Comparative Domestic Policy Paper Series 09

STRATEGIES AND INCENTIVES FOR MATCHING

DISABLED WORKERS WITH JOBS:
LESSONS FOR ITALY FROM THE UNITED STATES

Patrizia Saroglia
Fellow, Comparative Domestic Policy program
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 Strategies and Incentives for
Matching Disabled Workers with Jobs:
Lessons for Italy from the United States

Comparative Domestic Policy Paper Series

September 2009

Patrizia Saroglia, Fellow, Comparative Domestic Policy Program*

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Background: U.S. and Italian Frameworks and Challenges . . . . . . . . . . . . . . . . . . 4
Conclusion: Open Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

*Patrizia Saroglia is a research associate with A.lea Consulting, a research firm based in Turin, Italy, where she is responsible for
analyzing the performance of services offered to persons with disabilities by employment offices in Italy’s Piedmont region, as
well as services offered by local governments in the region. Ms. Saroglia is also coordinator of LAPO (Laboratorio di politiche
pubbliche), a research center for policy analysis located in Turin, where she oversees research projects on behalf of a number of
public administrations.

As a fellow of GMF’s Comparative Domestic Policy Program, Ms. Saroglia spent three months in the United States examining
services and programs—in Baltimore, Madison and Milwaukee, New York City, Philadelphia, and Washington, DC—that are
designed to encourage people with disabilities to find work and leave cash assistance. Ms. Saroglia’s research focused particularly
on programs for people with mental disabilities, the most stigmatized category of job-seekers; programs for young people with
disabilities looking for their first job; how recent changes in U.S. policies for people with disabilities have affected various disability
programs; and the role of public-private partnerships in the national network providing services at the federal or state and
local levels.
Executive Summary
This policy paper, based on three months of
research in the United States conducted under
the auspices of the German Marshall Fund’s
Comparative Domestic Policy Fellowship, provides
recommendations to Italy’s Piedmont region
government on how to better encourage people
with disabilities to become employed and to leave
cash assistance programs.
Since the 1990s, policymakers in the United States
and Italy have each demonstrated an increasing
interest in integrating people with disabilities into
the regular labor market, giving rise to employment
strategies for long-term welfare recipients. Both
countries are developing more customized and
more integrated services to match job seekers with
employers, but the fragmentation of these programs
remains a significant barrier. Many programs look
like puzzles with incorrect or missing pieces that
struggle to stay together.
Strategies and Incentives for Matching Disabled Workers with Jobs:
Serious challenges remain to be addressed. First,
in both countries, people and policymakers must
abandon the idea that there are only two categories
of people: those who are able to work and those
who are disabled and therefore must be supported
by cash assistance. Secondly, the programs must
shift from an attitude of “work based on disability”
to an approach of “work based on ability.” U.S.
programs need to eliminate the barriers created
by the current programs’ limits on earnings to
avoid the “trap of poverty” sometimes related to
the disabled person’s condition. Finally, Italian
programs need to change their approach toward
employers, designing a large and differentiated
set of incentives for employers to hire disabled
workers, rather than imposing penalties to force
employers to hire people with disabilities.
3
Lessons for Italy from the United States
1 Background: U.S. and Italian
Frameworks and Challenges
In the last decade, a hot topic for policymakers
in the United States and in Italy has been how
to encourage people with disabilities to become
employed and to leave cash assistance programs.
Since the 1990s, in both countries, an increasing
interest in integrating people with disabilities
into the regular labor market has given rise to
employment strategies for long-term welfare
recipients. Every year, more policymakers provide
an even broader range of services and incentives
to assist people with disabilities in keeping the jobs
they have and to facilitate the hiring of those who
are unemployed.
Signed in 1990 and amended for the third time in
2008, the Americans with Disabilities Act (ADA)
required employers for the first time to provide
reasonable accommodation for disabled workers,
and prohibits discrimination in hiring, firing, and
pay. As a result of this law, the United States has
developed a number of federal-level programs to
improve the productivity of disabled workers and to
remove existing barriers and disincentives to work.
An example is the Ticket to Work (TTW) program,
included in the Work Incentives Improvement
Act of 1999, and launched in the same year. TTW
represents the most significant U.S. effort to
increase access of Social Security Administration
(SSA) disability beneficiaries to rehabilitation,
training, and job placement services.
The prevailing Italian approach to this problem
(L. 68, 1999) has been to impose a quota system on
employers to guarantee access to work for people
who are at least 46 percent disabled, essentially
forcing employers to hire a given number of
disabled persons or face monetary penalties.
The national-level policy is supplemented by the
intervention of Provincial governments (the Italian
intermediate level government, roughly equivalent
to U.S. county government), which have worked
to improve cooperation between local agencies in
order to increase the availability of specialized and
more integrated services to persons with disabilities.
4 The German Marshall Fund of the United States
Neither the ADA (along with the ambitious
program launched in the last ten years in United
States), nor the Italian law enacted to guarantee
access to work for the hard-to-employ, has
achieved, in full measure, the outcomes expected.
As of 2009, a sizeable number of people with
disabilities in the United States continue to receive
cash assistance (14 percent of the U.S. population
is classified as disabled, and among this percentage
only 42 percent of the male population and 32
percent of the female population is working). The
number of such beneficiaries who have become
economically self-sufficient is significantly lower
than was originally estimated or expected.
A number of factors have contributed to these
disappointing results. A basic contradiction in the
current system is that a worker who earns more
than the amount of cash assistance is subject to a
consequent reduction or loss of benefits. People
with disabilities who are unemployed, therefore,
have little financial incentive to move from a
secure, permanent source of support toward the
uncertainties of the open labor market. In addition,
according to a research report carried out by
Mathematica Policy Research (2008), “The U.S.
cash disability benefit programs—Social Security
Disability Insurance (SSDI) and Supplemental
Security Income (SSI)—require that a person be
unable to work to qualify for benefits, which limits
the return-to-work outcomes, and in part explains
why few people leave the SSDI and SSI programs.”
In other words, a person receiving disability
benefits has, therefore, been classified as inherently
“unable to work,” a powerful administrative and
psychological barrier to transitioning into the
regular labor market.
Italy’s alternative approach, an imposed quota, also
fails to assure suitable and lasting employment
for the country’s 5.6 million disabled persons
(10 percent of the total population). The system is
especially ill-suited to the characteristics of small
businesses, which make up a large proportion—
approximately 34 percent—of the Italian economy.
A typical Italian small business cannot employ
more than one or two disabled people, and the
limited size of their staff makes it difficult for these
employers to dedicate themselves to the integration
of the disabled worker. Consequently, small
businesses often choose to pay a sanction rather
than employ disabled workers. This tendency
for the disabled worker to be isolated or poorly
trained, combined with the fact that the quota can
be filled with short-term contracts, often results
in a premature exit from the labor market by
persons with disabilities and return to a reliance on
disability benefits for the long term.
A number of special local initiatives have
been introduced in the province of Turin (an
administrative division of the Piedmont region that
includes the city of Turin), where approximately
1,700 people classified as “hard-to-employ” are
enrolled at Employment Centers, of which roughly
1,000 of these are disabled. These disabled people
represent 7 percent of the total unemployed
population in the province. Local policymakers,
utilizing funding from the European Regional
Development Fund Operational Programme for the
Piedmont region, have introduced several expensive
interventions to improve the opportunities for
these disabled persons to enter and remain in the
work force. The new regional program is designed
to enhance the employment chances of the
disabled through a combination of stronger work
incentives, counseling, and employment support.
However, now that the program has become better
established, shortcomings have become apparent.
So far a large fraction of the beneficiaries drop out
of the program very early because, for example,
they don’t receive all necessary information about
the program procedures to follow (resulting in a
lack of trust in the program), or they have to wait
too long to be served.
Strategies and Incentives for Matching Disabled Workers with Jobs:
Therefore, despite new policy frameworks and
major investments in both the United States
and Italy in the past two decades, initiatives to
integrate more people with disabilities permanently
into the regular labor force have significantly
underperformed. In both countries the question
remains: how can policymakers at the national,
regional, and local levels boost employment for
people with disabilities, and what services are
most effective in the effort to help them find and
keep jobs?
The policy framework in the
United States and Italy
In Italy, policies to help people with disabilities find
and maintain jobs are generally designed at the
regional level and implemented at the municipal
level.1 Employment programs for persons with
disabilities tend to be part of social policy—the
“social safety net”—rather than integrated into
broad strategies for employment and training.
This creates a basic contradiction where the
practitioners best trained to deal with disabled
clients are located in programs separate from
practitioners who are most experienced in placing
unemployed workers. On the one hand, the Italian
employment service, the nerve center of the
employment services network, lacks the capacity
to serve the target beneficiaries, especially people
with mental disabilities. On the other hand, the
social services that focus on people with disabilities
often can offer only sheltered employment, not real
jobs. In addition, the stakeholders in improving
these programs are mostly public sector entities and
the private sector struggles to compete with them,
or similarly, lacks the characteristics to serve this
specific target of population.
1 
Italy is subdivided into 20 regions with significant legislative
and administrative powers. Regions are further subdivided into
provinces, which tend to have little legislative authority and
municipalities (comuni). The comune of Turin, for example,
is part of the Province of Turin, which is in turn part of the
Piedmont region.
5
Lessons for Italy from the United States
 In contrast, American policies are designed at all
government levels, and it is the norm for private
and nonprofit entities to act as operational partners
in employment programs. Some individual U.S.
states’ labor departments house Divisions of
Vocational Rehabilitation (DVR), which can act
as primary policymakers and stakeholders who
Both the United cooperate with departments of health, housing,
States and Italy education, etc. to design, develop, and implement
are employing new disability programs. Furthermore, nonprofit
approaches in agencies, including disability associations,
the development universities, and foundations are frequently
of the next program leaders alongside public-sector
program staff.
generation of
policies to help
Serving diverse populations: The
people with
open challenges of stigmatization
disabilities and fragmentation
find and keep
To identify and understand the differences between
a suitable job,
Italian and American policy approaches, it is
shifting from the
necessary to characterize the programs designed to
belief that people help people with disabilities, first by observing the
with disabilities
common challenges that concern both countries.
are a cost to
One of the most difficult issues around
employers, to
the belief that implementing effective policies to match persons
they represent with disabilities to jobs is that, despite the laws
enacted to defend employment rights of people
a resource.
with disabilities, there remains in both countries
a stigma around the disabled, in particular a
strong stigma against mentally disabled persons.
While this stigma is prevalent throughout the
two societies, it is especially detrimental in the
context of attempts to induce employers to hire
persons with disabilities. Simply put, many
employers believe that people with disabilities really
cannot work.
In Italy, this belief translates into sheltered jobs
for people with intellectual and developmental
disabilities, an issue compounded by a lack of
support programs (e.g. training or on-the-job
6 The German Marshall Fund of the United States
counselling) targeted toward this range of
beneficiaries. In the United States, the stigma may
be more subtle, but as in Italy, many programs
have no special provisions to support this category
of beneficiaries, a problem that is all the more
acute given that many U.S. programs create overly
complex rules or conditions for participation in
employment programs. The complexity of many of
these programs risks leaving the beneficiary alone
to make difficult decisions about the path to follow,
and how to navigate among several different offices
or locations to access the full range of assessments
necessary to comply with the programs’
requirements for participation.
While, in both countries, major gaps such as
these prevent the efforts of recent decades from
forming an integrated, comprehensive framework,
both the United States and Italy are employing
new approaches in the development of the
next generation of policies to help people with
disabilities find and keep suitable jobs, shifting
from the belief that people with disabilities are a
cost to employers, to the belief that they represent
a resource.
A brief review of the last decade of American and
Italian programs shows a common desire to address
the unemployment of persons with disabilities.
Both countries are developing more customized
and more integrated services to match job seekers
with employers. But both countries need to increase
multi-agency coordination systems, improve overall
quality of services provided, reduce the duplication
of certain functions, and avoid misuse of funds.
This issue is more visible in American programs,
which have larger and more integrated stakeholder
networks (especially on the private side) than do
Italian programs. The impact of this wider network
on the overall ability to provide streamlined,
customized services to diverse populations is
mixed. Some argue that these networks contribute
to resource dispersion, but they also result in a
wider spectrum of solutions to better serve clients
with different kinds of disabilities.
But what does it mean to provide customized and
integrated services? The first order of business is
to match the needs of the target population with
the services of the program, clearly identifying
the categories of beneficiaries in order to design
and tailor the interventions—speaking about
“people with disabilities” is not enough. Often,
U.S. programs are launched with a block grant to
communities, which come with an assortment of
rules for the use of these funds (covering eligibility,
benefits, and services) and a set of specific and
general social goals. In many cases, the strategic
implementation of programs designed at the federal
or state level (U.S.) or at the regional level (Italy)
is left to local officials, and the resulting program
may not provide the services conceptualized in the
initial design. On the other hand, the block grant
program goals often don’t match the needs of the
target population because they are designed at a
broad, general level without taking the specific local
context into account.
Definition of disability and eligibility criteria—
integrating people who are “unable to work”
The Americans with Disabilities Act contains an
official definition of disability, as does the Italian
law. On the whole there are significant similarities.
However, in both countries, the real question
is whether or not the various stakeholders of
the programs interpret disability with any
commonality. A properly contextualized definition
of disability, especially in relation to work, can
make all the difference in choosing the proper
interventions to implement. Sharon Snyder
writes in Cultural Locations of Disability (2006)
that “disability no longer means a condition, an
incapacity, or lack that belongs to a body, but rather
a product of the interactions between self, society,
Strategies and Incentives for Matching Disabled Workers with Jobs:
body, and the variety of interactions (from political
economies to personal commitments) that they
engender.” If policymakers, providers, employers,
and beneficiaries all believe that a disability is
an “experience that everyone could have in his
life,”—not a lack of ability but a mismatch between
perceived capabilities and the perceived needs
of society—it makes a difference in the way that The first order
interventions are implemented. of business is to
In Italy and within Italian programs, the debate
match the needs
about what constitutes a “disability” is open. Here, of the target
there remains a basic contradiction in attitudes: the population with
government declares that persons with disabilities the services of
can’t really work and then proposes programs the program,
to put the disabled back to work. The same clearly identifying
contradiction exists with the American Ticket to the categories of
Work Program. As a Mathematica report (2008) beneficiaries in
affirms: “The primary U.S. cash disability benefit order to design
program […] requires that a person be unable and tailor the
to work to qualify for benefits, which limits the interventions—
return-to-work outcomes, and in part explains why
speaking about
few people leave the SSDI and SSI programs.”
“people with
In the United States, as in Italy, to become a disabilities” is
beneficiary in a program a person must prove that not enough.
he or she is disabled. In both countries the list of
eligibility criteria, the official reference in making
the first assessment of disability, is focused on
medical conditions and the individual’s illness.
This approach is ill-suited to determining an
individual’s skills and barriers to work, which are
the most important factors in matching him or
her with an appropriate job. This approach can be
misleading and may lead to a misrepresentation
of the type of job a person with a disability can
perform. For this reason the American Association
of People with Disabilities (AAPD) and the United
States Government Accountability Office (GAO)
recommended in 2007 that policymakers update
the criteria used to determine the capacity to work
on the part of people with disabilities, keeping in
mind the job seekers’ skills and the current labor
7
Lessons for Italy from the United States
 BOX 1. A large network of stakeholders in the United States
To give the sense of the variety and the extent of the U.S. network of services consider the following:

• Maximus, Inc. has been selected to serve as the program manager for the TTW program and manages all the
900,000 tickets sent to beneficiaries. One of their primary responsibilities includes the recruitment of Employment
Networks (EN).1

• The Humanim nonprofit social services agency, based in Columbia (MD), is one of the operators, with Johns Hopkins
The Piedmont University, of the Start on Success (SOS) program in Baltimore. The SOS program also exists in Philadelphia,
supported by the Marriott Foundation and the University of Philadelphia. SOS in Philadelphia is a transitional
Regional program from school to work for young people with disabilities.
Government
should set up • Humanim is also a lead developer of the just-completed restoration project of the American Brewery building in east
Baltimore. Humanim’s president and chief executive officer said they hope to provide hundreds of needy people
a deliberative with job training and clinical support for children and adults with developmental and behavioural disabilities. Current
public process, plans include hiring 250 employees from the immediate neighborhood and opening the 32,000-square-foot building
to the community for events and activities.
incorporating
people with • Another nonprofit organization, Melwood, an Upper Marlboro, Maryland-based agency, employs developmentally
disabled adults following completion of a specially designed training program. Their most recent contract was signed
disabilities, with the U.S. Department of Agriculture to care for and maintain the entire six-acre People’s Garden on the National
experts, Mall in Washington, DC.2
policymakers,
• As a final example, the Clubhouses of NYC, Madison and Milwaukee (WI) support individuals living with the effects
and medical of mental illness. A simple mission sustains the work of the International Center of Clubhouse Development (ICCD):
institutions, to “Through participation in a Clubhouse people are given the opportunities to rejoin the worlds of friendships, family,
important work, employment, education, and to access the services and supports they may individually need,”
work on new believing that recovery from mental illness is possible for all. In fact, every Clubhouse tries to enable its members to
eligibility criteria return to paid work through transitional and independent employment.
to add to the
1 
According to the Social Security Administration (SSA) website, an EN is “an organizational entity (State or local, public or private) that
International enters into a contract with SSA with the intention of coordinating and delivering employment services, Vocational Rehabilitation services,
Classification and/or other support services under the Ticket to Work Program,” and which works with beneficiaries “who have assigned their Tickets
to the EN which has accepted the Ticket.” Source: http://www.ssa.gov/work/envr.html#what_is_EN
on Functioning 2 
(as reported by the Washington Post, April 22)
of Health and
Disability (ICF)
currently in use. market needs. In Italy, a similar need to rethink the with limitation; temporarily employable; and
criteria of what constitutes ‘disability’ is manifested unemployable. This distinction helps to develop
in the classification of impairments as “temporary” different and personalized actions to assist
(reversible) or “permanent” (irreversible). individuals and families with physical and/or
mental health barriers to employment achieve and
In contrast, New York City’s Wellness, sustain their maximum degree of self-sufficiency.
Comprehensive Assessment, Rehabilitation and This approach affirms that the concept of disability
Employment (WeCARE) program categorizes is a concept in progress, and consequently the job
clients into five types of possible recipients: seekers’ eligibility criteria, needs, and barriers have
employable with no limitations; employable to be periodically redefined.
with minimal accommodations; employable

8 The German Marshall Fund of the United States

In order to create categories of disability that
are better suited toward matching persons
with disabilities with appropriate work, the
Piedmont Regional Government should set up a
deliberative public process, incorporating people
with disabilities, experts, policymakers, and
medical institutions, to work on new eligibility
criteria to add to the International Classification
on Functioning of Health and Disability (ICF)
currently in use. An open space technology event,
for instance, could be organized in Turin. The city
recently hosted a similar event to discuss health and
pollution issues and has the capacity to manage a
similar event on disability criteria.
The new approach—incentives for
programs to match abilities with jobs
The changing approach of the latest generation of
American programs for people with disabilities can
be characterized as work based on ability vs. work
based on disability. This stands in stark contrast to
the Italian policy perspective, which is still based on
a protective logic that emphasizes defining all the
impediments to work.
The “work based on ability” approach is a
complete change in point of view that provides
an important basis in designing new policies. The
U.S. federal government, as well as the Maryland
and Wisconsin Departments of Labor’s Divisions
of Vocational Rehabilitation (DVR), for example,
are designing new programs that ask services
within their systems to demonstrate the ability to
match job seekers with suitable jobs and with the
employers’ needs.
The federal TTW program exemplifies one
methodology for achieving this match. The
program employs a distinctive approach—money
in the hands of beneficiaries—that allows the
claimants to select the provider with whom to
Strategies and Incentives for Matching Disabled Workers with Jobs:
spend the voucher received to purchase services.
This payment system differs from the traditional
SSA payment standard of cost reimbursement,
instead using an outcome-oriented voucher system.
Known as the “Milestone payment” providers
receive partial payments when beneficiaries achieve
work-related milestones prior to leaving cash
benefits, and correspondingly lower payments once The changing
beneficiaries exit. approach of the
latest generation
Following this approach, the Wisconsin State
Department of Workforce Development recently of American
presented “Making Work Pay” to the Social programs for
Security Administration for a pilot demonstration people with
program. The Making Work Pay program is disabilities can
designed to address the issue of disabled workers be characterized
of a certain income level losing their cash benefits, as work based
and is targeted toward SSI or SSDI beneficiaries on ability vs.
with significant disabilities who want to work, but
work based
have high cost long-term care needs (disability- on disability.
related expenses that cannot completely be covered
through earned income). Making Work Pay is a
cost-sharing program that proposes eliminating
earning limits that cause beneficiaries to lose care
benefits. Beneficiaries can buy what they need in
exchange for a monthly premium determined by
individual earning capacity.
Incentives for employers instead of penalties
The American policy framework doesn’t apply a
quota system or penalties, as the Italian law does,
but rather employs an approach that communicates
the message that people with disabilities are
resources, not liabilities. In contrast to the Italian
system, U.S. employment support policies are
characterized by a set of incentives to encourage
employers to hire people with disabilities. The
incentives can be monetary resources, tax
discounts, or extensive support services needed on
an ongoing basis to support and maintain a person
9
Lessons for Italy from the United States
 in competitive employment, provided at no cost
to employers.2
These incentives need not be costly; in fact, the
most effective incentives often come in the form
of strong communication between services and
employers. One example is to assure employers that
The success their insurance premiums won’t increase if they hire
of people with people with disabilities (this cost is initially paid
by the program, then by the individual when he or
developmental or
she becomes self-sufficient). Another incentive is
mental disabilities
the provision of reasonable accommodations that
depends
an individual will need to compete for the job. For
on a strong example, an individual with a neck injury who
and trusting worked in a lab had difficulty bending his neck
relationship to use a microscope. The solution was to attach a
between program periscope to the microscope (cost: $2,400). Almost
services and all U.S. programs to encourage people to come back
the employers. to work give these types of incentives, relieving the
employers from a purchase. In another situation,
a teacher with bipolar disorder experienced
reduced concentration and short-term memory
loss. The solution developed by coworkers and the
supervisor: a checklist showing both the week’s
work and the following week’s activities (cost: $0,
and the time spent to write the checklist gave an
unintended bonus to the company in training
new staff).
In addition to such specialized equipment
or procedures, the success of people with
developmental or mental disabilities depends on a
strong and trusting relationship between program
services and the employers, and necessitates the
use of experts (psychologists and psychiatrists)
who remain available for resolution of new
2 
The Manual for Wisconsin Employers (a product of the non-
profit organization WorkSource Wisconsin, in cooperation
with the Wisconsin Division of Vocational Rehabilitation, the
University of Wisconsin-Stout, and the Wisconsin Department
of Health Services with the Pathways to Independence
program) describes benefit to employers, including on-the-job
training resources, no-cost job placement, operation analysis,
post-employment follow-up, and technical assistance with
workplace accommodations.
10 The German Marshall Fund of the United States
issues as they arise on the job, not just during the
process of job placement, as the Wisconsin DVR
Administrator underlines. This is considered high
cost, but it has to be seen as an investment that,
adopting a long term perspective, might cost less
than having a person fired, only to have to reinsert
that person in a new program. As the secretary of
the Maryland Department of Disabilities said at
the German Marshall Fund of the United States’
Marshall Forum in Washington, DC last May:
“The policies for people with disabilities are not a
cost like a grant, but a cost like a mortgage: they are
an investment.”
With regard to this, the Wisconsin DVR
administrator gave the example of a mentally
disabled worker employed in a laundry who had
a violent outburst with a client. After this episode,
the employer, instead of firing him immediately,
decided to call the DVR caseworker, a psychologist
who went to the place of work to examine what had
happened. The expert explained to the employer
that the worker, who suffered from schizophrenia,
could not have someone standing behind him
and proposed moving his workspace, in order to
position the man with his back facing the wall.
As a result, he can iron without having to worry
about people standing behind him. This solution
was accepted by both the employer and the worker
and seems to be working well. Such a practical
and simple solution cannot be applied every time,
but it gives the sense of importance in building
relationships of extended duration between service
providers, employers, and employees.
Targeted interventions for diverse
beneficiaries: Youth and persons
with mental disabilities
During my stay in the United States, I was looking
for programs for two specific target populations:
people with mental illness—the hardest to serve—
and young people with disabilities looking for their
first job.
With respect to the first group of people with
mental illness, I observed that every program in
the United States, from the federal to the local
level, mulls over this type of client and searches
for real, suitable jobs. They are not looking to put
the mentally disabled into sheltered positions.
However, simply guaranteeing access into a
program for people with mental disabilities is not
enough. Mental illness can make it very difficult
for the jobseeker to navigate the program’s often
complex procedures, pursue vocational training,
and look for a job. Furthermore, a person may have
multiple barriers to employment.
In this regard, the appropriate training of staff in
the various programs’ offices is essential. Vendor
staff also need training and must build the skills
necessary to better serve people with severe mental
diseases. A special liaison, such as a psychologist or
a psychiatrist, may be needed to follow recipients
from the first assessment to the actual place of
employment, and should be available over some
period of time for both the client and employer.
While providing this type of support is a financial
challenge for both the United States and Italy, it
is a highly effective way to improve the success of
employment placements for the mentally disabled.
This is the rationale behind the U.S. Disability
Navigator Program (DNP), jointly implemented in
2003 by the U.S. Department of Labor (DOL), its
Employment Training Administration (DOLETA),
and the Social Security Administration (SSA),
placing job counsellors with special training
to help persons with disabilities in One-Stop
Employment Centers throughout 44 states. These
centers facilitate access to and navigation around
the various programs that affect all categories of
SSA beneficiaries, including those with and without
disabilities, helping them obtain and/or retain
jobs. The initiative includes nonprofit partners like
the Pennsylvania Training Partnership for People
with Disabilities and Families (in partnership
Strategies and Incentives for Matching Disabled Workers with Jobs:
with Temple University’s Institute on Disabilities),
which works to provide information on and explain
the systems that serve people with disabilities,
allowing people “to move through more easily,
to use systems more fully, and to change systems
more effectively.”
With respect to young people with disabilities
Like the Starting
(14–24-year olds) in transition from school to
on Success (SOS)
work, the Italian system has no institutionalized
solution to offer. However, throughout the United
program in the
United States, the
States there are valuable initiatives like the Starting
on Success (SOS) program, launched in 1994 in Piedmont Regional
Philadelphia by the National Organization of Government
Disability (NOD). SOS is now becoming an urban should attempt
model, with programs in Baltimore and Pittsburgh a similar pilot
and a mix of urban and rural initiatives in Alabama program in Turin.
and Connecticut. SOS is a unique transitional
model intended to increase the career potential of
high school students with disabilities by offering
paid internships in a real place of work. For part
of each day, students attend special education
classes taught by their teachers at job sites—nearby
universities, hospitals, and corporations which are
partners of the project—and spend the rest of their
day working in other locations on site.
In regard to this, I propose that the Piedmont
Regional Government attempt a pilot program
like SOS in Turin, to test how a public-private
partnership can empower the community’s youth,
create tailored solutions for the local area, and
investigate which interventions are necessary to
prevent the increase of unemployed young people
and consequently an increase of beneficiaries
within the public programs.
11
Lessons for Italy from the United States
 2 Conclusion: Open Challenges
In both Italy and the United States there remain
serious challenges to be addressed. People and
policymakers from both countries must abandon
the idea that people with disabilities inherently
cannot work. The United States needs to address
the limitations created by the current restrictions
on earnings in programs like TTW. These
People and employment disincentives perpetuate the “trap of
policymakers from poverty.” In Italy, the welfare system guarantees
both countries public employment insurance for everyone, but this
must abandon the guarantee is only a starting point.
idea that people
The Italian programs need to change their
with disabilities approaches toward employers, designing a large and
inherently differentiated set of incentives rather than penalties
cannot work. that force employers to hire the disabled. They must
spread the message that people with disabilities are
resources, not liabilities.
In the United States, there are more than 20 public
agencies, 150 federal partner organizations, and 200
federal programs to help people with disabilities
find and retain employment, and the system is
enriched by the private sector’s contribution.
In Italy, the network is more restricted and a
narrower and less innovative range of policies is
implemented, yet the Italian stakeholder network
presents the same problem of fragmentation. When
new programs are piloted in Italy, interventions
tend to be specialized but short term, which is
inadequate in making a substantial impact on
increasing work opportunities for people with
disabilities. Finally, in both countries, even if issues
of program capacity are settled enough to operate
at an acceptable level, the programs still meet
implementation challenges in striving to provide
services in the right place at the right time.
12 The German Marshall Fund of the United States
More questions remain open: At which
governmental level should policies be designed
to boost employment for people with disabilities?
How can different public agencies, nonprofits,
and private actors in these countries improve
their ability to cooperate and clearly mark the
responsibilities for implementing programs? How
can services be integrated without losing their
autonomy and specialized nature? What are the
right rules (e.g. not overly strict or complex for
mental illness beneficiaries) and what is the right
amount of time to allow the program and the
employer to work together to find the right job for
a beneficiary? Is six months adequate or is more
time required?
Italian programs can learn from the United
States’ programs by adopting the most innovative
approaches, while taking into account the cultural,
economic, and legal differences between the two
countries. The American initiatives reviewed over
three months of my fellowship are proof that people
with mental disabilities can have real jobs and the
network of stakeholders involved may be large,
differentiated, and include employers and still
be effective.
3 Acknowledgements

Many people contributed in considerable ways to MAXIMUS Inc.; Donald R Pollock, Melwood;
the preparation of this paper. Henry Posko and Cindy Plavier Truitt, Humanim,
Inc.; Claude Schrader, Communities in Schools of
First and foremost, I’m grateful to GMF’s Philadelphia; Jill Welsh Davis, Greater Philadelphia
Comparative Domestic Policy Program staff: Urban Affairs Coalition, Donna Griffith, CAVS
Ellen Pope, Brent Riddle, Julianne Stern, and Volunteer Services Department of Philadelphia;
Elizabeth Woods. Kristin Ahrens, Training Partnership for People
with Disabilities and Families, Philadelphia
I would also like to thank all the people that I met
Temple University; Suzy Silverman, New York
in the three months of my fellowship for all the
City Fountain House; Michael Bosket, Human
time they dedicated to briefing me and navigating
Resource Administration (HRA) of the City of
me through the American policy and programs
New York; Mitchell Netburn, F·E·G·S WeCARE;
for people with disabilities in several cities and
Roberta Solomon-Citron, Assistant Vice President,
offices: Dan O’Brian and Tom Hale, Social Security
New York City VRS, Gabe Sofos, Wellness, CSP,
Administration (SSA); Rhonda Basha, Jennifer
SSI, CRT; Cynthia Gonzalez, CSP & Wellness;
Kemp, Randee Ellen Chafkin, Carol Boyer, Richard
Karen Berniker, Yasheenya Jackson Vocational
Horne, Mario Damiani, Sherry West and Beth
Rehabilitation Services (VRS) Manhattan; Myra
Bienvenu, U.S. Department of Labor, Office of
Mayo, WE cARE Case Management; and Pat
Disability Employment Policy (ODEP); Kate
Jenkins-Spady, Carl Cooke, Kelly Washburn,
Drake, Maryland State Department of Education,
Sophia James, Marcia O’Brien, and Wanda Moguel,
Division Rehabilitation Services; Andy Imparato,
Arbor WeCare.
American Association for Persons with Disabilities
(AAPD); Craig Thornton, Gina Livermore and
David Stapleton, Mathematica Policy Research
(MPR); Charlene L. Dwyer, Michael Greco, Joseph
D’Costa, Wisconsin State Department of Workforce
Development; Lea Collins Worachek and Meredith
Dressler, Madison Vocational Rehabilitation
Counselors (VRC); John Reiser, Wisconsin
State Department of Human Services, Office for
Independence and Employment; Cheryl Lofton,
Wisconsin State Division of Mental Health Services;
Mike Calvert, Peter Lunde, Keith Heimforth, Les
Mirkin and Christine Ahrens, Wisconsin State
Division of Vocational Rehabilitation; Rachel
Forman, Grand Avenue Club of Milwaukee; Gail
Marker, Madison Yahara Club; John F. Boyer,

Strategies and Incentives for Matching Disabled Workers with Jobs:

13
Lessons for Italy from the United States
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