A Community and Culturally-Centered Approach to Substance Use Workforce Development and Training: A State Case Study of Hawaii

Background & Purpose

In Spring 2022, the University of Hawaii partnered with the State of Hawaii Department of Health to plan and implement a substance use workforce development and training program intended to identify the workforce’s recruitment and retention needs and to improve the effectiveness of continuing education training. Among those aged 12 or older in Hawaii, 60% have used substances in the past year, nearly 8% have needed substance use treatment, and only 1.4% have received it, partially attributable to the workforce shortage and limited services available, exacerbated by the state’s geographic isolation, high cost of living, and unique cultural context. This study examines the question, what are the unique workforce, policy, systems characteristics needed to implement a community- and culturally-centered workforce development and training transformation in Hawaii?

Methods

This mixed-methods study examines findings from four sources: 1) surveys conducted with frontline behavioral health workers in the state, including social workers (n=108 respondents, collected 10/2023-7/2024); 2) surveys conducted with service provider agencies in the state (n=43 agencies, collected 5/2024-7/2024); and interviews and focus groups with community stakeholders (n=12, conducted 10/2024-5/2025); and 4) administrative data from post-training evaluation surveys (collected 10/2023-4/2025).

Results

Frontline staff and provider agency survey results describe: demographic and workforce composition, employer and workforce characteristics, service delivery focus and clientele, training and professional development needs, and workforce satisfaction and retention. Interviews and focus group results highlight barriers and facilitators to statewide planning, including challenges in recruiting qualified workforce and in obtaining professional certification. Post-training evaluation survey results characterize workforce training needs and preferred continuing education modalities.

This case study highlights three characteristics to program planning and implementation. First, program planning stemmed from stakeholder-identified principles valuing community-based and culturally specific knowledge originating from trainers from Hawaii’s communities rather than outside knowledge experts. Second, although there are workforce challenges that are shared with the social work and behavioral health workforce in other parts of the United States, there are unique geographical and contextual considerations to Hawaii that make it challenging to adopt workforce approaches used elsewhere. Third, the program continues to consider how to improve statewide access to a comprehensive training curriculum while also ensuring the effectiveness of trainings on the workforce’s practices and client and community impacts.

Conclusions and Implications:

In order to meet the substance use needs of Hawaii, the state must address its workforce through improved training, recruitment, and retention. A school of social work with its infrastructure for continuing education and professional development is at a vantage point for implementing impactful improvements to workforce development. Rather than embrace a top-down national approach to workforce development, however, an approach specific to Hawaii’s communities and context is believed to be the best approach for achieving sustainable improvements. However, several considerations and challenges exist in these transformations. This study holds significance in considering the value of taking a community-informed approach to workforce development and the role of schools of social work in eliciting transformative continuing education and workforce development change.