Why CNEST was developed

Across Cheshire and Merseyside, services were seeing a growing number of children and young people with multiple needs.  Many were presenting with combinations of neurodiversity, trauma, self‑harm, mental health needs, exploitation risks and placement instability. Services were not consistently responding early enough to their needs in a young person-centred, coordinated way.

CNEST Graphics heart.pngLocal systems recognised several recurring challenges:

  • Variation in thresholds and decision making
  • Fragmented communication between agencies
  • Delayed or inconsistent escalation
  • Professional disagreement about levels of need
  • A tendency toward reactive rather than preventative responses

Alongside this, the Cheshire and Merseyside Tier 4 CAMHS New Care Model highlighted the need for earlier identification of young people at risk of admission. The development of the Gateway model and a wider population‑health approach reinforced the importance of understanding the needs of young people in complex situations at a system level. National programmes such as Transforming Care and Building the Right Support further emphasised the need to support young people within their communities wherever possible.

The CNEST was developed to provide:

  • A shared language for describing complexity
  • A consistent way to identify unmet need
  • Improved system‑wide coordination
  • Earlier, more proactive intervention

It was designed to help local areas move from reactive crisis management to a more structured, evidence‑informed approach to understanding and responding to complexity.

Implementation across Cheshire and Merseyside

CNEST is already embedded across local systems:

  • 503 clinicians trained across CYPMHS
  • 222 practitioners trained across nine local authorities
  • 1000 licences for social care
  • 500 licences for CYPMHS as part of the CNEST Digital (2026)

CNEST builds on learning from the Dynamic Support Database – Clinical Support Tool (DSD‑CST), originally developed within Cheshire and Wirral Partnership NHS Foundation Trust to support autistic young people and those with intellectual disabilities. While the DSD‑CST demonstrated strong utility and reliability, it was limited to CYP with confirmed diagnoses and did not meet the needs of the wider population.

CNEST was created to address this gap by:

  • Including young people with suspected or emerging neurodevelopmental needs
  • Supporting those without a diagnosis but with significant complexity
  • Providing a tool applicable across all CYP pathways
  • Ensuring co‑production and clinical evidence informed the design

This evolution ensured CNEST could be used consistently across statutory services, social care, education and multi‑agency systems.

The CNEST was developed through a rigorous, multi‑stage process led by clinicians within NHS services. The methodology combined research evidence, clinical expertise and co‑production to ensure the tool is both robust and practical for everyday use.

Development drew on:

  • Literature review examining evidence on complexity and escalation
  • Analysis of admission data to understand patterns and drivers of hospital use
  • Delphi methodology with Cheshire and Merseyside clinicians
  • Co‑production with experts by experience, parents and young people
  • Focus groups including DSD‑CST learning, autism/learning disability pathways and multi‑agency perspectives
  • Clinical pilot and evaluation within Cheshire and Wirral Partnership
  • Continuous improvement based on feedback and implementation learning

The evidence base continues to grow. Completed and ongoing work includes:

  • Inter‑rater reliability study (submitted for publication)
  • Development paper (submitted for publication)
  • Validity study for autistic young people and those with an intellectual disability (in progress)
  • Alignment with national policy, NICE guidance and population‑health approaches

The CNEST has been developed, tested and implemented within NHS services, ensuring it reflects real‑world practice and supports clinical judgement rather than replacing it.

“CNEST provides a consistent and evidence‑based approach to identifying complexity and unmet need.”

Find out how CNEST can help you

Find out how CNEST can help you meet the needs of young people in your local area. For training enquiries, implementation support or general information, please contact the CNEST team.