NEST framework (mental health and wellbeing): implementation update 2024

The NYTH/NEST framework is a co‑produced planning tool for organisations and strategic leadership to share key principles and language for mental health and wellbeing.

The Welsh Government is committed to creating a whole system approach to mental health and wellbeing services for babies, children, young people and their families. Implementation of the NYTH/NEST framework is a key part of supporting services to work in partnership to deliver more joined up, nurturing, empowering, safe and trusted services.

This NYTH/NEST implementation update draws together reporting from Regional Partnership Boards’ NEST self‑assessments and Welsh Government to show the progress being made in NYTH/NEST implementation.

In February 2024, we launched the NEST self‑assessment tool. The tool was co‑produced with young people, practitioners and strategic leaders and underwent piloting in different sectors before being published.

Our workshop event to launch the NEST self‑assessment tool and training was attended by over 300 people with a further 135 requesting a recording of the event.

In addition, we are running a monthly national NEST forum for support with completing the NEST self‑assessment.

Feedback from the workshop included:

I thought it was excellent – I really enjoyed it. Great to hear from young people as well as excellent speakers and hearing about the pilot work.

NEST across Welsh Government

The draft mental health and wellbeing strategy had NEST as a key enabler for delivery which received support in the public consultation.

The national framework for the commissioning of care and support code of practice requires commissioners to use the NEST framework in their commissioning practices, to make use of NEST tools and training and to ensure a “no wrong door approach”. It also recommends that providers have a good understanding of NEST principles when delivering services.

The draft national vision for infants, children and young people with a learning disability is informed by the NEST framework and features many of the same principles and underpinning values.

NEST is being included in the new children and communities grant (CCG) guidance, with a recommendation that all projects funded through the CCG undertake NEST training and use the self‑assessment tool. There is opportunity to provide case studies on how NEST is being implemented through the CCG.

The neurodivergence improvement programme (NDIP) is aligned with NEST to ensure families of neurodivergent or potentially neurodivergent children can access support from wider services. NDIP offers support to upskill wider services to meet the needs of neurodivergent children and their families. Regions are working with partners to integrate neurodivergent and mental health support.

Our NEST community of practice continues to be a lively and engaging coming together of practitioners and strategic partners from across all sectors and professions associated with children’s mental health and wellbeing, with an average of 40 attendees per meeting.

Work has been carried out to identify regional youth work and play representatives to work with Regional Partnership Boards with the aim of supporting improved collaboration. This has included developing a play and wellbeing briefing on NEST for the wider sector.

In February 2024, we launched our introduction to NYTH/NEST and children’s rights training on the Y Ty Dysgu learning platform. It was co‑produced with young people, Gwent Regional Partnership Board, and the Children’s Commissioner for Wales.

As of October 2024, 147 people had enrolled on the course and 70 had completed.

The graph shows how learners rated the NYTH/NEST training:

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The pie chart shows the NYTH/NEST training participants by organisation:

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Feedback

Participants found the practical examples of how the NEST framework has been implemented particularly useful.

The inclusion of children’s voices and real life examples was highlighted as a powerful and engaging aspect of the training.

Respondents noted that the training provided valuable insights that they could apply directly to their roles, particularly in promoting children’s rights and embedding the NEST framework in their work.

Participants asked for more video testimonials and examples of the NEST framework in action.

Participants suggested incorporating more graphics and interactive elements to make the content more engaging.

Feedback included:

I will ensure I work with all agencies to get the voice of the child heard.

Very interesting examples of how NEST had been used to support co‑production and service development.

I found helpful the voices of the young people being part of the training, and all the information of the work being done by them and with them.

I thought it was very good, laid out training course. It had broken down activities and good amount of knowledge tests throughout the course. I really enjoyed the training.

In October 2024 all Regional Partnership Boards (RPBs) submitted NEST self‑assessments. This report covers the themes, good practice and concerns that came from the analysis of those self‑assessments.

To form their self‑assessments RPBs ran workshops with partners and listened to children, young people and families. Many projects funded by the Regional Integration Fund also completed NEST self‑assessments which informed the regional submissions.

This report uses the 6 key principles of NEST to show the progress being made in implementation. Against each principle you will find the average "NEST journey rating". This is an average of all RPB’s self‑awarded ratings on a scale of 1 to 4:

• 1 is basic level: principle accepted and commitment to action
• 2 is early progress: first stage development and action planning
• 3 is substantial progress: first stage actions done with good outcomes
• 4 is embedded (cycle of reflection and improvement): embedded good practice, keep on reviewing, learn from research

Trusted adults

Average NEST journey rating across all regions: 2.3.

In several regions trusted adult principles were being brought into recruitment and retention. This included:

• staff supervision
• policies to support retention
• young people being part of recruitment
• trusted adult principles in job descriptions

These actions responded to the identified need for better retention and care for staff who need to work long term and provide continuity to build trusted adult relationships. Additional barriers to this long term approach were identified as short term contracts and funding.

The benefits and importance of trauma informed training for trusted adults featured heavily in the self‑assessments with an acknowledgement that trauma informed practice creates trusted adult conditions.

Regions talked about the need to define the term trusted adults and acknowledged the complexities the term presents, with some working with children and young people to create regional shared understanding of the term and principle.

Whilst regions reflected on the importance of working with children’s trusted adults to support them to support the child, they also highlighted the importance of trust between services and professionals to ensure smooth transitions and signposting.

Feedback from the Gwent region:

Teams such as Cynefin and Gwent Child and Family Community Psychology work directly with trusted adults, not just parents but also professionals like teachers and social workers, to develop a shared understanding of the child’s needs. This holistic, partnership based approach helps to create conditions where children’s psychological and emotional needs are better understood and supported.

Feedback from the Cwm Taf Morgannwg region:

A key aspect of establishing trusted adults is consistent, long‑term engagement.

For the west Wales region, the trusted adult concept is:

a crowded arena with different philosophical approaches, depending upon your professional perspective.

Wellbeing across education

Average NEST journey rating across all regions: 2.1.

Whilst all regions acknowledged the importance of mental health and wellbeing support in education as part of the whole system, many areas found it difficult to get education representation on their working groups or children’s groups and had actions around increasing this.

Most regions focused this section on school provision. There was recognition of the importance of the "whole school approach to emotional health and wellbeing" and CAMHS in‑reach with many co‑ordinators involved in RPB partnership working. Some regions identified a need for clearer guidance on the alignment between the 2 frameworks and how NEST should feature in school approaches to wellbeing. Lots of regions talked about needing to increase the knowledge in schools of what mental health and wellbeing services are available and create links between education and services. This was being actioned in numerous ways, including:

• forums
• online resources
• education co‑ordinators

The mental health and wellbeing of those educated other than at school was a concern, with some areas providing targeted support for elective home educated children and young people and learners at pupil referral units.

In addition, regions highlighted the need to include childcare in wellbeing across education considerations. This was highlighted both in terms of representation on working groups and a need to embed NEST in childcare. In some regions this extended to early years more generally. Some regions identified a need to work more closely with higher and further education and had actions to gain representation on working groups.

What good would look like for the Cardiff and Vale region:

Clear and consistent messaging to schools and education partners that provides understanding of NEST and confidence in the alignment between NEST and the whole school approach to emotional wellbeing and inclusion of childcare settings caring for our babies and pre‑school children in NEST implementation.

Feedback from the Cwm Taf Morgannwg region:

We need the right representation on existing groups and regular attendance.

Feedback from the north Wales region:

Home schooling issues. Non-education systems are difficult to put in place if they are already not engaging with the wider community. Cohort of parents that do not engage with services, no wellbeing, which creates safeguarding risks.

This section should be updated to include quality childcare provision. Particularly for early years as it has such a strong influence on supporting children’s strong foundations and future prospects.

Co‑produced innovations

Average NEST journey rating across all regions: 2.1.

All organisations and partnerships completing the NEST self‑assessment are asked to ensure children and families’ voices are informing their reflections. There was some good practice with children’s voice informing NEST self‑assessments, but this was not across the country and there were significant gaps in engagement with children and families. However, where children’s voice was missing from assessments, it was highlighted as a gap and there were actions to address.

Many regions were able to give good examples of where services were co‑producing their delivery and individual planning and pockets of good practice. Generally (but not exclusively) lacking however, was a regional approach to children and families’ engagement in strategic planning. Regions recognised the need to close the feedback loop and ensure co‑production and engagement was carried out well.

Regions had plans to develop their engagement with marginalised children and young people including:

• homeless young people
• children with life limiting conditions
• non‑verbal children and young people

Most regions identified a need to include parent and carer voices, with actions to do so including establishing a parent’s forum to influence strategic decision making. Babies and younger children’s voice was largely absent from self‑assessments.

Family feedback from Cwm Taf Morgannwg:

Listen to children and their families, not every answer fits all.

Feedback from the Gwent region:

Children and parents have been part of the interview panels for new staff in certain services, ensuring that their perspectives influence who is hired to work with them.

Feedback from the Cardiff and Vale region:

We have also worked with Ty Hafan to develop a resource on coproduction with children with life limiting conditions and the positive impact this can have on their wellbeing.

Feedback from the Powys region:

Future plans include developing a parenting forum to enable parents to actively contribute to the design of projects and services.

West Glamorgan said that they will:

embed ways of working with partners to ensure the business of the children and young people programme is a continuous loop of input, feedback and delivery so that the voice of the child is heard and acted upon.

Easy access to expertise

Average NEST journey rating across all regions: 2.1.

Regions spoke about the barriers to accessing expertise and services in general and identified rurality and transport links as well as poverty as the main barriers. North Wales spoke about the need for access to services in Welsh, whilst other regions highlighted the need for other languages to be made available.

Regions spoke about creating or maintaining websites that offer information on mental health and services, including co‑produced websites and improving health board webpages for CAMHS and neurodiversity. Some regions pointed to the role of family information services to provide easy access to expertise for families.

There was feedback that services felt more streamlined and co‑ordinated when delivered through the Regional Integration Fund. However, the main barrier was cited by services and families as long waiting lists to access expertise.

Feedback from north Wales:

Easy access is not just access to the knowledge. People need to physically be able to access some services. Rural places in the west will struggle to attend face to face services, due to poor community transportation. Professionals needs to understand how difficult it can be for families to access expertise.

Feedback from the Cardiff and Vale region:

It is recognised that a lack of understanding about neurodiversity and how to support a child who may have these needs can significantly impact the wellbeing of both a child and their families, and that aligning approaches for emotional wellbeing and neurodiversity can deliver significant benefits to children, families and the system that supports them.

Feedback from the Powys region:

The family information service is a good example of where information is shared with local families regularly.

Feedback from the Gwent region:

In addition to providing expertise directly to families, many services also prioritise sharing knowledge with other professionals who work with children and young people. This includes offering consultation and reflective practice sessions for teachers, social workers, and healthcare staff, helping to build their capacity to support families.

Safe and supportive communities

Average NEST journey rating across all regions: 1.8.

This was the lowest rating for all the principles, with regions identifying the breadth of work to do. Rurality and transport were again highlighted as barriers in this section as well as a propensity for focusing on larger towns for provision at the expense of rural villages. In addition, the accessibility of green spaces and space to play were mentioned in several regions as areas of concern with regions recognising the importance of such access as preventative factors for mental health and wellbeing.

Several regions identified actions to work with Public Services Boards on wellbeing issues and many had either begun to include, or had actions to include, wider influences on children’s mental health and wellbeing including youthwork, play work and housing in their partnerships.

Many regions reflected on the importance of youth provision and community activities targeted at vulnerable or marginalised groups. Some regions also talked about social prescribing as both a supporter of easy access to expertise and a connector to safe and supportive communities.

West Glamorgan said an example of safe and supportive communities in action:

is a Friday night youth club and outreach service. It supports young people vulnerable to County Lines, antisocial behaviour, exploitation, and those not in education or training.

Feedback from the west Wales region:

This year we have continued to develop work on social prescribing to increase understanding of, and access to, wider community support for families and children.

Feedback from the Powys region:

Issues with accessible green spaces, such as schools closing gates or restricting access to playing fields out of hours.

No wrong door

Average NEST journey rating across all regions: 2.3.

Across the country regions reported time and investment in improving No Wrong Door procedures, with this being one of the highest scoring principles. All regions were either developing single points of access or no wrong door procedures through learning from other region’s good practice, or, where regions already had such models in place, they were being reviewed for effectiveness. These were large and long‑term actions which included aspects of culture change, partnership working arrangements and data sharing agreements.

Some regions were looking at extending or including no wrong door arrangements to include neurodiversity and crisis provision. In addition, there were good examples of services working together to provide wrap around and complementary support for the whole family.

West Glamorgan described what good would look like:

An integrated and streamlined access route to health, community and social care services for all children and young people and their families. This would mean a 'first contact, right response' approach with the focus on presenting need and what matters.

Feedback from the Cardiff and Vale region:

We want to build on the success of the early intervention and prevention no wrong door model by adopting this approach for the complexity of need and crisis end of the system. There is also a commitment to replicate this approach for neurodiversity.

Feedback from north Wales:

Building a culture of supporting families to navigate in addition to signposting. Parents have requested simple, accessible information that is jargon free.

Feedback from the west Wales region:

Training has been provided for health visitors to develop closer working links with neurodiversity services. A referral pathway has been revised to ensure health visitors explore early intervention work with children and families prior to a referral to neurodiversity service.

NEST implementation has seen a significant step forward this year with the development of the national self‑assessment tool and training. This has enabled a standardised offer across the country with regions then offering locality specific support. There is commitment to the framework throughout Wales and good progress is being made in implementation. However, it remains the case that NEST is a long term ambition of culture change which will need the whole system to work together to achieve.

Together with Regional Partnership Boards, Welsh Government will work to continue NEST implementation at pace, supported by the new mental health and wellbeing Strategy published in 2025. In particular, we will develop guidance for the inclusion of childcare and early years provision in NEST implementation, recognising the importance of younger children’s mental health and wellbeing and those best placed to support it. We will work to further align our whole school approach to emotional health and wellbeing and the NEST framework and its implementation, acknowledging the opportunities to bring education closer into existing partnership arrangements. We recognise the excellent work being done around no wrong door procedures and will build on this to ensure equity across the country and a true whole system approach to accessing support.

Finally, we will continue to be responsive to the emerging needs and developments presented by all partners working with us to implement NEST and ensure that babies, children, young people and families’ voices continue to inform and shape our work.