PROTOCOL: Communication skills training for improving the communicative abilities of student social workers: A systematic review

Good communication is central to social work practice (Koprowska, 2014; Lishman, 2009), underpinning the success of a wide range of social work activities. People in receipt of social work services value social workers who are warm, empathic, respectful, good at listening and demonstrate understanding (Beresford, Croft, & Adshead, 2008; Department of Health, 2002; Munford & Sanders, 2015; Social Care Institute for Excellence, 2000). Even in diverse and challenging circumstances, effective communication is thought to build constructive working relationships and enhance social work outcomes (Healy, 2018). Communication, sometimes referred to as interpersonal communication, is ‘a two-way process. It involves two (or more) people interacting to exchange information and views’ (Beesley, Watts, & Harrison, 2018, p. 2). Hargie (2017) suggests interpersonal communication is driven and directed by the desire to achieve particular goals and is underpinned by perceptual, cognitive, affective and behavioural operations. In social work practice and education, the values of the profession and the specific social and cultural contexts in which social workers operate, influence the nature of interpersonal communication (Harms, 2015; Koprowska, 2014; Thompson, 2003). Research has thus tended to focus on particular aspects of communication, or the impact of communication in specific contexts. In a study about how social workers communicate with parents in child protection scenarios, for example, it seems that social workers who demonstrated empathy towards simulated clients, encountered less resistance and more disclosure (Forrester, Kershaw, Moss, & Hughes, 2007). Social workers who use creative and play-based approaches confidently, facilitate engagement and communication with children (Ferguson, 2016; Handley & Doyle, 2014). Adapting skills and strategies to address specific communication difficulties is equally important in social work with adults. Offering choices through pictographs (Rowland & McDonald, 2009) can help people with Aphasia to answer open questions, whilst Talking Mats can facilitate conversation with people who have dementia (Murphy, Gray, & Cox, 2007). Communicating effectively with adults in receipt of health and social care services enables them to better participate in important decisions about their care. The impact of failing to communicate effectively has been well documented, particularly through reports into incidents of child deaths (Laming, 2003, 2009; Munro, 2011). Consequently, the importance of teaching communication skills to social work students to enable them to communicate effectively has long been recognised (Smith, 2002), followed by more recent calls for the expansion and/or improvement of this training (Luckock, Orr, Marchant, & Tanner, 2006; Narey, 2014). Considerable time, effort and money has been spent on achieving this aim, leading to a wide range of communication skills training courses becoming embedded in social work programmes across the globe. Communication generally, and some communication skills specifically, feature in the educational standards of different countries including the Australian Social Work Education and Accreditation standards, the Professional Capabilities Framework in the UK and the Educational Policy Accreditation Standards in the US (Australian Association of Social Workers, 2008; British Association of Social Workers, 2018, Council on Social Work Education, 2015). Communication skills training (CST) can be defined as ‘any form of structured didactic, e-learning, and experiential (e.g., using simulation and role-play) training used to develop communicative abilities’ (Papageorgiou, Loke, & Fromage, 2017, p. 6). Although ‘communication skills training’ (CST) is the name given to the intervention on a wide range of professional and vocational courses, in social work education, the intervention is more commonly referred to as the ‘teaching and learning of communication skills’; a trend reflected in the titles of various knowledge and practice reviews. Purpose, role and context have a significant impact on communication in social work practice, hence the need to integrate knowledge, values and skills has been recognised, with the conceptualisation of knowing, being and doing developed by Lefevre, Tanner, and Luckock (2008) becoming increasingly popular (Ayling, 2012; Woodcock Ross, 2016). In social work education, the intervention includes not only communication processes, but also an understanding of the broader contextual issues in which communication in social work practice occurs. This view of communication in social work as both an art and a science (Healy, 2018), alongside a move away from purely instructional methods, helps explain the preference for the term ‘teaching’ or ‘education’ rather than ‘training’ among social work academics and researchers. There is a tendency within this discipline for significant variation in terminology due to the wide knowledge base from which social work draws. The term ‘communication skills’ is not applied uniformly in the social work literature - microskills, interpersonal skills and interviewing skills are frequently used alternatives. In spite of a lack of consensus about what the intervention is called, Dinham (2006, p. 841) identified that ‘the inclusion of a dedicated communication skills module early in the course, or a strong communication component within an early module about methods, skills and practice’ is commonplace. A consensus appears to be emerging in the wider social work literature, in terms of what the basic communication skills for social work practice actually entail. These microskills, comprise non-verbal communication such as making eye contact and nodding, alongside a range of verbal techniques including clarifying, reflecting, paraphrasing, summarising and asking open questions. Described in detail in a number of social work text books (Beesley, Watts and Harrison, 2018; Cournoyer, 2016; Healy, 2018; Sidell & Smiley, 2008), and featuring in the educational standards, competency and capability frameworks of various countries (Australian Association of Social Workers, 2008; British Association of Social Workers, 2018; Council on Social Work Education, 2015), these skills form part of the content of a number of communication skills courses and preparation for practice modules. Microskills help social workers and social work students to ‘establish and maintain empathy, communicate non-verbally and verbally in effective ways, establish the context and purpose of the work, open an interview, actively listen, establish the story or the nature of the problem, ask questions, intervene and respond appropriately’ (Harms, 2015, p. 22). Microskills are considered to be transferable across client groups and settings. Using case study scenarios that students might encounter in practice, microskills are rehearsed in relation to social work contexts. Typically, students practice the microskills through undertaking simulated social work tasks such as assessments and care planning. When applied to social work tasks and contexts, communication skills are sometimes referred to within the social work literature as interviewing skills. An interview is a 'person-to-person interaction that has a definite and deliberate purpose' (Kadushin & Kadushin, 2013, p. 6). It is through social work interviews that ‘important connections and relationships are developed, and where important concepts such as partnership and empowerment are taken forward’ (Trevithick, 2012, p. 185). The pedagogic practices used to teach communication skills to social work students include a wide range of affective, cognitive and behavioural components, whereby students participate in a variety of activities. Following face-to-face taught input including theory, communication skills are generally rehearsed, using role-play with peers (e.g., Koprowska, 2003), simulated practice with service users (e.g. Moss, Dunkerly, Price, Sullivan, Reynolds et al., 2007) or actors (e.g., Petracchi & Collins, 2006). Tutors and peers may also model communication skills to demonstrate different techniques. Critical reflection, which facilitates students' self-awareness is encouraged. Feedback is an important component in helping learners develop an understanding of their strengths and areas for development, and a range of feedback mechanisms are welcomed by students (Tompsett, Henderson, Mathew Byrne, Gaskell Mew, & Tompsett, 2017). Video and playback are often used to support the learning that occurs through feedback and reflective processes. Some universities have purpose built video suites or provide students with recording equipment such as tablets to facilitate the recording of communication skills practice. The rationale for video and playback is ‘that each student's adult ability to be their own best assessor’ is ‘utilised to the full’ (Moss, Dunkerly, Price, Sullivan, Reynolds et al., 2007, p. 715); the value of which has been recognised by students elsewhere (Bolger, 2014; Cartney, 2006). A learning environment, characterised by trust, safety and security, appears to be an important mechanism for students to make use of experiential activities. Opportunities for observing skills in practice, through shadowing a social worker or allied practitioner, are a feature of some communication skills or preparation for practice modules. Attention may also be devoted to specific areas of communication: communicating with children, communicating with people who have hearing impairments, and inter-professional communication are some examples. No specific blueprint for communication skills training in social work exists, hence the nature of the training sessions and course length vary from one educational institution to another. Typically, communication skills training is delivered to first year undergraduate and postgraduate students before they commence their first practice placement: in England, this may comprise some of the 30 days of skills training which universities are required to provide. Content and teaching activities tend to be designed and delivered on an individual basis by social work academics, often with involvement from service users and carers, practitioners and local employers. Minimum requirements, dosage, and delivery methods are not prescribed, leading to considerable heterogeneity of the intervention. Subgrouping the different types of intervention and population, based on factors such as length of course and teaching methods, age and sex would be helpful, if a sufficient number of trials are found through the review. Training or education-based interventions aimed at improving the communicative abilities of student social workers seek to bring about changes in learners' knowledge, values and skills in terms of how to communicate effectively in social work practice. Psychological perspectives and counselling theories, particularly humanistic and client-centred theorists such as Rogers, Carkhuff and Egan tend to underpin microskills training. Other communication theories, including Hargie's (2006) model of interpersonal communication also provide a theoretical basis for the skills taught on some of these courses. Concerns have been raised that psychological and counselling theories have been applied to social work uncritically (Trevithick, Richards, Ruch, Moss, Lines et al., 2004), without due consideration of the challenges this may present. A number of social work academics have pulled together theory and research on communication skills in recent years (e.g., Beesley et al., 2018; Harms, 2015; Healy, 2018; Lishman, 2009; Woodcock Ross, 2016) in an attempt to address this issue. Nonetheless, it still remains ‘difficult to identify a coherent theoretical framework that informs the learning and teaching of communication skills in social work’ (Trevithick et al., 2004, p. 18). The theoretical underpinnings of the pedagogic practices used to teach communication skills are not always clear (Dinham, 2006; Trevithick et al., 2004). Schön's (1983) conception of reflection in and on action and the importance of ‘learning by doing’ (1987, p. 17) are often cited as underpinning the teaching of communication skills modules in social work education. Experiential learning, ‘the process whereby knowledge is created through the transformation of experience’ (Kolb, 1984, p. 38) is another of the prevailing philosophies, although Trevithick et al. (2004, p. 24) suggest there is an uncritical assumption that ‘experiential is best’. Reference is sometimes made to theories of adult learning, whereby students are expected to draw on their own experiences, take responsibility for their own learning, and engage in peer learning. This mode of learning ‘is understood to encourage the sustained internalisation of skills' (Dinham, 2006, p. 847). Such ideas build on the concept of andragogy (Knowles, 1972, 1998) where mutual processes of learning and growth are encouraged. The knowledge review conducted by Trevithick et al. (2004) identified articles where the theoretical foundation for teaching skills in social work were made explicit. The communication skills module at the University of York in the UK, based on Agazarian's theory, is located within a systems framework (Koprowska, 2003), whilst Edwards and Richards (2002) propose that relational teaching based on relational/cultural theory should underpin teaching in social work education, whereby mutual engagement, mutual empathy and mutual empowerment foster growth in relationships between tutors and students. These examples are the exception to the rule; few articles theorise the teaching and learning process (Eraut, 1994). Generally speaking, ‘communication skills have been taught, but not reflected upon; experienced, but not theorised’ (Moss, Dunkerly, Price, Sullivan, Reynolds et al., 2007, p. 711). A wide variety of approaches for teaching communication skills to social work students exist in practice. Dinham (2006) suggests there is more expertise in the teaching and learning of communication skills than the literature denotes and encourages academics to continue theorising and researching this aspect of the curriculum. Although rigorous high quality evaluation of outcomes in social work education is still in the early stages of development (Carpenter, 2011), teaching communication skills to social work students is an aspect of the curriculum which has attracted considerable attention, a review of the help to what about this important This review to that have the of communication skills training programmes for social work students. 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