NEST framework (mental health and wellbeing): implementation update 2025

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.

Our NEST community of practice engages a wide range of over 200 stakeholders across Wales with topics such as babies’ rights, outcomes and evaluations, mental health strategy and child poverty. 

The NEST self-assessment tool is being used across Wales, by all sectors, to imbed the NEST principles into delivery. 

We run a monthly national NEST forum for support with completing the NEST self‑assessment.

We have co-produced good practice videos showing NEST in action. 

NEST is being used across Welsh Government and with national partners including in the CAMHS service specification and the Multi Agency Framework for Children’s services.

In an acknowledgement of the importance of infant mental health and the key role childcare and play providers have in a whole system approach, we have updated the framework to include babies as key stakeholders and childcare as part of the whole system.

Our coproduced NEST and children’s rights training has had 536 enrolments from across sectors with a high satisfaction rate. Evaluations from the training show;

• a strong commitment to child-centred practice and rights-based approaches
• widespread intention to share learning, embed principles, and drive systemic change
• high engagement with “forming a nest around the child” and the ethos of “nothing about you, without you"

In October 2025 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. We asked all projects funded by the Regional Integration Fund to complete 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

This table shows the average NEST Journey ratings from 2023 to 2025. It shows the significant progress being reported across regions. 

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Trusted adults

Average NEST journey rating across all regions: 3

Feedback from Interplay Engagement Report West Glamorgan:

Many young people emphasised the importance of having trusted adults they can talk to, such as parents, grandparents, teachers, and friends.

Regions continue to make progress in embedding the Trusted Adult (TA) role within recruitment, supervision, and training processes. Notably, Powys has developed ready-to-use interview questions, recruitment statements, and supervision formats to support consistent implementation of the TA principle.

Feedback from the Cwm Taf Morgannwg region:

"Services demonstrate clear evidence of structured supervision, long-term planning, and integration of trusted adult roles into recruitment and service delivery"

Despite these advances, several challenges remain. Staff turnover, time constraints, often exacerbated by short term funding arrangements, and inconsistent understanding of the trusted adult role continue to present barriers to effective implementation. Additionally, there is a lack of shared language and clarity about what constitutes a trusted adult, which can hinder consistency across services.

To address these challenges, regions are developing enhanced supervision, reflective practice, and peer support mechanisms for trusted adults. There is also an emphasis on involving young people in defining what a trusted adult means to them. This goes hand in hand with the importance of children and young people choosing and naming their trusted adults and services valuing existing relationships.

Trauma informed training and practice was seen as a key enabler of the trusted adult principle. However, embedding trauma-informed approaches consistently across all services remains an ongoing challenge, with further work required to ensure that all staff are equipped to deliver relational, trauma-sensitive support.

Feedback from the Caerphilly Children’s Services Team Area:

It’s great giving us knowledge and tools but its supporting us through being able to implement them and being the steady hands to say 'try it’ 

There was a focus from many regions on the importance of supporting trusted adults in the first 1000 days of a child’s life. Services consider the best way of delivering infant mental health support is to provide support to parents, focusing on helping them to be attuned their baby’s voice.

Feedback from the West Wales region:

The Early Years Intervention Team (EYIT) believe that the best way to support a child is to support the parent/s: “EYIT is friendly, approachable and non-judgmental. Eager to support and willing to come and visit immediately. EYIT has been consistent and checks in via texts often, which I feel as a new mum reduced the feeling of isolation.

In West Glamorgan, CAMHS now offers Parent and Carer workshops designed to equip parents and carers with the knowledge and strategies needed to address mental health concerns. These workshops empower adults to become emotionally attuned, supportive trusted adults for children and young people. In North Wales, programmes such as Gro Brain, Circle of Security, and parent-infant relationship work are being used to strengthen positive relational development.

Wellbeing Across Education

Average NEST journey rating across all regions: 2.7 

Across Wales, there is a continued focus on supporting children and young people through key transitions, including the move from early years settings to school, and from primary to secondary education. Regional self-assessments highlight the importance of ensuring that emotional wellbeing and trusted relationships are maintained throughout these critical periods.

Feedback from the Powys region:

The Flying Start Advisory Childcare Team embed NYTH/NEST principles into everyday practice. They’ve built these values into their quality assurance and support visits, developed practical resources, and delivered staff training across settings. Their NYTH/NEST Champion Award has helped highlight and celebrate good practice. 

Regions are aligning their NYTH/NEST implementation with the Whole School Approach to Emotional and Mental Wellbeing. This alignment is helping to embed emotional health as a core priority within education settings and is supporting a more consistent, system-wide approach to wellbeing. Whilst significant strides have been made to integrate education into the whole system, challenges continue with securing education representation on regional working groups and there remains a clear desire to further connect schools with a wider range of services to ensure holistic support for learners.

Youth voice and co-production are increasingly being incorporated into school wellbeing planning, with several regions reporting growth in youth-led initiatives. 

Some parents have expressed concerns that schools are placing too much emphasis on negative behaviour management, rather than fostering trusted adult relationships that support emotional wellbeing. In response, the need for ongoing training for education staff remains a priority, particularly in the areas of trauma-informed practice, neurodiversity, and mental health. Where such training is available it has a positive impact on practice. For example, in West Glamorgan, specific neurodiversity advice and guidance has been issued to schools to support teachers in understanding and responding to behaviour in the classroom.

In West Wales, Carmarthenshire’s Education Wellbeing team has embedded trauma-informed practitioners within schools to provide regular support, advice, and training to staff working with looked-after children. The creation of non-judgemental and ‘safe spaces’ for school staff to share their concerns has been described as significant, enabling placements to be sustained and thrive even in challenging circumstances.

Feedback from the West Wales region:

To experience the difficulties that autistic people encounter (on a daily basis) was eye-opening. I now understand the types of sensory issues that autistic people have and feel better equipped to support them (Teacher)​.

Examples of effective practice include the appointment of school-based wellbeing leads, the implementation of Emotional Literacy Support Assistants (ELSA), and the development of youth-led wellbeing initiatives.

Co-produced Innovations

Average NEST journey rating across all regions: 2.8

Feedback from the Cwm Taf Morgannwg region:

They actually changed things. That’s never happened before.

Co-production is increasingly embedded in strategy and practice with the use of youth boards, parent forums, and co-production champions. There has been a marked increase in an understanding of meaningful engagement and the importance of using different forms of engagement to ensure marginalised or disengaged young people’s voices are heard.

Feedback from the Gwent region:

Families and young people have been directly involved in co-producing training materials and workshops for both professionals and other service users. This includes participation in the design of emotional well-being toolkits, mental health resources, and school-based programmes, ensuring that the content is relevant and meaningful.

Coproduction is being built into system structures, including the use of patient experience reporting and coproduction charters and pledges. However, there is an acknowledgement that more needs to be done to ensure children’s voices are heard at every level including facilitating their engagement in population needs assessments.

Examples of good practice include Cwm Taf Morgannwg running a co-production grant to enable innovative co-production approaches such as co-created theatrical performances and art.

Easy access to expertise

Average NEST journey rating across all regions: 2.7 

There was significant evidence from regions that embedding expertise as a multi-disciplinary approach works to improve outcomes. Examples of this were given in numerous sectors including CAMHS in-reach for education, CAMHS liaison role with social workers, early years psychology expertise and therapeutic support for care experienced children. 

Feedback from the Cardiff and Vale region:

Babies Best Beginnings formulations focus on offering psychology advice to other professionals working with vulnerable families during pregnancy, ensuring psychology is woven into discussions, creating a trauma informed approach.

There is, however, challenge in shifting support from being reactive, in response to crisis rather than proactive, as a preventative offer. In addition, regions reported difficulty achieving consistent approaches to easy access to expertise across sectors, with pockets of good practice rather than a regional consistency.

The need for joint data sharing protocols and improved integrated systems remains key to achieving a whole system approach, particularly when including third sector. Whilst rural barriers remain a challenge for some regions, with physical access to services proving difficult for many families.

Powys highlighted ensuring easy access to expertise was exercised within their children’s subgroup, encouraging members to share their own expertise or offer training opportunities, helping to build a collaborative learning environment that strengthens practice and fosters a culture of shared responsibility and continuous improvement.

Services and regions acknowledged the need to improve access to expertise for ethnic minority families and those from marginalised backgrounds. Some regions were improving translation services for non-English and Welsh speaking families and using home or community visits to support families to feel more comfortable and able to access the service. Trusted adult relationships developed with services were understood as key to achieving accessibility:

Feedback from the Powys region:

We need to make sure this support goes beyond signposting. The NYTH/NEST principle of holding on reminds us that it’s not just about pointing families to the right door, it’s about walking with them, staying alongside them, and making sure the door is the right one for their needs.

Safe and supportive communities

Average NEST journey rating across all regions: 2.7

Regions and partners are concerned about the end of the Regional Integration Fund in 2027, which will impact staffing and projects’ viability. The sustainability and short-term funding of projects were discussed as significant barriers across all principles.

Young people consistently highlight the importance of supportive family, good advice, local shops, parks, access to clubs and groups, and better transport. Barriers such as lack of transport and awareness of available resources are also identified.

Following previous recommendations, regions have worked hard to integrate youth and playwork to their whole system approach, some regions are now using play sufficiency assessments to inform their understanding of communities and needs. In North Wales, this is reflected in their residential provision maintaining connections to youth services and activities as well as utilising leisure partnerships and access to green spaces.

Feedback from the Gwent region:

Working with local partners to create safe environments such as parks, community centres, and schools where children can build relationships and develop a sense of belonging.

Regions reported an increased appreciation of the importance of the wider determinants of mental health and the need to address housing and poverty alongside mental health concerns.

Feedback from the Cardiff and Vale region:

Goleudy and Enfys are seeing a cultural shift in approach with social work colleagues better understanding the needs of children entering the care system, for example “the support has been so valuable and (x) wanted to share…after you spoke, she felt so much better and that she is having incredible sessions with (child).” The approach emphasises consideration of the systems around the CYP from what the bedroom looks like to what they eat, play and learn, and access to community activities. 

No wrong door

here was a strong appetite for change across all reporting under this principle with all regions either fully delivering or piloting single points of access, no wrong door models. Many are drawing on the good practice of Gwent’s SPACE wellbeing panels to establish their own multidisciplinary team approaches to ensuring a whole system approach to referrals. However, this work is often hindered by a lack of shared databases and directories and data sharing agreements.

The need for support to be proactively offered, with tenacity and sensitivity to the family’s individual needs and experiences was recognised. Learning that what matters is how families feel when they reach out for support.

Feedback from the North Wales region:

The team (Supported Lodgings) help young people navigate referrals and eligibility by offering clear, tailored support through in-person, phone, or digital meetings. This approach adapts to cultural needs, learning styles, and communication preferences. Emotional support, crisis help, and interim check-ins are available, even during referral processes.

Many services spoke about offering proactive, compassionate engagement which is responsive to the needs and preferences of the children, young people and their families. Whilst RPBs are have in place children’ strategies that provide leadership for the no wrong door principle. 

For example, The Whole System, Whole Heart Strategy in Cwm Taf Morgannwg:

aspires to foster a culture of early intervention and community-based care, envisioning a future where children's wellbeing is supported by strong inter-agency collaboration and data-driven service design. - Cwm Taf Morgannwg

Whilst it is acknowledged that trusted adult relationships are central to families’ engagement, it was also highlighted that there is a danger of an overreliance on individual professionals to help families navigate a fractured system rather than co-ordinated, easy to understand pathways creating a joined-up system.

The significant increase in use of the NEST self-assessment tool and training represents the ever-growing commitment to the aims of the framework across a broad range of partners and sectors. Whilst use of the framework is becoming widespread and there is a shared understanding of the language and principles there is further work to do to address the challenges highlighted in this report. 

Welsh Government will work to share good practice examples that demonstrate how data sharing agreements and joint protocols can be achieved to support a no wrong door approach. And we will work with the third sector and those with lived experience, to address the systemic barriers babies, children, young people and families from ethnic minority backgrounds face when seeking mental health and wellbeing support.

As ever, we remain committed to ensuring that the perspectives and experiences of babies, children, young people, and families shape and direct our ongoing work.