Do levels of evidence affect breadth of service? A study on the use of clinical guidance in a learning disability service

Background: For services across the UK, increasing emphasis is placed on the use of evidence-based psychological treatments. In this context, the Scottish Government published the MATRIX, a best-practice clinical governance document, with a brief section on therapies for people with learning disabilities. As with most clinical guidelines, randomised-controlled trials were considered the ‘gold standard’. However, within the learning disability field the existing evidence-base is relatively limited, resulting in a narrow guidance for services.
Methods: This study evaluated the use of best-practice guidance (the MATRIX), in a Psychology service for adults with learning disabilities, covering one of the largest NHS Boards in Scotland. A randomly selected 50% (N=73) of case notes opened since October 2011 (publication date for the MATRIX) was reviewed. Eight case notes were second-rated by an independent clinician.
Results: Findings showed that service users typically presented with multiple psychological difficulties and clinicians offered a range of therapies additional to those suggested in the guidance. This was particularly evident in cases managed by Clinical Psychologists.
Conclusions: Applying rigid therapeutic recommendations may limit opportunities for integrative practice. The potential impact of inflexibly adopting clinical guidelines on service planning and resources is discussed.