PRIMARY OBJECTIVE:To evaluate the effectiveness of a communication training programme for paid carers to improve their conversational interactions with people with TBI. RESEARCH DESIGN:Single blinded randomized controlled study. METHODS AND PROCEDURES:Ten paid carers were randomly selected from a post-acute residential rehabilitation programme and allocated to either a training or control group. Training comprised a 17-hour programme (across 8 weeks) with conversational interactions (i.e. structured and casual) between paid carers and people with TBI videotaped pre-training, post-training and at 6-months follow-up. Interactions were rated on the Adapted Measure of Support in Conversation (MSC), Adapted Measure of Participation in Conversation (MPC) and Global Impression Scales of conversation. MAIN OUTCOMES AND RESULTS:Trained paid carers were more able to acknowledge and reveal the competence of people with TBI. Conversations were perceived as more appropriate, interesting and rewarding compared to the control group. Improvements were confined to the structured conversation and were maintained for 6 months. CONCLUSIONS:Training paid carers has a positive effect on improving conversational interactions with people with TBI in a long-term care facility. These improvements can help to foster increased independence for the person with TBI in the home and community.