Some families require support that goes beyond just being assisted in their parenting techniques, Home-Based Therapeutic Services (HBTS) parenting leader Francesca Giordano said.
“For instance, some have children aged 12 and over, or who have been through physical or sexual abuse. In those cases, we cannot start straight away with the parenting programme, we first need to create safety and stability,” Giordano told The Malta Independent on Sunday in an interview.
The process begins by setting boundaries and rules in the home before focusing on the parent-child relationship, she said.
“We always try to adapt to what each family needs rather than just follow the manual. We also hold regular feedback sessions with therapists and other professionals involved with the family,” Giordano said.
It is not always possible for the HBTS to give support, largely because the programme is specifically designed to cater for particular situations.
For example, parents raising children with autism in Malta who turn to HBTS for guidance are given as much assistance as possible, but then are referred to other organisations for more specialised assistance.
Giordano, who leads the HBTS North team within the Agency for Community and Therapeutic Services (ACTS) under the Foundation for Social Welfare Services (FSWS), said that the team has already proposed specialised training for HBTS staff to better support these parents.
“We want to equip ourselves with more knowledge so that we can respond effectively,” she said. In the meantime these parents are referred to other agencies like Inspire and Agenzija Sapport, she added.
“Many families tell us there isn’t a service that can help them develop parenting skills for children with autism. We try to help as much as we can, but we are transparent that our programmes were designed for ADHD and Oppositional Defiant Disorder (ODD), not for autism,” Giordano said.
Recently, HBTS was honoured with the Making a Difference award, recognising its innovative approach and impact.
“We were humbled and flabbergasted. Even being nominated was an honour,” Giordano said, crediting the families themselves for the recognition.
“We could not have done it without our clients; it is truly a collaboration. They are the experts in their lives. We just bring the tools,” Giordano said.
Giordano said the team constantly looks for ways to improve and innovate.
“We really try to be diverse in how we deliver the service. We also offer group sessions where we provide refreshments, childcare, and even transport when possible. We want to make it easier for families to participate,” Giordano said.
The award, she said, helped give the service more visibility, as more people now know about HBTS and what it does.
A service for Malta’s most vulnerable families
HBTS was set up under ACTS to provide therapeutic and parenting support to vulnerable families, often those facing social, emotional, or behavioural difficulties at home.
“The main referrals come from Child Protection Services, as well as from Looked After Children and other community services,” Giordano explained.
“Currently, we don’t accept walk-ins. There has to be a social worker’s referral, although schools can now also refer families,” she said.
The agency provides both home-based and in-office sessions. “If the home environment isn’t suitable, we offer the service at our offices. We also sometimes meet families in community spaces or online,” Giordano said.
Some families referred for parent coaching are those at risk of a care order, or where a child might be reintegrated into the home, she said.
To help these families, the HBTS team uses the Incredible Years Parenting Programme, an evidence-based model designed for children aged 0 to 12.
“The sessions are very structured. Each has a topic of the day, for example, child-directed play, and includes videos, discussions, and role-playing to help parents practise new skills,” Giordano said.
The service, she said, “really deals with the most vulnerable population of Malta”, often working with families in difficult life circumstances. Giordano said that HBTS handles around 100 open cases every year.
Giordano said the service has observed a notable rise in referrals involving children with ADHD and, increasingly, autism.
“From what our intake team tells us, many families feel there isn’t a service dedicated to helping them with parenting skills for children with autism,” she said.
“We use what we can from our existing programme and collaborate closely with parents, because they are the experts in their lives,” Giordano continued.
The growing demand has prompted the team to seek new training opportunities, as Giordano said that the team is doing its best to train themselves so that they can better support these families.
To assess effectiveness, Giordano said that the HBTS team uses structured feedback and evaluation tools.
“Before clients start the programme, we give them a questionnaire to identify their parenting style and skills,” Giordano said.
“We repeat this at the beginning, midway, at the end, and again six months later to see if skills have been retained,” Giordano said.
She said that each session also includes a weekly evaluation sheet for parents to provide feedback on videos, discussions, and the overall experience.
“We take their feedback seriously, even negative feedback helps us improve,” Giordano said.
The general feedback, she said, has been positive, as parents appreciate what the team does to support them.
Over time, the HBTS team has expanded beyond structured programmes, to include life coaching and therapeutic parenting elements.
Giordano explained that with older children, therapy often needs to come first.
“Imagine being 12, with no rules at home, and then suddenly your mother starts imposing limits,” she said.
“There has to be an earlier and more complex conversation about the programme,” Giordano said. For younger children, parents are also encouraged to discuss the programme openly.
“They should tell their children that things might change, that they’re learning new ways of doing things,” she said.
Giordano said that a core principle of HBTS’s work is involving both parents and, when possible, extended family members.
“We always ask if the father will be attending, because sometimes attention is not given to him as much. If everyone follows the same approach, the chance of success is much higher,” Giordano said.
The programme also encourages parents to build a support system – family, friends, or community, while completing the programme.
However, Giordano said that before tackling parenting issues, basic needs such as housing and stability must be addressed.
“If the family doesn’t have a place to live, I can’t expect them to focus on parenting skills. We need to start from the basics. Many of the people we see have gone through a lot of challenges in their lives,” Giordano said.
The parenting coaches also encourage parents to reflect on their own experiences, she said.
“If someone has a permissive style, we ask them to reflect – where does that come from? What would change if they adjusted their approach?” Giordano said.
Sometimes, deeper issues may emerge that require therapy, Giordano said.
“If we see unfinished business from the past, we encourage them to seek therapy. They are often more open to it when it’s explained by someone they already trust from our team,” Giordano said.
Giordano recalled that when HBTS started in 2016, many clients were hesitant to engage with therapy. “They didn’t know what therapy was, but once they got to know us, they became more open to it,” she said.
She said that each full programme typically takes at least 20 sessions, though some clients require more time.
“Sometimes it takes a year to finish with a particular client, because parenting is lifelong. That is why our waiting list can get long, though right now, we only have around 10 clients waiting,” Giordano said.
She added that it takes courage for parents to reach out, as they would be in a vulnerable position to come forward and say they need help with their parenting skills, noting that stigma and misconceptions still exist.
Giordano said that HBTS works closely with other FSWS entities, including Child Protection Services, Looked After Children, and local community social workers, as well as schools and NGOs.
“We collaborate internally and externally. For example, if a school identifies that parents are struggling with introducing rules, they refer them to us. We might then create a specific group for those parents,” Giordano said.
Last year, the team organised group sessions in Birkirkara, where instead of the full programme, parents could select the topics they most wanted to explore, such as managing anxiety in children. Giordano said that this is an approach which the team will also be adopting this year.
“In those cases, we bring in other professionals from our therapeutic team for a more integrated approach,” she said.
She also acknowledged that fragmentation between services remains a challenge.
“There needs to be commitment. If we decide to meet every month, people need to show up. Communication must be open and constant,” Giordano said.
Different services often focus on different clients, where one professional would be working with the parent and another with the child.
“That is why it is so important for professionals to align and communicate. At the end of the day, the family lives together, parents need children, and children need parents,” she said.
Apart from the parenting programme, the Qawra branch also runs other initiatives, including Dawra Durella for children, and a community living room open twice weekly for adults in the area to socialise.
She said that anyone needing support can contact the service through Appoġġ on 2295 9000 or ask for the intake team for the Home-Based Therapeutic Services.
“If they need therapy or parenting support, we’re here to help,” Giordano added.