Background: There are few identified risk factors that may contribute to the increased risk of hospital admission for children and young people with intellectual disabilities. This qualitative study aimed to identify the key risk factors that precipitate admissions to Tier 4 child and adolescent mental health services (CAMHS) inpatient services for young people with an intellectual disability living in the North East of England in accordance with the Transforming Care programme. Methods: This qualitative study captures the narrative of five young people admitted to hospital following a crisis period. Semi-structured interviews were carried out with two adolescents with an intellectual disability and five caregivers of a young person with an intellectual disability to identify challenges from those with lived experience. Findings: The findings were analysed using interpretative phenomenological analysis and indicated pathological, interpersonal, social, education and intervention challenges. Nine re-emerging central themes highlighted that young people experienced particular difficulties before admission such as behaviours which challenge, comorbid diagnoses, isolation, insufficient crisis planning, care coordination problems, familial stressors, availability of community service provision, school placements and late intervention. Conclusions: These results have contributed to developing the children's Tier 4 CAMHS Learning Disability pathways within a large NHS Foundation Trust as practitioners and professionals are mindful of these areas exacerbating risks and challenges that a young person with an intellectual disability and their family may experience. Findings could be considered when nationally reviewing services following the Transforming Care programme, aiming to provide care as close to home as possible. This may contribute to future research developing "At Risk" screening tools and formal "At Risk" registers for those with an intellectual disability.