"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.

The rational of the project was shaped at the European parliament meeting “The challenges of health inequalities in the treatment and prevention of birth defects in Europe” in Brussels (9/10/2012) since it was identified that the psychosocial aspects for individuals with disfigurement is less than optimal in many instances across Europe. The validity of idea was further strengthening by the approved COST Action IS1210 – Appearance Matters that acknowledges the psychosocial consequences of having a negative body image or disfigurement is a European priority. The lack of adequate psychosocial training in order to provide suitable provision of care to families that is affected by disfigurement and in many cases the unintentional marginalization and socially exclusion that can occur. In many cases the health care professionals lack the capacity to deliver appropriate psychosocial care in combination with not understanding the specific cultural stigma associated with disfigurement. In Bulgaria, by a request from UNICEF, a survey highlighted that 40% of the parents were advised to abandon their child with cleft in an orphanage where they can expect life-long institutionalization, because of the financial and emotional burden. Of 89% of these, the advice was given by a qualified health professional (ECO, 2011). In Bulgaria, Latvia, Turkey and Serbia, the psychosocial care provision is not adequately developed or in some cases non-existing. This is mostly due to that the health staff or members of relevant NGO’s has no training in regards in how to deliver appropriate psychosocial support. By having a consortium of psychosocial experts (UK), pedagogical experts in vocational training in accordance to the European Qualification Framework (NO) together with hospitals that deliver care for disfigurments (RS, TR) and NGO’s (BG, NL) that works directly with individuals with disfigurement and their families as well as providing training to health professionals. The aim is to generate the training course “Face Value” since it is established that health professionals can be taught to provide psychosocial support when given simple training and access to appropriate resources. Evidence indicates that voluntary organizations can have an equally important part to play in the training of qualified health professionals (Clarke, A. & Cooper, C., 2001). The Serbian and Bulgarian partners work extensively with the Roma population, which would further contribute to the specific societal and cultural understanding for this often socially disadvantaged group. The project addresses EU priorities that have been identified in several publications -European Disability Strategy 2010-2020: A Renewed Commitment to a Barrier-Free Europe, 2010; Early Childhood Education and Care: Providing all our children with the best start for the world of tomorrow, 2011; The European Platform against Poverty and Social Exclusion, 2010. This will be accomplished by to develop a training course in modular form that will be piloted on 80 – 120 health professionals in the following partners countries (BG, LV, RS, TR) in order to ensure the effectiveness and cultural adaptation. The final product will be available for free via the projects website. The impact is the following:- A functional training program for health professionals and members of NGO’s. The material will adhere to the European Quality Framework level 3 and the learners will achieve the following a) a range of cognitive and practical skills required to accomplish tasks and solve problems by selecting and applying basic methods, tools, materials and information b) take responsibility for completion of tasks in work or study c) adapt own behaviour to circumstances in solving problems- Increase the staffs' understanding how individuals with disfigurement and their families can experience discrimination and stigmatization, which can result in social exclusion, especially if they are already are a member of a social disadvantaged group such as the Roma population for example. - Quickly have an impact that enhance the psychosocial service provision for the affected individuals/families with disfiguring conditions - Since the training course is short, it become economical viable to implement it as well as facilitate it to more members of health staff or NGO’s. - Between 120 – 160 health professionals and relevant members of NGOs partake in a National Multiplier event in BG, LV, RS and TR. The project will also raise awareness and contribute to a social dialogue about discrimination and social exclusion for individuals/families with disfiguring conditions. This is especially important since a considerable proportion of the discrimination is conducted by health professional due to inadequate training. By highlighting this kind of training and making it easily transferable could result in that this type of discrimination will become less prominent.

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.

There is a substantial need for the development of high quality work-based VET in the healthcare sector that works with congenital anomalies. In Europe, 1 one out of 40 pregnancies is affected by a congenital anomalies that can result in medical, social and/or psychological disabilities throughout the lifespan for the affected individuals and their families. When it come to children with disabilities there are often negative consequences in their education, which can have a detrimental effect on their future. One of the most common congenital anomalies is orofacial cleft that requires treatment from birth to adulthood. Besides from the obvious medical perspective, studies have reported poorer performance trajectories in educational settings for individuals with orofacial cleft in comparison to their otherwise healthy peers. Currently, the resources in our health care system across Europe are quite varied and the demand on resources is increasing rapidly. This result in that children do not get the access to the necessary care provision, especially in screening for diagnostics or treatment implications that can have a negative impact on their education. The idea of the project was shaped at the European parliament meeting “The challenges of health inequalities in the treatment and prevention of birth defects in Europe: An information workshop for MEPs and NGOs at the European Parliament” in Brussels and further strengthening and supported by the on going networking project COST Action IS1210 funded by the EU Framework Programme Horizon 2020. By having a consortium of psychosocial (UK), public health (SE) and pedagogical experts in vocational training in accordance to the EQF, ECVET and EQAVET frameworks (NO) together with hospitals (BG, LT, RS, SE, TR) and NGO’s that works directly with individuals with congenital anomalies and their families (BG, NL) ensures that a functional training program can be delivered.The aim is to develop a training package for health care professionals that has limited or no access to psychological input about the medical and psychosocial variables that can influence educational achievement. They would also be trained to deliver this information to the parents of the children with orofacial clefts. The parents would be trained to recognise behavioural symptoms and other psychosocial aspects that could negatively influence educational outcomes. This would result in that the parents can feedback to the health professionals in a systematized way.The preparatory work by the consortium validates that this is a project that meets the focus 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 ‘Early Childhood Education and Care: Providing all our children with the best start for the world of tomorrow’, February 2011; European Commission Communication ‘The European Platform against Poverty and Social Exclusion’, December 2010) and that each partners is highly motivated to allocate resources since there is an established need and consequently implementation and sustainability of the project is assured.This will be accomplished by to develop a training course in modular form that will be piloted on 50 – 100 health professionals in the following partners countries (BG, LV, RS, SE, TR) in order to ensure the effectiveness and cultural adaptation. The final product will be available for free via the projects website. The impact is the following:- A functional training program for health professionals and members of NGO’s. - The material will incorporate recommendations from EQF, ECVET and EQAVET frameworks -Through the development of a short training course for health professionals that addresses the medical and treatment aspects that can influence educational outcomes in individuals with orofacial cleft that is also cultural adopted to each participating partner increase significantly the long term effect.- The project would facilitate parental engagement since they will be actively involved in their child’s health care and educational achievements - It will also contributing to reducing the unintentional marginalization and socially exclusion in health care settings by promoting cross cultural care - Quickly have an impact that enhances service provision for the affected individuals/families- Since the training course will be short, it will be economically viable to implement it on a broad scale across Europe.- Between 100 – 200 health professionals and relevant members of NGOs partake in a National Multiplier. Not only the design and methodology of the project ensure long-term effect, all partners are known actors in the field of VET in relation to the training of Health Professional and are well known in health networks and Higher Education. The partners are regarded as a source of reliable information among the target