The Second National Conference on Disability, held in Bari in 2003, took the World Health Organization's International Classification of Functioning, Disability and Health (ICF), adopted by all WHO member states in 2001, as its frame of reference for future action and policies on disability. The ICF broke decisively with the medical model by seeing disability as an interaction between a biological and psychological condition and environmental and attitudinal barriers. Although existing Italian legislation on access to work for persons with disabilities, particularly Law 68/1999 on ‘collocamento mirato’ (targeted placement), anticipated some of the principles and definitions of the ICF, its implementation in practice was often snared in complex bureaucratic procedures and compromised by narrowly medical assessments of impairment and by considerable variations in standard from region to region. In 2009–2011 a pilot project, Progetto ICF4, was launched in 11 regions of Italy. It applied ICF principles, using Social Network Analysis (SNA) to assess the suitability of a work environment in terms of the networks of relations between the different actors involved in it. The way this has functioned in practice is illustrated by a case study of Teramo, one of the provinces in the pilot.