Six steps to building a practice to serve special needs children

As a specialist in dispensing for paediatrics – Wogin works with the Special Schools Eye Care Service and is an assessor for ABDO’s Professional Certificate in Paediatric Eyecare, as well as working in independent practice – he knows what it takes to engage some of optometry’s most underserved patients.

Here, he shares his wisdom – including why getting it right first time should not be the goal, why communication ahead of the appointment is invaluable, and how the whole practice team has a part to play in making a special needs paediatric visit successful.

1 Sustaining interest and thinking on your feet

Wogin explained to OT that his focus during a paediatric dispensing appointment is personalised communication, rather than the finer details of the dispense itself.

“We have quite a non-clinical environment outside of the testing room,” he said.

He added: “A lot of what we do, both for young patients and adults, is about psychology. It’s less about whether we can do the job – it’s about how we adapt our practice for the patients.”

A one-size-fits-all approach does not work in special needs dispensing scenarios, Wogin said.

He explained: “I’ve seen children from three months old. You have to behave differently with every child.

“You see various neurodiversities too. It’s about really being able to read the room and adapt your practice in a microsecond to make sure you don’t lose that patient.”

Jamie Wogin

2 Enabling a tailored environment for special needs children

“From a practice point of view, we have a less busy environment. We are a busy practice, but we create a calm situation for our child patients,” Wogin explained.

Practically, this means paediatric dispensing as far as possible away from reception, where there is less clutter and less noise.

It also means tailoring each appointment for each child.

“Often we have these conversations in advance with parents,” Wogin said.

“Depending on the child’s needs, we can choose when in the day they want to come in. Depending on what their triggers are, we can reduce a lot of those triggers in advance.”

He added: “Learning about what that patient needs starts way before they come to practice. It’s about knowing the little things, and what they’re interested in. It could be that a kid has closed up like a clam, until you realise they’re wearing a Minecraft t-shirt. You then start talking to them about Minecraft, and suddenly they become really open and interested, and much calmer and less inward.”

Information on what to expect – and in turn how to prepare – comes directly from the child’s parents or carers, Wogin explained.

Learning about what that patient needs starts way before they come to practice

“Generally, the parents are aware of their children’s fear of medical places,” he said.

“They might have autistic spectrum disorder, autism, ADHD – anything where they feel that special requirements might need to be taken into account.”

Parents of children with special needs are often proactive in contacting the practice to discuss their child’s needs, he said.

After a phone conversation, the child’s specific needs are added to their record within the practice management system.

Wogin also advises adapting existing forms, such as the About My Eyes form that is used in special schools, to find out about children’s interests in advance.

“We effectively build a picture of who this child is,” he told OT.

Wogin added: “Because I’ve worked in a lot of places, I’ve witnessed some really good and some really bad ways of dealing with children.

“You can see instantly what does and doesn’t work. Beyond anything else, it is icebreakers that work with these kids, and embracing your inner children’s TV host.”

3 Speak to the child, not the parent – even when the child is non-verbal

Wogin notes that speaking to the child directly, whatever their level of additional needs, is often a way in – and that this can often surprise their parents.

“By far the most disarming thing for children is to be really friendly and open and talk to them,” he explained.

“I talk to the parents too, but mostly my conversations are with the child, and it works really well.”

The simpler the better when it comes to explaining options, Wogin said.

He shared: “I don’t use a lot of grown-up language. I’ve always been quite heavy on the layman’s terms. Unless you’ve got someone with that kind of background in front of you, you can end up talking an entirely different language.

“The more you simplify it, the better. Talk to that child on their level. I have children who are completely non-verbal, and the temptation would be to not talk to them, because they can’t talk to you.”

Communicating with a child does not always mean speech, Wogin believes.

“Always talk to the child,” he advised, because “they are the person who you are doing everything for.”

He added: “I’ve surprised some parents who think their kids are non-verbal. I can have a conversation – it might not be verbal, but there’s so much in the way of body language that’s really important when somebody can’t really tell you what they want.”

Jamie Wogin

4 Understand that paediatric dispensing is about practice, not theory

OT is interested in hearing Wogin’s advice for practice team members who might be nervous about communicating with or dispensing for child patients, especially those with special needs.

Wogin acknowledged that it is very easy to be nervous about something that you are unfamiliar with.

However, he believes that this is an area that cannot be fully understood before you are in the midst of it.

“You need to be aware that it’s not a topic you can 100% understand before you start doing it,” Wogin said.

“It’s much more of a practical thing than a theory thing. It’s about starting that journey and learning as you go, and being adaptable.”

There’s so much in the way of body language that’s really important when somebody can’t really tell you what they want

He added: “I guarantee that the person on the other side is more scared than you are of the whole situation.”

For those interested in paediatric eye care, Wogin’s advice is to “embrace it. Get involved. Do some research.”

There are various courses for optical professionals interested in paediatrics and special needs, he explained – and there are many sources to learn from.

“I work in schools, and in taking in information on neurodiversity from teachers, I find there’s a lot to pick up and learn, to then adapt my practice accordingly,” he said.

5 Getting it right is the responsibility of the whole practice team

“I think everybody can get involved in the process. If your optometrists know how to do a wonderful paediatric test, that has to continue out for everybody, from the point where that child walks through the door,” Wogin shared.

“That first impression is so, so important. Whoever is on reception, however your practice is set up – however bad your day is, open with a smile and be as disarming as you can,” he advised.

Wogin added: “A lot of children have a fear of the unknown, and don’t want to walk into a practice that's clinical and serious. It’s so important to make sure you start off on the right foot, because it’s really hard to get it back if you get it wrong, but it’s really easy to keep it going if you’ve got it right.”

6 Getting it right first time is not the most important thing

Despite paediatric special needs dispensing being a sensitive process to handle, Wogin emphasises that perfection is not the goal.

“As optometrists and dispensing opticians, we’re so used to having to get everything right,” he said.

“However, I think it’s really important to work slightly outside the box in terms of dealing with children. There may be some children who you have two minutes with, because they’re going to be more upset the longer you take.”

It is important to know that not all the clinical boxes need to be ticked on every visit in order to do a good job, Wogin believes, “because each time you see that child, you’ll get more accurate.”

He continued: “It’s about building a picture over time. Don’t worry too much about getting everything done on that first visit. It’s more about rapport and putting them at ease than it is clinically getting your measurements to half a millimetre.”

Wogin added: “Sometimes you need a lot less time, and you sometimes need a lot more. I would say shorter visits, but more regular ones, are by far the most successful.

“For some of the kids who find it hardest to walk through the door, we’re not doing anything on the first visit. We’re potentially just getting them through the door, having a nice chat, playing with some toys, and off they go. Nothing to do with glasses. That’s a really important thing. It’s a different hat.”