14 © South African Professional Society on the Abuse of Children: ISSN 1562-1383 Child Abuse Research: A South African Journal 2019, 20(2): 14-29 Evaluation of the ECO-MACH assessment and intervention protocol Yolande Heyns Social Worker in private practice under ECO-GPS Pty Ltd E-mail: yolandeallers@gmail.com Willem Roestenburg School of Psychosocial Behavioural Sciences at North West University E-mail: wim.roestenburg@nwu.ac.za Literature shows a lack of structured assessment and intervention protocols to manage the care of children with developmental delays and/or disabilities in rural child and youth care centres across South Africa. The aim of this study was to gain an understanding of contextual implementation processes, issues and challenges in implementing an existing protocol for assessing and managing children with mental health concerns (ECO- MACH), with the goal of adapting it to the needed context. Data was collected by means of qualitative focus groups targeted at staff that have been trained in the use and implementation of the ECO-MACH. The effectiveness of the ECO-MACH could not be established entirely, because none of the participants implemented the protocol with fidelity. Results however provided valuable recommendations on how to improve implementation fidelity of an adapted protocol. Recommendations include improved and prolonged training, and the establishment of implementation teams that can render follow-up supervision and support. Further follow-up research will be conducted to translate the identified implementation challenges of the ECO-MACH into a version refined for use with children with developmental delays and/or disabilities in rural child and youth care centres. Keywords: ecological care management protocol for use in children with mental health concerns (ECO-MACH), a proprietary protocol distributed under license by ECO-GPS Pty Ltd; mental health; developmental delays and/or disabilities (DDD); evidence based practice (EBP); implementation science INTRODUCTION “It is essential to think of mental health as an integral part of health” (Tomlinson et al, 2005: 153). Although mental health is defined as the absence of psychopathologies (Westerhof & Keyes, 2010: 110), the World Health Organisation (WHO), states that it is more than the absence of mental disorders (2018). WHO continues that mental health is a state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community (2018). WHO consequently reiterates that the promotion, protection, and restoration of mental health is vital (2018). The reality is however that, internationally, efficient, practical, evidence-based mental health services for children are lacking and under-resourced (Huang, Stroul, Friedman, Mrazek, Friesen, Pires & Mayberg, 2005: 615, Whiteside, Leffler, Hord, Sim, Schmidt, & Geske, 2018: 1). In South Africa specifically, substantial gaps in service delivery remain (Petersen & Lund, 2014: 751). It is estimated that 75% of South African people with a mental health disorder do not receive mental health services (Hall, Sambu, Berry, Giese & Almeleh, 2017: 154). The mental health needs of children in alternative care settings such as child and youth care centres (CYCCs), are especially underserved (Pugh, 2009: 284). A CYCC is a facility that provides residential care for more than six children who are not living with their biological families (Children’s Act, 2005: s191(1): 95; Mahery, Jamieson & Scott, 2011: 28). Reasons for removal of a child from his/her primary caregiver and consequent placement into a CYCC include; abandonment, physical, mental, or social harm, physical or mental neglect, maltreatment, abuse, etc. (Children’s Act, 2005: s150(1)(a)(c)(d)(e): 78). These reasons for removal are also risk factors that could render a child vulnerable for developing a mental health disorder (Chinitz, Guzman, Amstutz, Kohchi, & Alkon, 2017: 191; National Integrated Early Childhood Development Policy (NIECDP), 2015: 14). Previous research has confirmed that children in out-of-home care have significantly poorer mental health compared to children outside the care system (Baker, Kurland, Curtis & Papa-lentini, 2007: 116; Baldwin, Biehal, Cusworth, Wade, Allgar & Vostanis, 2019: 189; Ford, Vostanis, Meltzer & Goodman, 2007: 323; Lou, Taylor & Di Folco, 2018: 83; Soenen, D’Oosterlinck & Broekaert, 2014: 155). Researchers therefore strongly suggest that youth in CYCCs require substantial and intensive professional