Conversational Skills Training Research Articles

The promise and practice of teaching social communication skills: A commentary on Abbot-Smith et al., 2023

In this commentary, I endorse Abbot-Smith and colleagues’ call for social conversation skills training and raise challenges to designing such efforts. One challenge is to identify a set of conversational skills that are essentially universally important insofar as what is appropriate and effective conversational behavior varies situationally and culturally. A second challenge is to identify meaningful outcomes for training and how they should be assessed. In considering these challenges, I discuss Social Problem-solving Skills Training, cultural variability in children’s conversational behavior, and governmental agencies’ standards for students’ conversational competence.

Topic maintenance in social conversation: What children need to learn and evidence this can be taught

Individual differences in children’s social communication have been shown to mediate the relationship between poor vocabulary or grammar and behavioural difficulties. Moreover, there is increasing evidence that social communication skills predict difficulties with peers over and above vocabulary and grammar scores. The essential social communicative skills needed to maintain positive peer relationships revolve around conversation. Children with weaker conversation skills are less likely to make and maintain friendships. While helping all children to participate actively in collaborative conversations is part of school curricula, evidence-based training on how to achieve this is rarely provided for teachers. In this review, we first provide an overview of the key components of conversation skills and the cognitive abilities required to maintain them. We then present a narrative review of randomised controlled trials and experimental studies that either trained child conversation skills or included conversation skills in both training and outcome measures. Most of the studies focussed on training conversational ability in autistic children. The general finding was that verbally fluent autistic children improve following conversation training on blind-assessed reciprocal conversational ability. Only two studies were found that trained conversation skills in typically developing children with adequate controls and outcome measures, which directly assessed conversational proficiency. Both studies focussed on typically developing children who, at baseline, were in the weaker third of the mainstream classroom. Importantly, training not only improved the conversational ability of these children, it also improved their rates of lunchtime interaction with peers and their peer popularity ratings. We argue that there is considerable potential for supporting conversation skills in the classroom as a universal or Tier 1 intervention. Future research should explore whether conversation skills training would benefit the whole classroom.

The development of the conversation skills assessment tool.

Having a conversation with someone or even more within a group of people is complex. We are never taught at school how to do it, which implies we consider having a conversation as something simple and straightforward. Instead, we just learn from observing others. Some people are great conversationalists - it comes naturally to them - while others struggle. Some people may not fully understand how the process works, how turn-taking happens, don't understand visual cues such as body language and facial expressions, and fail to comprehend that some topics may be appropriate or inappropriate. This can be the case for both neurotypical and neurodivergent people. The Conversation skills Assessment Tool has been developed in this first instance to help in assessing and examining conversation skills in an intervention with young autistic adults on a virtual platform (a virtual world). This paper will present the evolution of the new measure through the exploratory phase, the development phase and finally a detailed account of the inter-rater reliability process. The intervention associated with this study was carried out though a multiple baseline design with 3 autistic participants (in their early 20 s) and took place over 4 phases (15-17 sessions). The sessions involved semi-structured conversations in face-to-face (phases 1 and 4) and virtual (phases 2 and 3) settings and were videotaped with the participants' consent. Twelve of those were used by this study in the development process through iterative inter-rater reliability stages between two coding teams. Evaluation of the Conversation skills Assessment Tool tool revealed the potential benefit of implementing interventions with measures that more objectively and concretely (e.g., by noting frequencies) assess observable behaviours that are associated with having positive conversations with others. Beyond this, it is anticipated that Conversation skills Assessment Tool can emerge as a tool capable of not only accounting for the environment an interaction takes place in (e.g., professional, casual), but also offers beneficial feedback for both autistic students and other populations (e.g., young children, English language learners). This measure has the potential to offer quantifiable and trackable guidance to people who have difficulties conversing. The authors do not wish to perpetuate an ableist social construct of what is a 'good' conversation, nor do they suggest that conversation skills training is useful solely for people with communication and/or socialization difficulties. Rather, they hope that Conversation skills Assessment Tool can be adopted more broadly to give both neurotypical and neurodivergent people a better understanding of how to communicate more effectively with others, while also becoming more aware and accepting of differing conversational styles. Because of its ability to track (or self-monitor) one's development of conversational skills over time, Conversation skills Assessment Tool could serve as an educative tool in early childhood education. It can be used by occupational/speech therapists and other professionals and also used to self-monitor one's development of conversational skills. Conversation skills Assessment Tool was developed to assess conversation skills on a one-to-one basis; therefore, another iteration of Conversation skills Assessment Tool would have to look at group conversations.

The impact of Healthy Conversation Skills training on health professionals\u2019 barriers to having behaviour change conversations: a pre-post survey using the Theoretical Domains Framework

BackgroundChanging people’s behaviour by giving advice and instruction, as traditionally provided in healthcare consultations, is usually ineffective. Healthy Conversation Skills (HCS) training enhances health professionals’ communication skills and ability to empower and motivate people in health behaviour change. Guided by the Theoretical Domains Framework (TDF), this study examined the impact of HCS training on health professional barriers to conducting behaviour change conversations in both clinical and non-clinical settings. Secondary aims were to i) identify health professionals’ barriers to having behaviour change conversations, and explore the ii) effect of HCS training on health professionals’ competence and attitudes to adopting HCS, iii) feasibility, acceptability and appropriateness of using HCS in their clinical and non-clinical roles, and iv) acceptability and quality of HCS training.MethodsHCS training was conducted in October-November 2019 and February 2020. Pre-training (T1), post-training (T2) and follow-up (T3; 6-10 weeks post-training) surveys collected data on demographics and changes in competence, confidence, importance and usefulness (10-point Likert scale, where 10 = highest score) of conducting behaviour change conversations. Validated items assessing barriers to having these conversations were based on eight TDF domains. Post-training acceptability and quality of training was assessed. Data were summarised using descriptive statistics, and differences between TDF domain scores at the specific time points were analysed using Wilcoxon matched-pairs signed-rank tests.ResultsSixty-four participants consented to complete surveys (97% women; 16% identified as Aboriginal), with 37 employed in clinical settings and 27 in non-clinical settings. The training improved scores for the TDF domains of skills (T1: median (interquartile range) = 4.7(3.3-5.3); T3 = 5.7(5.3-6.0), p < 0.01), belief about capabilities (T1 = 4.7(3.3-6.0); T3 = 5.7(5.0-6.0), p < 0.01), and goals (T1 = 4.3(3.7-5.0); T3 = 4.7(4.3-5.3), p < 0.01) at follow-up. Competence in using ‘open discovery questions’ increased post-training (T1 = 25% of responses; T2 = 96% of responses; T3 = 87% of responses, p < 0.001), as did participants’ confidence for having behaviour change conversations (T1 = 6.0(4.7-7.6); T2 = 8.1(7.1-8.8), p < 0.001), including an increased confidence in having behaviour change conversations with Aboriginal clients (T1 = 5.0(2.7-6.3); T2 = 7.6(6.4-8.3), p < 0.001).ConclusionsProvision of additional support strategies to address intentions; memory, attention and decision processes; and behavioural regulation may enhance adoption and maintenance of HCS in routine practice. Wider implementation of HCS training could be an effective strategy to building capacity and support health professionals to use a person-centred, opportunistic approach to health behaviour change.

Scaling Implementation of the Serious Illness Care Program Through Coaching

BackgroundWe designed group coaching calls to reinforce communication skill acquisition and Serious Illness Care Program uptake in adult primary care. MeasuresPercentage of primary care physicians (PCPs) who have documented a serious illness conversation in the electronic health record (EHR) approximately three and six months after the coaching intervention. Participant feedback surveys to better understand provider attitudes toward the coaching intervention. InterventionWe offered 60-minute group coaching calls to internal medicine PCPs, previously trained in serious illness conversation skills, as part of an institutional quality incentive program. The calls addressed communication challenges common to serious illness care and instructed participants about how to document and bill for conversations. OutcomesWe completed 31 coaching calls during three months, in which 170 of 228 PCPs attended in groups of two to nine participants per call (74.6% penetration rate). The percentage of PCPs who documented at least one serious illness conversation in the EHR increased from 18.4% to 41.2% six months after the intervention. Primary care internal medicine physicians found the one-hour coaching calls to be highly valuable, with 86.9% of respondents attesting they would recommend the calls to their colleagues. Content analysis of participant feedback identified the most useful coaching content elements to be self-reflection around the impact of prior conversation skills training, instruction around using the EHR to find and document advance care planning discussions, the opportunity to share individual challenges and successes with peers, and feedback/advice from communication experts in palliative care. Conclusions/Lessons LearnedGroup coaching of PCPs resulted in more than a twofold increase in documented serious illness conversations.

Are women empowered to make decisions about the use of antidepressants in pregnancy?

Background Untreated depression is related to maternal mortality and morbidity. The most frequent treatment is antidepressant medication, but studies have shown that women find decisions about the use of antidepressants in pregnancy difficult and confusing. Aim To explain if women are empowered to make decisions around the use of antidepressants in pregnancy. Methods A literature review was conducted using CINAHL Complete, Intermid, Proquest and Discover More. Findings Information provision was inadequate and women experienced decisional conflict. Women wanted to be involved in a collaborative decision-making process. Conclusions Women want to be provided with clear and accurate information and prefer to collaborate when making decisions about antidepressants in pregnancy. More research is needed to explore demographic gaps within population samples, and women's experiences of decision-making about antidepressant usage. Undergraduate and postgraduate health education should include conversation skills training, associated with collaborative discussion and informed choice.

Training communication partners of people with severe traumatic brain injury improves everyday conversations: A multicenter single blind clinical trial

To determine effectiveness of communication training for partners of people with severe traumatic brain injury. Three arm non-randomized controlled trial comparing communication partner training (JOINT) with individual treatment (TBI SOLO) and a waitlist control group with 6 month follow-up. Forty-four outpatients with severe chronic traumatic brain injuries were recruited. Ten-week conversational skills treatment program encompassing weekly group and individual sessions for both treatment groups. The JOINT condition focused on both the partner and the person with traumatic brain injury while the TBI SOLO condition focused on the individual with TBI only. Primary outcomes were blind ratings of the person with traumatic brain injury's level of participation during conversation on the Measure of Participation in Communication Adapted Kagan scales. Communication partner training improved conversational performance relative to training the person with traumatic brain injury alone and a waitlist control group on the primary outcome measures. Results were maintained at six months post-training. Training communication partners of people with chronic severe traumatic brain injury was more efficacious than training the person with traumatic brain injury alone. The Adapted Kagan scales proved to be a robust and sensitive outcome measure for a conversational skills training program.

Effects of social skills training on improving social skills of patients with schizophrenia

This study examined the effect of conversation and assertive skills training on social skills of schizophrenic patients. Patients who met the study criteria were randomly assigned to the experimental or control group. The experimental group received eight group training sessions and the control group received routine nursing care treatment. Data were collected at pretreatment (before group treatment), intratreatment (after fourth group treatment), posttreatment (after eighth group treatment), and follow-up (1 month after the end of group treatment). Conversation and assertive skills of the experimental group improved significantly with treatment and were superior to the control group at intratreatment, posttreatment, and follow-up. We suggest incorporating social skills training into treatment plans for patients with schizophrenia to improve their social skills ability.

Efficacy of conversational skills training of schizophrenic patients in Sweden and Norway

A structured method of conversational skills training was applied to ten Swedish outpatients (mean age 45) and five Norwegian inpatients (mean age 26), all with chronic schizophrenia. Conversational skills were assessed before and after training through video-taped standardized role-plays. Patients improved substantially and to approximately the same extent regardless of age, sex, chronicity, symptoms (BPRS), nationality, or being in- or outpatients. The older Swedish outpatients needed more motivational work before they were willing to enrol in the training program, in contrast to the younger Norwegian inpatients. Improvement was not mediated by symptom reduction; thus, substantial training effects can be attained for a wide range of schizophrenic patients.

Gespreksvaardigheidsonderwijs in de Moderne Vreemde Talen in het Hoger Onderwijs, in het Bijzonder de Lerarenopleiding

Foreign language conversational skills training is gradually becoming a debated issue in higher education foreign language departments in the Netherlands. Pressure on the student-staff ratio and, consequently, increasingly large classes raise questions with regard to the effectiveness of traditional methodology. In this paper an attempt is made to outline an approach which, in the long run, will considerably reduce staff-time investment and increasingly encourage student activity. The approach proposed is based on the one hand on recent insights into the role of the learner in his own learning process, and on the other on the hypothesis that languages are acquired first and foremost by conducting conversations (the 'Active Process Hypothesis'). On the whole, tertiary students in the Netherlands start their language study with sufficient linguistic skills in the target language to make such an approach feasible. The paper opens with a discussion of the what of communicative competence and proceeds to how it may be acquired. Discourse elicitation and subsequent analysis and the development of strategic competence in the broadest sense of the term play a central role in the methodology suggested. In conclusion, a practical example of the procedure advocated is presented by way of illustration.

Conversational skills training with schizophrenic inpatients: A study of generalization across settings and conversants

Three male schizophrenic inpatients were taught appropriate conversational behavior using social skills training (SST). Subjects were taught verbal skills in an office and those behaviors were monitored in that setting as well as covertly assessed in the ward dayhall and courtyard during encounters with unit staff and strangers. SST produced large and consistent increases in responding in the training setting; however, generalization across settings and conversants varied greatly depending on the subject, skill, and conversant. When an intervention consisting of homework assignments plus intermittent prompts and consequences was applied in the dayhall, responding rose substantially in that setting. Follow-up assessments conducted 3 months after the completion of training showed that the verbal skills were maintained. Social validity ratings given by stranger confederates directly after treatment revealed improvements for 2 of the 3 subjects on several measures of social competence and attractiveness.

Conversation skills training of thought-disordered schizophrenic patients through attention focusing

An attention-focusing procedure was designed as discrete trials and multiple prompts with contingent social reinforcement to facilitate the acquisition of conversational skills in thought-disordered schizophrenic patients. Three patients with DSM-III-R diagnoses of schizophrenia completed a standard social skills training program and the attention-focusing procedure in multiple baseline experimental designs. While social skills training had little effect on the acquisition of skills, patients who completed the attention-focusing procedure significantly increased performance of conversational skills and showed some generalization of trained behaviors.

Conversational skills training with a chronically hospitalized psychiatric inpatient

AbstractWhile conversational skills training has been conducted with select psychiatric populations, it has rarely been used with severely debilitated inpatients. The purpose of this study was to use a multiple baseline design across conversational components to evaluate the effectiveness of a conversational skills training package to enhance the conversational repertoire of a severely impaired inpatient. Audiotaped conversations with a standard confederate were evaluated for the frequency of questions, self‐disclosures, and reinforcing/acknowledging comments. Generalization probe conversations to novel partners were also obtained. Training effects were noted for the 3 conversational units. Mixed results were obtained for generalization and follow‐up.

Social and conversational skills training with long-term psychiatric inpatients.

Social and conversational skills training has proven effective with chronic psychiatric populations. Little attention, however, has been directed towards examining the use of this training with individuals who have severe disabilities and have not been released from psychiatric institutions to the community. The present case study examined the utility of this training and constraints in attempting to conduct treatment with two groups of 4 and 3 female psychiatric inpatients who averaged 20 yr. of institutionalization. Significant improvement in orientation and attention, reduction in psychotic talk, and gains on three of five conversational skills were noted. Generalization gains were evident on two of the five specific skills. Observations of group process, examination of indicators of emotional impact, and suggestions for practice are discussed.

Social skills training for psychiatric patients. I: Concepts, methods, and clinical results.

Deficits in social skills are often seen in psychiatric patients. In particular instances these may be a consequence of the psychiatric illness, a contributing cause to that illness, or a feature of the psychiatric disorder. During the last two decades, systematic training programs in social skills have been developed and evaluated for the amelioration of these deficiencies. The author critically reviews basic concepts and methods in social skills training and the results of treatment in case reports, analogue studies, and single-case experimental designs.

The Effects of Social Skills Training and Peer Involvement on the Social Adjustment of Preadolescents

This study examined the effects of social skills training and peer involvement on the peer acceptance of disliked preadolescents. 56 fifth- and sixth-grade children were identified as unaccepted by their peers and deficient in conversational skills. These children were then randomly assigned to 1 of 4 treatment conditions: (1) conversational skills training (individual coaching), (2) peer involvement under superordinate goals (group experience), (3) conversational skills training combined with peer involvement (group experience with coaching), and (4) a no-treatment control. Differential treatment effects were observed at both a posttreatment and follow-up assessment. As predicted, conversational skills training promoted skill acquisition and increased skillful social interaction. Peer involvement increased peer acceptance and children's self-perceptions of their social efficacy. The results were interpreted in terms of a developmentally based multidimensional model of social competence.

Conversational skills training with aftercare patients in the community: Social validation and generalization

Ten chronic psychiatric patients enrolled in a partial hospitalization program and who had conversational difficulty received group skills training that focused on specific conversational components and on speech content. Components and criterion levels for training were established from an assessment of the conversational skills of “normal” nonpsychiatric persons in their community. Training was evaluated with a multiple baseline design. Effectiveness was demonstrated through (1) behavioral ratings during dyadic and unstructured conversations with other former patients; (2) behavioral ratings during extended conversations with unfamiliar nonpsychiatric persons; and (3) maintenance of improvement at 1-, 3-, and 7-month follow-up.

Conversational skills training for retarded adolescents

Five retarded adolescents who had difficulty conversing with others received group conversational skills training that focused on both discrete social behaviors (such as asking questions, talking about oneself, and making speech acknow-ledgers) and on the topic content of their conversations. Training was introduced across these skills in multiple baseline fashion. The intervention's effectiveness was shown through: behavioral ratings of unstructured and extended conversations between pairs of subjects and of extended conversations between each subject and unfamiliar nonretarded partners; global judgments of improved skill; and maintenance of skill improvement at 5-month follow-up.

Group Skills Training to Increase the Conversational Repertoire of Retarded Adolescents

Ten retarded adolescents in a short-term residential center lacked appropriate social itneraction skills and were referred for group conversational skills training. Group treatment consisted of an instruction-modeling-rehearsal procedure sequentially targeting three classes of converstaional skills:(1) eliciting information from others;(2) appropriate self-disclosing of interests and personal information; and (3) using reinforcing-complimentary conversational behaviors. During baseline and following each training group, social behavior was assessed by recording unstructured 8-minute dyadic conversations between randomly-paired subjects. Weekly generalization probes consisted of unstructured 8-minute conversations between each subject and a different nonretarded, unfamiliar partner. Results indicated that contingent upon group targeting of a specific conversational skill, the frequency of that skill increased in both (1) the unstructured dyadic interactions between pairs of retarded subjects, and (2)the ge...

Improving heterosocial conversational skills of male psychiatric patients through a small group training procedure

A frequent problem facing formerly hospitalized psychiatric patients is re-establishing appropriate social relationships through conversational interactions. The current study evaluated the use of a small group conversational skills training intervention. Following baseline assessment of each male subject during 8-minute unstructured conversations with unfamiliar females, group training sequentially targeted three classes of skills: eliciting information from another person, appropriate self-disclosing, and using complimentary social behavior. Each subject's performance was assessed repeatedly through unstructured conversations with additional unfamiliar females following each treatment group, consituting a “single group” multiple baseline design. Group training effectiveness was demonstrated by (1) increased frequencies of targeted skills during the subjects' individual conversations which followed each group session, (2) favorable global evaluations of each subject's posttraining conversational competence by naive female judges, providing social validation of the procedure, and (3) 10-week follow-up conversations with additional unfamiliar partners.