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The World Health Organization estimates that about 15% of the world population, or roughly 1 billion people, can be classed as having a disability (Disability & Health fact sheet, WHO, 2015). Although there has been an increase in disability awareness in many countries and legislation and polices have been put in place to reduce barriers, there is significant evidence that people with physical, mental, and emotional impairments continue to face segregation and discrimination . Individuals with disabilities are “frequently found to be disproportionately denied access to education and employment, living in poverty, or subjected to violence and abuse” (Disability & Health fact sheet, WHO, 2015). In the United States, individuals with disabilities make up almost one-fifth of the American population, but they are unemployed at a rate that is twice that of people without disabilities (Erickson, Lee, & von Schrader, 2016). This gap in engagement in the workforce continues despite there being anti-discrimination laws that specifically cover employment, policies to assist employers and job seekers, and many research studies showing the benefits of hiring individuals with disabilities (Kessler/NOD, 2010). Unfortunately, it is not difficult to understand this employment gap, as throughout society individuals with disabilities continue to experience stigma and are often treated with minority group status . There are multiple interacting factors that result in significant barriers to employment and many of them are related to disability stigma and resulting discriminatory behavior. This chapter will examine the complexity of disability stigma in employment by exploring the micro (the individual), mesa (the employers), and meta (society) interactions leading to organizational access and opportunity. The stigma around disability itself will be briefly discussed, followed by a more detailed look at the specific concerns related to access and opportunity as they pertain to employment for individuals with disabilities.

Disability Stigma

As with many other personal characteristics, having a disability can carry significant stigma. The concept of stigma was articulated by Goffman (1963) over 50 years ago and still accurately describes the phenomenon as we know it today. According to Goffman (1963), stigmas are personal attributes that are viewed as personal flaws within a social construct. Stigmatized people are seen to have undesirable, deviant, or repulsive characteristics which often result in devaluation, prejudice , and discrimination against the stigmatized group (Crocker & Major, 1989; Dovidio, Major, & Crocker, 2000; Goffman, 1963).

The first aspect of disability stigma that increases the complexity of the discussion involves the micro focus of the individual and the difficulty in comprehensively defining the term ‘disability’. Although people with a physical or mental impairment are universally identified as ‘different’ in some way, the term ‘disability’ itself is very difficult to define. The medical community generally defines disability in terms of physical or mental differences (outside of statistical norms ) that result in physical or mental impairments and is primarily concerned with the detection, avoidance, elimination, and categorization of impairment, and how people with disabilities can be assisted through medical and psychological interventions (Thanem, 2008). Disability can also be viewed as a social construct, where the ‘impairment’ caused by differentness is largely due to environmental barriers (physical, social, and economic). Under this model, individuals with disabilities are subjected to differences of power in social, institutional, and material environments. Conversely, it assumes that disability can be resolved by removing barriers in the social and material environment and focusing on perceptions, attitudes, and biases relating to individuals with disabilities (Thanem, 2008). Additionally, different from most other stigmatizing characteristics, the definition of disability can change based upon the purpose of the definition (i.e. medical intervention, the Americans with Disabilities Act (ADA) protection, Social Security Benefits, Human Rights Advocacy, etc.).

This perception of the pervasive differentness of ‘disability’ is often viewed as an unfortunate and inherently negative characteristic and carries significant stigma and stereotypes. Disability stigma often comes with discriminatory behavior and impacts all aspects of life roles and environments (i.e. school, work, community living). “The everyday experience of many people with impairments remains one of exclusion and of having their identities ‘defined’ by their impairment rather than by any other ontologically significant trait” (Scully, 2003, para 3). This inevitably leads to stigmatization , segregation, and marginalization of people with disabilities and in turn results in a perception of them as a minority group and all that it inherently carries (Buljevac, Majdak, & Leutar, 2012). This meta focus on larger society shows the minority status which plays a complex role in the ability of individuals with disabilities to have access and opportunity to participate in the workforce. This inevitably has a direct effect on their quality of life.

Another critical difficulty in understanding the phenomenon of disability stigma is that it is nearly impossible to discuss disability stigma in an inclusive way. Society reveals different levels of stigma to different disabilities. Regardless of whether the disability is physical , cognitive, sensory, or psychological, it can carry a stigma resulting in devaluation of the person, with some disabilities carrying more stigma than others. For example, depending on the context of the work, physical disabilities (e.g. a person with an amputation of a lower arm) may be seen as less concerning to an employer than an intellectual impairment (e.g. a person with Down syndrome). Additionally, there are significant differences between visible disabilities (i.e. paraplegia) and invisible disabilities (i.e. epilepsy or bipolar disorder). There have been a number of studies examining the different experiences of individuals with invisible disabilities and the impact of disclosure often resulting in stigma and discrimination in employment (Bell & Klein, 2001; Bishop, 2004; Brohan et al., 2012; Dalgin & Bellini, 2008). This hierarchy of disability acceptance has been documented to be a significant factor in access and opportunities in employment (Bricout & Bentley, 2000; Unger, 2002).

Interestingly, as with other historically oppressed minority groups (i.e. women and racial/ethnic minorities), when the entire disability community has joined together as a whole, significant legislative and policy changes have been made (i.e. ADA). This has led to increases in civil rights, increased visibility and community participation, as well as a surge in disability culture and pride. However, many disability specific groups continue to struggle with being compared to or lumped into a group of other types of disabilities, primarily because other groups may carry more intensely negative stigma. Different types of disabilities garner different societal reactions and media representations which result in various implications. For example, psychiatric disabilities often carry a significantly negative stigma which is too often reinforced by the media representation attached to violent crimes. In actuality, individuals with psychiatric illnesses are no more violent than individuals without a psychiatric condition and are more likely to be victims of violence than the perpetrators (Stuart, 2003). However, the negative stigma from linking violent crimes to people with mental illness gets perpetuated by the media. Research shows that psychiatric disabilities have been found to carry the same stigma as convicted criminal status or drug abuser (Holmes & Rivers, 1998).

In addition to the type of disabilities, attitudes and reactions to disability can depend upon the medical complexity and functional limitations (perceived and actual), as well as attribution of responsibility or moral causality of the disability. For example, Mitchell and Kovera (2006) found employer participants granted more accommodations for a hypothetical employee whose disability was caused by an external factor than when the disability was a result of the employee’s own behavior. External attribution of disability stigma is also a factor for employers when hiring a returning veteran with a disability (Kravetz, Katz, & Albez, 1994).

These complexities of defining disability lead to difficulty in understanding and researching the experience of individuals with disabilities in employment settings. There are bodies of literature focused on the medical model approach, looking at the micro view of physical phenomenon and associated employment barriers related to impairments. This has made a significant impact on employment discrimination legislation in the United States like the ADA. There is also significant literature focused on a more macro view of the social model’s approach to the oppressive phenomenon and associated employment barriers of exclusion and segregation. Thanem (2008) argues for an embodied approach to disability in organizational contexts noting that not all of the bodily problems and experiences that affect individuals with disabilities are socially constructed. He suggests looking at people’s lived and embodied experiences of living with a disability and the resulting impairments, thereby drawing attention to the bodily differences of individuals with disabilities and their unique experiences, problems, and needs. However, regardless of the theoretical approach, the overall concern about the lack of organizational access and opportunity for individuals with disabilities remains a concern.

Disability Stigma—Impact on Employment—Access

The realm of employment is one context where the complexities of disability stigma have been clearly observed and documented. The lack of equitable access to attaining and maintaining gainful employment continues to be a significant challenge for individuals with disabilities. As was previously noted, the employment rates of individuals with disabilities remain consistently poor despite policy and legislation aimed directly at this issue as well as the increasing diversity of the US workforce with regard to other groups protected under anti-discrimination laws such as women, minority groups, and older workers (Erickson et al., 2016; Toossi, 2012). This significant unemployment gap clearly leads to high levels of poverty and tremendous differences in quality of life. This section will look at some of the issues blocking access to employment for individuals with disabilities from a micro, mesa, and macro level.

Since the 1970s the United States has passed major federal legislation and created other initiatives to focus on the critical need to increase employment opportunities and outcomes for individuals with disabilities. The landmark Vocational Rehabilitation Act of 1973 pioneered disability discrimination legislation and was followed by the ADA of 1990, the Workforce Investment Act (WIA) of 1998, the Ticket to Work and Work Incentives Improvement Act (TWWIIA) of 1999, and most recently the Workforce Innovations and Opportunities Act (WIOA) of 2014. All of this legislation attempts to reinforce the federal emphasis on enhancing competitive employment for individuals with disabilities. Although many of these efforts have increased community integration and accessibility, they have not made the anticipated increases in employment for this population. For example, the landmark passing of the ADA, in 1990, has had a tremendous impact on the overall lives of Americans with disabilities; however, one key area addressed in the legislation has not lived up to its intent. Title I of the ADA specifically addressed discrimination in employment and yet, the rates of unemployment and underemployment for individuals with disabilities have not improved. Employment levels of people with disabilities continue to be very low, and those who are employed tend to be in low-paying occupations. In the year 2014, an estimated 34.6% of survey responders of people with disabilities (noninstitutionalized, male and female, aged 21–64, all races, regardless of ethnicity, with all education levels) were employed; this compares to 77.6% (plus or minus 0.09 percentage points) of the population without disabilities with similar demographics (Erickson et al., 2016). In a study by Harris Interactive, the Kessler Foundation and National Organization of Disability (Kessler/NOD, 2010), a significant minority of Americans with disabilities (43%) claim that they have encountered some form of job discrimination throughout their life. The percentage remains the same when considering only those who are 18–64 and employed full or part-time (43%) but drops to 26% when limiting it to employees’ experiences of the past five years. This suggests that job discrimination based on disability status has been declining in recent years. Researchers continue to try to understand this complex phenomenon; however, there continues to be concern about employer attitudes based on disability stigma and stereotypes, which result in disparate employment practices (Kessler/NOD, 2010). According to the US Equal Employment Opportunities Commission (EEOC):

Disability discrimination occurs when an employer or other entity covered by the Americans with Disabilities Act, as amended, or the Rehabilitation Act, as amended, treats a qualified individual with a disability who is an employee or applicant unfavorably because she has a disability.

The law requires an employer to provide reasonable accommodation to an employee or job applicant with a disability, unless doing so would cause significant difficulty or expense for the employer (“undue hardship”). The law forbids discrimination when it comes to any aspect of employment, including hiring, firing, pay, job assignments, promotions, layoff, training, fringe benefits, and any other term or condition of employment. (Disability Discrimination, n.d.)

Despite the changes in legislation, employers have been slow to change their attitudes and hiring practices regarding individuals with disabilities. There have been many studies done to look at employer’s attitudes and perspectives on hiring individuals with disabilities in attempts to understand their concerns in efforts to increase employment opportunities (Burke et al., 2013; Hernandez, Keys, & Balcazar, 2000; Ju, Roberts, & Zhang, 2013; Unger, 2002). One early study, (Dixon, Krouse, & Van Horn, 2003) found that some employers are apprehensive about hiring people with any kind of disability. They listed employer concerns, which included unfamiliarity with people with disabilities and fear of accommodations (Dixon et al., 2003). Other studies have compared employer attitudes or employment decision-making with regards to one type of disability over another. For example, McMahon et al. (2008) examined EEOC data of charging parties who had filed allegations of hiring discrimination . They found that hiring discrimination was more often directed at persons with physical or sensory impairments than for those with behavioral manifestations of disability.

However, Ju, Roberts, and Zhang (2013) conducted a more recent analysis of 15 studies over the past 10 years. They found positive general attitudes from employers toward workers with disabilities, although concerns toward hiring workers with certain types of disabilities were noted. Positive contact with or positive past experiences with individuals with disabilities were associated with more willingness to hire and retain employees with disabilities. Although there continues to be barriers to hiring, fewer concerns were identified in this review than previous reviews (Ju et al., 2013). Similarly, Erickson, von Schrader, Malzer, Bruyere, and VanLooy (2013) found that fewer employers reported organizational barriers to hiring individuals with disabilities. Although the cost of providing accommodations is still a concern, fewer employers said that attitudes/stereotypes, supervisor knowledge of accommodations, cost of training, or increased need for supervision were barriers when compared to a survey 12 years before. Erickson et al. (2013) noted that these findings may indicate that informational efforts to raise awareness among employers are slowly reducing barriers.

Similarly, Burke et al. (2013) found employers hold relatively positive attitudes regarding individuals with disabilities. However, behavioral intentions of employers toward disability in the work setting were less positive and hiring practices may still be discriminatory. Burke et al. (2013) focused on demand-side concerns of employers (organizational behaviors, employer needs, and the changing labor economy) noting that employers are less risk averse in occupations where the demand is high and the supply of qualified workers is low.

The US Department of Labor—Office of Disability Employment Policy (DOL-ODEP) conducted a focus group study with employers in 13 major metropolitan areas representing a variety of industries, company sizes as well as for-profit and not-for-profit organizations examining issues affecting the poor hiring of people with disabilities. The most common answer given was that employers did not have accurate and practical information about the employability of individuals with disabilities, thus preconceptions and concerns about hiring and retaining this population are driving organizational behavior (Grizzard, 2005). This work was then followed by a large-scale survey. Domzal, Houtenville, and Sharma (2008) reported that nearly three-fourths (72.6%) of the companies participating in the survey noted concerns that employees with disabilities may not have the ability to effectively perform the work required. Small- and medium-sized companies noted health care costs, worker compensation as well as fear of litigation as challenges to hiring people with disabilities.

However, it is not just the hiring decision which impacts employment and career movement for individuals with disabilities. Title I of the ADA protects individuals from discrimination in job application procedures, hiring, firing, compensation, and advancement and training (ADA: A Guide for Individuals Seeking Employment, 2008). When an individual believes he/she has been discriminated against by an employer they contact the EEOC to determine if he/she should file a claim. The database maintained by the EEOC demonstrates a snapshot of the employment discrimination in America. In 2015, they had recorded nearly 27,000 charges of ADA claims of discrimination based on disability (ADA of 1990 Charges FY 1997–FY 2015). Unfortunately, this number represents only those who took action to file a claim, while others may have experienced discrimination but have not filed a claim with the EEOC. Many individuals with disabilities may not understand or be aware of the ADA and the filing process, have the resources to file such a claim, or believe that they have evidence of discrimination that would make a claim successful. Under the ADA, having a “record of” disability allegation may also involve stigma and unconscious stereotyping on the part of the employers. Analysis of EEOC data shows that there is a disproportionate, statistically significant higher rate of merit resolution for allegations of historical disability than there is for current disability (Draper, Hawley, McMahon, & Reid, 2012).

An, Roessler, and McMahon (2011) conducted an analysis of the EEOC database of Title I ADA claims. Once again, the hierarchy of disability stigma became evident. An, Roessler, and McMahon (2011) found that when looking at the EEOC Title I claims, psychiatric disability was the most frequently cited disability in the database. Research tells us that the specific type of disability may also affect employers hiring decisions and that they tend to hire certain types of disabilities more than others. Employers are more likely to hire individuals with sensory or physical disabilities than individuals with intellectual or psychiatric disabilities (Bricout & Bentley, 2000; Dalgin & Bellini, 2008; Ju et al., 2013). For example, Dalgin and Bellini (2008) showed employers a short interview vignette of a potential candidate and then asked them to make a hiring decision and rate the candidate’s employability. They found a significant effect for disability type, with employers rating the candidate with a physical disability significantly higher than the candidate with a psychiatric disability (Dalgin & Bellini, 2008).

Regardless of what type of disability one has, stigma has a direct impact on an individual’s ability to access all aspects of society including employment. Many individuals with disabilities try to ‘manage’ the impact of the stigma. Disabilities can be visible as well as invisible and that visibility can be a central factor in the management of and reaction to a stigmatized identity (Crocker, Major, & Steele, 1998). One of the hallmarks of ADA coverage is the mandate that qualified individuals with disabilities be provided reasonable accommodations. To receive this support on the job, an applicant would need to disclose his/her disability to the employer. The decision to disclose a disability is a personal one that can have a significant impact on the individual’s employment status . For many people with disabilities whether or not to disclose a disability presents a large conundrum. Baldridge and Veiga (2001) found that the willingness of employees with disabilities to request accommodation depends on factors such as their perception of the usefulness and fairness of accommodation, help-seeking appropriateness, social obligation, and their anticipated image cost. Individuals with disabilities often do not disclose their disability for a variety of reasons including lower employer expectations, lack of respect, isolation from coworkers, a decrease in job responsibility, being passed over for promotion, and increased likelihood of termination (Brohan et al., 2012; Dalgin & Gilbride, 2003). However, there are also benefits to disclosing including the obvious access to accommodations, the ability to explain behavior to a supervisor or coworkers, explaining gaps in employment history, and increased support from coworkers and supervisors (Brohan et al., 2012; MacDonald-Wilson, 2005).

There may be no one correct approach to this dilemma. “Complete or selective disclosure may work for some, whereas nondisclosure may be best for others, and this may change” over the course of an individual’s career (Goldberg, Killeen, & O’Day, 2005, p. 496). One study by von Schrader, Malzer, and Bruyere (2014) looked at factors contributing to an employee’s decision to disclose a disability. They found that the relationship with his/her supervisor, workplace culture , and the employers’ commitment to disability inclusion all rated high when deciding about disclosing .

Disability Stigma—Impact on Employment—Opportunity

The global market place, increasingly diverse demographics, and the social policy of the United States have made the practice of Diversity Management a significant part of many large companies. Human Resource professionals receiving training in accredited programs have mandated curriculum addressing diversity issues. However, many employers fail to include disability within the list of minority groups being addressed through diversity initiatives. In a study of Fortune 100 companies, Ball, Monaco, Schmeling, Schartz, and Blanck (2005) found that only 42% of companies had diversity policies that included people with disabilities. It is here that employer initiatives and strategies can widen the opportunities for employment success for individuals with disabilities.

According to Baldwin and Marcus (2006), the problem does not lie with the workers with disabilities (micro level), but in their work environment (mesa level). They call for interventions which will “combat the stigma of mental illness in competitive jobs, for example, educating employers, changing employment policies, providing sensitivity awareness training for supervisors and coworkers, and instituting employment practices that tolerate diversity” (Baldwin & Marcus, 2006, p. 391).

In a study examining employer practices with regards to individuals with disabilities, Erickson et al. (2013) found that although a large proportion of responding employers have developed disability-friendly practices, many more have not. In their study, Erickson et al. (2013) surveyed 675 members of the Society of Human Resource Management randomly sampled across small, medium, and large employers. There were a number of initiatives that many of the survey responding employers were already doing. These included including people with disabilities in the diversity plan, requiring subcontractors to adhere to disability nondiscrimination requirements, having relationships with community organizations, providing training on disability awareness, establishing a grievance procedure for reasonable accommodation, allowing extended leave as an accommodation, designating a specific person for accommodation, offering flexible work arrangements, and having a return to work program. However, there were a number of practices that received very high ratings of effectiveness, although these were only being implemented in a few organizations. These included centralized accommodation fund, formalizing the decision-making process for case-by-case provision of accommodations, and establishing a disability-focused network (resource/affinity group) (Erickson et al., 2013).

Although the previous study shows positive gains for employers in this area, employers are not making decisions in a vacuum; they are part of the larger context of society (macro level). Comprehensive efforts to change public stigma toward individuals with disabilities are on the rise. The Office of Federal Contract Compliance Programs (OFCCP) proposed new regulations in December of 2011, addressing the implementation of the disability nondiscrimination and affirmative action requirements of Section 503 of the Rehabilitation Act of 1973, as amended (Affirmative Action and Nondiscrimination Obligations of Contractors and Subcontractors Regarding Individuals with Disabilities, 2011). The proposed regulations add a target for creating equal employment opportunities for people with disabilities, and the requirements for tracking recruitment, hiring, and retention would be similar to those now in place for gender and race/ethnicity.

Another positive change is the increasing visibility of individuals with disabilities in the media . Television and other forms of media are embracing disability concerns and increasing visibility of individuals with disabilities in marketing campaigns as well as primetime television dramas and reality shows. When these initiatives are positive and show the range of abilities and contributions of people with disabilities (especially in work settings), employers are inadvertently gaining information with the potential to dispel misperceptions and disability stigma thereby opening up opportunities in the workforce. Moreover, the Disability Rights and Independent Living movements have greatly grown a sense of disability pride and culture .

Access and Opportunity—The Convergence

It is at the convergence of micro (individual), mesa (employer), and macro (society) levels of disability stigma interventions that we will see increases in employment for individuals with disabilities (see Fig. 4.1). The micro level includes the individual’s unique traits, strengths and skills, education and work history, as well as his/her disability related impairments, needed accommodations, and decisions about disclosure , all of which can be impacted by disability stigma but can also be strengthened by the individual and supportive resources.

Fig. 4.1
figure 1

Convergence of micro (individual), mesa (employer), and macro (society) levels of disability

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The mesa level includes the employer’s diversity initiatives that include disability, organizational culture accepting of disability, willingness and ability to provide accommodations, and the level of knowledge and positive attitudes about disability. The macro level includes society’s disability and employment related legislation and social policy as well as the pervasive cultural attitudes toward disability (media, environmental barriers, and community inclusivity). The more the strides each level makes toward reduction of disability stigma the larger the convergence area will become, and ideally this increase in access and opportunity will lead to increased employment of individuals with disabilities.

Ultimately, the influence of disability stigma on employment greatly impacts quality of life for individuals with disabilities. One’s ability to work carries great meaning in the United States. It is a large part of one’s identity and plays a huge role in one’s ability to interact within a community . Obviously, the financial gains from work cannot be overlooked; however, many would argue that the meaning of work goes beyond the pay check. Some level of employment provides social connection, daily structure and routine, intellectual and physical stimulation, a sense of purpose and role, and is considered fundamental to the well-being of people with and without disabilities (Dutta, Gervey, Chan, Chou, & Ditchman, 2008). Therefore, in the twenty-first century US society, employment is critical and for too many people living with disabilities, stigma affects access and opportunity to the critical component of quality of life. It is imperative that we continue to strive for more overlap between micro (individual), mesa (employer), and macro (society) levels to increase access and opportunity for employment of individuals with disabilities.