DEVELOPMENT OF A MODEL FOR EMOTIONAL WELL-BEING ADVISERS

European Economic Area Financial Mechanism Programme 2014-2021 "Health" instrument
"Emotional counselling services for people experiencing emotional difficulties (Emotional Well-being Advisers)"
Project

DEVELOPMENT OF A MODEL FOR EMOTIONAL WELL-BEING ADVISERS
(LT03-1-SAM-TF-002)

Project funding:
European Economic Area Financial Mechanism Health Programme 2014-2021.
Project promoter:
LITHUANIAN UNIVERSITY OF HEALTH SCIENCES

Summary of Project

INTRODUCTION. Lithuania is one of the leading countries in terms of the number of suicides in the world (18.64/per 100,000 inhabitants aged 15-19 and 31.5/per 100,000 adult population). More than 50% of those who committed suicide suffered from depression. Human resources for mental health care are scarce and expensive, so it isn't easy to attract mental health care specialists to work in provincial municipalities in Lithuania. Cognitive Behavioral Therapy (CBT) is well-developed in countries such as the United Kingdom, the Netherlands, and Norway. CBT has been extensively tested and has been shown to work as well as antidepressants. To address the lack of human resources and overprescribing, many countries have begun to train not only psychologists or psychiatrists but also nurses, social workers, and other professionals to provide brief, cost-effective, and evidence-based, standardized CBT counseling to help people cope with the first episodes of depression and anxiety symptoms.
AIMS OF THE PROJECT: To develop a training program and at least 30 highly motivated specialists will be trained to provide short, evidence-based, standardized consultations for people on how to deal with the first symptoms of depression and anxiety.
PLANNED ACTIVITIES: 1) prepare or adapt a training program for social and health science specialists to train specialists to provide brief, evidence-based, standardized consultations based on CBT. 2) select suitable candidates for the training program; highly motivated, with exceptional interpersonal skills and empathy; 3) prepare specialists to provide short, evidence-based, standardized, CBT-based consultations; 4) supervise newly trained specialists during the first three years of their practice; 5) implement a system for evaluating the client's well-being and other program indicators; 6) perform an efficiency assessment.
TARGET GROUPS: The main target group is nurses, social workers, psychologists, lifestyle medicine, and public health professionals who will provide emotional support to clients. The extended target group includes people experiencing mild symptoms of depression or anxiety who will receive the services of professionals trained in the project.
ACHIEVED RESULT: 1) Prepared, adapted, and developed a training program for specialists in the field of social and health sciences "Basics of emotional well-being consulting"; Postgraduate training courses (420 hours) for the training of emotional well-being advisers approved in LUHS, which will be conducted as needed, but no more than once a year. In this way, the long-term use of the training program and the training of specialists will be ensured. 2) At the beginning, it is planned to prepare at least 30 specialists who can provide short, evidence-based, standardized, CBT-based consultations on how to act in the event of mild depression and anxiety; During the first training, 28 specialists were trained, then three more specialists were trained individually due to the need to change consultants, and then second training was organized during which 29 more consultants were trained for work - 60 specialists were trained at the expense of the entire project. 25 more specialists were additionally trained, who studied at their own funds. Currently, 85 emotional well-being advisers are prepared in Lithuania for independent work with clients. 3) Prepared work with clients in the form of a report with used questionnaires (PSO-5, PSK-9, GAD-7) for monitoring the client's well-being and other indicators; 4) A statistical analysis of the work results of emotional well-being advisers and a service efficiency evaluation report was prepared. The analysis showed that the work of consultants effectively almost doubled the emotional state of clients. Almost all customers were satisfied or very satisfied with the services and only 0.2 percent of customers were not very satisfied with the services provided. Even 50 percent of individuals who received the services of emotional well-being counselors were in a significantly more difficult emotional state than expected. However, despite this, the counseling was very effective and the conditions improved as assessed by standard scales.
Well-being advisers – a new free service in Lithuania: 1. Emotional well-being services were provided to 4,221 clients in fourteen municipalities, 67% of them were women, 59% were city residents, aged from 18 to 95, the average age was 42.39±14.44; median 41 years. There was no difference in age between men and women. 2. Consultants worked with a total load of 15.5 full-time hours. On average, during one full-time job, a consultant consulted 272 clients, an average of 4.5 consultations were provided per client. 3. Even half of the clients had more severe emotional disorders than the WHO-5 <50, 11 percent. had severe anxiety symptoms and 3.5 percent had severe depressive symptoms. 4. The emotional state of all counseled persons improved statistically significantly by two times after counseling by emotional well-being counselors. 5. Almost all persons stated that they were satisfied or very satisfied with the services and only 0.2 percent were not very satisfied with the services. 6. The services of emotional well-being counselors are very effective in helping people with emotional disorders. 7. It is necessary to provide such services as widely as possible to improve the mental health of society.

About the project

Cognitive Behavioral Therapy (CBT) has now become the predominant form of psychological treatment and psychotherapy in developed countries. This is due to the advantages of CBT, such as:
1) its sound (1) a research-based treatment approach, (2) a structured approach compared to medication and other (3) a structured set of interventions that is consistent with medical and therapeutic approaches, (4) a good cost-effectiveness ratio, (5) an (4) has a high educational and enduring value, (5) is relatively short and easy to assimilate. It is fully can be fully assimilated by psychotherapists, psychiatrists and psychologists, and the individual elements and some of the techniques can be applied by general practitioners, other specialist doctors, nurses, and other health professionals. Another major advantage of CBTs is that they can be easily fragmented, i.e. it can be used to reduce individual disorders and even symptoms, as well as to significantly It can also be used for a much broader range of work on personality disorders or severe behavioral and mental disorders.

In Lithuania, as in the rest of the world, the incidence of mental and behavioral disorders is increasing. According to the Lithuanian Institute of Hygiene, over the last 10 years (from 2007 to 2017), the incidence of these diseases has increased (from 23.3 per 1,000 inhabitants to 35.2 per 1,000). The prevalence of mental and behavioral disorders increased from 55.6/1000 inhabitants to 78.3/1000 inhabitants. Depression is one of the most common and debilitating mental illnesses. In Lithuania, the incidence of depression is 4.76/1000 inhabitants, and the morbidity rate is 16.13/1000 inhabitants. Depression is particularly associated with suicide.

Even though suicide rates in Lithuania have been decreasing in recent years (according to the Institute of Hygiene, from 2000 to 2016, suicides in Lithuania decreased from 45 cases to 31 cases per 100 000 inhabitants), Lithuania still remains in the first place in the suicide statistics in Europe and in the top ten in the world. The figures are truly ominous: according to the latest Eurostat data, the standardized death rate due to suicide in Lithuania in 2017 was 31.5 deaths per 100,000 inhabitants (47.2/100,000 men and 9.1/100,000 women). This makes Lithuania the absolute leader in suicide rates. In 2017, 749 people committed suicide in Lithuania (596 men and 153 women), compared to 793 000 people worldwide, with an average of 10.5/100 000 inhabitants and 11/100 000 inhabitants in Europe.

Depression and anxiety are the main causes of suffering, according to researchers from the UK's London School of Economics and Political Science, who have carried out research on well-being around the world.
Depression, which affects as many as 25% of Europeans in their lifetime, is a major cause of sickness absence (about half of all sick days) and low productivity. Depression shortens life as much as smoking and is more disabling than asthma, angina, arthritis, or diabetes. Only one in four people with depression receives treatment, and an even smaller proportion get the treatment that is right for them.

Health and social protection systems have a key role to play in reducing suicide rates. It is essential that as many professionals as possible, not only psychologists and psychiatrists, but also doctors, nurses, public health or lifestyle medicine specialists, social workers, and others, are able to recognize emotional disturbances and the risk of suicide and are able to use low-intensity psychological well-being counselling. It is particularly important that people affected by mental disorders receive timely, evidence-based, and effective support. And health policy makers should organize effective treatment services for all illnesses, not just somatic ones.

The support system should start much earlier, not only when suicidal thoughts occur, but also when the first symptoms of possible depression are noticed. Research shows that psychological therapies can be, and often are, more effective and have a longer-lasting effect than medication in such cases. It is important to create a network of services in the country that are available to citizens at the first sign of possible depression.

One approach to modern psychotherapy that is suitable for this type of help is the research-based Cognitive Behavioral Therapy (CBT). It is a particularly appropriate approach for treating a wide range of anxiety disorders and to treat not only depression but also other mood disorders, various addictions, including alcohol, computer, and gambling addictions. CBT is a modern, evidence-based, proven in practice, in developed countries (the United Kingdom, the United States, the United States of America, the United States of America, the United Kingdom of Great Britain and Northern Ireland, and the United States of America). UK, Norway, etc.), which is the dominant treatment approach in developed countries, helping to eliminate symptoms and restore psychological balance in people suffering from various disorders. CBTs can also be used It can be used with or without medication and its effects last for a very long time - often for life.

DESCRIPTION OF THE MODEL FOR EMOTIONAL WELL-BEING  ADVISERS/COUNSELLORS GENERAL PROVISIONS

1. The description of the Emotional Well-being Advisers Model (hereafter referred to as "the description") sets out the emotional well-being the vision, purpose, and objectives of the recommended model for the provision of emotional well-being counselling services in Lithuania, the structural-functional set-up.
2. The Description has been prepared in cooperation with the Ministry of Health, the Ministry of Social Affairs, and the Ministry of Health. Ministry of Social Security and Labor, the Association of Lithuanian Municipalities, the Municipal Society Association of Municipal Health Offices, the Mental Health Unit of the Ministry of Health, and specialists from the Centre for Mental Health of the Hygiene Institute and based on good practice Norway, Australia, and England, where evidence-based low-intensity emotional Low-intensity low-impact counselling services have been successfully implemented and developed.

TERMS USED AND DEFINITIONS USED IN THE SCHEDULE
Low-intensity advisory services. The term low-intensity psychological counselling service is most often used in the context of step-by-step problem solving. Stepped problem-solving emphasizes the fact that, following an assessment of the service user's condition, mild disturbances or problems may be addressed by minimal interventions from lower-skilled professionals and referral to higher-level professionals is only suggested when the condition is not improving or is deteriorating or if the initial assessment already indicates that the problem is more serious than a low-intensity emotional counselling specialist can help with.

Emotional Well-being Counselling Services (EWC Services) are low-intensity psychological well-being and mental health promotion services for adults, in which people experiencing emotional or psychological difficulties are counselled by professionals using low-intensity interventions based on cognitive behavioral therapy.

Cognitive behavioral therapy (CBT) is a type of psychotherapy that has been proven effective in clinical trials. Cognitive Behavioral Therapy combines two highly effective types of psychotherapy - cognitive and behavioral therapies - to explore and understand how people's thoughts, emotions and behavior are connected, enabling modern people to discover quick and goal-oriented solutions to their problems, to understand the root causes of their problems and to change them.
Emotional Well-being Adviser/Counsellor (EWC) - a professional who has the required training and who has received specific training in low-intensity psychological well-being counselling for people experiencing psychological and emotional difficulties, based on cognitive behavioral therapy.

Emotional Well-being Counsellor Service Delivery Centre - this is the facility where the EWC works and where emotional well-being counselling services are provided to the public.

EMOTIONAL WELL-BEING COUNSELLING SERVICE TARGET GROUP
1. The target group of the EWC, or clients (hereinafter referred to as "service recipients"), are adults aged 18 years and older who show mild signs of stress, anxiety, insomnia, depression, and psychological adjustment problems.
2. The service recipients contact the Emotional Well-being Counselling Centre for the provision of services, either on their own or based on a referral.

VISION, AIM, OBJECTIVES OF THE MODEL

The vision of the model is to introduce and develop evidence-based, low-intensity psychological well-being counselling services that are accessible to people with mild emotional difficulties, to improve their well-being and to prevent the potential deterioration of their psycho-emotional state and the development of mental disorders.
The aim of the model is to encourage people to seek help for emotional difficulties, i.e. mild signs of stress, anxiety, insomnia, depression, and psychological adjustment problems, and to provide them with evidence-based, accessible, low-intensity psychological counselling services that are tailored to their needs.

Objectives of the model:
- Ensure the availability of low-intensity psychological well-being counselling services.
- Ensure that EWC services are non-discriminatory.
- Ensure confidentiality and privacy of EWC services.
- Ensure that EWC services are provided in a safe environment that meets the needs of service users in a safe and secure environment that is appropriate to the service users' needs.
- ensure the quality of EWC services.
- ensure that EWC services are provided only by appropriately trained and prepared, trained and competent professionals, and that the monitoring and control of these services by the EWC is carried out by the founders of the service centers or by other bodies that fund the services of the EWC service centers.
- Ensure the publicity of EWC services to ensure their availability and accessibility.

KEY ELEMENTS OF THE MODEL

A SERVICE DELIVERY CENTRE FOR EMOTIONAL WELL-BEING COUNSELLORS ENSURES:

• AVAILABILITY OF SERVICES
- Services are provided free of charge to persons aged 18 years and over (funding is defined by legislation).
- Referrals are accepted without any specific referral or referral.
- The venue is in a convenient and easily accessible location for the service users.
- Opening hours at the convenience of service users, including after working hours.
- Possibility of different ways of registering for services, including online.
- Adequate scheduling of services to reduce waiting times for consultations.
- In case of unfavorable conditions, the possibility of providing consultations online.

• EWC SERVICES are NON-DISCRIMINATING, maintaining CONFIDENTIALITY and SAFETY
- Services are provided to individuals regardless of their gender, age group, views, sexual orientation, race, or nationality. Non-discriminatory services for persons with disabilities.
- Service provision is based on mutual respect, understanding and agreement.
- The confidentiality of the service recipient shall be ensured, and personal information shall be encrypted and stored in accordance with the requirements for the protection of personal data.
- Services shall be provided in a safe and secure environment that meets the needs of the service user. Physical premises should be soundproof, and consultations should be well planned to minimize the need to wait at the office door, in the corridor or outside.

• QUALITY OF SERVICE
- Services are provided by EWCs who have received specific training and are continuously upgrading their qualifications (see point 2.1.).
- To select the most appropriate measures to assess the applicant and his/her condition and the dynamics of his/her condition, the following are used:
o WHO (5) Well-being Assessment Survey;
o Visual analogue scales;
o The standardized health questionnaires PSQ-9 and GNSS-7.
- Service users are adequately informed about the nature of the service, their own condition, and their options for accessing the service.
- The evolution of the service recipient's condition is monitored during each meeting with the EWC.
- The services provided shall be documented. Service documentation and the use of standardized emotional state assessment questionnaires are validated and used at regular intervals during sessions.
- Preparation and submission of reports according to defined indicators.
- To the evaluators of the work of the EWC service centers, i.e. to the founders of the EWC service centers or to the other institutions that finance and control the services provided by the EWC service centers. Annual reports shall be submitted by 15 February each year.
- Convenient working conditions in EWCs to retain professionals and avoid burnout.
- A well-developed service delivery infrastructure.

EMOTIONAL WELLBEING COUNSELLORS

An emotional wellbeing counsellor can be:
- a natural person who has a higher education degree in medicine, public health, rehabilitation, nursing, midwifery or social work, psychology in the group of health sciences, and has completed at least 320 hours of the postgraduate programme of postgraduate studies in the basics of emotional well-being counselling, based on cognitive behavioral therapy and who has a document proving this (hereinafter referred to as an EWB professional).
The main functions of emotional well-being counsellors:
o To organize an initial meeting to assess the mental health needs, level of psychological well-being and risk factors of the person applying for services, and to develop a service delivery plan through a survey.
o The assessment of mental health needs, level of psychological well-being and risk factors is based on the reports of the Emotional Well-being Counsellors' Centres and the analysis of questionnaires and scales. In case of suspicion of signs of mental and behavioral disorders, which the Emotional Well-being Counsellor is not able to help with within the scope of his/her competences, to recommend a referral to a personal health care institution providing mental health services, to provide information on which institution provides such services, and to explain the procedure for obtaining these services.
o Provide evidence-based low-intensity emotional well-being counselling services on an individual basis to people experiencing emotional difficulties, in accordance with the service delivery plan established at the first meeting, and to provide periodic emotional assessment during the counselling sessions.
o To administer its activities, i.e. to keep a logbook of service provision, which must include the service user's details, in accordance with the principles of confidentiality, the time of arrival, the duration of the consultation provided, and the results of the questionnaires used to assess the service user's standardized emotional state.
o Where necessary, to recommend that service users should be referred to a specialist or body in the relevant field for issues outside the remit of the Emotional Well-being Consultant.
o To continuously improve the qualifications of the Emotional Well-being Counsellor by participating in sub-specialist training, conferences, seminars, and supervision, with a minimum of 120 hours of training over a period of 5 years.

švietimo įstaigos (pavz., mokyklos psichologas, mokytojas) (2)

gerovės konsultanto paslaugų teikimo algoritmas (2)

TRAINING CENTRE FOR EMOTIONAL WELLBEING COUNSELLORS

The EWC training is provided by the Lithuanian University of Health Sciences. For this purpose, there are a postgraduate training programme (theory, practice, supervision, independent "BASICS OF EMOTIONAL WELL-BEING CONSULTING" KMU-962. Upon completion of the training a document proving this is issued.

COOPERATION WITH OTHER INSTITUTIONS AND ORGANISATIONS

- The EWC Service Delivery Centre actively cooperates with personal health care institutions (PHCIs), especially family doctors, and mental health centers (MHCs):
o If the condition of the EWC service recipient (person) or the appropriate assistance is beyond the EWC's competence, the EWC proactively advises/recommends that the person should be referred to a PHC, e.g. his/her family doctor, or directly to the PHC of his/her own PSC, e.g. for a consultation with a psychiatrist.
o If the EWC, after assessing the evolution of the service recipient's condition over time, sees that his/her efforts are not sufficiently effective, he/she shall stop the counselling and actively advise/recommend the person to seek a referral to an AACP, e.g. his/her family doctor, another specialist, or directly to his/her own PSC, e.g. for a consultation with a psychiatrist.
o The ASPs and PSCs inform their service users on a voluntary basis about the services provided by the EWC and recommend referrals to them for those persons who would need/ benefit from such services.
- The EWC Service Delivery Centre cooperates on a mutually beneficial basis with other institutions and organizations, such as: social service providers, pharmacies, psychological services, voluntary organizations, physical activity and sports providers, art, folk art and other similar activities, and other relevant non-governmental organizations:
o Institutions exchange relevant and useful information with each other for their service users.
o Refer their service users to specific services when the need for such services arises.
o Initiate and organize joint publicity campaigns to promote the services to the public and other stakeholders.

PRINCIPLES FOR IMPROVING THE PERFORMANCE OF EMOTIONAL WELLBEING COUNSELLING CENTRES

1. Developing innovative, accessible, non-discriminatory services adapted to different groups of society.
2. Introducing and developing remote services.
3. Future plans to create the conditions and possibilities for group psycho-emotional support and self-help services.
4. Introduction and use of electronic administration and evaluation tools.
5. Close cooperation with the PHCs (family doctors), PSCs and other institutions of interest or relevance to the service users.
6. Sharing best practices and problems with EHC service centers in the same and other municipalities, e.g.: organization of annual events/meetings/conferences, joint training, etc.