"VET context In this project it has been CVET (Continuing Vocational Education and Training) that has been in focus. The definition of CVET is (according to eqavet.eu) ""Education or training after initial education and training – or after entry into working life aimed at helping individuals to:- improve or update their knowledge and/or skills;- acquire new skills for a career move or retraining;- continue their personal or professional development."" This project directly corresponds to the aims of CVETThis project has fostered excellence in the sense that healthcare professionals who have pursued high quality in their job with children born with clefts have had access to high quality work based learning giving them new tasks and competences, so as to allow them to do an even better job with those children born with cleft.EQAVET in the Netherlands have been approached by the project coordinator with a view to ensuring the training reaches, and is adopted by,relevant vocational training platforms in the Netherlands. However, because of the very specific medical nature of the project, the platforms are more likely to be in hospital environments than in training schools.Need for training programmeThere are around a million people in Europe born with a cleft. Many of these will not enjoy the same educational and employment opportunities as their peers as a result of being marginalised for looking or sounding different. If correct care is not offered in the first year of life, babies with clefts will fail to thrive and in some countries are abandoned in institutions. The 2015 report of the European Committee for Standardisation - TR 16824 – Early Care Services for Babies Born with Clefts indicated that there is a skill shortage in provision of care for cleft. This was also aknowleged at the European Parliament meeting “The challenges of health inequalities in the treatment and prevention of birth defects in Europe” in Brussels (9/10/12) and again at the European Committee for Standardisation in Brussels ‘Impact of new guidelines on the early care of babies born with cleft lip and or palate’ (21/03/2016)., Aims and objectivesThe aim of this project has been to develop a training programme for health professionals working with families with children with clefts that will equip the participants with the necessary skills to assess the infant, to determine whether there are any other associated anomalies needing specialised support and intervention, and formulate a treatment plan that allows the infant to thrive normally. It has highlighted the support needs of the child and family and provided the healthcare professionals with the tools to address these needs through patient-centred information and guidance. The developed course has 4 key modules – Understanding of cleft lip and palate; Early care focusing on diagnosis and feeding; Support and for families: Practical exercises and case histories. The course handbook spells out exactly how the course is delivered.Partners and participants By having a consortium including an expert NGO working in the specific arena of clefts, a training organisation comprising pedagogical experts in vocational training in accordance to the EQF, ECVET and EQAVET frameworks, and five hospitals routinely involved with the care of babies born with clefts (see partner organsiations, below) we have developed a functional training program.. The fact that these partners have come from diverse cultural areas has strengthened the project and made it adaptable for use in a variety of settings and contexts. The training course is in modular form and was piloted on, and promoted to, 300 health professionals and related professionals in the partners countries in order to ensure the effectiveness and cultural adaptation. In the original application we set a target of 180 to be reached by pilots and multiplier events but we well exceeded this. The modular course, handbook, national reports and promotional material are available as an open resource via the project website www.celftectp.com in 6 partner languages (BU,NL,EN, GR, LV LT and RO). ImpactThe course teaches effective care for children born with clefts from the point of diagnosis. We have been informed that the course material will now form the basis for cleft nursing education in the UK. . All partners in the project are drawing on key aspects of the programme to enrich training in their countries. Bulgaria has developed a cleft nurse network, training nurses with the material from this project. Slovenia has just let us know that they intend to use this material. We are keen to continue to promote the project and the resources we have developed. ECO Executive Director presented on the project at the US Cleft Lip and Craniofacial Congress in Arizona in April 2019 and again at the European Cleft and Craniofacial Congress in June 2019. Total audience reached by the project has been around 7500 individuals."

There was and still is a substantial need for the development of high-quality work-based VET in the healthcare sector specialising in the care of patients undergoing appearance altering procedures that result in scarring and body form changes such as cancer, burns, limb loss, mastectomy, plastic surgery and congenital disabilities. As the patients undergo treatment, many have a difficult time to deal with their altered appearance, or they have an unrealistic expectation of the treatment. At the same time, health care professionals do not have the knowledge. A study that surveyed 718 health workers in Europe found that 87% wanted to know more about how to support their patients and 70% wanted to attend an accredited course to address knowledge and skill deficits (Williamson et al., 2017). This proposal was a direct outcome from the COST Action IS1210 network supported by the EU Framework Programme Horizon 2020. Members from the 34 countries involved in this network have concluded that it is paramount to train healthcare professionals in the psychological and psychiatric aspects of care are crucial for the individuals undergoing appearance altering procedures. In particular, feedback from health professionals in Norway, Bulgaria, Italy, Romania and Sweden acknowledge that they do not have the right skills to address with the psychological and/or psychiatric consequences. In many cases, they report that individuals with these problems isolate themselves from society resulting in unemployment and/or poor physical and psychological health. The health care professionals report that they feel inadequate equipped to support their patients; they also experience increased stress and frustration. Extensive research document the significant negative impacts of disfigurement and appearance altering treatment has further indicated that staff report having the insufficient time and little confidence in meeting these patients' information and support needs (Persson et al. 2008; Konradsen et al. 2009). Research by Clarke & Cooper (2001) has shown in addition. However, health professionals do not feel as skilled in delivering psychosocial support to patients that they can very quickly take on this role when given training and access to appropriate resources. The consortium consisted of public health, psychology and pedagogical experts in vocational training in accordance to the EQF framework together with hospitals and NGOs that work directly with individuals undergoing appearance altering procedures, resulted in that a state of the art training material was developed. The training course is in a modular form and was piloted on 46 health professionals in the partners' countries (BG, IT, RO) in order to ensure the effectiveness and cultural adaptation. The project included a purpose-designed pre and post KAPb test. This evaluation questionnaire was developed to measure the participants' levels of knowledge before and after the training. It covers the three dimensions - Knowledge, Attitude and Practice behaviour in relation to the European Qualification Framework level 4. The KAP test consists of 26 questions that are administered before (pre) the training, and after the training (post). The statistical analysis (T-test for paired samples) indicated a significant increase in knowledge. The outcome was a functional continuing education and training package for healthcare professionals who currently have limited or no access to psychological expertise about the psychiatric and psychosocial variables that are associated with disfigurement and appearance altering procedures. As indicated, this issue is a comprehensive European problem, and by utilising a transnational project approach, the consortium was able to generate training materials that functioned effectively in the context of European diversity in social and cultural aspects. By increasing knowledge and awareness of the negative impacts of appearance-related distress amongst partners and their networks, the project promoted a broader social dialogue about the need to encourage positive attitudes towards diversity in appearance, thus enhancing the future social integration of those who are affected by disfigurement – particularly those with additional risk factors for discrimination, including migrants, refugees and those from other socially disadvantaged groups. The longer-term benefits are accelerated enhancements to service provision and the quality of psychological care offered to patients undergoing appearance altering procedures via a succinct and economically viable training module. All the material developed is an open resource and available to download at the website of the project. The dissemination and sustainability plan ensured that a broad group of healthcare professionals across Europe and beyond was reached.

A cleft of the lip and/or palate is the most common birth defect. Approximately 900,000 children, adults and their families are affected by this condition across Europe. This project offers an exciting opportunity to develop innovative information and resources for use by health professionals to enable parents to identify signs of impairment and to offer practical ways of supporting their child born with a cleft and experiencing speech and language difficulties and/or psychological challenges associated with their condition. Speech, appearance and psychological adjustment are inextricably linked. Subjective satisfaction with speech and reading skills have also been shown to be associated with self and parent reported psychological adjustment in children with a cleft palate. The family environment is key in promoting positive adjustment in a child with a cleft. Parents are considered key agents for change in their child’s development and well-being including communication and speech disorders. Parents want the best for their children and to optimise their child’s chances of successfully dealing with life’s challenges, yet often lack the specialist information and advice to help them in this goal. The provision of care for children with cleft and their families varies markedly across Europe. The ‘gold standard’ of multidisciplinary care is available only to a small minority. Parental need for information and advice about how to identify early warning signs of challenges and address the difficulties, is acute. There have been calls from parents and healthcare professionals to develop authoritative information to support parents in promoting positive adjustment in their children. Looking and/or sounding different does not have to be a barrier to a happy and successful life. Parents are uniquely influential in shaping their child’s experience of being born and treated for a cleft, in the values, attitudes and behaviours their child develops, and in how to interpret social and cultural information. But parents need help to achieve this, particularly if the health care resources available to them are limited. “For patients, ‘innovation’ means not only new treatments, but also new and better ways to organise and deliver care. Empowered patients are partners in improving care quality, from self-management support through shared care planning to service evaluation and (re-)design'' European Patient Forum ‘Putting what matters to patients at the heart of EU Health Policy’ 2019.This project will develop materials to be delivered by health professionals to parents offering practical ways of helping children to improve their speech and language and to build their psychological resilience. Giving parents training and insight leads to positive benefits to their child’s language and speech. Similarly, with appropriate information and skills, for example, parents can be effective in promoting psychological resilience and positive adjustment in children in early and middle childhood. For example, skills in identifying early signs of sub-optimal social or psychological adjustment, educational or social difficulties can alert parents to the need to seek out credible sources of further support, thus improving the chances of optimising later outcomes for their child. The project consortium covers a wide geographical and social dimension: partners come from Bulgaria, Estonia, Italy, Ireland, Malta, Netherlands, Norway, Romania and Serbia . The consortium includes a combination of “players” in research, health care delivery and training expertise (VET) together with an international NGO meaning that the partnership possesses a variety of high-level and complementary skills. The partnership is built with organisations having extensive national and European level knowledge, networks and experience . The coordinator (NL) is a specialist Europe wide NGO promoting best practice cleft care from the user perspective that has run training programmes in 8 countries for healthcare professionals and user groups. The Norwegian partner (NO) is a specialist in VET and EQVET and also has experts focusing on psychology and resilience. Additionally, there is a highly experienced partner in research and knowledge in speech and communication disorders and therapies (IRL) together with specialist multidisciplinary cleft healthcare providers (BU, EE, IT, MT, RO, RS ) The majority of partners have successfully cooperated in various European strategic partnerships before, delivering projects with outstanding quality and outputs which is reflected in the final assessment rating. Two new partners will have the opportunity to gain new knowledge and skills by working in an experienced partnership.

In Europe it is estimated that approximately 12 million individuals have a disfigurement that results in body image dissatisfaction (BID), which is recognised as a global public health concern. Healthcare professionals (HP) across Europe commonly report caring for patients who have BID as a result of a disfiguring condition. There are many causes of disfigurement, including craniofacial conditions (e.g. cleft lip and/or palate), injury (e.g. burns and combat-related injuries), skin conditions (e.g. psoriasis) and medical treatment (e.g. following cancer or meningitis). Given their high level of contact with patients with disfiguring conditions, HP are well placed and motivated to positively address patients' BID, but many lack knowledge and confidence to do so. Research shows that giving HP simple training and access to specialist resources enables HP to take on this role. Acceptance and Commitment Therapy (ACT) offers a psychological model well suited to the needs of patients with a disfiguring condition. ACT focuses on helping patients to lead fulfilling lives and teaching them skills to manage difficult thoughts and feelings, which enhances their quality of life. The objectives of this project were to (i) develop, (ii) test (iii) implement and (iv) disseminate a training package for Health Professionals (HP), enabling them to use Acceptance and Commitment Therapy (ACT) principles to facilitate patient adjustment to a disfiguring condition. A further objective was to produce a functional training programme, reflective of the sociocultural diversity across Europe. A needs analysis of each partners' healthcare setting was carried out. The project managed to make the training material accessible to a broad range of HP and will continue to do so through multi-mode delivery. A highly experienced research team (United Kingdom, Sweden) and a knowledge mobilisation partner with extensive VET experience (Norway), along with Health Care providers (Estonia, Greece, Cyprus, Slovenia, Romania) and NGO (Netherlands) collaborated to complete the project. These partners have been selected to provide the necessary expertise and experience of the project's educational remit, and to target HP from Estonia, Greece, Cyprus, Slovenia and Romania, in order to implement the training into service provision. Project methodology and activities comprised: 1. A functional and evaluated training material that was based upon research evidence and the needs analysis from the target recipient nations. 2. The training which promptly created an impact through high quality work-based VET by addressing the need to create tools on how to address the patients with body image dissatisfaction (BID) as a result of disfiguring conditions 3. Health care organisations became able to access this open resource material and provided continuing education and training (CVET) to HP to enhance their clinical skills. 4. In line with the European Commission's priorities, the project contributed to a more sustainable health care system that safeguards access to affordable, preventive and curative health care of good quality. 5. The training proved to be economically viable to implement and at the same time able to reach a large group of members of healthcare staff, students or NGO's, as it is short and concrete. In the long-term, the training package together with its implementation plan will be updated and adapted for other partners' operational directives. The project's key products (project outline, reports, didactic guidelines, extracts from the training pack) will remain freely available online for a minimum of 5 years after funding, allowing longer-term access for HP and healthcare stakeholders. It is anticipated that the transnational networks and relationships formed through this project will also lead to new training initiatives and projects across Europe. The project resulted in raising a European awareness of these aspects, which adheres to the established priorities of the European commission (European Commission Communication 'European Disability Strategy 2010-2020: A Renewed Commitment to a Barrier-Free Europe', November 2010; European Commission Communication 'The European Platform against Poverty and Social Exclusion', December 2010).

In Europe, about 5 million live births occur each year, and it is estimated that 18% of women will develop depression during pregnancy, 13-20% of women will develop post-natal depression within the first 12 weeks of childbirth, and for 8% of women, this extends beyond the first year. Many studies have reported that negative affect and depression predict body dissatisfaction and to complicate further these relationships, poor dietary and exercise habits are also likely contributors to depression in mothers, reinforcing negative body image and poor health outcomes. At the same time, there is an established need to train healthcare professionals (HCP) and other relevant stakeholders in how to support the mental and physical wellbeing for mothers of children 0-5 years. HCP and other relevant stakeholders are well placed and motivated to address this issue positively, but many lack knowledge and confidence to do so. Research shows that providing evidence-based training and resources enables them to take on this role. By implementing an innovative approach for teaching and learning, based upon evidence-based outcomes, as well as to design continuing education and training (CVET) activities that link with the European Social Charter (ETS no.163) and the European Pillar of Social Rights (2017), will ensure a functional project. The objectives of this project are to (i) develop, (ii) test (iii) implement and (iv) disseminate the training package for HCP, enabling them to support the mental and physical wellbeing for mothers of children 0-5 years. A further objective is to produce a functional training programme, reflective of the sociocultural diversity across Europe. The project aims to make the training material accessible to a broad range of HCP and other relevant stakeholders and will do so through multi-mode delivery. In the partnership there is highly experienced researcher partners (Norway, Sweden) and knowledge mobilisation partner that has extensive VET experience (Norway), Health Care providers and other relevant stakeholders (Estonia, Greece, Romania, Serbia, Sweden, Italy, the Netherlands, and Malta) who are highly motivated to implement the training into service provision.Project methodology and activities comprise: 1. A functional and evaluated training material that is based upon research evidence and the needs analysis from the target recipient nations. 2. The training will quickly have an impact through high quality continuing vocational education and training (CVET) that enhances service provision by addressing the need to support the mental and physical wellbeing for mothers of children 0-5 years.3. Health care organisations and other relevant stakeholders will have access to this open resource material so they can provide continuing education and training (CVET) that will update their health professionals' knowledge in this area in order to maintain a safe and effective practice4. As prioritised by the European Commission, it is paramount to create a more sustainable health care system that can address that everyone has access to affordable, preventive and curative health care of good quality. 5. The training will be economically viable to implement and at the same time be able to reach a large group of members of healthcare staff, students or other relevant stakeholders. This is due to the methodological design of ​concrete and focused 1-day training course that emphasis on addressing knowledge and skill deficits in this area.6. Another significant aspect to consider is that around half of all patients in Europe cannot understand basic health care information, which indicates that health literacy is a fundamental challenge that needs to be addressed (World Health Organization, 2013). Therefore, the project will develop information material for mothers about maternal wellbeing for various societal backgrounds including mothers that have a child born with a congenital disability. Because of the issue of health illiteracy, that material will be developed at EQF level 2 for easy accessibility. In the long-term, the training package together with its implementation plan will be updated and adapted for other partners' operational directives. The project's key products will remain freely available online for a minimum of 5 years after funding, allowing longer-term access for HCP and relevant stakeholders. It is anticipated that the transnational networks and relationships formed through this project will also lead to new training initiatives and projects across Europe.The project will result in raising a European awareness of these aspects, which adheres to the established priorities of the European Commission (European Commission Communication 'European Disability Strategy 2010-2020: A Renewed Commitment to a Barrier-Free Europe', November 2010; European Commission Communication 'The European Platform against Poverty and Social Exclusion', December 2010).