Body image dissatisfaction, resulting from disfigurement or the consequence of perceived social pressure to conform to unrealistic and narrow beauty (and ageist) ideals, indiscriminately affects the mental and physical health of a significant and growing proportion of the European population. Those with disfigurement also experience social discrimination that negatively impacts on personal aspirations, education and work opportunities. As medical advances improve the survival rates of those born with or who acquire a disfigurement, and the demand for cosmetic interventions and psychological support increases, professionals from diverse health and social care areas are increasingly being exposed to the challenges of identifying and addressing the needs of patients burdened by complex and unique psychosocial issues. These professionals are perfectly placed to ameliorate these issues but report that they often lack the necessary expertise to help and therefore patient access to expert support is inadequate.A consortium led by the internationally renowned Centre for Appearance Research in the UK with university partners in IT, LT, SE and TK and the European Cleft Organisation (NGO) in NL, who have collaborations with health professionals and patients in various healthcare settings, will execute an innovative project to design, test and implement a multi-modal, evidence-based course for use in higher education that will equate to 2.5 credits (75 hours required to achieve learning outcomes). It will have extensive and culturally specific materials to enable health and social care trainee and qualified professionals identify and manage patients and clients affected by disfigurement and body image concerns. The need for action in this area is further validated by the current COST action IS1210 of which most partners are members, that highlights the negative psychosocial impact of appearance concerns and the importance of these issues within health settings (http://www.cost.eu/domains_actions/isch/Actions/IS1210) and Partners will form strategic regional working groups and will be allocated tasks to suit their strengths and expertise. University partners will survey at least 100 multidisciplinary health professionals in each partner country to determine the current state of training for health professionals involved in the care of people with any disfigurement, their awareness and understanding of the issues facing those affected, their confidence in supporting patients with appearance-related concerns, their training needs and views on the best way to deliver and promote educational materials. The European Cleft Organization will also produce a European report on health professionals' current awareness of appearance issues and training needs. Reports from each partner will inform the development of multilingual material for a 6 module course, that will adhere to the European Quality Framework and provide education on the psychology of body image and disfigurement, risk factors for body image dissatisfaction and its psychosocial and health impact across the lifespan, the impact of disfigurement for the individual and family with reference to protective and risk factors for adjustment, the development of skills to the promote positive body image, assess and meet the needs of people with disfigurement and skills to manage professional issues related to instigating and sharing best practice around this subject. Materials and their mode of delivery will be pilot tested in each country by potential users and reviewed by the NGO and if necessary adapted further. A course handbook providing guidance to course administrators and course website with down-loadable multilingual materials will be developed and the course will be widely advertised using the many contacts and networks provided by the partners. National exploitation multiplier events in each country and via the COST action above, will ensure dissemination to hundreds of multidisciplinary health professionals from a minimum of 30 countries and 50 relevant organizations.In the short term this project will provide a unique, cost-effective , widely available and internationally transferable course, informed by a UK partner with extensive expertise in the field that addresses educational and skill deficits identified by multidisciplinary health professionals across the UK and EU. We expect this expertise will improve health care provision for people affected by disfigurement and more general body image dissatisfaction, which in the longer term has the potential to improve associated physical and mental health-related outcomes. It will also challenge poorly informed attitudes that can lead to discrimination, by raising awareness of these issues to health professionals and contributing to a social dialogue about stigmatization and the social exclusion of individuals/families with disfiguring conditions and appearance-related concerns. .

"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.

<< Objectives >>There are around 10 million people in Europe with a disfigurement who face enormous challenges and stigma. This project aims to improve the lives and opportunities of this group by training health professionals (HCPs) and NGOs on how these challenges can be reduced. The trainees will be given a toolkit enabling them to go out and train in the community and use adapted material directly for affected families, thus providing a cascading awareness of the dificulties and stigma faced by this group<< Implementation >>1. Development of a one-day training programme for HCPs & NGOs on (a) societal context and pressures for people affected by disfigurements (b) challenges for this group (c) effective interventions (individual; community-based; societal level) (d) basic course in social activism (e) skilling workers in the community; 2. Development of a train the trainer package to enable HCPs & NGOs to train in the community.and direct to affected families. A thorough pedagogical guide will also be included<< Results >>Development of training for health professionals and NGOs to help them understand and support the challenges faced by people with disfigurements. This knowledge is then rolled out to the community and adapted for families. The project provides slills for key workers to help people with a visible difference to gain the skills and coping strategies to deal with challenges as they occur, rather than retrospectively . Furthermore, by disseminating knowledge in the community, stigma will reduce

"It is of paramount importance to support the development of relevant and high-quality skills and competences further to strengthen key competences in VET concerning health care. European healthcare systems show significant gaps in healthcare provision (Council of Europe, 2016). At the same time, our health care system is under considerable budgetary and societal strain (European Commission, 2017). To improve our provision of care, we need to devise a more efficient and sustainable healthcare system. Then it is essential to be able to implement change and monitoring the outcomes. At the same time, numerous studies show that implementing the proposed changes in a healthcare setting remains fragmented, inconsistent, and inefficient. Hence, there is a substantial need for the development of high-quality work-based VET in the healthcare sector that facilitates the process of implementing change in an efficient and structured way and being cost-efficient. The need for ongoing training and development of health care professionals is highlighted in the Directive 2013/55/EU ""Member States shall ensure, by encouraging continuous professional development, that health professionals are able to update their knowledge… to maintain safe and effective practice"". A key priority is the need to train healthcare professionals to implement change and monitor the effect at the clinical levels. The healthcare partners from Slovenia, Greece, Estonia, Latvia, and Romania report that they do not have the resources or training to address these issues adequately and are therefore neglected. The objectives of this project were to develop, test, implement and disseminate the developed training material for healthcare managers and healthcare professionals and students. A further objective was to produce a functional training programme reflective of the sociocultural diversity across Europe. The project succeeded to make the training material accessible to a broad range of stakeholders via multi-mode delivery accessible as an open resource. The consortium consisted of public health experts in change and implementation methodology (SE) and pedagogical experts in vocational training (NO) with an NGO (NL) that incorporated the patient perspective. The hospitals (LT, EL, RO, SI, EE) generated a needs analysis of each partners' healthcare setting to achieve the best way to implement the project. The methodological approach and activities generated the following results: 1. A functional and evaluated training material that is based upon research evidence and the needs analysis. 2. The training has quickly impacted work-based CVET that enhances service provision by addressing the need to create tools for implementing and evaluating change in a structured way. 3. The pilot data of the training course showed a significant increase in learning between pre and post in 121 healthcare professionals. 4. Health care organisations have now access to continuing education and training (CVET) that will update their health professionals' knowledge in this area to maintain safe and effective practice 5. 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. This developed training course provides the tools to implement and monitor these changes for all patient groups, including those at risk for social exclusion and poverty. 6. The developed training curriculum is economically viable to implement and can reach a large group of members of health staff or NGO's. This is due to the methodological design of concrete and focused 1-day training courses that emphasise addressing knowledge and skill deficits in this area. The long-term benefits are that staff/students in the health care sector and NGOs have access via the partners a training program that will directly enhance their skillset and facilitate better health care provision for their intended target groups and in the same way make the health care system more efficient. Better implementation strategies that can ensure that improvement in health care provision will be more successful. This results in that patients will receive improved timely access to affordable, preventive and curative health care of good quality. Individuals that also belong to socially disadvantaged groups benefits since the training will address the circumstances that need to be considered when implementing change to avoid unintentional marginalisation. The project has 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)."