WHAT DOES DISSEMINATION COST?
Although there are no published guidelines, experience suggests that between $50,000 to $250,000 or even more in funding may be necessary to begin dissemination activities. Unlike pharmaceutical development, there is not an industry and associated infrastructure directed at promoting behavioral intervention research. In this respect, the drug development pipeline is significantly distinct from the dissemination activities necessary for behavioral interventions.
Finding access to sufficient capital for broad national or even international dissemination can be a challenge. Select private foundations can provide significant seed funding, sometimes ranging into the millions of dollars. For example, the Robert Wood Johnson Foundation and several other private funders provided significant seed money to establish the Center to Advance Palliative Care and the dissemination infrastructure that has ultimately established palliative care programs in hundreds of hospitals and more broadly (Center to Advance Palliative Care, 2014). The John A. Hartford Foundation and other funders provided more than $11 million to conduct a multisite trial of the IMPACT depression intervention. Following the positive results from this trial, the Foundation granted the University of Washington $2.4 million to start a dissemination effort and ultimately helped to establish the Advancing Integrated Mental Health Services (AIMS) Center, which now generates revenue sources from other private sources as well as grants and training fees (John A. Hartford Foundation, 2013). Between 2003 and 2012, the federal Administration on Aging, as well as private funders including The Atlantic Philanthropies, invested more than $50 million to help the National Council on Aging and 45 states build a national infrastructure to disseminate to community groups and help them implement evidence-based health promotion programs for older people, notably the Stanford CDSMP This dissemination and implementation effort resulted in more than 100,000 participants in these programs between 2010 and 2012 alone and supported efforts sustained by many states to continue to make the program available to older people. Throughout this period and subsequently, Stanford has maintained its own dissemination system that has been fostered by this federal effort (National Council on Aging, 2012). Whatever the source of capital, resources are needed to pay for staff, materials, websites, meetings, and other necessary resources to launch, establish, and sustain an effective dissemination effort. Dissemination activities must be sustained, often through a combination of sources of funding including but not limited to some kind of government funding, in-kind university support, outside grants, and/or ongoing training and licensing revenue.
Efforts directed toward advocating for policy and reimbursement changes are related to this search for capital. This can be labor-intensive, requiring time, relationships, and resources. Seeking legislative or administrative support for a new program’s distribution through a state or nationally is dependent on both the research team’s capacity and the opportunities that may be (and are often not) available in the prevailing political environment. Seeking reimbursement adjustments to make an intervention more financially attractive to clinical providers can be a similarly challenging (though completely necessary) aspect of a dissemination effort. In all cases, it is better to know early on whether an intervention can be easily reimbursed, or know the payment mechanism that can support its implementation. If current payment structures are a barrier, then it may be very challenging for a proven intervention to be adopted by organizations. Alternately, the investigator needs to adjust his or her expectations accordingly, or seek modifications to the intervention to make it a more natural fit in a dynamic reimbursement environment.