Social Work Workforce, Licensing, and Hawai‘i: An Overview

Abstract

Social work is an academic and professional discipline that has been part of the Hawai‘i social service workforce since the late 1800s. As the largest provider of mental health services in the United States, social work is a regulated profession in Hawai‘i, but current information about the size and scope of the profession is limited by significant data issues stemming from varying definitions at state and federal levels. However, the need for more social work professionals in the state, which is already experiencing a social work workforce shortage, is clear. In addition, opportunities to support the social work workforce exist through advocacy efforts and policy changes that would increase education and training opportunities as well as increase providers to meet the demands of the community.

Introduction

Hawai‘i, both as a territory and a state, has a long history of social service provision, focused on providing high-quality social welfare support by utilizing trained social workers. Although social workers are engaged across many practice settings, including medicine, behavioral health, child welfare, the justice system, social policy, social advocacy, and more, many people are unfamiliar with the profession. Similarly, information about the current social work workforce, nationally and particularly in Hawai‘i, is limited.¹ This is despite the profession’s continued growth and its focus on addressing the significant challenges in many of the most vulnerable communities. Through their work on health equity issues and advocacy, social workers are critical to the public health workforce.²

Method

Using a scoping review method, this article highlights the types of activities social workers engage in, summarizes current state and federal social work workforce data, and identifies opportunities for the profession to enhance its primary and interdisciplinary practice spaces within the state of Hawai‘i. The authors drew from the peer reviewed literature, government reports and data, and the expertise across diverse areas of social work represented on the authorship team.

Social Work Profession

As with many practice-based professions, social work is an academic discipline that “promotes social change and development, social cohesion, and the empowerment and liberation of people.”³ Rooted in a social justice framework, social work relies on the application of values, principles, and techniques to address social ailments at the micro (eg, with individuals and families), mezzo (eg, with groups, agencies/organizations, small communities), and macro levels (eg, advocacy and intervention with large communities, government, and other systems). Social work is an umbrella term that encompasses professionals in various specialized areas of practice, including clinical social work, child and family welfare, forensic social work, community organizing, lobbying, policy advocacy, and social service administration, among others. In some instances, these professionals have “social work” in their position title, while in others, they may not be called social workers, but their knowledge, skills, abilities, and functional work align with the profession. Social work holds its roots in the legacy of community mutual aid with the profession’s earliest roots dating back to the late 1800s through the creation of nongovernmental charitable organizations primarily focused on helping individuals who were immigrants, those in poverty, and those impacted by health disparities and social injustices.⁴ As cities, states, and the federal government created more infrastructure and policies to increase the social welfare of their constituents, social work also became essential to developing key social welfare programs, such as in assisting in the writing of the Social Security Act, leading early federal agencies like the Children’s Bureau, and in being an important force behind the creation of the juvenile justice system to address juvenile offenders differently than adults.⁵

The professional practice skills of social workers are utilized in various settings and are complementary to other professions while still having a unique knowledge base and practice approach. Truly interdisciplinary, social workers collaborate with lawyers and judges within child welfare systems, in schoolbased settings, adult protective services, and in the criminal justice system, among other settings. They are also integral to health care teams working alongside physicians, nurses, and pharmacists; nationally, clinical social workers are the largest provider of mental health services.⁶ Social workers engage in prevention and intervention work, contributing to public health through advocacy, disaster response, grief counseling, and health promotion efforts.⁷ Additionally, social workers respond to health equity issues by advocating for policy changes to improve health care access, including issues related to reproductive rights, advanced-care planning, and behavioral health parity.² These activities support public health generally and are often part of public health programs in a variety of settings.⁸

Defining Social Work in Hawai‘i

Social work in Hawai‘i is regulated through the Department of Commerce and Consumer Affairs (DCCA) and is governed by Hawai‘i Revised Statute §467E Social Workers.⁹ There are 3 license types: (1) LBSW - licensure for those who hold a Bachelor’s in Social Work (BSW) degree from an accredited program and who successfully pass the Association of Social Work Boards (ASWB) basic licensure exam; (2) LSW - licensure for those who hold a Master’s Degree in Social Work (MSW) from an accredited program and who successfully pass the ASWB licensure exam; and (3) LCSW - licensure for those who hold a Master’s Degree in Social Work from an accredited program and who successfully pass the ASWB clinical licensure exam after accruing at least 3000 hours under supervision by an Licensed Clinical Social Worker (LCSW). An LCSW’s scope of practice includes diagnosis and psychotherapy, services that psychologists also provide, and their communications with clients are considered privileged and treated the same as a psychologist-client privilege, which fall under Rule 504.1 of the Hawai‘i Rules of Evidence.^9,10 Clinical social workers are also included in several statutes in Hawai‘i, including the Our Care, Our Choice Act, which requires a counseling referral to determine if the patient is making an informed decision.¹¹ They are also listed in Hawai‘i law §571–46.4¹² pertaining to who is eligible to serve the courts as a child custody evaluator. To use the title social worker, an individual must be licensed as outlined by the statute unless an individual falls under one of the allowable exemptions, including those employed in federal, state, or county positions titled social work.⁹ In general though, licensing requirements and scope of practice are state-specific, and variations can occur.¹³

Counting Social Workers in Hawai‘i

Identifying the number of social workers practicing in the state is an ongoing challenge due to the variety of fields where social workers can be found and inconsistencies in professional title and licensure requirements. Exemptions in the law regulating social work provide an additional challenge as not all individuals who call themselves social workers are required to be licensed, and a review of existing data sources shows additional ways of identifying social workers including by job title and training.

The DCCA provides a yearly report of active licensed social workers in the state (LBSW, LSW, and LCSW) referenced in Table 1.^14,15 In the September 24, 2022, Number of Current Licenses by Geographic Area Report¹⁵ there were 2321 social workers, most of whom were LCSWs. While the state averages around 128 social workers per 100,000 people, there are clear discrepancies between the counties. Typically, non-rural locations have a higher per capita number of social workers than rural locations. When examining the number of active licensed social workers inclusive of all license levels across the state, Honolulu has the highest per capita concentration at about 136 social workers for 100 000 people, while Kaua‘i and Hawai‘i counties each have approximately 92 social workers per 100 000 people.¹ In addition, these numbers are still lower than the national average; consequently, Hawai‘i ranks in the lower half of states in terms of the number of social workers per person.¹⁶

Table 1.

Active Licensed Social Workers in Hawai‘i, Hawai‘i Department of Commerce and Consumer Affairs^14,15

Profession	Number of Active Licenses 2004	Number of Active Licenses 2022
Licensed Clinical Social Worker	166	1 141
Licensed Social Worker	1 351	826
Licensed Bachelor Social Worker	0	17
Total	1 517	2 321

In addition to identifying social workers in the state by the number of people with an active license, identifying the number of people in official social work positions within the state government assists in further enumeration as these individuals are exempted from the licensing requirement as outlined in Hawai‘i Revised Statute §467E.⁹ In 2022, there were an additional 629 social workers identified as employed within the Hawai‘i State Judiciary, Department of Health, Department of Human Services, Department of Public Safety, Department of Education, and Hawai‘i Health Systems Corporation.¹⁷ Within Hawai‘i, state social work positions are most abundant in the Hawai‘i State Judiciary. In 2005, Act 238 required that individuals holding a state position with the title “social worker” must have a degree in social work from an accredited social work program.¹⁸ However, the Hawai‘i State Judiciary and the Hawai‘i Health Services Corporation were exempt from the provision of Act 238, solidifying a discrepancy in the definition where individuals who have not graduated from an accredited school of social work are able to be called a social worker.

National sources, such as the Health Resources and Services Administration (HRSA) and the US Bureau of Labor Statistics, indicate further variation in the estimate of social workers in Hawai‘i. For example, as of 2022, the US Bureau of Labor Statistics estimates 2730 social workers employed in Hawai‘i, of whom 810 are in “healthcare social work.”¹⁹ In contrast, HRSA utilized American Community Survey data to estimate over 2000 social workers who were in “medical/health” field.¹⁴ These estimates from to 2000 to 2730 social workers in 2022 vary widely and perpetuate the difficulty in understanding the current workforce.¹⁹

Nationally, the social work profession is projected to grow 9% over the next ten years, which is above the national average for growth.¹⁹ Critical workforce shortage areas in social work settings such as behavioral health, health care, child welfare, and judiciary, are projected to increase dramatically over the next decade. For example, in 2021 the Projections Management Partnership, a nationwide program that integrates national, state, and county projections, estimated that the 10-year projected need for social work positions focused on child, family, and school social work will increase by 5%, in health care by 18%, and in mental health and substance abuse services by 22%.²⁰ Another study grading states by their current social work workforce shortage and state’s projected shortages in 2030 graded Hawai‘i as a C+.²¹ The study further predicts that Hawai‘i’s grade will drop to a C by 2030 because the need for social workers will continue to increase.

Social Work Salaries

Even though social workers fill multiple workforce needs, social workers’ average salaries in Hawai‘i are significantly lower than many of their interdisciplinary partners, such as psychologists, nurses, psychiatrists, lawyers, and doctors. Nationally, the US Bureau of Labor Statistics reported that the median pay for social workers in 2021 was $50 000.¹⁸ By contrast, the national median pay in 2021 for psychologists was $81 000, $60 000 for counselors, and $77 000 for nurses. However, social work salaries vary by field of practice, with health care social workers reporting higher average salaries than those who provide services to children, families, and schools, or who provide mental health or substance use services. In addition, median social work salaries are slightly higher by a few thousand dollars a year in Hawai‘i than the national average, but this does not take into account the higher cost of living in the state. As demonstrated in Arndt et al, the median social work salaries do not provide enough income for a living wage for a family of 4 to survive in the state without additional supports (such as nutrition assistance, housing vouchers, etc.), and it does not come close to high enough income to facilitate purchasing a home.¹ In a recent member study by the National Association of Social Workers (NASW) - Hawai‘i Chapter, one of the main concerns identified by respondents were the low salaries in the profession, leading to higher rates of turnover, and difficulty attracting people to the profession.²²

Opportunities for Advocacy

Advocating for workforce development in social work would be of strong value through policy changes related to professional policy innovations and innovations in education and training.

Innovation in Training and Education

With an increasing need for advanced, highly skilled practitioners, training is among the most valuable innovative approaches to address the current workforce shortage in social work and ensure a highly skilled future workforce. These initiatives include incentives to provide access to advanced degrees and training for child welfare-connected workers through the Hawai‘i Child Welfare Education Collaboration, a partnership between the University of Hawai‘i at Mānoa Thompson School of Social Work & Public Health²³ and the State of Hawai‘i Department of Human Services-Child Welfare Services; the Hawai‘i Interprofessional Program for Parity - Behavioral Health, a HRSA funded initiative; and other initiatives that provide stipends to students pursuing specific specialized areas of social work practice. Current incentive programs range from $10 000 to $18 000 per academic year, with some initiatives requiring a post-graduation employment requirement. With support from public/private funding, these models could be adopted for other high-need areas, such as developing an incentive program for students pursuing a social work career in the judiciary or establishing a stipend program to promote practitioners providing services related to substance use.

Students pursuing a BSW or MSW degree from an accredited social work program must complete field hours under the supervision of a practicing social worker in the community. Currently, social workers in the community are not compensated for their time mentoring and supervising students. Vital legislation was introduced in the 2023 legislative session, HB82 related to health care preceptors (another word for supervisors in an internship setting). HB82 would have expanded the definition of preceptor to include dieticians, physician assistants, and social workers. This bill would have provided preceptors with a state tax credit, to incentivize people to volunteer to supervise students in internship settings. HB82 indicated that those eligible for the tax credit must have a current social work license (LBSW, LSW, or LCSW) in the state of Hawai‘i. This stipulation would have also been a strong incentive for social workers to pursue formal licensing. While the bill was unsuccessful during the 2023 session, this incentive likely would have opened doors to field placements and preceptors/field instructors in innovative and hard-to-service locations as well as social service settings.

Identifying how the social work workforce continues to professionalize, including through licensure attainment after obtaining a degree, is vital to ensure Hawai‘i has the necessary credentialed social workers, particularly in rural areas or high-need practice settings. One component of the LCSW license requirements is attaining 3000 supervised hours post-graduation. It is of strong value to know how many individuals are in the process of attaining their LCSW, where they are engaged in service delivery, and what settings are providing the space for supervision. At present, the state of Hawai‘i does not have a registry or process to track these efforts. LCSWs are the only members of the social work profession who are eligible to bill insurance for clinical service provision. A person pursuing their LCSW, under the supervision of an LCSW is not allowed to have those services billed for, despite being under the supervision of someone who can bill. This practice is a disincentive for LCSW’s to provide supervision to individuals working to complete their hours. Similar laws exist in California and Washington. In 2023, the Hawai‘i State Legislature introduced a bill to help resolve this barrier. House Bill 1300 would have allowed for the creation of a provisional/associate-level license category. The provisional/associate licensed individual would be under the supervision of an LCSW, giving both the supervisor and the person with the associate/provisional license working to obtain their LCSW, the ability to bill insurance providers and be paid for their services. However, this bill did not pass.

Profession Policy Innovations

As previous articles and reports have outlined, there remains a need for more robust data on the social work workforce and the projected need for services. Though the DCCA licensing data shows 2 321 social workers licensed in the state of Hawai‘i, this number does not reflect whether the individuals are practicing in Hawai‘i, only if they hold an active license in the state. In addition, the current law governing social work licensure has exemptions that some consider problematic, including an exemption that social work positions within the state government require an accredited BSW/MSW social work degree but not a license, weakening the title protections in the law. Moreover, Act 238 established an additional exemption allowing individuals who do not hold social work degrees to practice under the title social worker in 2 state departments, the Hawai‘i State Judiciary and Hawai‘i Health Services Corporation. These exemptions create 2 large gaps in understanding the social work workforce, first by allowing non-licensed individuals to practice under the title social worker in state positions, and secondly, by creating an avenue for those who do not hold a social work degree to call themselves social workers in 2 state departments. Updating the law to eliminate these exemptions for federal, state, and county government employees would remove the double standard noted in 2000 by the State of Hawai‘i Auditor²⁴ and establish a single standard for all degreed social workers in the state of Hawai‘i would be held to.

In the US each state has its own social work licensing requirements; this means unlike other professions social work does not have license mobility. The Council of State Governments, partnering with the ASWB and the Department of Defense, recently released model language for states to adopt, establishing a social work licensure compact with other states.²⁵ Establishing the compact would allow for the mobility of licensed social workers to other state jurisdictions, allow social workers to practice telehealth with clients from other state jurisdictions, and reduce barriers created by social workers needing to be licensed in multiple states. Additionally, adopting the model language would support military families and increase access to services provided by social workers.²⁶ Currently, 2 states, Missouri and South Dakota, have enacted the compact legislation, and 29 states have introduced compact legislation. With Hawai‘i’s large military population and isolated geographic location, participation in the compact would support social work and add options to the workforce, particularly for specialized providers, through social work and telebehavioral services.

Conclusion

Social work is a broad-based profession that provides services and support to the most vulnerable populations in Hawai‘i and the US. Though the need for social workers is anticipated to grow, challenges remain with counting the current workforce, limiting the ability to plan for future workforce growth and support opportunities for enhanced professionalization of the social work field. To address these challenges, advocacy and policy change are imperative, particularly in Hawai‘i. Legislation is needed to ensure social work title protections, ease licensing restrictions, increase license mobility, and facilitate post-graduate clinical placements, among other areas of improvement. These advancements would enhance the social work workforce to better meet the needs of Hawai‘i’s communities.

Glossary

Abbreviations

ASWB

Association of Social Work Boards

DCCA

Hawai‘i Department of Commerce and Consumer Affairs

HRSA

Health Resources and Services Administration

LBSW

Licensed Bachelor Social Worker

LCSW

Licensed Clinical Social Worker

LSW

Licensed Social Worker

Conflict of Interest

None of the authors identify a conflict of interest.