Parent training can help support the development of communication skills for young children with complex communication needs (CCN). Online delivery of such training may alleviate some of the burden on families, thereby increasing participation and outcomes. To determine the effectiveness of online parent training in communication partner strategies, a single-subject, multiple-probe design study was conducted with four parents and their children with developmental disabilities and CCN. Parents completed an interactive online training and then participated in live sessions to demonstrate trained skills. Results indicate that online parent training resulted in higher levels of communication opportunities provided by parents to their children with CCN. Increases were also noted for child communication and responses provided by parents to child communication. Results varied for participants. Parent evaluations of the training, limitations, and future research directions are discussed.

Children with autism spectrum disorder (ASD) show core deficits in social interaction and communication (American Psychiatric Association [APA], 2013). In early childhood, more than half of children with ASD demonstrate limited verbal skills, referred to as complex communication needs (CCN; Anderson et al., 2007), which exacerbate their ability to connect and communicate. Augmentative and alternative communication (AAC), including technologies such as pictures, speech generating devices, and sign language, can be beneficial for children with both ASD and CCN, and can support communicative development (Nunes, 2008). Language development is also dependent upon the quality of language input provided by communication partners (Vukelich, Christie, & Enz, 2002). Parent support (e.g., communication opportunities, increased wait time, responsiveness) in particular is essential for child communicative development. It is especially crucial for children with ASD, and predictive of language development (Huttenlocher, Waterfall, Vasilyeva, Vevea, & Hedges, 2010; Siller & Sigman, 2002). However, few studies have been identified that examine online parent training approaches for children with ASD who also require AAC, despite the benefits of online training (e.g., flexible scheduling, no travel; Lakes et al., 2009) and the overall sustainability and scalability of such approaches.

More than half of the children who receive special education services in early childhood have speech and language delays (Hebbler et al., 2007). Many of these children have significant delays called complex communication needs (CCN), which includes a lack of speech production, and impacts communication and social development (Raghavendra, Virgo, Olsson, Connell, & Lane, 2011). Children with CCN require specialized supports from communication partners (e.g., siblings, parents, teachers) to learn communication skills (Kent-Walsh & McNaughton, 2005). Unfortunately, communication partners often hinder communicative development by asking closed questions, dominating communicative interactions, and providing few opportunities, which leads to limited communication by the child with CCN (Kent-Walsh & McNaughton, 2005). However, communication partner training can improve communication partner supports from individuals such as parents and peers (Kent-Walsh, Murza, Malani, & Binger, 2015), and also improve communication by individuals with CCN (Douglas, Light, & McNaughton, 2013). Although all individuals in a child's social environment are important, the sibling relationship is especially crucial (Shivers & Plavnick, 2015). Siblings frequently play together and spend more time together in childhood than other individuals (Kim & Horn, 2010). Sibling relationships are also the longest lasting relationships in life (Shivers & Plavnick, 2015). However, for children with CCN, sibling interactions may be challenging due to communication difficulties, which can make typically developing (TD) siblings feel incompetent (Kim & Horn, 2010). Sibling interventions can boost TD sibling confidence, increase skill acquisition for both siblings, and positively impact sibling relationships (Shivers & Plavnick, 2015). Despite evidence suggesting that siblings are ideal communication partners, sibling research is still limited (Shivers & Plavnick, 2015). However, sibling training has been shown to positively impact the communication of children with autism spectrum disorder (ASD) and the communication supports by their TD siblings (Oppenheim-Leaf, Leaf, Dozier, Sheldon, & Sherman, 2012). TD siblings have also been successfully taught to support play behaviors (Celiberti & Harris, 1993), and social skills (Tsao & Odom, 2006). Research indicates that sibling interventions are effective for children with ASD and other developmental delays (e.g., Down syndrome, William's syndrome, cognitive 703366C DQXXX10.

School-based health centers (SBHCs) positively influence student health. However, the extent to which these benefits are actualized varies across sites. We conducted focus groups with high school students and teachers at an underperforming SBHC to identify facilitators and barriers to student access to SBHC services. Our qualitative analysis revealed four main emergent categories: (1) students' knowledge of SBHC services; (2) teachers' perceptions of, and experiences with, the SBHC; (3) accessing and utilizing SBHC services; and (4) student and teacher suggestions to improve the school–SBHC relationship. Our findings suggest that the relationships between health center staff and teachers are crucial and can be damaged with poor implementation. Additionally, there was a general lack of knowledge about the procedures for accessing services at the SBHC. Participants provided recommendations, including strategies for better outreach and engagement with teachers and students, as well as operational strategies to enhance communication systems and the physical environment.

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