What is CNEST's core purpose?
The Complex Needs Escalation and Support Tool (CNEST) is a needs stratification tool for young people up to age 25 with significant mental health difficulties. It recognises the degree and complexity of a young person's unmet needs as they pertain to their significant mental health difficulties. It helps professionals allocate and mobilise appropriate resource to meet the mental health and care needs of young people. It aims to reduce the likelihood of hospital admission, entry into care or custody. CNEST is NOT a clinical risk assessment tool.
CNEST should only be used by professionals who have completed CNEST training. It should be used together with clinical risk assessments and psychological formulation to contribute to multidisciplinary decision making and clinical prioritisation and it should be used in a dynamic way to reflect changes in a young person’s situation.
When used routinely and embedded into electronic records, CNEST provides cohort level data on level and complexity of unmet need for young people with significant mental health difficulties. Within statutory services and across place based multi-agency systems, CNEST supports oversight and escalation so that resources can be allocated and mobilised appropriately.
CNEST training for Cheshire and Merseyside local authority children’s practitioners and keyworkers is now live: https://www.levelupcm.nhs.uk/cnest
Level Up Tier 4 CAMHS Lead Provider Collaborative have funded the development and roll out of the CNEST tool for Children's Practitioners in Cheshire and Merseyside. The Change and Integration Programme supported the rollout of CNEST training to Local Authority professionals across Cheshire and Merseyside during 2025, with hundreds of local authority staff completing the programme. Since then, we are pleased to announce that Level Up Tier 4 CAMHS Lead Provider Collaborative has developed and launched a digital version of CNEST. They are funding 1000 places for Cheshire and Merseyside Local Authority Children's Services professionals to be trained in the Complex Needs Escalation and Support Tool (CNEST).
Once all training is completed you can start to use the CNEST tool in your case work, be sure to refer to your local authority’s guidance notes/booklet, this should be available via your CNEST Champion / internal communications.
A CNEST Champion is a professional who can make decisions at principal social worker level or uses CNEST as part of their role e.g. dynamic support keyworker teams.
For more information about becoming one for your area please contact the CNEST Programme Manager at the Change & Integration Team - kerrymacfarlane@wirral.gov.uk
A key milestone is the establishment of a CNEST Community of Practice, which will operate alongside the bi-monthly Implementation Group to support shared learning, collaboration, and continuous improvement.
Once your CNEST training is completed you can sign up to the CNEST Community of Practice sessions. Ask your CNEST Champion for details about these regular online meetings.
Additional licences can be requested, please contact changeandintegration
The Change and Integration Programme is now supporting implementation across all nine local authorities, initially focusing on practitioners working within safeguarding and pre-proceedings services, as these teams are most likely to identify children and young people (CYP) with escalating and complex needs. While we recognise the wider potential of the tool, this focused approach will help ensure CNEST becomes embedded within practice through local guidance, supports effective planning for CYP, and contributes to quality assurance and oversight arrangements.
The rollout of CNEST aligns closely with wider system priorities, including the Gateway process, APOC and the new Home Again programme. Health partners have also agreed to adopt CNEST in place of the Dynamic Support Database (DSD) process, recognising its greater value in informing assessment and planning. This demonstrates the significant opportunity for Cheshire and Merseyside to take a genuinely innovative and integrated approach.