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

team

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 . 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

| How the intervention might work
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(Knowles, , 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, therefore a review of the findings will help to clarify what we know about this important topic. number of practice and knowledge reviews highlighted the lack of evaluation into communication skills courses, an issue which warranted further research (Trevithick et al., 2004;Dinham, 2006).

| OBJECTIVES
To support this endeavour, methodological guidance for evaluating outcomes in social work education (Carpenter, 2005(Carpenter, , 2011 has been produced. Consequently, a number of empirical studies (Koprowska, 2010;Lefevre, 2010; have sought to evaluate the teaching of communication skills among social work students, or investigate the impact of particular components of the intervention. Existing literature suggests that teaching social work students communication skills increases their self-efficacy in terms of communicative abilities (Koprowska, 2010;Lefevre, 2010;. No comprehensive systematic review or meta-analysis of this aspect of social work education has been undertaken and questions about whether or not teaching communication skills to social work students is effective, remain unanswered. It is time therefore to gather, summarise and synthesise empirical research so that the evidence can be used by educators and policy-makers to guide decisions about which approaches are effective in teaching communication skills to social work students. In this time of political uncertainty and financial constraint, 'it is important to accumulate evidence of the outcomes of social work education so that policymakers and the public can be confident that it is producing highquality social workers' (Carpenter, 2016, p. 192), who are suitably equipped to deal with the demands of social work practice. We are conducting this systematic review to determine whether communication skills training for social work students works and which types of communication skills training, if any, are the most effective.
To improve uptake and relevance, the systematic review is being developed in consultation with stakeholders (including academics, students, practitioners, service users and carers) and advice has been sought from leading social work organisations. It will further aim to point to areas where more research is required in this aspect of social work education. three data points before and three after the intervention will be excluded. The justification for this wider range of study types is to identify any potential risk of harm which we hope to assess through wider evidence. Potential risk of harm would include any negative effects of CST on students' communicative abilities, for example, service users and carers might indicate that students' poor communication has left them feeling more confused, agitated, misunderstood or distressed (i.e., worse) than they did before the interaction.
To ensure quality of evaluation all studies will be critically appraised and an analysis of the results by study design will be considered. The comparison group will be composed of those who receive no educational intervention or those receiving educational interventions other than communication skills training. Trials comparing the effects of two different educational interventions to improve communication skills will also be included in this review. In accordance with Campbell policies and guidelines (The Campbell Collaboration, 2014), studies without comparison groups or appropriate counterfactual conditions will be excluded.

| Types of participants
All social work students taught communication skills on a generic qualifying social work course in a university setting will be included.
This can include undergraduate and postgraduate students. Social work courses designed for a specific client group will be excluded, as will students on post-qualifying courses.

| Types of interventions
Only studies in which the intervention group receives communication skills training and in which the control group receives nothing or receives an alternative training to the intervention group will be included. For the intervention, any underpinning theoretical model and any mode of teaching (taught input, videotape recording, role-play with peers, simulated interviews with service users and carers) is considered acceptable. Interventions aimed at improving the communication skills of specific client groups for example children will be also be included in the review, providing they meet the inclusion criteria.

| Types of outcome measures
Outcomes will include changes in (a) knowledge, (b) attitudes, (c) confidence and (d) behaviours measured using objective and subjective scales. It is anticipated that these measures might be study-specific rating scales, developed for use in evaluating communication skills. Stakeholder involvement indicated that behavioural change is an important outcome for all stakeholders. In addition, students and educators deemed confidence/self-efficacy to be a relevant outcome. In keeping with the literature on outcomes in social work education (Carpenter, 2005(Carpenter, , 2011, student satisfaction alone will not be considered as an outcome measure in the review.

| Types of settings
Interventions that take place in university settings will be included, however if a component of the intervention takes place in a practice setting, that will also be included and made clear in the analysis and report.

| Search strategy
The search strategy will include multiple electronic databases, research registers, grey literature sources, and reference lists of reviews and relevant studies. Study selection will not be restricted by language, publication date or publication status.
To identify eligible studies the following data sources will be searched using the search strings set out in Appendix A: of key journals will be conducted. To do this, the top 5 journals that have provided included studies so far, will be identified and checked.
One reviewer will conduct the database searches, remove duplicates and irrelevant records. We anticipate that the searches will result in very few records to screen, so to ensure robustness, each record will be screened by title and abstract by two reviewers.
Any studies deemed to be potentially eligible will be retrieved in full text and will be screened by two reviewers. Any disagreements will be discussed with colleagues until a consensus is reached.
The search strategy will be developed using the terms featuring in existing knowledge and practice reviews and in consultation with social work researchers and academics, to ensure that the broad range of terminology is included. Search strings will include terms relating to the intervention and population but not study design. Search strings and search limits will be modified for each database. Searching for exact phrases or proximity searching will be used to increase search specificity.

| Criteria for determination of independent findings
To ensure that the effects of an individual intervention are only counted once, the following conventions will apply. Where there are multiple measures reported for the same outcome, an average effect size for each outcome will be calculated within each study. Where the same outcome construct is measured across multiple time domains, the main analysis will focus on synthesising the evidence relating to effect sizes at immediate post-test. Any subsequent measures of outcomes beyond immediate post-test will be metaanalysed and reported separately.

| Details of study coding categories
Once eligible studies have been found, an initial analysis of programme descriptions will be undertaken for all programmes.
The Campbell data collection template form will be used to identify the core components of programmes and to develop an overarching typology and coding frame.
It is anticipated that such components are likely to include: • Duration and intensity of the programme.
• Whether programme delivery included service users and carers Alongside extracting data on programme components, descriptive information for each of the studies will be extracted and coded to allow for sensitivity and subgroup analysis. This will include information regarding: • study characteristics in relation to design, sample sizes, measures and attrition rates, and whether the study was conducted by a research team associated with the programme or an independent team. REITH-HALL AND MONTGOMERY | 5 of 9 • stage of programme development, for example whether it is a new programme being piloted or an established programme being replicated.
• participants' characteristics in relation to age, gender, ethnicity, geo-political region and socio-economic background.
Coding will be carried out by the review team independently and discrepancies will be discussed and a consensus agreed.
Quantitative data will be extracted to allow for calculation of effect sizes (such as mean change scores and standard error or pre and post means and standard deviations). Data will be extracted for the intervention and control group on the relevant outcomes measured in order to assess the intervention effects. If study reports do not contain sufficient data to allow calculation of effect size estimates authors will be contacted to obtain necessary summary data, such as means and standard deviations or standard errors.
Assessment of methodological quality and potential for bias will be conducted using The Cochrane Risk of Bias tool for randomised studies and the ROBINS-I tool (2016) for non-randomised studies.
The overall quality of evidence relating to the primary outcomes will also be summarised using the new GRADE Guidance for Complex Interventions (unpublished).

| Statistical procedures and conventions
3.6.1 | Approach to meta-analysis Random effects models, using inverse-variance estimation, will be used as the basis for meta-analysis, due to the likely heterogeneity of interventions that this review is likely to find. Analysis will be conducted using REVMAN. Heterogeneity will be measured and reported through the Q, I2 and Tau2 statistics.

| Calculation of effect sizes
It is anticipated that most outcomes reported will be based upon continuous variables and so the main effect size metric to be used for the purposes of the meta-analyses will be the standardised mean difference, with a 95% confidence interval. Social work cohorts tend to be relatively small, so Hedges' g will be used to correct for any small sample bias. Where other effect sizes have been reported, such as Cohen's d or risk ratios (for dichotomous outcomes) these will be converted to Hedges' g for the purposes of the meta-analysis. The formulae provided in the Cochrane Handbook (Higgins & Green, 2011) will be used for this purpose. Studies are likely to involve group-level allocation, hence data will be included which have been adjusted to account for the effects of clustering, using multilevel modelling or adjusting estimates using the intra-cluster correlation coefficient (ICC). If the effects of clustering have not been taken into account, estimates of effect size will be adjusted following guidance in the Cochrane Handbook.

| Treatment of qualitative research
This systematic review is limited to synthesising the available evidence on the effectiveness of communication skills training to social work students. It is beyond the remit of this present review to synthesise the associated evidence related to process evaluations of such programmes hence we do not plan to include qualitative research.

SOURCES OF SUPPORT
Emma Reith Hall is hoping to undertake the systematic review as part of her PhD research, for which she receives ESRC funding.
We are particularly grateful to our stakeholdersthe students, practitioners, service users and carers, social work academics and social work organisations who gave their input into the development of this systematic review.

DECLARATIONS OF INTEREST
Emma Reith Hall teaches communication skills to social work students and is therefore involved in the design and delivery of the intervention at her place at work. She has conducted some primary research, but it would not fulfil the criteria required to be included in this review.
Paul Montgomery-None known.

PRELIMINARY TIMEFRAME
Approximate date for submission of the systematic review.

January 2021
Submission is expected one year after the publication of the protocol.

January 2021
Please note this should be no longer than two years after protocol approval. If the review is not submitted by then, the review area may be opened up for other authors.

PLANS FOR UPDATING THE REVIEW
Reviews should include in the protocol specifications for how the review, once completed, will be updated. This should include, at a minimum, information on who will be responsible and the frequency with which updates can be expected.
PM and ERH would anticipate updating the review every 5 years.

Authors' responsibilities
By completing this form, you accept responsibility for preparing, maintaining and updating the review in accordance with Campbell Collaboration policy. The Campbell Collaboration will provide as much support as possible to assist with the preparation of the review.
A draft review must be submitted to the relevant Coordinating Group within two years of protocol publication. If drafts are not submitted before the agreed deadlines, or if we are unable to contact you for an extended period, the relevant Coordinating Group has the right to de-register the title or transfer the title to alternative authors. The Coordinating Group also has the right to de-register or transfer the title if it does not meet the standards of the Coordinating Group and/or the Campbell Collaboration.
You accept responsibility for maintaining the review in light of new evidence, comments and criticisms, and other developments, and updating the review at least once every five years, or, if requested, transferring responsibility for maintaining the review to others as agreed with the Coordinating Group.

Publication in the Campbell Library
The support of the Coordinating Group in preparing your review is conditional upon your agreement to publish the protocol, finished review, and subsequent updates in the Campbell Library. The Campbell Collaboration places no restrictions on publication of the findings of a Campbell systematic review in a more abbreviated form as a journal article either before or after the publication of the monograph version in Campbell Systematic Reviews. Some journals, however, have restrictions that preclude publication of findings that have been, or will be, reported elsewhere and authors considering publication in such a journal should be aware of possible conflict with publication of the monograph version in Campbell Systematic Reviews. Publication in a journal after publication or in press status in Campbell Systematic Reviews should acknowledge the Campbell version and include a citation to it. Note that systematic reviews published in Campbell Systematic Reviews and co-registered with the Cochrane Collaboration may have additional requirements or restrictions for co-publication. Review authors accept responsibility for meeting any co-publication requirements.

APPENDIX A
Search string 1) Population Concept: social work students ("social work student*" OR "student social worker*") 2) Intervention Concept: communication skills training a) (Communicat* OR Interpersonal OR Interview*) Note: Interviewing skills has a very specific meaning in social work that relates to communication in a range of social work encounters b) (train* OR educat* OR teach* OR learn* OR curricul*) Combined search string "social work student*" OR "student social worker*") AND Communicat * OR Interpersonal OR Interview* AND train* OR educat* OR teach* OR learn* OR curricul* REITH-HALL AND MONTGOMERY