October 17, 2019 | Advocacy
As we celebrate our 50th anniversary as an association, we are seeing great momentum in our licensure effort, with a new license signed into law just last month. Over fifty years, we have reached many milestones that illustrate our mission – to advocate for expansion of access to professional art therapists and lead the nation in the advancement of art therapy as a regulated mental health and human services profession. And we look forward to many more achievements as we work to realize our vision – that the services of licensed, culturally proficient art therapists are available to all individuals, families, and communities.
One of the core roles of any professional association is legislative advancement to benefit those in the profession, so we’re taking the opportunity to review the history and current status of the five building blocks of our national licensure strategy. The building blocks will directly support us in reaching our goals of having distinct art therapy licensure as well as insurance reimbursement in all U.S. states and territories.
Delaware Governor John Carney (left) with art therapists and AATA Executive Director Cynthia Woodruff after signing the art therapy license into law on September 8, 2017.
1) Independent National Professional Credentialing
How we got here
Therapeutic use of art was defined and developed into a discipline, first in England in the 1940s, then in the United States during the 1950s in pioneering art therapy programs at the National Institutes of Health, Menninger Foundation, Hahnemann Hospital in Philadelphia, and other distinguished medical institutions. By the 1960s, hospitals, clinics and rehabilitation centers increasingly began to include art therapy programs in addition to traditional “talk therapies,” recognizing that the creative process of art-making enhances recovery, health, and wellness. Art therapists recognized the need to set standards in order to further define the profession and to protect the public from the potential harm of working with someone who claims to be an art therapist but lacks the educational and professional qualifications.
In 1969, the American Art Therapy Association (AATA) was founded. Shortly thereafter, at the first AATA annual conference in 1970, the Registered Art Therapist (ATR) credential was created. The Art Therapy Credentials Board (ATCB), a separate organization from AATA, was established in 1993 to develop a national board exam, to oversee the credentialing of art therapists, and to set ethical practice standards for the profession of art therapy.
Where we are today
In 2012, the ATCB received accreditation by the National Commission for Certifying Agencies (NCCA), providing impartial, third-party validation that the ATCB has met recognized national credentialing industry standards for the development, implementation, and maintenance of certification programs. Today, over 7,000 professional art therapists hold national art therapy credentials.
2) Independent Competency Exam
How we got here
The first Certification Exam for art therapists was offered on November 20, 1994 in Chicago Illinois, with the first art therapists earning board certification, their ATR-BC credentials, shortly thereafter.
Where we are today
The Art Therapy Credentials Board Examination (ATCBE) serves a crucial purpose in AATA’s licensure strategy. A valid and reliable test measuring the knowledge and skills required for professional competency reduces cost and burden to state licensing boards to administer and create examinations. In states that provide licensure for art therapists, licensing boards can rely on the quality of the ATCBE to ascertain the competency of art therapists, at no additional cost to the state. This is the case today in eleven states, including Connecticut, Delaware, Kentucky, Maryland, New Jersey, New Mexico, New York, Pennsylvania, Texas, Oregon, and Wisconsin.
3) Independent National Program Accreditation
How we got here
The number of education programs offering art therapy grew rapidly in the early years of the profession. In 1971, four programs offered master’s degrees in art therapy, and by 1980, 22 graduate programs offered either art therapy concentrations or degrees.
In 1979, AATA replaced Guidelines for Art Therapy Training, a document written and adopted by the Association in the early 1970s to provide some direction and fundamental standards for training, with a more formal approval process. The Education and Training Board, the precursor to the Educational Program Approval Board (EPAB), was formed to oversee the standards of art therapy graduate programs, and the first cohort of programs became AATA-approved in 1980. By 2014, there were 39 EPAB-approved art therapy programs in accredited institutions in 20 states and Canada.
AATA’s Education Committee recognized the importance of third-party accreditation outside the Association and applied for accreditation through the Commission on Accreditation of Allied Health Education Programs (CAAHEP), a Recognized Accrediting Organization through the Council on Higher Education Accreditation (CHEA). CAAHEP approved the application in 2016, and AATA began the transition process from EPAB-approval towards program accreditation managed by the newly-formed Accreditation Council for Art Therapy Education (ACATE).
Where we are today
Many state licensing boards and agencies require that applicants hold graduate degrees from independently accredited professional programs, citing the excessive time and cost of conducting individualized academic credential reviews. Similar to the importance many states now attribute to a national credential and competency exam overseen by third-party organizations, national program accreditation saves state agencies and licensing boards time and energy in determining the educational qualifications of art therapists.
In 2017, existing EPAB-approved and several new graduate art therapy programs began the independent national accreditation process through CAAHEP, with the first 12 programs having received accreditation to date. During this transition, AATA, when working with state chapters and licensure task forces, includes language in proposed legislation making it clear that both AATA-approved (through EPAB) and newly CAAHEP-accredited programs prepare their students for entry-level skills and post-graduate certification as art therapists.
4) Comparability with other Mental Health Licensing Standards
How we got here
While art therapy is unique in its focus on non-verbal information processing, art therapy shares important foundations and training with other mental health professions. Upon graduation and after completing the relevant hours of clinical supervision, art therapists have historically qualified for licenses in related mental health professions on an individual basis. In other words, while art therapists are not specifically included in a state’s licensing statute or rules as a qualifying profession, graduates of art therapy programs can meet the individual requirements for the license in a related mental health profession. As a result, in the absence of distinct art therapy licensure in most states, art therapists have sought licenses in related professions. In a 2016 membership demographic survey, 20 percent of participants reported licensure as Licensed Professional Counselors, 12 percent as Licensed Clinical and/or Mental Health Counselors, 10 percent as Licensed Marriage & Family Therapists, and three percent as Licensed Social Workers, respectively.
Where we are today
Today, many art therapy graduate programs offer dual degrees in art therapy and counseling or art therapy and marriage and family therapy. However, movements by related professions to solidify their own professional identity have made it more and more difficult for art therapists to qualify for these licenses. Almost all states now require a degree from programs accredited by the Council on Social Work Education (CSWE) to obtain licenses as clinical social workers; most states also require applicants for marriage and family therapy licenses to hold degrees from specific accredited programs of the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE); and growing numbers of states are requiring applicants for professional counseling licenses to hold degrees from programs accredited by the Council on Accreditation of Counseling and Related Educational Programs (CACREP) or the Council on Rehabilitation Education (CORE), or from substantially equivalent counseling programs. Distinct licensure for art therapists has become a priority not only to solidify art therapists’ own professional identity but also to ensure access to licensure for art therapists.
Since 2013, AATA’s efforts to assist chapters and members in drafting licensing legislation has focused on creating licensing standards for art therapists that require comparable academic and clinical training as other master’s level mental health professionals licensed by a state. Where possible, proposed legislation provides for a distinct art therapist license within the same statute and under the same licensing board as these licensed professions. In addition to allowing art therapists to advocate for licensure on its own merits, this approach also provides equal treatment under state law for comparably trained mental health professionals. Additionally, it helps encourage legislators, state officials, private insurers, and other professionals to view art therapists on an equal basis as previously licensed mental health professionals for purposes of participation in state programs and insurance reimbursement.
5) License Portability
How we got here
AATA’s ultimate goal is that art therapists will not only have access to licensure as art therapists in all states but also that they will be able to move easily from state to state – or extend their practice across borders into neighboring states – to continue to serve clients at the highest standards. While efforts to create comparable licensing requirements with other mental health professions in each state can result in differences in licensing requirements, such as in the number of required hours of supervised practice, a fifth building block has focused on establishing as much uniformity as possible in state licensure requirements to facilitate license portability. All states currently provide for some level of license portability, which permits practitioners licensed in one state to move to another state and obtain licensure by “endorsement” without having to go through the state’s formal application and examination process, provided that the state views the other as having generally comparable licensing standards. As AATA continues to pass licensure legislation across the country, it becomes crucial that we maintain as uniform an approach to licensure as possible, understanding that we must balance this with the unique existing licensure structure in every state.
In all its licensing proposals, AATA has sought to implement a “three-legged stool” approach to licensure, making sure that all license statutes are written with the same three standard requirements to assure the maximum degree of uniformity:
- A master’s degree from an approved/accredited art therapy program or a substantially similar program.
- Between 2,000 and 3,000 hours of post-degree supervised clinical experience based on standards of supervised practice established by ATCB to qualify art therapists for the ATR credential.
- Passing the ATCB certification exam.
This “three-legged stool” approach, combined with the first three building blocks, offers easily verifiable licensing requirements and promotes license portability. Licensing boards recognize master’s degrees from accredited programs as automatically meeting their state’s education requirements; applicants who achieve national ATCB registration are presumed to have met acceptable standards for qualifying supervised practice; and individuals are considered to have attained necessary levels of competency to engage in practice by passing a national professional certification examination.
Where we are today
Art therapists are engaged in licensure campaigns in more states than ever before. We have already achieved distinct licensure for art therapists in seven states – Connecticut, Delaware, Kentucky, Maryland, New Jersey, New Mexico, and Oregon. Seven art therapy licensure bills were active in the 2019 legislative session, and another fifteen states have engaged art therapists in licensure campaigns. While each license is different, the underlining three elements remain largely consistent, allowing easier portability from state to state.
The “three-legged stool” approach supports portability. The standard requirements mean that when art therapists move from one state to another, they can apply for licensure by “reciprocity” or “endorsement,” because the licensure requirements of the state they are moving from meet or exceed those of their new state.
The art therapy profession has grown significantly in the last fifty years thanks to the contributions of many dedicated art therapists along the way. As AATA advocates for licensure across the country, we continue to learn from our successes as well as the obstacles we face. The five building blocks that make up our licensure strategy ensure the highest clinical standards for professional practice of art therapy. Even as art therapists continue to lose access to related mental health licenses, we are encouraged by the progress we have made in creating distinct art therapy licensure to ensure the continued expansion of art therapy as a profession and to solidify the identity of licensed art therapists.
Former Representative Marlene Anielski with art therapists and art therapy supporters following a House Health Committee hearing for HB 557, Ohio art therapy licensure bill, on April 11, 2018.