Referrers

Alcedo Care brings together our 24/7 Rapid Response Team and Intensive Community Care Service into a single, cohesive pathway. Commissioners and clinicians have one referral route, while people experience continuity from crisis through to long-term stability.

Step 1 – Crisis Response (0–4 hours)

When risk is high or breakdown is imminent, our Rapid Response Team mobilises within 2–4 hours. We deploy experienced staff, complete dynamic risk screening and provide immediate “keep safe” support at home, in temporary accommodation or in the community.

Step 2 – Short-Term Stabilisation (days–weeks)

High-intensity support to re-establish structure and routine, working with MDT partners to reduce distress and risk. Safeguarding actions are implemented and a clear crisis prevention plan is started.

If ongoing complex support is required- to prevent further crisis and embed complex wrap around support, we can work hand in hand, to transition to ICSS Team.

Both services can work together and independently, depending on the specific needs of the individual and commissioner.

Step 3 – Intensive Community Care (weeks–months)

Our ICSS offers comprehensive, multi-disciplinary holistic assessment covering behaviour, trauma, mental health, environment, family/carer needs and quality of life. Co-produced complex care plans, PBS plans, risk & safety plans and goal plans are put in place and delivered by a skilled community team.

Step 4 – Stabilised Support & Relapse Prevention (ongoing)

As risk reduces, support steps down through targeted PBS input, and flexes as necessary. Crisis prevention plans are updated, early warning signs are monitored and regular MDT reviews maintain stability and prevent relapse or re-admission.

We work with children, young people and adults who have complex presentations and are at risk of hospital admission, placement breakdown or crisis escalation. Many have experienced trauma, multiple breakdowns or delayed discharge.

We support people with:

• Learning disabilities
• Autism and wider neurodivergent profiles
• Complex mental health conditions
• Behaviours of concern and significant risk behaviours
• Co-existing trauma histories and attachment difficulties
• Forensic histories and higher-risk presentations (community managed)
• Crisis safeguarding situations or sudden family/carer loss
• Urgent hospital discharge needs where community support is not yet in place

When situations are critical and stability is urgently required, our Rapid Response Team provides an immediate, practical solution.

Core principles

• Trauma-informed: safety, trust, choice, empowerment and collaboration
• Positive Behaviour Support: improving quality of life and reducing behaviours of concern
• Human-rights based and least restrictive, with robust governance around any restrictive interventions
• Genuine co-production with people and those who know them best
• Community-focused, keeping people close to home and natural networks

Our Multi-Disciplinary Team

• Complex Needs Support Workers / PBS Practitioners – direct support, coordination and family contact
• RMN / RNLD – health stability, medication safety, mental health input and upskilling of support staff
• PBS Lead (Board Certified Behaviour Analyst) Practitioner – functional behaviour assessments, behaviour plan delivery, deescalation and behaviour incident trend analysis, post-incident review and strategy oversight
• Social Worker / Head of Mental Health, Learning Disability and Neurodiversity – MDT coordination, legal frameworks (MCA, Care Act, Mental Health Act), Safeguarding and Best Interest decisions
• Allied professionals such as Occupational Therapists and Psychologists as required

Governance & Quality

• Commitment to least restrictive practice with CPI training and clear MDT/safeguarding sign-off frameworks
• Trauma-informed supervision and reflective practice
• Quality dashboards tracking admission prevention, crisis episodes, restrictive practices, engagement and quality of life
• Incident learning loops feeding into active care planning and service improvement
• Strong information governance and MCA compliance

Our approach is designed to improve people’s lives while delivering clear value to ICBs and Local Authorities.

We focus on:

• Admission prevention – reducing Tier 4 and other hospital admissions
• Crisis reduction – lowering 999 calls, A&E attendances and police involvement
• Reduction in restrictive practices – fewer incidents, holds and emergency PRN
• Improved quality of life – increased engagement, independence and meaningful activity
• Better family outcomes – improved confidence, stability and involvement
• System value – sustaining placements, reducing breakdowns and avoiding high-cost out-of-area solutions

Outcome data, case summaries and commissioner references are available on request.

Our referral and support process for RRT

1. Initial Contact & Triage
   We take key information about the person, risks, current setting and timescales, and complete an initial risk and safeguarding screen.
2. Crisis Response
   High-risk or immediate crisis cases, our Rapid Response Team deploys within 2–4 hours, keep safe plans and active risk/ crisis management in place to stabilise the situation and prevent escalation.

For ICSS Follow on

1. Holistic Assessment
   Within 1–2 weeks, our MDT completes a comprehensive PBS and holistic assessment, covering function of behaviour, trauma, mental health, environment, family and quality of life.
2. Co-Produced Care Plan & Mobilisation
   A complex care plan, PBS plan, risk & safety plan, crisis prevention plan and goal plan are agreed with the person, their family and professionals, and the package is mobilised with person-specific training for staff.
3. Ongoing Review and Step-Down
   Crisis plans are reviewed weekly during crisis phases, MDT meetings are held fortnightly, and outcome reviews take place at least every 12 weeks, with support stepped down as stability is maintained.

Use our secure online referrers form to share key details and timescales. A member of our team will contact you promptly to discuss the case and agree next steps.