Children with Down syndrome are at increased risk for a variety of deficits, including those in the area of speech, language, and literacy. Speech-language pathologists (SLPs) have historically focused on building children's verbal and signed vocabulary, but these efforts do not always result in significant changes in children's functional communication. Augmentative and alternative communication (AAC) systems and interventions have been recommended by the American Speech-Language-Hearing Association as appropriate options for facilitating functional communication skills with children with Down syndrome ([American Speech-Language-Hearing Association [ASHA], 2010; New York State Department of Health [NYSDOH], 2006). In spite of these recommendations, there exists a critical shortage of SLPs who are clinically competent in providing necessary AAC services to children with Down syndrome (Edgar & Rosa-Lugo, 2007; Light, McNaughton, Drager, Roberts, & Wilson, 2004). As a result, families of children with varying disabilities, including Down syndrome report high levels of stress related to accessing important professional expertise and intervention for their children (Dabrowska & Pisula, 2010). Researchers and clinicians alike must consider alternative treatment delivery options that are responsive to the needs of families and children with complex communication needs (Cirrin et al., 2010; Light & McNaughton, 2015). A telepractice service delivery model has been documented to ease burdens felt by families when attempting to access rehabilitative services (Gladden, 2013). Telepractice involves the use of technology to connect clinicians and clients at a distance for the purposes of assessment, intervention, or consultation (Theodoros, 2011). An expanding body of research promotes the use of telepractice service delivery within AAC to address the needs of both children and families. One evidence-based AAC intervention of interest is communication partner instruction. Communication partner instruction, even in small doses, has been proven to be an effective method for providing parents and children with complex communication needs, specifically children with Down syndrome, access to necessary intervention (Kent-Walsh, Murza, Malani, & Binger, 2015). Partner instruction involves educating those critical stakeholders who surround the child most frequently (e.g., parents, educators, educational assistants) to recognize and respond to children's communicative signals and to create opportunities for children to participate in the conversation (Pennington, Goldbart, & Marshall, 2004). Despite the evidence supporting the use of communication partner instruction, SLPs continue to struggle with implementation in billable contexts (Ogletree, 2013). SLPs in the United States often operate in a billable context, where the client must be actively involved in the therapy session in order for practitioners to receive reimbursement from insurance companies for time spent with clients. This issue has served as a barrier to use of communication partner instruction, as currently accepted research-validated models use introductory parent sessions independent of the children's learning to teach partner skills. Therefore, the current investigation examined the effects of a communication partner instruction using a mixed-mode service delivery model, which incorporated face-to-face and telepractice sessions, as well as a billable context. The focus of the protocol was on educating parents in one aided language strategy using a communication partner instruction program incorporating continuous child involvement and a mixed-mode service-delivery model, including both face-to-face and telepractice intervention components (e.g., Skype/FaceTime), to address the need for interventions which consider stressors faced by families when attempting to access evidence-based AAC intervention. The study utilized a single-case, multiple-probe experimental design across three parent-child dyads. Baseline, intervention, generalization, and maintenance phases were used to investigate the efficacy of the nine-session intervention. Visual analysis and Improvement Rate Difference (IRD) analyses indicated that the intervention was highly effective in increasing parents' use of the target strategy and children's communicative turntaking during shared storybook reading. One-hundred percent of parent participants increased their performance from baseline to post-intervention (IRD = 1.0), and all parents maintained these levels of achievement during the maintenance phase (IRD = 1.0). Similarly, children increased their frequency of communicative turns from baseline to post-intervention (IRD = 1.0), and all children participants maintained these levels of turntaking during the maintenance phase (IRD = 1.0), as well as during a novel book series (IRD = 1.0). These findings suggest that the mixed-mode service delivery model, which includes both face-to-face and telepractice sessions, as well as continuous child involvement is an effective method for increasing parents' use of a target strategy and children's frequency of multimodal communicative turns. Clinical and professional implications, as well as future directions for research are discussed.

Graduation Date





Kent-Walsh, Jennifer


Doctor of Philosophy (Ph.D.)


College of Education and Human Performance

Degree Program

Education; Communication Science and Disorders









Release Date

November 2017

Length of Campus-only Access

1 year

Access Status

Doctoral Dissertation (Campus-only Access)