Communication Strategies Training Chapter 9

1. Communication Strategies TrainingChapter 9 Introduction to Audiological Rehabilitation

2. Training Content Considerations • Communication problems associated with hearing loss • Facilitative strategies • Repair strategies • Communication styles • Assertiveness training • Self-efficacy

3. Self-Efficacy Self-efficacy: confidence that a person has for performing a particular task AR self-efficacy: beliefs patients have about their abilities to manage difficult communication situations

4. Self-Efficacy • Can influence person’s willingness in activities and conversations • Can influence the efforts persons will invest into completing an activity, the time devoted to an activity or challenge

5. Bolstering Self-Efficacy • Master experience: direct experience in a successful communication interaction • Multiple practice experiences • Vicarious experience: direct observation of others succeeding in communication interaction • Watching others succeed in interaction • Verbal persuasion: Explaining or telling how to manage communication challenges • Didactic training, feedback, involving others • Emotional arousal: emotional reactions in response to communication interactions • Relaxation or breathing activities

6. Program Considerations • Length of training sessions • Group vs. individual • Gender • Age of individual(s) • Life stage • Culture • Motivation • Specific communication difficulties

7. Question Communication Training consists of how many stages: • 1 • 2 • 3 • 4 • 5

8. Communication Strategies Training Model Stage 1 Formal Instruction Stage 2 Guided Learning Stage 3 Real World Practice

9. Stage 1– Formal Instruction Lecture Workshops Provide information about various types of communication strategies and appropriate listening and speaking behaviors Stage 1 Formal Instruction Discussion Presentation Tutorials Handouts

10. Stage 2– Guided Learning Modeling Individuals use conversational strategies in a structured setting Scenarios Stage 2 Guided Learning Continuous Discourse Tracking Drill Activity Role-playing Barrier Games Focused attention

11. Stage 3– Real-World Practice Diaries Individuals practice new skills or behaviors in everyday environment Stage 3 Real-World Practice Calendars Worksheet Assignments

12. Short-term Training • Materials approach • providing materials, brochures, etc. • Dr. Sam Trychin • Audiology Awareness • SHHH (Hearing Loss Association of America) • ALDA • John Tracy Clinic • Beginnings for Parents • GoHear • Consumer Handbook on Hearing Loss and Hearing Aids • Hear Again Publications • Dr. Ross • HearingVision (Norm Erber) • Arthur Boothroyd • HearingLoss Web • Short Tutorials • brief tutorial on communication strategies

13. Short Tutorial Example(Formal Instruction) W=watch the talker’s mouth, not his eyes A=ask specific questions T=talk about your hearing loss C=change the situation H=acquire health care knowledge Montgomery, 1994

14. SPEECH(Formal Instruction) S = spotlight your face Keep face visible, distance, same room P = pause slightly while speaking Moderate rate E = empathize and be patient Be patient, utilize facilitative and repair strategies E = ease their listening Gain listener attention, ask for communication solutions C = control the circumstances Manage environment H = have a plan • Use appropriate communication strategies for situations

15. Training Communication Partners • Empathy • Organized messages • Comprehension • Repair strategies • Facilitative Strategies • Clear Speech

16. TOPICON(Guided Learning) • Each participant independently examines a list of topics and indicates a topic of interest or familiarity • One participant or instructor selects a topic for conversation • The two participants engage in a brief conversation during which the instructor monitors the discussion assesses the conversation • Participants and instructor discuss the discourse, fluency considering avoidance resolution of difficulties

17. Example TOPICON Topics babies electronics writing poetry dancing cave exploring antique furniture cheese barbecues friends gossip cats newspaper ads computers best recipes going fishing shopping tennis last weekend astrology saving money house renovation television sailing recent illness beer the theatre going to work

18. TOPICON Evaluation Clinician and the client discuss what happened during the conversation, for example: • What are the advantages/disadvantages of discussing a familiar/unfamiliar topic? • What happens when both people know little about the topic? • Who talked more during the conversation? Why? • Who asked more questions? Why? • What was the general direction of "information flow"- to/from the client? • Which factors resulted in disruption/fluency during the conversation? • Which clarification requests/strategies were applied (in)effectively

19. Continuous Discourse Tracking(Guided Learning) • A talker reads a passage of text, phrase-by-phrase, to a listener • After each phrase has been delivered, the listener attempts to repeat the phrase verbatim • If there are errors, the talker repeats or paraphrases until the response is word-for-word accurate • Performance is measured in number of words of text repeated correctly per unit of time • The sender coaches the receiver on use of repair strategies

20. Continuous Discourse Tracking Purpose: • Increase speech recognition skills • Increase utilization of contextual cues • Improve coping skills • Use of repair strategies • Improve conversational fluency • Word per minute rate

21. Continuous Discourse Tracking • Novels • Harry Potter books • Readers Digest • Books • Newspapers • Audiology speech materials (Everyday Sentences, etc.) • Listening to tapes • Kid Trax

22. KidTrax

23. Active Communication Education (ACE) • Group training program to help people over the age of fifty with HL to become more effective communicators in everyday life. • program offers guidance and strategies that will help to: • Improve the person’s communication abilities • Reduce the hearing difficulties experienced • Improve the person's quality of life.

24. Active Communication Education (ACE) • The facilitator asks participants to consider: What hearing/communication difficulties do you experience in everyday life as a result of your HL? • The facilitator asks each participant to state one difficulty only. • The facilitator writes each difficulty on a board. • Group members state one difficulty at a time until all difficulties are recorded. • The facilitator leads a discussion to clarify the difficulties and pulls together any difficulties that are similar. • Each group member given three Post-It notes with 3, 2, or 1 on each. Participants asked to place the sticker labeled rating each difficulty. • Facilitator gives score of 3 to the difficulties labeled 1, a score of 2 to the difficulties labeled 2, and score of 1 to difficulties labeled 3. • The difficulties with highest scores become topics in sessions that follow.

25. Adult Benefits of Training • Good patient participation • Change in communication strategies • Change in perceived hearing-related disability

26. Children Benefits of Training • Increased responsibility for initiating and managing repair • Better matching of strategy to situation • Greater variety of strategies used • Improved assessment of partner’s viewpoint

27. Communication Training Considerations • Can empower persons with HL • Persons vary in willingness to participate • Some are incapable of changing • Some lack metacommunication skills to examine conversational styles and monitor their interactions