Back to CNEST home
How to use this guidance
Introduction to the Complex Needs Escalation and Support Tool (CNEST)
Using CNEST Sections A, B and C
Related documents

In this section you will find guidance around CNEST ratings and clinical recommendations. 

Final risk stratification 

For the final risk stratification, use the rating for the section A and section B in the following matrix to get the final rating. The purpose of the tool is to do a risk stratification considering relative risks; it does not replace individual risk assessments.

  Section B: Impacting Factors
High Medium Low
Section A: Complex Risk Factors High High High Medium
Medium High Medium Low
Low Medium Low Low

Once you have the final risk stratification you will be able to access which clinical recommendation to use this will be HIGH, MEDIUM or LOW. You can find the clinical recommendations in the tool by using the tabs along the bottom. 

Risktables.gif

We have also included the clinical recommendations below:

A CNEST rating of high means that if there is no increased response from the multiagency system around the young person and family, and their needs remain unmet, it is very likely the young person will require admission to a Tier 4 CAMHS unit or present at A&E in mental health crisis.  The clinical presentation is considered severe, and the young person may require urgent specialist and high intensity intervention(s).

With a high rating, the needs of the young person should be taken to the relevant multi-disciplinary team meeting and follow CYPMH service local escalation procedures.  The young person’s needs may also be discussed at the place-based Gateway Meeting. These meetings can be called as a matter of urgency if required (see Appendix C). This meeting aims to ensure that all agencies take collective responsibility for the care and welfare of young people at risk of admission to Tier 4 CAMHS and meet any identified unmet needs as a matter of urgency.  

At this level of need, clinicians should ensure the following steps have been considered and completed as appropriate:

  • Consultation with Tier 4 CAMHS Assessment and Outreach Team
  • Input from Crisis Services and LD/Autism Intensive Support Functions
  • A Care Education and Treatment Review (CETR) if the young person has a Learning Disability and / or Autism
  • A review of the formulation, care plan and associated safety plans, with all agencies involved
  • Completion of all relevant clinical and safeguarding assessments– this may require expedition
  • Use of internal and multiagency escalation policies where there is disagreement or concern regarding service offer

Please ensure all recommendations for medium and low have already been considered and completed as appropriate.

A CNEST rating of medium means that there is a possibility of Tier 4 CAMHS admission. The young person’s presentation is concerning and could still worsen. There is a risk that this young person will move into a ‘high risk’ rating, if there is not a review of the multiagency package of care to ensure that all appropriate actions and interventions are being put in place. At this level, clinicians should ensure the following steps have been considered and completed as appropriate:

  • Consider consultation with Tier 4 CAMHS Assessment and Outreach Team
  • Consider input from CYPMH Crisis Services and LD/ Autism Intensive Support Functions
  • Review the formulation, care plan and associated safety plans, with all agencies involved
  • Ensure all relevant clinical and safeguarding assessments have been completed – this may require expedition
  • Use of internal and multiagency escalation policies where there is disagreement or concern regarding service offer

Please ensure all recommendations for low risk of admission have already been considered and completed as appropriate.

A CNEST rating of low means the young person has identified needs requiring specialist children and young people’s mental health service intervention and their needs are currently been met by appropriate services.

For young people at all levels of risk:

  • Case Manager/Keyworker is allocated by the service to the young person
  • Ensure a biopsychosocial and risk assessment is undertaken. Following this, a formulation and care plan should be developed collaboratively with the young person and family as appropriate and with any associated agencies
  • If the young person has a presentation of a learning disability and / or autism, you may use the CNEST rating to complete the Dynamic Support Database risk rating (high=red, medium=amber, green=low)