondents
report they need a lot of help. Few of them are capa
aid from others. When
considerable
ble of living independently without
care
in
need
self
asked how much assistance
(e.g., bathing, grooming
they
55.2%
and eating),
(58.5%) report
respond "a lot." A high proportion
a
others.
in
with
and
lot
of
understanding
communicating
help
needing
the lowest percent (38.4%) report they need a lot
The activity with which
and over 90% re
of help is personal mobility
transportation),
(excluding
in living on their own,
life management,
port needing a lot of help with
this
needs a lot
and in supporting themselves
Thus,
population
financially.
of help in doing a variety of basic things that would be necessary for them
to live independently.
from many sources.
It needs assistance
of independ
is reinforced when we examine measures
This notion
ence. The respondents perceive
in matters
that they exercise
little choice
areas
71%
in
lives.
of
their
them
respond
Although
everyday
key
affecting
29% respond they do not
that they choose their friends and acquaintances,
make

this choice.

Likewise,

40.1%

do not decide

what

to buy with

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

their

131
BOBWELLER

spending money, 40.2% do not determine what clothes to wear, 43.1 % do

not determine what
their weekend
and evening
activities will be. More
in other aspects of their lives. As may be
than half do not exercise choice
seen in Figure 1, over 42% rate themselves as "not at all" independent on
a 5 point scale.
The survey data also show low perceived measures
of productivity.
as "not at all" productive.
rated themselves
Half of the respondents
Even
(defined to include day and
though a very liberal definition of working
training programs) was used, only 27.3% of the respondents were currently
and only a slightly higher percentage
working
reported they had ever
worked.
This is consistent with Bowe's
report (1984) that, by nearly any
are unem
available
two-thirds of all persons with disabilities
analysis,
or community
in domestic
involvement
affairs is mini
Likewise,
ployed.
as fairly unproductive
rate themselves
members
mal, and the respondents
of their community.
The respondents
fare somewhat
better when measures
of integration
into the mainstream
of the community
and society are considered.
Al
though only 5% of the respondents
reported they voted in the last election,
more than half of them believed
in a variety of activities with
they engage
the "right" frequency. One must be careful in interpreting this evaluation.
Itdoes not mean they do the activity frequently (or as frequently as a per
as developmentally
son not classifiable
In fact, they may never
disabled).
in a particular activity.
Itmerely means
in a par
that they engage
engage
ticular activity with a frequency they believe
is "right" for them. The aver
lower (and
age score on the scale of self-perceived
integration is 3.3, much
hence more desirable)
than the scores for productivity
(4.0) and independ
ence (3.9). Nevertheless,
over one-third of the respondents
reported them
selves as lonely, less than half visit regularly with friends who do not have
a disability,
and almost three-fourths of the respondents believe
that most
of their friends are developmental
ly disabled.
the
in
this survey are not capable of independ
respondents
Generally,
ent living, they are not productive members
of the community,
and they
are segregated
from its mainstream.
This is very consistent with Biklin's
of the situation of disabled persons as exem
(1988) recent characterization
Biklin
contends
that any other group subjected
to
plifying marginality.
as a minority
these circumstances
would
be characterized
How
group.
has been to view persons who are developmental
ever, the tendency
ly
disabled as (a) victimized
by a disabling condition and (b) in need of treat
ment. He believes
that this clinical perspective
detracts from recognizing
that persons with a disability need rights. This keeps disabled persons from

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

132
POPULATIONAND ENVIRONMENT

FIGURE 2. Client

Satisfaction

with

Services.

0.0% 50.0% 100.0%

PERCENT

SATISFIEDg|
VERY
?2 DISSATISFIED ||

SATISFIED

|
VERY
DISSATISFIED

NEUTRAL

are disabled are per

being seen as a minority group. Thus, persons who
from social ostracism
than
rather
ceived as suffering from their disabilities
and discrimination.

SATISFACTIONWITH SERVICES
for various types of services
levels of satisfaction
Figure 2 presents
source. The respondents
of
received,
programmatic
regardless
currently
have been
95
with
of
satisfaction
were asked their level
services, which
cases
of
number
The
into eight general categories.
classified
upon which
not
of
number
are
the
is
based
the percentages
persons receiving services.
Some
services
received.
of
persons received none
Rather, it is the number
more than one. The
some
received
in
that particular group;
of the services
is health services (1135), followed
type of service most frequently received
services
and
services
(1002).
(1119)
transportation
by individual support
followed
is
vocational
service
The least received
(194),
by caregiver sup
port services (233) and residential services (315).
One must be careful not to equate higher levels of satisfaction with
levels of service may increase satisfaction
higher levels of service. Higher

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

133
BOBWELLER

is also a function of the client's expec

with those services. Yet satisfaction
are high, they are more difficult to fulfill
tations. When
these expectations
and hence a given level of service may be more likely to be regarded with
itmay be easier to meet
low expectations,
and
dissatisfaction.
Likewise,
have
low
be
satisfied
with
levels
who
low
of
may
persons
expectations
service received. The issue of how much satisfaction
should there be also
is faced with the
makes
the subject of satisfaction difficult to assess. One
dilemma of choosing between how full or how empty is a jar. For instance,
report they are satisfied
slightly more than three-fourths of the respondents
life in general. Yet almost one out of every four respondents do not
life in general. The same situation exists with
report they are satisfied with
services the respondent currently receives. Most of the reports are that the
is satisfied with the service. Still, there is room for improve
respondent
some clients are not satisfied with the particular service they
ment because
are receiving. Moreover,
these are current clients. One would expect cli
ents who are dissatisfied with services to be less likely to remain clients
than are those who are satisfied. Hence there is some selectivity
involved.

with

ismost frequently reported with caregiver support serv

Dissatisfaction
ices. There, one out of ten reports are that the client is "very dissatisfied."
Another 21.3% are "dissatisfied/'
Levels of dissatisfaction
10%
exceeded
for case coordination
individual support services
services, health services,
services. The level of satisfaction was highest for resi
and transportation
dential services, where 60.3% were "very satisfied" and 30.2% were "sat
isfied."

FACTORS ASSOCIATED WITH SERVICESATISFACTION

Because the level of satisfaction varies from person to person, one line
is the examination
is associated with the
of enquiry
of whether
satisfaction
client's
characteristics.
Different
levels of satisfaction
among particular
types of persons suggest that gaps exist in the service delivery system and
in which
it can be improved to increase overall
there are ways
levels of
client satisfaction. To do this, a summary measure has been devised which
is the chance that a service which
is received
is regarded as "very satisfac
re
For each respondent,
the number of services
tory" or "satisfactory."
as was the number of these which were satisfactory.2
ceived was counted,
terms for each respondent,
these in percentage
it is possible
By calculating
2For literary ease,
in the remainder
or "satisfactory".

of

this paper

satisfactory

means

a response

satisfactory"

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

of

"very

ro O O O

z
<

1^ CNo> o
rr CN
d d

00 O O O
r- O O d

CN ??N(NNN^---lflON
mOWKvON*?"l^K^(N
0000000000

Tf
- , m rn
\0 00
00 d d

t? <y\ tn (N cn v?>oor^mooorxTf
v?>CO ?? hv CN ,
rj-M f^ K C^ _
CNO O O O O O
O O O i- r?
00000000000
II
II
ill
?S?
-D
.2
*?Z

OINfNNvO^ONOOOivO
rOKr-0<-???^inr-roooqoqt-qor-^???oo??????
I
III

>
"S
-a
o

2
D
Z

LU

Q
O
oc

fi?

< I?
K
o

Il ^ '5 ? fl
u u y
LU IIJ2 '!/>ft
> ~

l?#

o g
5 T3

<u? =
fl
& >
S 3 ?

O _C

Q &\

.o

'IO ujMS'?75
1 s.

r- IX C0O
r- O O 0> CN vu i? ^t LO
O unm m O on CNm lo , cNo lo m
o CNo q
o o o o O CN "?tro m
ooooooooo
d d d d

5
O
X

l/l O 't n m
, m m i\ o v?>
mO??
OO
ddddd

o|l3

? il

O O O O O O O
I
III

d d d d d d
l l l l l l
cN r? o> oo tt oo
^r
r- sO
CN IX CT>
00 ^t
cNm t?- i? r- o q
d d d d d d d

i? m i\ rx lo m
O?- ro 0> ?CN ?? ?i\
o o
o
d d d d d d
I I I I l l

.2 <

t-vCN
cN Ln
r0L0rtO00CNv?5O
i\ o
?
~ro CN .Ixrj-oOrofNT?-t?
~ r(N r- (N tO O '
oooooooo
o o o o o

rE
. Z Z
u
"gd .1
<D.?

Il ?z
1h" Il -c

O?
d

"5
? >
in

>
>
o
5

o o o o
O O O O

z
i

-o
c

CNiri'tfON^rfNrN
CN'? ^f00OI\OO0>
OOCNOOOOOO
OOOOOOOOO

mM^inincotNr-K
o<-ooocnooo
o o o o o o
I I I I

l\ o o
LH CN
? *- I r\ in o
o o
o o o
ooooooooooo

|O

^^?=

l\ O ("O
O CNLO
O c*oO CN l\ ro
o o o o o o

vno^T? r^t? o??

T-inocNCNr, t? OcNOOt^OCNOOOro^t-^
O O O O O ?? rnr-OCNOCNCN
0000000000000

?
^s

Z > <

?] 5

'"

-?;""

?> ^ Q.'o

<NfNu-)Lnroo>r-omooocr>
t?
LDCNOrors
l^mOrno^t?
OOOOOOOOOOOO
dddddddddddd

<

>

o o o

c
<
5

>r

;2 5 >

</>

O?

.u

111
!'2

eu 'cy

r<) t^ O l\
Or- Tf rro
O sO '^,

vO0> CNLT)
CN0> CNvO

c
o

?-g

1* ? *

oo o> mr- o *?
M (N
(NK<00 IX rCNO
O O O
o o o o o o o
III
I

C^r-Ktn'tfN^
o??
olocooov.0??
*?O O
O O ?- ro ro
dddddddd
I I
I

I Qz
O
k
No?
oc
?5

o f

_ 5=* ?o
CD .?

QJ 3^ "3
I?& II

y? oooO'^-rMoor^'^-r^
fOOMINO^Cf>OKO
COr-fN o
OOOOOCN??
o o ooooooooo
I I
O CNO
CNO O

oc
c
o
E
<
c/i
C
O

'?t
,M
|rd

o d

O ? J

3ro c "E?. S
c? yoj
^ .2 J
?
u
? ^2 -E

"<
EI ?? eu
l
h

ii ?r - y?.
?2 o
tu ,_
E
< i
5 -: & il

O tri
ai
00 ?2 ?

UJ /)
O
<

o
E

?5 I

??8

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

135
BOBWELLER

to talk about
it. This
with
receive many

receives a service
is satisfied
the chance that a person who
across all types of service. Persons who
is a total measure
as equal to those who receive only a
services are considered

few.

Table 4 presents a matrix of the zero order correlation

coefficients
of
factors that may be related to satisfaction with service. Four of the correla
tions with satisfaction with service are statistically significant: age of client,
the client's
the number of services
and
received,
living arrangement,
and physical disabilities.
whether
the person has emotional
the
Although
is
it
is
between
and
satisfaction
nonlinear.
Closer
age
positive,
relationship
is high in the
examination
of the data reveals that the chance of satisfaction
to the 10-14 age group and then increases, reach
0-4 age group, declines
exists when
educa
ing a plateau around age 25. The same association
from consideration.
tional services are excluded
is a stressful time for all persons and their families be
Adolescence
cause itmarks a transition between childhood
and adulthood. Adolescents
are uncertain of what behavior
is appropriate for them. Persons who
inter
act with them frequently do not know whether
to interact with them as
lower levels of satisfaction among both
children or as adults. This creates
and the adults around them. Persons who are developmentally
adolescents
in this respect. This un
disabled may not be different from other persons
to
interact
how
and
deal
with
about
adolescents
may carry over
certainty
to the service providers. Services that are appropriate
for younger persons
and there may be a time lag before
may be inappropriate for adolescents,
this is recognized. Appropriate modes of service delivery may be different
than for younger persons. Thus, systems may be better at
for adolescents
providing appropriate services for children and adults than for persons who
are neither. Finally, young children should have joined the service delivery
network more recently than adolescents.
They may be more grateful to be
or
aware of the system's
services
less
be
inade
receiving any
they may
are
lines
These
fruitful
of
future
quacies.
inquiry.
Persons
living in a family setting report lower levels of satisfaction
than do other clients. This may be due to higher expectations
by those who
in family settings
live in family settings (or their surrogates). Also, persons
receive
less services that are needed and this may create a
may actually
with
dissatisfaction
the service delivery
system.
generalized
Publicly
to persons
in a family setting. Persons
funded services are less available
test.
live in families may have income too great to meet the means
who
test is present, case workers may expect the family to
Even if no means
assume a greater share of the responsibility
services. At the
for providing
same

time,

private

services

may

strain

or

even

exceed

the

economic,

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

psy

136
POPULATIONAND ENVIRONMENT

TABLE 5
Multiple

Classification

Analysis
with

of Predictors
Services

of Client

Satisfaction

Adjusted
No.

of

Unadj.
Mean

Cases

Eta

Mean

0.33

Age

0.20

0-4

29

75.9%

5-14

28

65.9%

72.9%

15-24

71

81.9%

80.9%

25-39

127
45

86.9%

86.9%

87.9%

83.9%

147
153

89.9%

90.9%

75.9%

75.9%

40 +
Family
Other

93
99
57
51

0-14
15-19
20-24

25 +

85.9%

84.9%

85.9%

80.9%

78.9%

79.9%

36
186
78
300

only

Phys/Mental
Mental only
All Cases
R Squared =

75.9%

Main effects
Age

0.08

74.9%

82.9%

84.9%

83.9%

80.9%

79.9%

82.9%

.214
Mean

Sum of
Source of variation

Home

0.21

82.9%

0.16

Type

Multiple

0.37

0.10

Numsr

Phys.

80.9%

0.34

Home

Beta

Squares

0.422
1.125

DF

Signif.

of F

Square

0.105
1.125

Numsr

0.410

0.137

Type

0.080

0.040

3.222

34.382
4.181
1.216

0.013

0.000
0.006
0.298

resources of the family. Also, obtaining

and emotional
needed
chological
inconvenient
services may be more
for persons
living in a family setting
in a setting such as an institution because of the need to
than for persons
transport the client to and from the provider. Table 4 also shows that per
sons living in a family setting perceive
as more
themselves
independent,

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

137
BOBWELLER

more

and more productive

than do persons
integrated into the community
live in other settings.
There is an inverse relationship between
number of services received
re
and the percent of services received satisfactorily.
Thus persons who
ceive many services are less likely to be satisfied with the services they
receive than are those who
receive only a few. This may be due to many
itmay be easier to overlook
factors. Need may be greater. Alternatively,
one
in
in 5 services.
service
than
shortcomings
shortcomings
seems
to
to
be
related
likelihood of satisfaction.
Finally, disability type
Persons who have at least one physically disabling condition
and at least
one mental/emotionally
are
more
condition
disabling
likely than other cli

who

ents to report satisfaction with services

When
these variables are subjected
Classification
(MCA), a
tiple
Analysis
for categorical
variables,
they explain
faction. After controls are introduced

received.
to multivariate
analysis using Mul
form of multiple
regression suitable
21% of the variance
in client satis
for the other three variables,
living
is the most
Number
of
arrangement
important predictor of satisfaction.
services received and age also remain important predictors. The relation
is not statistically sig
ship between disability type and service satisfaction
nificant. Treating age and number of services received as continuous
vari
ables produced
the same results: age, living arrangement
and number of
services received are statistically significant predictors of satisfaction with
services

received.

CONCLUSIONS
Most of respondents have multiple conditions.
Almost half report both
a physical and an emotional/mental
condition.
This means
that services
need to be tailored to individual needs rather than to program slots to
account for the multiplicative
nature of multiple conditions.
Levels of independence,
and integration
into the main
productivity
stream of society are very low for this group. Thus clients may need con
siderable support in daily living and in supporting themselves.
Clients are
active
to
Some
barriers
only marginally
greater productivity
economically.
are societal and need to be removed. Where
barriers to greater produc
in nature and cannot be removed, we may need to
tivity are not societal
can be enhanced.
design some creative ways that feelings of productivity
The clients are in effect socially segregated from society. Greater
inte
of the public,
increased ac
gration can be produced
through education
of discrimination.
The
cess, supportive
services, and the discouragement

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

138
POPULATIONAND ENVIRONMENT

recently enacted Americans with Disabilities Act is a promising start in this

direction.
with services cur
The reasons most frequently given for dissatisfaction
are
received
and
of amount. This
inappropriateness
insufficiency
rently
to
amount
services
the
of
needs
be
that
increased
and services
suggests
need to be tailored to meet the needs of the individual.
is caregiver
The area associated with the lowest levels of satisfaction
a
services.
Florida
better
of
the
do
needs
of the
may
support
job
meeting
individual client than those of his/her support system who provide care.
This is an area in which
the amount and appropriateness
of services ex
tended needs to be increased.
A number of fruitful areas for additional
inquiry are suggested by the
are
less
Adolescents
than
other
persons to be satisfied with
findings.
likely
are received. This may be due to the stress associated
the services which
adolescence
itself. Itmay also be the case that the service delivery
system does better at delivering appropriate services in an appropriate fash
ion to children and to adults than it does to persons undergoing
the change
to adulthood.
from childhood
is a period when
Adolescence
self-identity
as an adult emerges.
The adolescent
may feel frustrated that the service
that is perfect.
system does not produce a self-identity

with

The greater the number of services a client receives the greater the
level of dissatisfaction
with services. A high number of services received
of a situation for which
may be indicative of the existence
simple and
solutions are extremely difficult to attain. Need may be greater.
adequate
it may be easier to overlook
in one service
Alternatively,
shortcomings
than to overlook
in several services. Moreover,
shortcomings
receipt of
services may raise expectations
if unmet,
increase levels of dissat
which,
isfaction. Thus, there may be a cumulative
effect which
is transformed
into
an expression
of dissatisfaction.,
live in a family setting are less likely to be satis
Finally, persons who
fied with the services they receive than are other persons. This may be due
to higher levels of expectations,
lower levels of public funding for services,
or the inconvenience
of obtaining
the appropriate
services.

REFERENCES
Journal of Social
Biklin, D. (1988). The Myth of clinical
Issues,
judgement.
F. (1984). Demography
A chartbook
and disability:
for rehabilitation.
Bowe,
Arkansas
Rehabilitation
Research
and Training Center.

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions

44,

127-140.

Fayetteville,

AR:

139
BOBWELLER

for the Study of Population.

(1987). A demographic
study of persons with develop
in Florida, Part I, Demand
mental
disabilities
FL: Center
for the
Tallahassee,
analysis.
Florida State University.
Study of Population,
of multiple
dis
(1983). Observed
J.W., & Janicki, M.P.
Jacobson,
prevalence
developmental
abilities. Mental
Retardation,
21, 87-94.
on disability
M.
Data
from
the National
Interview
Health
(1988).
LaPlante,
Survey,

Center

1983-1985.
D.C: National
Institute on Disability
and Rehabilitation
Re
Washington,
search.
Association
National
of Developmental
Disabilities
Councils
(NADDC).
(1990).
Forging a
new ERA: The
1990 reports on people
with developmental
disabilities.
Washington,
Association
of Developmental
D.C: National
Disabilities
Councils.
B. & Sincich,
F. (1988). Population
estimates
and projections
Smith, S.K., Ahmed,
by age,
sex and race for Florida and its counties,
1987-2000.
Bulletin No.
Studies,
Population
85-86. Gainesville,
FL: Bureau of Economic
and Business
of Flor
Research,
University
ida.
M.S.
retarded? severely
(1984). Severely
J.W. & Demchak,
Tawney,
handicapped?
multiply
A definitional
in Early Childhood
handicapped?
4,
analysis.
Topics
Education,
Special
1-18.
of Education
on the implementa
U.S. Department
(1985). Seventy annual report to Congress
tion of Public Law 94-142:
The education
for all handicapped
act. Washington,
children
D.C: U.S. Department
of Education.
L.M. (1982). Sex differentials
in health. Public Health
97, 416-437.
Verbrugge,
Reports,
M.M.
(1989). A demographic
R.H., Sly, D.F.,
Weller,
Serow, W.J. & Micklin,
study of per
sons with developmental
in Florida. Tallahassee,
disabilities
FL: Center
for the Study of
Florida State University.
Population,

This content downloaded from 137.151.141.100 on Thu, 20 Nov 2014 13:39:45 PM

All use subject to JSTOR Terms and Conditions