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Description
Programme outcome the project contributes to: “Improved access to and quality of health services in Malta”.
The project will improve access to and quality of health care services in Malta with particular focus on closing gaps in health care provision to children with disabilities associated with Autism Spectrum Disorder, genetic conditions, intellectual disabilities, attention problems or mental health problems as well as introducing screening of newborns for phenylketonuria (PKU and Nucleic Acid Amplification (NAT) testing of blood products for infectious diseases.
Project activities shall include:
- development of sensory integration therapy services (SIT);
- structural works (modifications) and renovations of the building hosting the SIT services;
- screening of PKU;
- NAT testing of blood products;
- training of health service professionals in SI therapy, PKU screening and NAT testing;
Summary of project results
Prior to the establishment of the Sensory Integration Therapy Center (SITC), several critical gaps existed in the provision of sensory integration (SI) services within Malta’s public healthcare system. These challenges included:
1. Lack of Sensory Integration (SI) Services within the Ministry of Health
- Before the program''s initiation, no SI therapy services were available within Malta’s public healthcare system. Parents who sought sensory integration therapy for their children had no choice but to seek services abroad or through private clinics, which led to significant financial burdens and accessibility issues.
2. Limited Access & Financial Barriers for Families
- Since SI therapy was only available in the private sector or overseas, families who could not afford the high costs of private therapy were left without access to crucial intervention services.
- This inequitable service provision created a gap in healthcare accessibility, disproportionately affecting lower-income families while favouring those who could afford private interventions.
3. Shortage of Qualified Therapists in Sensory Integration
- At the start of the program, very few Occupational Therapists (OTs) in Malta were certified in Ayres Sensory Integration (ASI).
- The lack of trained professionals made it difficult to develop and implement standardized SI therapy programs, further delaying intervention for children in need.
4. Lack of Infrastructure to Provide Sensory Integration Therapy
- The Ministry of Health did not have the necessary facilities or equipment to provide ASI programs.
- Specialized infrastructure, such as beams for suspended equipment, therapy rooms, and standardized equipment, was required to properly implement SI therapy, but these were not available within public healthcare settings.
5. High Demand for Sensory Integration Therapy
- Sensory integration therapy is one of the most requested Occupational Therapy (OT) interventions in paediatric settings worldwide, especially for children with autism spectrum disorder (ASD).
- Research shows that SI therapy is the third most requested intervention in the United States for children with autism, highlighting its importance in addressing sensory processing difficulties.
- Given the rising prevalence of sensory processing disorders and autism in Malta, the need for publicly accessible SI programs was urgent.
6. Urgent Need to Establish SI Therapy Services in Malta
- Recognizing the importance of early intervention and the high demand for SI therapy, the establishment of SITC was crucial to:
- Provide equitable access to therapy services for all children, regardless of financial status.
- Ensure that qualified professionals were trained in SI therapy to meet the needs of children requiring intervention.
- Develop infrastructure and resources to support the effective implementation of SI therapy programs.
The introduction of SITC addressed these long-standing challenges by integrating evidence-based sensory integration therapy into Malta’s public healthcare system, ensuring that all children, regardless of socioeconomic background, could receive the intervention they need.
7. Lack of Specifically Designed Assessment Rooms for children with ASD and SEBD
- The setting up and resourcing of the SIT Centre made possible the development of services related to the assessment of children with Autism Spectrum Disorders (ASD) and those presenting with Social, Emotional and Behavioural Difficulties (SEBD). These services are provided at the SIT Centre in specifically designed rooms that are conducive to the assessment and intervention process and which are not available within most school settings.
The Sensory Integration Therapy Center (SITC) project focused on establishing a high-quality, evidence-based sensory integration (SI) and feeding therapy service within Malta’s public healthcare system. The key activities undertaken included:
1. Infrastructure Development – Creating a Therapy Clinic
- Provided funds to refurbish an existing building to create a specialized clinic space designed for Sensory Integration Therapy.
- Ensured the clinic design adhered to the Fidelity Measure in Sensory Integration, which regulates therapy standards and guarantees authentic, evidence-based SI interventions.
- Addressed infrastructure issues, such as creating appropriate therapy spaces, ensuring proper installation of SI equipment, and making modifications to meet therapy standards.
2. Purchase of Specialized Sensory Integration & Therapy Equipment
- Funded the acquisition of essential SI and Sequential Oral Sensory (SOS) therapy equipment required to implement structured therapy programs.
- Equipment included:
- Suspended therapy systems, swings, weighted materials, balance boards, tactile exploration tools, and feeding therapy kits to support sensory processing and feeding intervention.
- Ensured that the equipment setup met international therapy standards, allowing therapists to conduct authentic, high-quality SI interventions.
3. Therapist Education & Certification in Sensory Integration & Feeding Therapy
- Funded education and certification programs for 20 Maltese and 2 Norwegian Occupational Therapists (OTs) in Ayres Sensory Integration (ASI) and Sequential Oral Sensory (SOS) Approach to Feeding (for Speech Language Pathologists) and basic concepts of ASI (Physiotherapists).
- Enabled OTs to receive formal training and mentorship in advanced SI therapy techniques, and mentoring in the SOS Approach to feeding therapy.
- Supported OTs in weekly mentoring sessions with CLASI ASI Mentors, ensuring ongoing skill development and clinical excellence.
4. Equipping Therapists with Knowledge for Program & Service Development
- Provided therapists with the expertise to design and implement structured SI and SOS therapy programs, enhancing service provision in both areas.
The project laid the foundation for sustainable Sensory Integration and Feeding Therapy services in the public healthcare sector, ensuring that children with sensory and feeding difficulties could receive high-quality, evidence-based intervention locally rather than seeking services abroad.
A national screening programme for autism was required which would bring Health and Education in partnership working on a coordinated referral and support pathway.
For the assessment of children with social communication difficulties, the project assisted in providing the required assessment environment. Furthermore, SPS personnel were trained in the use of the ADOS-2 which forms a central part in the diagnostic assessment for autism. The training of 22 practitioners was provided by Dr. Ellin Antonissen (Norway; 2019). Another group of 30 practitioners was provided by Prof. Kenneth Larsen (Norway; 2023).
In relation to the assessment of children with SEBD, 52 practitioners were trained in the understanding of children’s drawing. This was provided by Dr. Roberta Attard, clinical psychologist, University of Malta
The project also provided funds for the purchase of psychometric tests for the assessment of child development, intellectual ability, social communication, attentional functioning and literacy skills development.
The project provided the opportunity for the organisation of a Networking Conference to enhance collaboration between Health and Education Services providing services within the SIT Centre.
The Sensory Integration Therapy Centre (SITC) project successfully improved therapy accessibility, service quality, and clinical outcomes for children with sensory processing and feeding difficulties. The key results achieved are outlined below:
Impact on Children and Families
- 923 children received therapy as of November 2024, providing crucial intervention for those with sensory and feeding challenges.
- Statistically significant improvements in therapy outcomes were measured using the Goal Attainment Scaling (GAS) method, confirming effective intervention strategies.
- Reduced need for families to seek therapy abroad, increasing accessibility to high-quality, evidence-based care within Malta’s public healthcare system.
Effectiveness of Therapy Interventions
The project delivered structured Sensory Integration (SI) and Sequential Oral Sensory (SOS) therapy programs:
- ASI Therapy was provided through three structured programs (30 sessions, 20 sessions, and 10 sessions).
- SOS Feeding Therapy was delivered in 12-session programs, targeting children with feeding difficulties.
Clinical Outcomes (GAS Analysis & Statistical Achievements):
- A T-test analysis of pre- and post-intervention GAS goal scores showed a statistically significant improvement (p < 0.05), confirming the effectiveness of the interventions.
- Cohen’s d values indicated large-to-extremely large effects, signifying substantial developmental progress in key domains:
- Activities of Daily Living (ADLs): 2.54
- Health & Safety: 3.78
- Play Skills: 3.05
The project primarily benefited:
Children with sensory processing and feeding difficulties – Improved participation in daily activities, social interactions, and self-regulation.
Parents and caregivers – Received training and guidance on how to support their child''s sensory and feeding challenges at home.
The Maltese public healthcare system – Developed a structured, evidence-based SI and feeding therapy service, reducing dependence on private or foreign therapy services.
The SITC project significantly improved therapy outcomes for children with sensory and feeding challenges, closing a major healthcare gap in Malta. The strong clinical results, high success rates, and improved accessibility highlight the project''s long-term positive impact on both families and healthcare providers.
The project also benefitted children who were presenting with difficulties related to development, learning, behaviour and social communication. In 2024, 652 children were referred for SPS services through the SIT Centre.