Using CNEST Sections A, B and C

Risk of harm to self

Scores for this factor reflect the level of assessed risk to self. This should include self-harm (e.g., cutting, poisoning), self-injurious behaviours (e.g. head banging, hitting, biting), and suicidal ideation/intent/behaviours. (NICE, 2022).

• “In the last month, the young person has engaged in self-harming behaviour or has expressed suicidal ideation and has attended an Emergency Department”

If this statement is true, then a score of 3 should be given. If not consider a score of 2, 1 or 0.

• “In the last month, the young person has engaged in self-harming behaviour or has expressed suicidal ideation”

If this statement is true, then give a score of 2. If not consider a score of 1 or 0.

• “There are concerns that self-harm or suicidal ideation are present”

If this statement is true, a score of 1 is given.

• “No concerns present”
  If there are no concerns present relating to self-harm or suicide, a score of 0 is given.

Risk of self-neglect

Scores for this factor reflect the level of assessed risk of self-neglect to the extent it threatens personal health or safety for example: the young person has difficulty managing their hygiene or physical health (including if the young person is not at the expected height to weight trajectory for their stage of development). This item should be scored if the self-neglect is as the result of a mental health presentation rather than the result of parental neglect or a physical health difficulty.

• “Yes”

A score of 2 means there are concerns by anyone (i.e., the young person and / or parents/carers/professionals).

• “No”

A score of 0 means there are no concerns regarding self-neglect.

Risk of harm to other(s)

Scores for this factor to reflect the level of assessed risk of harm to other(s). Harm can take any form or severity; however, it must result in a negative outcome for other(s) (e.g., physical, emotional, social). This includes harm to animals and significant property destruction or fire setting. These behaviours need to be considered driven by a young person’s mental state.

• “In the last month, the young person has caused or attempted to cause harm to other(s)”

If actual harm (e.g., physical, emotional, social) has been caused, or the person has attempted to harm other(s), then a score of 2 is given.

• “In the last month, the young person has expressed thoughts of harm to other(s)”

If the young person has expressed thoughts or intent but caused no actual harm to other(s), then a score of 1 is given.

• “No concerns present”

If there are no concerns regarding risk of harm to other(s) present, then a score of 0 is given.

Neurodevelopmental Condition

Scores here reflect actual or suspected Learning/Intellectual Disability, Autism Spectrum Disorder, Attention Deficit Hyperactivity Disorder and Foetal Alcohol Syndrome.

• “Yes”

A score of 2 relates to young people where there are diagnoses or professional concerns around neurodevelopmental condition(s).  This may be an initial hypothesis, or the young person may be awaiting assessment or formal diagnosis or already have a diagnosis.

• “No”

A score of 0 relates to young person formulated as being “neurotypical”.

Previous admission to any hospital for a mental health need

Scores relate to an admission to any hospital bed due to mental health difficulties.

• “Yes”

A score of 3 should be given when there has been an admission to any hospital bed due to mental health difficulties: this includes Tier 4 CAMHS inpatient or a bed at an acute trust.

• “No”

Young people who present at A&E without being admitted (to Tier 4 CAMHS or an acute bed due to mental health difficulties), would not meet the threshold for a score of 3 and therefore should be scored 0.

Parent(s) / carer(s) do not feel able to keep the young person safe OR does not feel able to maintain family safety / stability

This relates to the parent(s)/carer(s) who have day to day caring responsibilities for the young person (e.g., Parents, Foster Carers, Special Guardians, care staff in residential care homes).

The score for this factor is based on the parent(s)/carer(s) subjective perception of their ability to keep the young person safe at home and maintain family safety/stability.

• For a score of 3, the parent(s)/carer(s) do not feel able to keep the young person safe at home, or maintain family safety/stability, in the context of the current multiagency plan of care. This is based on their subjective perception and their self-report.  This factor DOES NOT relate to whether professionals feel that parent/carers are able to cope / keep the young person safe. 
• For a score 2, the parent(s)/carer(s) have expressed concerns about being able to keep the young person safe at home or maintain family stability/safety.

For a score of 0, the parent(s)/carer(s) feel able to keep the young person safe at home, and maintain family safety/stability, based on the support and care plan currently in place.  

Professionals have concerns about the level of engagement with the multiagency care plan, by either the young person, parent/carer, or family

• “Yes”

A score of 2 reflects a lack of meaningful engagement as perceived by at least one of the professionals involved. This may include, missing appointments or not adhering to the care plan. Parent(s)/carer(s) may disagree with this view.

• “No”
  There are no concerns regarding meaningful engagement.

The young person is unable to access education due to current difficulties

This factor relates to young people who, because of their mental health difficulties are not currently accessing education.

• “Yes”

For a score of 2, the young person is unable to attend school or access education as per their care plan.

• “No”
  For a score of 0, the young person is able to attend school or access education as per their care plan.

There is a lack of multiagency consensus around formulation and care planning

Scores for this factor consider the agreement or disagreement within the multiagency system currently supporting young people and families. This may include: children and young people mental health services, Tier 4 services, acute trust services, commissioners of services, local authority children’s services and education services.

• “Yes”

For a score of 3, there should be significant disagreement surrounding the formulation and/or care plan relating to the young person’s mental health needs. An example of this might be disagreement and lack of progress around whether a young person requires increased levels of mental health intervention OR social support i.e., Tier 4 CAMHS admission or social care placement (such as foster care or residential).

• “No”

For a score of 0, the multiagency system has been able to work collaboratively to develop a shared understanding of the young person’s needs and are able to progress the care plan effectively. Alternatively, there are minor disagreements and progress is being made towards resolving these.

Please refer to your local safeguarding children policies for more information

The young person is open to Local Authority Children’s Social Care Services

This factor relates to the level of service being offered by Local Authority Children’s Social Care Services (in line with The Children’s Act 1989).

• “Yes”

The young person is open to Children’s Social Care at either: Child in Need (CIN), Child Protection (CP), Child Looked After (CLA) or open at Early Help Level (known in some areas as CAF or TAF).

• “No”

The young person is not open to Children’s Social Care Services.

The young person is open to Youth Justice Services

This factor captures whether or not the young person is currently open to Youth Justice Services as a result of their current presentation.

• “Yes”

The young person is currently open to a Youth Justice Service.

• “No”

The young person is not currently open to a Youth Justice Service.

The young person has an unstable or untreated physical health condition

This factor considers the interplay between physical and mental health.

• “Yes”

The young person has a physical health problem, and this is either unstable AND/OR untreated.

• “No”

The young person EITHER does not have any physical health concerns OR their physical health difficulties are appropriately managed.

The young person is believed to have recently been exposed to high-risk behaviour from other(s)

The young person has someone close to them, who has engaged in behaviour that cause harm to themselves or others. This may include but is not limited to friends or family engaging in self-harm, suicide, violence, substance misuse, criminality, or exploitation.

This factor addresses the known risk of a contagion effect and the increase in risk when young people are exposed to high-risk behaviour by others.

• “Yes”

The young person is believed to have witnessed or be aware of those around them engaging in high-risk behaviour.

• “No”

The young person is not believed to have witnessed or be aware of those around, them engaging in high-risk behaviour.

There are current problems in peer or intimate relationships, on/offline

This factor relates to any difficulties a young person may be experiencing within their social network, whether friendship, intimate, in person or online.

• “Yes”

The young person is having trouble in their relationship(s). This is based on their perception and subjective experiences, rather than whether professionals and/or parent(s)/carer(s) deem these as being appropriate.

• “No”
  
  The young person is not having trouble in their relationships.

The young person currently has substance misuse difficulties (i.e., with drugs and/or alcohol).

This factor relates to substance misuse difficulties (i.e., with drugs and/or alcohol).

• “Yes”

There are current concerns (by anyone) about the young person having substance misuse difficulties. This may be the young person expressing concerns about their own use or there may be concerns noted by parent/carer or professionals.

• “No”
  There are no concerns expressed by anyone relating to substance misuse difficulties.

The young person is having difficulties coping after a stressful life event

This factor relates to adjustment difficulties after a stressful life event such as (but not limited to): bereavement, illness, divorce, house move, change of school or death of a pet. This factor can be based on the young person’s self report or as perceived by parent(s)/carer(s) or professional(s). There is no time frame associated with this factor; the important point to consider is whether there is a difficulty adjusting and coping to the extent that it is having a negative impact on mood and/or functioning.

• “Yes”

The young person is having difficulties coping after a stressful life event.

• “No”
  The young person is not having difficulties coping after a stressful life event.

The young person has experienced prejudice and/or discrimination

Prejudice can be defined* as ‘an unreasonable dislike of or preference for a person, group, custom, etc…, especially when it is based on their race, religion, sex etc…’                                                              

Discrimination can be defined* as ‘the practice of treating somebody or a particular group in society less fairly than others.’

• “Yes”

The young person has identified experiencing prejudice and / or discrimination.

• “No”

The young person has not identified experiencing prejudice and / or discrimination.

• “Unknown”
  It is unknown whether the young person has experienced prejudice and / or discrimination.

*Definitions taken from the Oxford learner’s dictionary accessed at www.oxfordlearnersdictionaries.com January 2023.

The young person is in transition to adult services

Transition is defined as the period before, during and after a young person moves from children to adult services (NICE, 2016). Consideration needs to be taken as to whether a young person should be receiving transition support.

• “Yes”

The young person is in transition from children to adult services.

• “No”

The young person is not in transition from children to adult services.