Post-Grads/Pre-Licensed Providers: Do You Know the Way to Licensure

Post-Grads/Pre-Licensed Providers: Do You Know the Way to Licensure?

Section 1: Current Status, Supervision, and the National Exam

Supervision

The National Exam

Section 2: Motivation & Background

Section 3: Mental Health Graduate Program Reflections & Professional Development

Section 4: Financial Planning

Section 5: Hawai'i-Specific Mental Health Practice Considerations

Demographic Information

Where were your primary caregivers born?

Where were your parents or primary caregiver(s) raised?

Invitation for Follow-up Interview

Post-Grads/Pre-Licensed Providers: Do You Know the Way to Licensure?

From Graduate School to Professional Practice: A Study on Trends in Hawaiʻi’s Mental Health Workforce
Aloha/Hello!

Mahalo/Thank you for taking the time to participate in this important study. This survey-based research aims to explore the experiences of those interested in becoming or who already are, mental health professionals in Hawaiʻi. Our aim is to identify trends that will allow us to make recommendations to reduce barriers encountered and improve supports needing during the licensure process.

Your insights will help us with the ultimate goal of improving equitable access to licensure and strengthening Hawaiʻi’s mental health workforce.

Before proceeding, please carefully review the below informed consent form. This document provides important details about the study, including your rights as a participant and how your information will be handled.

This survey will take approximately 30 minutes to complete. Your responses will remain confidential, and your participation is entirely voluntary. If you have any questions about the study, please feel free to contact Dr. John Souza, Principal Investigator, at jgs808@hawaii.edu.

Your input is invaluable to this project, and we greatly appreciate your contribution. Mahalo nui loa,

Dr. John Souza, Jr, LMFT, DMFT
Assistant Professor

Human Development & Family Science
Department of Family & Consumer Sciences
University of Hawai'i-Mānoa

2515 Campus Road, Honolulu, HI 96822
(808) 956-2258 (office)

Website
INFORMED CONSENT DOCUMENT
By entering and signing your name below, you are digitally signing this consent form and consenting to participate in this study.*

First NameLast Name
Signature*
Todayʻs Date*

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Section 1: Current Status, Supervision, and the National Exam

This survey is for individuals who have completed a graduate mental health program and are in the process of obtaining full licensure in Hawai‘i. If you are licensed in another state but are seeking or considering licensure in Hawai‘i OR If you are already fully licensed in Hawai‘i, please complete our Licensed Provider Survey instead. You can access it here: LINK
Licensed Clinical Social Worker (LCSW)Licensed Marriage and Family Therapist (LMFT)Licensed Mental Health Counselor (LMHC)Licensed Psychologist (LP)I am not working toward a licenseOther
I have completed my clinical hoursI have passed the national examI have submitted my paperwork for full licensureNone of the aboveOther
Yes, I am actively pursuing licensure in another state.Yes, I am considering it but have not started the process.No, I do not plan to pursue licensure in another state.Unsure at this time.Other
Minimal ExperienceSome ExperienceModerate ExperienceExtensive ExperienceOther
Community Mental Health CenterPrivate PracticeHospital / Inpatient SettingOutpatient ClinicSchool-Based Counseling / Academic SettingCrisis Helpline / Emergency ServicesSubstance Use Treatment FacilityResidential Treatment ProgramCorrectional Facility / Forensic SettingVeterans Affairs / Military Mental Health ServicesApplied Behavior Analysis (ABA) / Autism ServicesGroup Therapy / Support GroupsCase Management / Social ServicesOther

How much clinical experience do you have working with the following populations?*

Rows	No Experience	Limited Experience	Some Experience	Moderate Experience	Considerable Experience	Extensive Experience
Children (ages 0-12)
Adolescents (ages 13-17)
Adults (ages 18-64)
Older Adults (ages 65+)
Families (multigenerational or parent/child)
Couples (dating, partnered, married)
LGBTQ+ individuals
Native Hawaiian communities
Pacific Islander communities (other than Native Hawaiian)
Asian populations
Military service members, veterans, or their families
People affected by adverse experiences (e.g., survivors of abuse, disaster, violence)
Other specific community (please specify)

If you have experience in an "other specific community", please clarify:
Type your response

Please rate your level of proficiency in the following clinical skill areas.*

Rows	Not Proficient	Minimally Proficient	Developing Proficiency	Proficient	Highly Proficient
Assessment & Diagnosis
Treatment Planning
Case Conceptualization
Clinical Documentation & Record Keeping
Crisis Intervention & Risk Management
Cultural Responsiveness & Competence
Ethical & Legal Decision-Making
Professional Boundaries & Self-Regulation
Business & Practice Management
Telehealth Delivery & Digital Tools
Community Outreach, Advocacy & Social Justice
Self-Care & Burnout Prevention
Evidence-Based & Research-Informed Practice
Leadership & Supervision Skills

How much experience do you have using the following therapy formats/modalities?

If you have experience in an "other specific format/modality", please clarify:
Type your response
Teaching (e.g., teaching assistantship, guest lecturing)Research (e.g., research assistantship, project collaboration)Conference participation (e.g., attending, presenting, organizing)Publications (e.g., journal articles, book chapters, blogs)Professional association involvement (e.g., membership, committees, working groups)Leadership roles (e.g., student organizations, mentorship, advocacy)Community engagement (e.g., volunteering, outreach programs)Workshops and continuing education (e.g., certifications, skill-building trainings)Grant writing or funding applicationsOther

Rate how developed you feel in the following aspects of your professional identity as a mental health provider:*

Rows	Not Developed	Minimally Developed	Moderately Developed	Well Developed	Highly Developed
Clarity in Career Goals
Professional Confidence & Self-Efficacy
Cultural Responsiveness & Adaptation
Professional Networking & Collaboration

Do you or did you have a mentor(s) helping you with your mental health career journey?*
Clinical supervisionResearch guidanceCareer planningCultural mentorshipPeer mentoringOther
Through my academic program (e.g., assigned faculty mentor, fieldwork supervisor)Through a workplace or internshipThrough a professional organization or networking eventThrough a formal mentorship programThrough personal connections (e.g., family, friends, colleagues)Reached out to them independently (e.g., cold email, social media, LinkedIn)Other
Thinking about your licensure journey, how would you describe your progress?*
From the time you first applied to a mental health graduate program, how many years did it take you to complete your graduate degree?*
This includes all coursework, internships/practicum, and any final projects, theses, or comprehensive exams required for your degree.
Since graduating, how many years do you estimate it will take to complete all requirements for full licensure as a mental health provider?*
This includes the time required to complete post-graduate supervised clinical hours, pass any required licensing exams, and receive your official license from your state licensing board.
Financial challenges (e.g., cost of education, loan burden)Difficulty balancing work, family, and personal obligationsLack of available supervision or mentorshipLimited job opportunities in a relevant fieldChallenges navigating licensure requirements and application processNeed for additional coursework or exam preparationRelocating or personal life transitionsMental health or personal well-being concernsNone of the aboveOther
Financial support (e.g., scholarships, employer assistance, savings)Strong mentorship or supervision availabilityJob opportunities that aligned with licensure requirementsClear understanding of licensure steps and requirementsAccess to professional networks or support groupsFast-track educational programs or exam preparation resourcesPersonal motivation and time management skillsNone of the aboveOther
Supervision

The following questions are about your progress toward licensure as a mental health provider in Hawai'i.
Individual supervision (1–2 supervisees, in-person)Individual supervision (1–2 supervisees, virtual)Group supervision (3 or more supervisees, in-person)Group supervision (3 or more supervisees, virtual)I am not currently receiving supervisionOther
How many supervisors have you had or do you anticipate needing for licensure?
Referred by my graduate programReferred by a colleague or mentorFound through my workplace or employerSearched online (e.g., professional directories, websites)Found through a national professional association (e.g., AAMFT, NASW, APA, ACA)Found through a local professional association (e.g., HIAMFT, NASW-HI, HPA, HCA)Connected through networking events or conferencesSocial media or online professional groupsOther
Cost of supervisionAvailability of qualified supervisorsQuality of supervisionLack of paid work opportunities that provide supervisionOther
How do you feel about your supervision experience so far?

1

2

3

4

5

6

7

1 is Very dissatisfied, 7 is Very satisfied
How important do you believe supervision is in preparing you to be a mental health provider in Hawai'i?

1

2

3

4

5

6

7

1 is Unnecessary – Should not be required, 7 is Essential – Critical and necessary
Paid for supervision out-of-pocketReceived employer-sponsored or covered supervisionUsed a sliding scale or reduced-cost supervision optionExchanged work or services for supervision (e.g., internship, volunteer hours)Received supervision through a university or training programHave not been able to afford supervisionOther
To become fully licensed, what is the estimated TOTAL amount you will end up paying out-of-pocket for supervision?
Just enter numbers; no "$" or commas needed
Start looking for a supervisor early – Finding the right fit can take time.Clarify expectations upfront – Discuss fees, availability, and supervision style before committing.Be proactive in your learning – Come prepared with questions and cases to discuss.Track your hours meticulously – Keep detailed records to avoid issues later.Consider multiple supervision options – Individual, group, and peer consultation all offer value.Advocate for yourself – If a supervisor isn’t a good fit, seek alternatives.Network with other pre-licensed professionals – They can share insights and recommendations.Understand state licensure requirements – Make sure supervision aligns with licensing board rules.Seek financial support if possible – Look for employer reimbursement, grants, or shared-cost options.Be patient and persistent – The process can be long, but consistency pays off.None/I don't have any advice to offer at the moment.Other
The National Exam

The following questions are about your progress toward licensure as a mental health provider in Hawai'i.
Yes, and I passedYes, but I did not passNo, but I am preparing to take it soonNo, and I am unsure when I will take itOther
How many times have you taken the national licensure exam?
Insufficient study timeUnexpected difficulty of exam questionsAnxiety or test-taking stressLack of preparation resourcesOther
What is your expected exam date?
Self-study with textbooks and materialsOnline prep coursesIn-person prep workshops or coursesStudy groups with peers (online or in-person)Individual tutoringPractice examsOther
How confident do you feel (or did you feel) going into the exam?

1

2

3

4

5

6

7

1 is Not at all Confident, 7 is Extremely Confident
How important do you believe the national exam is in assessing readiness for being a mental health provider in Hawai'i?

1

2

3

4

5

6

7

1 is Unnecessary – Should not be required, 7 is Essential – Critical and necessary
Cost of study materials or prep coursesFinding time to study while workingAnxiety or test-taking concernsDifficulty understanding exam contentLack of guidance on what to expectLogistical barriers (e.g., travel to/from the testing site, scheduling conflicts)Administrative challenges (e.g., delays with DCCA processing, exam registration difficulties)Other
How much have you spent (or do you expect to spend) on exam preparation?
Did you or will you receive any financial assistance for exam fees or prep materials?
Start studying early and create a structured study planTake as many practice exams as possibleFocus on understanding concepts rather than memorizing answersUse multiple study resources (books, courses, online materials)Join a study group or find an accountability partnerSet realistic study goals and stick to themTake care of your mental health and manage test anxietyGet plenty of rest before the exam and avoid last-minute crammingFamiliarize yourself with the exam format and timingSeek mentorship or guidance from those who have taken the examInvest in a prep course or tutoring if neededNone/I don't have any advice to offer at the moment.Other

Section 2: Motivation & Background
PsychologySocial WorkHuman Development & Family ScienceNursingPublic HealthBiologyNeurosciencePre-Med / Health SciencesOther Health-Related MajorEducationSociologyAnthropologyPolitical ScienceCriminology or Criminal JusticeBusiness AdministrationFinance or AccountingEconomicsMarketing or ManagementComputer ScienceEngineering (any field)Mathematics or StatisticsEnvironmental ScienceChemistryPhysicsEnglish or LiteratureHistoryPhilosophyCommunications or JournalismCreative Arts (e.g., Music, Theater, Fine Arts, Graphic Design)Interdisciplinary StudiesGeneral StudiesOther
Personal experience with therapy/counselingFamily member's experience with mental health servicesProfessional exposure to the fieldAcademic interestDesire to help othersCommunity needsNone of the above/prefer not to answerOther

Have you had any of the following experiences?*

Rows	Yes, POSITIVE experience	Yes, NEGATIVE experience	None/Prefer not to answer
Personal therapy/counseling
Family member in therapy/counseling
Work in mental health setting
Volunteer in mental health setting
Mental health advocacy
Peer support role

How influential are the following family and community factors in shaping your mental health career decisions?*

Rows	Not Influential	Slightly Influential	Moderately Influential	Influential	Very Influential
Family support for career choice
Community needs
Cultural considerations
Professional role models
Personal experiences
Educational opportunities

Become a licensed clinician in private practiceWork in a community mental health settingSpecialize in a specific population (e.g., children, families, BIPOC communities)Work in an integrated healthcare setting (e.g., hospitals, primary care)Pursue a career in academia or researchBecome a clinical supervisor or mentor for future therapistsAdvocate for mental health policy and systemic changeProvide culturally responsive or indigenous-informed therapyDevelop and run mental health programs or nonprofitsI am unsure of my long-term career goals at this timeOther
Children (ages 0-12)Adolescents (ages 13-17)Adults (ages 18-64)Older Adults (ages 65+)Families (multigenerational or parent/child)Couples (dating, partnered, married)LGBTQ+ individualsNative Hawaiian communitiesPacific Islander communities (other than Native Hawaiian)Asian populationsMilitary service members, veterans, or their familiesPeople affected by adverse experiences (e.g., survivors of abuse, disaster, violence)I am unsureOther
Individual therapyCouple therapyFamily therapyGroup therapyI am unsureOther

Section 3: Mental Health Graduate Program Reflections & Professional Development
Clinical Social WorkMarriage and Family TherapyMental Health CounselingClinical PsychologySchool PsychologySubstance Abuse CounselingOther

How important to you were the following factors in choosing a mental health graduate program?*

Rows	Not Important	Slightly Important	Moderately Important	Important	Very Important
Program reputation
Faculty expertise
Mentorship opportunities
Clinical training opportunities
On-campus practicum/internship
Practicum/internship placement support
On-site clinical supervision
Research opportunities
Presentation and publication opportunities
Teaching assistantships
National exam preparation
Licensure process preparation
Business training (e.g., private practice, billing, marketing)
Job placement assistance
Multicultural focus and immersion experiences

How important were the following structural aspects when choosing or considering which mental health graduate programs to apply to or attend?*

Rows	Not Important	Slightly Important	Moderately Important	Important	Very Important
Full- and part-time study options
Evening/weekend classes
Online course components
Graduate assistantships
Clinical placement support
On-campus practicum/internship
Cohort model (fixed group moving through together)
Program length (e.g., accelerated vs. traditional timeline)
Location and accessibility
Program cost and affordability

Social WorkMarriage and Family TherapyMental Health CounselingClinical PsychologyOther
HawaiʻiAnother U.S. State or Washington, D.C.U.S. TerritoryAnother Country
Please specify where the program was located. *
Which state, territory, or country?
What was the program's delivery format?*
How many TOTAL graduate programs did you apply to before choosing to enroll in your program?*

Rate how you feel about the following aspects of the mental health program from which you graduated:*

Rows	Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied
Faculty support and accessibility
Course content relevance to real-world practice
Administrative support and responsiveness
Resources and facilities (e.g., library, study spaces, materials)
Technology and online learning resources
Practicum/internship placement support
Clinical training opportunities
Supervision and mentorship quality & quantity
Career preparation and job placement support
Opportunities for research, publication, or conference presentations
Cultural responsiveness training
Multicultural competence and inclusion
Non-English language considerations in training
Indigenous healing practices integration
Hawaiian values and cultural frameworks
Focus on local contexts and community-based care
Opportunities to engage with and serve the community
Peer/cohort experience and collaboration
Opportunities for networking and professional connections
Overall program quality

Teaching assistantshipResearch assistantshipConference presentationsPublicationsProfessional association membershipLeadership rolesCommunity serviceOther
Did you have clinical experience PRIOR TO entering your graduate program?*
Please briefly explain:
No Experience – No clinical experienceLimited Experience – Some exposure through coursework, volunteering, or shadowingSome Experience – Internship or practicum experience but not in a primary clinical roleModerate Experience – Hands-on support role (e.g., case management, crisis helpline, behavioral technician)Considerable Experience – Direct clinical work under supervision (e.g., counseling, therapy assistant, applied behavioral analysis)Extensive Experience – Independent clinical work (e.g., licensed, credentialed, or primary clinical role) [PLEASE STOP THIS SURVEY AND COMPLETE THE LICENSED PROVIDER SURVEY]Other
Community Mental Health CenterPrivate PracticeHospital / Inpatient SettingOutpatient ClinicSchool-Based Counseling / Academic SettingCrisis Helpline / Emergency ServicesSubstance Use Treatment FacilityResidential Treatment ProgramCorrectional Facility / Forensic SettingVeterans Affairs / Military Mental Health ServicesApplied Behavior Analysis (ABA) / Autism ServicesGroup Therapy / Support GroupsCase Management / Social ServicesOther
Community Mental Health CenterPrivate PracticeHospital / Inpatient SettingOutpatient ClinicSchool-Based Counseling / Academic SettingCrisis Helpline / Emergency ServicesSubstance Use Treatment FacilityResidential Treatment ProgramCorrectional Facility / Forensic SettingVeterans Affairs / Military Mental Health ServicesApplied Behavior Analysis (ABA) / Autism ServicesGroup Therapy / Support GroupsCase Management / Social ServicesOther
How to evaluate program accreditation and its impact on licensure requirementsThe differences between program types (e.g., MA vs. MS vs. MMFT, online vs. in-person)The total cost of the program, including hidden fees and living expensesAvailability of financial aid, scholarships, or loan forgiveness programsThe quality and availability of supervision opportunities within the programHow well the program prepared me for licensure requirements in Hawai‘iThe structure of clinical training, including practicum/internship placementsNetworking opportunities and professional connections the program could provideHow to navigate the post-graduate licensing process effectivelyWork-life balance and managing stress during graduate schoolNothing/I don't knowOther

Section 4: Financial Planning
Are you currently employed/working?*
How many paid jobs do you have?*
Mental Health (e.g., therapy, counseling, case management, social work, psychology)Education (e.g., teacher, professor, tutor)Healthcare (e.g., nursing, medical assistant, public health, allied health professions)Business/Finance (e.g., accounting, HR, management)Technology (e.g., IT, data science, software development)Customer Service (e.g., retail, hospitality, food service)Government/Public Service (e.g., policy, law enforcement, nonprofit work)Creative Arts & Media (e.g., writing, performing arts, graphic design)Trades & Skilled Labor (e.g., construction, mechanic, electrician)Other
On average, how many hours per week are you working?*
Type numbers only
Do you currently participate in any volunteer work or community service?*
On average, how many hours per week are you volunteering?*
Type numbers only
What impact (if any) is working more than one job having on your licensure journey?

1

2

3

4

5

6

7

1 is Very Negative Impact, 7 is Very Positive Impact
What was the total cost of your graduate education, including tuition, fees, and other expenses (e.g., textbooks, course materials, practicum costs, laptop/software, graduation fees, etc.)? *
Just enter numbers; no "$" or commas needed
Federal loansPrivate loansScholarshipsPersonal savingsFamily supportEmployer assistanceIncome from working while enrolled in the programOther

Please rate how knowledgeable you feel about the following financial aid options:*

Rows	Not at all Knowledgeable	Slightly Knowledgeable	Moderately Knowledgeable	Knowledgeable	Very Knowledgeable
Federal loan options
Scholarship opportunities
Loan forgiveness programs
Work-study options
Graduate assistantships
State-specific aid programs

Graduate program advisorsOnline researchFinancial aid officePeers/mentorsI didn’t research any optionsOther
How much student loan debt did you take on to complete your graduate education?*
How does your actual student loan debt compare to what you expected to borrow for graduate school?*
I have a clear plan and budget for repayment.I have a general idea but haven’t worked out the details yet.Still exploring repayment options.N/AOther
Standard repayment (fixed monthly payments over a set period).Income-driven repayment (payments based on income and family size).Graduated repayment (payments start low and increase over time).Extended repayment (lower monthly payments over a longer period).Loan forgiveness program (e.g., Public Service Loan Forgiveness, Teacher Loan Forgiveness).Refinance or consolidate loans.Deferment or forbearance (temporarily pausing or reducing payments).Employer assistance or loan repayment benefits.Make extra payments to pay off loans faster.Not currently making payments (e.g., still in school, grace period)N/AOther
I don’t have enough information about repayment options.I am unsure about my future income or job prospects.I plan to use loan forgiveness or assistance programs but haven’t researched them yet.I am prioritizing other financial obligations (e.g., rent, family support, daily expenses).I feel overwhelmed by my debt and don’t know where to start.None of the above/I have a planN/AOther

How concerned (or not) are you about the following financial factors related to your graduate education and early career in mental health?*

Rows	Not Concerned	Slightly Concerned	Moderately Concerned	Concerned	Very Concerned
Cost of supervision for licensure
Availability of paid positions that provide supervision hours
Ability to afford supervision while working in low-paying mental health roles
Cost of national licensure exam(s) and study materials
Likelihood of passing the licensure exam on the first attempt
Time required to complete supervised hours versus financial needs
Access to employer-sponsored supervision or training programs
Cost of maintaining an associate/pre-licensed status (fees, CEUs, etc.)
Ability to pay student loan debt while working toward licensure
Cost of additional training or certifications to become more competitive
Financial impact of taking on multiple jobs while completing licensure requirements
Availability of loan forgiveness or repayment programs
Work-life balance while juggling supervision, work, and personal expenses
Cost of professional memberships (e.g., AAMFT, NASW, APA, HPA, HCA)
Cost of malpractice insurance for pre-licensed professionals
Availability of scholarships or financial support for post-grad clinical work
Long-term financial return on investment for pursuing licensure

Section 5: Hawai'i-Specific Mental Health Practice Considerations
I currently practice exclusively in Hawai‘i full-timeI currently practice exclusively in Hawai‘i part-timeI practice in multiple locations, including Hawai‘iI am not currently practicing in Hawai‘iOther
In what other state(s) do you practice?
Type your response
No, I plan to stay and practice in Hawai‘i long-termYes, I am actively planning to leave Hawai‘i for workI am unsure; I may leave depending on circumstancesOther
What other state(s) are you considering?
Type your response
Yes, I would continue practicing in Hawai‘i in some capacityNo, I would not continue practicing in Hawai‘iUnsureOther

How prepared do you feel to practice in Hawai‘i across the following domains?*

Rows	Not at all Prepared	Slightly Prepared	Moderately Prepared	Prepared	Well Prepared	Very Prepared
Understanding of local culture and values
Familiarity with local mental health resources and referral networks
Cultural responsiveness in Hawai‘i’s diverse communities
Understanding Hawai‘i’s mental health laws and licensing requirements
Establishing a professional network in Hawai‘i
Navigating local language and communication styles
Community engagement and outreach

Housing costsProfessional isolationLimited supervision or mentorship optionsCultural adaptation (for those not from Hawai‘i)Language barriersCompetition for positionsLimited specialized trainingLicensing requirements and bureaucratic barriersWork-life balance challengesLimited mental health infrastructure (e.g., clinics, funding, resources)Other
Clear guidance on licensure requirements and processAccess to supervision, mentorship, and professional developmentMore clinical training opportunities in Hawai‘iSupport with licensure exam preparation (if applicable)Financial assistance (e.g., loan forgiveness, scholarships, continuing education funds)Employer support for licensure and training costsHigher salaries or financial incentivesJob opportunities that align with my professional expertiseTraining in local cultural practices and Hawaiian valuesStronger professional and community networksExpanded mental health infrastructure (e.g., clinics, funding, resources)Better work-life balance in clinical settingsPolicy changes to streamline licensure and professional requirementsOther

No Experience

Limited Experience

Some Experience

Moderate Experience

Considerable Experience

Extensive Experience

Individual therapy

Couple therapy

Family therapy

Group therapy

Other specific format/modality (please specify)