Assertive Outreach worker (Qualified)

Job overview

Band 6 Full Time Qualified Assertive Outreach Worker (Nurse / OT / Social Worker) at Community Mental Health Hub (Kensington & Chelsea)

Make engagement happen. Prevent crisis. Change trajectories. We’re building a focused Assertive Outreach (AO) offer within our Community Mental Health Hub to reach adults with severe mental illness (SMI) who are at risk of disengaging from care. If you thrive on meaningful relationship-building, rapid decision-making, and real-world impact, this role is for you.

About the role As an Assertive Outreach Worker, you’ll be the consistent, trusted keyworker for a small caseload, delivering time‑limited, intensive support over a stepped 6‑month model. You’ll combine clinical skill with creativity and persistence—meeting people where they are, in homes and community spaces across Kensington & Chelsea—to stabilise engagement, reduce risk, and prevent crisis.

Main duties of the job

The Assertive Outreach Worker will deliver time‑limited and intensive support to adults with severe mental illness (SMI) who are at risk of disengaging from care. The role is central to stabilising engagement, reducing risk, and preventing crisis escalation, in line with the Assertive Outreach Standard Operating Procedure.

The postholder will:

• Provide assertive, flexible, and persistent outreach, including home visits, community‑based contacts, and phone/text engagement
• Act as a consistent keyworker, building therapeutic relationships with individuals who find it difficult to engage with services.
• Work within a stepped 6‑month model of intensive support, transition, and reintegration into routine CMHH care.
• Deliver holistic, person‑centred interventions addressing mental health, physical health, housing, substance use, and social needs.
• Work collaboratively with the CMHH MDT, crisis services, inpatient wards, and external agencies to ensure continuity of care and safe transitions.

This role requires strong clinical skills, excellent risk management, and the ability to work autonomously in the community.

Detailed job description and main responsibilities

• Provide intensive outreach in line with the SOP: First 3 months: minimum 3 contact attempts per week, aiming for 1–2 successful contacts. Next 3 months: minimum 2 contact attempts per week.
• First 3 months: minimum 3 contact attempts per week, aiming for 1–2 successful contacts.
• Next 3 months: minimum 2 contact attempts per week.
• Deliver flexible contact through home visits, community meetings, phone calls, texts, and occasional evening/weekend availability.
• Maintain a “no discharge for DNA” approach, using persistent and creative engagement strategies.
• Build strong therapeutic relationships through empathy, reliability, and trauma‑informed practice.
• Provide continuity and consistency as the allocated AO keyworker.
• Complete and update care plans, risk assessments, and safety plans in line with Trust policy.
• Conduct frequent dynamic risk assessments and escalate concerns promptly.
• Lead on transition planning back to routine CMHH care.
• Ensure timely documentation of all contact attempts, outcomes, and risk assessments.
• Work collaboratively with the CMHH Care Coordinator where this is a separate role.
• Deliver meaningful intervention
• Use therapeutic engagement to support patients to engage.
• Supervision of band 4 support staff
• To hold case load of 10-15 patients