How to use this guidance

This guidance has been developed to support clinicians in community CYPMH services to complete the CNEST. The aim is for the CNEST to be completed for all young people open to CYPMH services. 

It is important to follow this guidance as it is designed to support clinicians in using the tool and will offer clinical recommendations that may address areas of unmet need that are contributing to the young person’s risk of Tier 4 CAMHS admission. Clinicians are to complete this tool based on a young person’s current presentation.

Clinicians will need to regularly review a person’s CNEST rating. This should be with any care plan/risk assessment changes or at regular intervals.   

The importance of regular review of the tool is essential to ensure that a young person’s needs are being identified and met by all the relevant agencies including health, education, and social care. More information and downloadable versions of the tool and guidance can be found at

This guidance is split into six sections:

  1. How to use this guidance 
  2. Introduction to CNEST
  3. Who is the CNEST for?
  4. Using CNEST Sections A, B and C
  5. How to get final CNEST ratings and what clinical recommendations to use
  6. Related documents (You can find the CNEST tool and guidance document here.)