Protocol for a Mixed-Methods, Implementation-Focused Economic Evaluation of the Safe at Home-Hamilton Program

Purpose and Objectives: The primary aim of this study is to estimate and contextualize the resources required to implement the Safe at Home-Hamilton (SAH-H) model in Hamilton, Ontario. Safe at Home is a survivor-centered approach that enables women and children experiencing violence to remain safely in their homes while the perpetrator is removed and wrap-around supports are coordinated. This evaluation identifies the financial, organizational, and system supports required for effective delivery and potential future scale-up in the Canadian context. Study Design and Framework: This study utilizes a mixed-methods, prospective observational design guided by the Active Implementation Framework (AIF). The evaluation integrates two primary methodologies: a quantitative costing component that applies the Cost of Implementing New Strategies (COINS) framework to estimate direct and indirect implementation costs by milestone and activity across the installation and initial implementation phases, and a qualitative mapping component using System Support Mapping (SSM) to examine how multi-sector actors perceive, access, and coordinate the supports necessary for delivery. Methodological Scope: The methodological scope of the evaluation is defined by a societal perspective that captures direct expenditures, in-kind contributions, and staff time across all involved agencies. The study is set in Hamilton, Ontario (a city characterized by high shelter demand and fragmented coordination across housing, justice, and social services), and covers a time horizon from 2023 to 2025 to capture both the installation and initial implementation phases of the program. Expected Outcomes: The study will produce phase-specific cost summaries, cost per woman served, and sector-specific resource distributions. These quantitative outputs will be triangulated with qualitative insights to reveal the structural and organizational conditions that shape implementation resource needs. Findings will provide actionable evidence for policymakers to support the sustainable delivery and scale-up of survivor-staying models in Canada. Ethical Oversight: This initiative was formally reviewed through the quality improvement review process at Unity Health Toronto using the Research Quality Improvement & Secondary Use Tool (ReQuIST) and deemed exempt from formal Research Ethics Board approval as it utilizes organizational-level data.