0:00:00 - (Karen Schetzina): Growing stronger together is a podcast developed by faculty at East Tennessee State University for people who care about children and families. We appreciate support provided for the podcast from Ballad Health's Department of Population Health and Tennessee Department of Health's Maternal Mortality Prevention program. Our Moms on Monday series features topics important for the health and wellbeing of mothers, including expectant moms.
0:00:32 - (Karen Schetzina): I am host doctor Karen Schatzina and AM thrilled to welcome my guest today, Mark Cruz. Mark is the director of the Strong Accountable Care Community, a bi state collaborative of over 400 organizations working together to improve physical, social, and economic health in northeast Tennessee and southwest Virginia. Mark, thank you for joining me today. It's great to see you.
0:01:01 - (Mark Cruise): Thank you, Karen. It's great to be with you. Thank you for having me.
0:01:04 - (Karen Schetzina): So, I have known Mark and worked with Mark through the strong ACC for several years now and actually serve as a member of the leadership council for strong accident. So I am really excited to have this conversation with you today. Mark, we do not have any conflicts of interest to disclose. To start, could you share a little more about your role at strong ACC and the career pathway that led you here?
0:01:42 - (Mark Cruise): Sure. Well, I'm the director and I was the first employee hired by the Strong accountable care Community Leadership council back in March of 2021, and you were part of the team that formed the search committee to decide to bring me here. So thank you again for that opportunity. It's been quite a ride these past three and a half years. I lead a team of collective impact specialists that work to promote and advance our agenda in southwest Virginia and northeast Tennessee, working with 400 plus partner organizations.
0:02:22 - (Mark Cruise): I also oversee a program called Strong Families Northeast Tennessee that we'll get into a little bit later that has upwards of 40 team members and serving families that have needs for family support and education in raising their children and helping them get on their feet financially so they can support themselves and be self sufficient. I have a 30 plus year background in health and human services for vulnerable populations. I spent a good chunk of that time in the free and charitable healthcare sector, working with free clinics and volunteer physician programs.
0:03:02 - (Mark Cruise): I have a master of Divinity degree and did some church work at the very beginning of my career. And I'm also a native of southwest Virginia. I'm from a little town called Radford that many of your listeners probably have heard of, and I'm very happy to be back in the region working to support the things that we're doing through the strong ACC.
0:03:24 - (Karen Schetzina): Well, we are so fortunate and thankful for having you back here with us and heading up the strong ACC, could you tell us a little bit more about the strong ACC and why was it established?
0:03:40 - (Mark Cruise): Sure. Strong accountable care community, we refer to it as Strong ACC for short, was established in 2018, when a group of organizations and leaders across the region convened and had meetings to discuss really how the region could improve health and well being over the long term. This was around the same time that the merger that led to the creation of ballad health was consummated, bringing together two legacy health systems to form one health system.
0:04:22 - (Mark Cruise): And so people recognized at that time that it made a lot of sense, for a number of reasons, to consolidate and merge these two systems to improve care for people when they get injured or when they get very sick. But there were a whole lot of people that were also very interested in looking at how do we as a region, change the trajectory of health and wellbeing long term. And there is a, in the literature, there's something called an accountable health community.
0:04:53 - (Mark Cruise): They're synonymous. These are really efforts that bridge clinical and social care providers to better meet the health related social needs of patients so that they can have improved health and wellbeing, and also lower costs and just improve the efficiency of healthcare in the region. And so we started as an accountable care community. The acronym strong was not added until a little bit later. And so we are very much still to this day, an accountable care community in terms of creating an organized, coordinated system of care that seeks to address the health related social needs of patients, whether they're ballot health patients, or patients of safety net clinics, or patients of other physicians and groups, ETSU health, and others that know that in order to really help their patients have health and wellbeing, they need to address those social needs. And by social needs, we're talking about things like housing and food and nutrition, and childcare, and transportation and employment and good paying jobs and so forth, that really are necessary to help people have a quality of life that includes health and well being.
0:06:23 - (Mark Cruise): So that accountable care community is still very much in our DNA. We established an initiative early on called the no wrong door initiative. And the vision for that was that no person in the region would ever have to go through a wrong door when they were seeking assistance for themselves or a family member, that somebody would be there to help connect them to those resources. And so the only way to rationally achieved that vision was through technology.
0:06:57 - (Mark Cruise): And in the marketplace today, there are a number of so called social determinants of health, technologies that have created much more efficient pathways for people to get care. And so we undertook a study of the products in that marketplace and landed on a company called Unite us, which is a company that was started by two veterans who came out of the service and were trying to help their buddies who were having some challenges. And they found this incredibly fragmented social care system.
0:07:39 - (Mark Cruise): And they said, we can solve some of this fragmentation with technology. And so they put together a solution that was initially for veterans and military families, and it was a wild success. And from that, they said, let's make it open and available to a wider audience of all kinds of people in need and care providers. And so they did. They got some venture capital funding, and today they're one of the leading providers of social care integration.
0:08:09 - (Mark Cruise): Technology, as we call it, in the nation, and are active in just about every state, and they are very active here. We've been working together closely with them. We have about 400 organizations that belong to that network, and it's widely used by both healthcare and social care providers in the region to again meet the needs of people today more efficiently and effectively than ever before.
0:08:41 - (Karen Schetzina): Well, one of the things I have greatly appreciated in being part of the strong ACC leadership council is that I have gotten to know and work with representatives from organizations in all different sectors, like you said, business, faith based community organizations, health education, and gotten to understand the programs and resources they offer, the challenges that they see in the region. And then we use at EtsU Health in our clinics, unite us. As you know, it's been really helpful to have that technology platform available to connect us so that if we see a family in our clinic that has a need for housing resources or food resources, we can easily connect with other organizations that could provide those in the region through Unida. So I think that initial no wrong door initiative has been really helpful.
0:09:57 - (Karen Schetzina): I also know, as a leadership council member, that the strong ACC recently updated the strategic agenda. Could you talk a little bit more about that?
0:10:10 - (Mark Cruise): Absolutely. And I'll just sort of begin by adding to the rest of the story of our inception. The acronym strong, which stands for striving toward resilience and opportunity for the next generation, came into being and was attached to our name because a good part of those early conversations was around how do we address the root causes and underlying factors that lead to things like the opioid epidemic, like high rates of chronic illness, like generational poverty.
0:10:47 - (Mark Cruise): And there was a real desire to try and try and bring together organizations from across these many sectors, public, private, and nonprofit sectors, to tackle those underlying factors together and to really change the trajectory from that standpoint over time. And so that is sort of the rest of the story of our founding. And that really led to sort of a focus on not just the accountable care community to meet the needs of people today, but this sort of longitudinal approach to establish the conditions for the next generation to prosper and thrive.
0:11:33 - (Mark Cruise): And really doing that by creating a conception to career continuum of care, education and support in which all these organizations have a stake to then help that next generation thrive. And so that was really how we started out in 2018 and 19. And then the COVID epidemic threw us a big curve of ball, and I started right smack in the middle of the COVID epidemic and things were in a state of sort of a pause, really, with the strong ACC, but we knew that there needed to be staying of the course and a continuation.
0:12:18 - (Mark Cruise): But the world had changed so much and organizations had shifted their focus so much that we knew that we needed to sort of reset our strategic agenda. And so we spent the good part of the next year studying and engaging with stakeholders and subject matter experts about what does the science tell us are the best ways to improve health and wellbeing over time. And so we developed six goals that really became markers of success along that continuum.
0:12:57 - (Mark Cruise): And they start from birth and go all the way through the early post secondary years and include great beginnings, thriving at five, early grade success, connected and supported youth, workforce ready, college bound graduates, and then financially independent young adults. And that is really our North Star, the financially independent young adults, because we know from a lot of science and research that there's a strong correlation between health and income, or health and wealth.
0:13:35 - (Mark Cruise): The more resources a person has, the likelier they are going to be to have health and have longevity. So achieving that economic health piece became a big part of our new updated strategic agenda. And our mission statement was updated as well. So we exist to improve physical, social and economic health, especially for economically disadvantaged children and families in northeast Tennessee and southwest Virginia, again, because poverty has such a disproportionate and outsized impact on health. And so we, we, our target population is really that group of families with children and young people that we have our eyes on.
0:14:26 - (Mark Cruise): And then subsequent to that, we identified some key metrics that we wanted to address, and those include kindergarten readiness, third grade reading and math proficiency. Reducing chronic absenteeism, which is a been a real big problem the last few years. Chronic absenteeism. Absenteeism is defined as a child being absent from school for any reason, for 10% or more school days in a year. So that's 18 days or more out of 180 day school year and then finally thriving wage employment for 25 to 34 year olds. Those are our key metrics that we have our sites aimed on to improve over the next two years especially, but ultimately over the rest of the decade.
0:15:18 - (Mark Cruise): And then finally, we adopted five sets of evidence based strategies that, again, based on the research and also based on assessing our region's assets and programs and resources, we found to be the most important ways that we could come together and move the needle. So those have to do with expanding family education and support for families with young children, again going from conception on through the birth journey and the early years, strengthening the early care and education system.
0:15:58 - (Mark Cruise): Child care continues to be a major need, and we have some exciting developments happening in the region, but we need to do more around that. Replicating the community schools model, which is a very, very innovative approach to sort of changing how the school setting affects not only students, but also their families and their communities. And then we also have making achievable futures available for more young people.
0:16:32 - (Mark Cruise): And that includes everything from career exploration and exposure to career and technical education, work based learning, dual enrollment, career advising, all the things that are that help a young person connect to a career that they're interested in, and then land in thriving wage employment. And then the fact the last is expanding support supported in second chance employment. We have a lot of people in our region that have suffered from addiction and are in recovery and need assistance and support to get reemployed, that they need a second chance.
0:17:17 - (Mark Cruise): Some of them need a third and fourth chance to sort of get themselves back on their feet and be productive and successful in the workplace. We also have a lot of people that have been incarcerated and coming out of the justice system need to re enter society and land in a good job. And we need employers who are willing to hire those folks and give them a chance to succeed. And so that's another part of our strategy. So those five strategies are now forming our 2025 2026 strategic action plan, and I'm really excited to see it take off.
0:17:58 - (Karen Schetzina): I am too. And that is why you are. Director Mark, you summarized just years of work so succinctly and so clearly, but really, hundreds of folks contributed ideas. You and your staff worked tirelessly to look at evidence, collect feedback in the region to help us form this updated strategic agenda recognizing the interconnectedness of education, income and health. And I how important it is for us all to work together across sectors.
0:18:50 - (Karen Schetzina): You've got metrics that the strong ACC is following. It's evidence informed, so it's really exciting to be at this point and just to hear how you summarize the work that's been done and the work yet to come. So I wondered if you could highlight some examples of the work that strong ACC partners are doing together to strengthen resilience and opportunity for the next generation.
0:19:32 - (Mark Cruise): Sure, there are many, too many to cover in the time that we have, but I'll share a couple examples. One is a project around kindergarten readiness in northeast Tennessee. So on the Virginia side of our footprint, and throughout all of Virginia, Virginia kindergarteners all undergo a universal screening assessment to determine their readiness for school at kindergarten. And the data from those assessments help educators be able to sort of plan interventions and supports to help those young people who are not necessarily ready for kindergarten to be able to get additional support and mentoring and tutoring.
0:20:27 - (Mark Cruise): But as well as those who are the areas which have low rates of kindergarten readiness, they're using that data to then plan strategies in the community and working with parents and caregivers to help more children become ready for school at kindergarten. On the Tennessee side, there is no such universal screening. Every school district has the option to do a kindergarten screening of their own choice or to not do one at all.
0:20:56 - (Mark Cruise): And so therefore, we don't have the data that would allow educators to better serve children and communities to better serve parents raising children. So the Nicewanger foundation, in partnership with the 17 school districts in our ten counties in northeast Tennessee, has developed a plan to implement a universal screening tool for all entering kindergarteners in northeast Tennessee this year. As a matter of fact, this was the first year to implement it.
0:21:33 - (Mark Cruise): And the plan is within two years to be able to ensure that 100% of all kindergarteners undergo this assessment, and then to then take that data and begin to help school districts and help communities plan strategies to improve those rates. We know that, for example, a big driver of third grade reading and math proficiency is kindergarten readiness. And it just makes sense if students aren't ready for school at kindergarten, they're going to be behind from the start and have a uphill struggle to get to where they can read proficiently and do math proficiently at third grade.
0:22:12 - (Mark Cruise): So this is a great example of a public private partnership on the northeast Tennessee side of our footprint that shows great promise and is going to give us great data going forward.
0:22:23 - (Karen Schetzina): I think it's a great example, too, of the benefits challenges, as well as being part of a bi state collaborative. So I understand at its inception, the strong ACC was maybe the only accountable care community that spanned multiple states, and we've seen that that can present challenges. States may track metrics like kindergarten readiness or educational metrics differently, but it's also been a huge benefit because each state is able to learn from the other.
0:23:05 - (Karen Schetzina): And we're in strong ACC meetings in the same room with leaders from Virginia and Tennessee. It's just been a great environment, I think, to facilitate innovation across states and improvement.
0:23:24 - (Mark Cruise): Yes, thank you for sharing that. And it is a rich part of what we bring to the table, for sure. And in the case of the kindergarten readiness example, one of the things we learned from Virginia's data on the kindergarten readiness is that the single greatest predictor of kindergarten readiness was participation in the quality learning environment outside the home. And, you know, think of so that, and it just goes to make sense, if a child's in a preschool or a childcare setting that's focused on literacy and numeracy and social emotional learning, they are going to be readier for kindergarten. And so that's an example of what this can mean on the northeast Tennessee side. So, yes, the rich interaction of people across the state line is a big part of what the value proposition for the strong ACc.
0:24:26 - (Mark Cruise): The other example I wanted to share was the regional childcare and workforce development hub in Abingdon that EO, the organization that spun off from the United Way of South Carolina, southwest Virginia, has led. And that hub is really a magnificent example of public and private partners in the strong ACC coming together to not only meet a huge need around childcare, but also develop a. A program for young people, middle school and high school, to be exposed to the careers and the employers in our region in a very hands on way that they would not otherwise have a chance to do. And so the career Commons and the child care center in Abingdon is another great example of this huge focus on collaboration and the strong accident.
0:25:26 - (Karen Schetzina): Well, thank you for sharing those examples of just some of the exciting work that strong ACC partner organizations are doing together. What else should people and organizations serving our region know about the strong ACC? And how can they be involved if they're not already?
0:25:49 - (Mark Cruise): Yes. So I would say one thing to understand is that the big challenges that we're facing in the region that I mentioned earlier, things like the opioid epidemic, generational poverty, high rates of chronic illness, were not things that developed overnight, and they're not going to be fixed overnight. And so partners in the strong ACC have sort of embrace the idea that they need to be in this for the long haul, and they need to have a long term investment mentality and stay the course that said, we're still looking for every opportunity we can to have an early win, early victories because you need those in this line of work to keep people's energy and enthusiasm up. And we've had a number of those and those are exciting and really help continue the excitement and energy level.
0:26:49 - (Mark Cruise): We also are, you know, it goes without saying, but it needs to be said nevertheless that we talk a lot about partnership and collaboration and we sort of pay lip service to that, but we don't always practice it the way that we could and should. And so the ever present threat that we have is for organizations to sort of revert back to business as usual and sort of staying in their lane and staying siloed from others and not working together or collaboratively to fix some of these big problems.
0:27:36 - (Mark Cruise): So we're looking for partner organizations all the time that understand that threat but are proactively taking steps to work together with others and join hands with other organizations around these strategies so that they can together help us produce better results and outcomes for the region. So that mentality is important within our partners. Our partners are organizations, not individuals. Now, of course individuals make up organizations. So our partner contact list is full of over 1200 names, but our partners are organizations and it's free to become a partner organization in the strong Acc.
0:28:25 - (Mark Cruise): It's easy. We have a one page partner agreement that we ask groups to sign, complete and sign and, and they're in. We don't want to have barriers for organizations to join us. And as we mentioned, we have closing in on 425 partner organizations today. So if there are listeners out there whose organizations are not yet partners in the strongacc, we would love to have them get in touch with us and join.
0:28:57 - (Mark Cruise): Our website, strongacc.org has a whole webpage dedicated to a list of the partner organizations, alphabetized and organized by state, so you can look up and see if your organization is a partner. But we would love to have more partners. There's room for more hands and feet to get this job done and we will work with partners to help them figure out where they can best make a difference within this overall regional strategy and agenda.
0:29:40 - (Mark Cruise): And we're very grateful that we average about one new partner a week. They just keep coming, Karen, and they find out about us or people tell them about us and they just come. And we're grateful for that.
0:29:55 - (Karen Schetzina): We certainly are. So we'll definitely include that website address in the show notes and any other contact information that you'd like us to share. I know the StrongACC also uses social media to communicate. And in the coming weeks and months, I'm excited to share that I am going to be sitting down with leaders and representatives from a number of strong ACC partner organizations so that we can hear more about their work and also how they are working collaboratively with other partner organizations in the strong ACc.
0:30:37 - (Karen Schetzina): So, thank you again for helping me kick off this mini series. What about parents, caregivers, other members of our community? What would you like them to know about the strong ACC?
0:30:54 - (Mark Cruise): Well, as far as parents and caregivers go that are raising children the next generation, I just want to say you have the most important job in the world, and there are many resources in our region to help you do that job. It's a heavy lift. There are days that can be very taxing and tiring. I'm a parent and I've been there, and it's tough. There are so many things that parents and caregivers have to deal with today, and I want them to know that there are people and organizations in our region that are well positioned and well equipped to help them in that job of raising children. And so, please reach out to our organization and we will connect you with those groups.
0:31:50 - (Mark Cruise): Whether you need help with parenting, education, financial matters, matters pertaining to dealing with basic needs and assistance for your home, anything that you need to be effective as a parent or caregiver, we can connect you to those resources through the strong ACC. Then, in terms of I should mention that we were fortunate in the strong ACC a couple of years ago because of our track record in collective impact and building partnerships across sectors.
0:32:35 - (Mark Cruise): We competed successfully for a $25,000,000.03 year grant from the Tennessee Department of Human Services Tennessee Opportunity Pilot Initiative to launch a program called Strong Families Northeast Tennessee, which we've done. And that program has a goal of serving 800 families over the course of the three years, helping those families who are economically disadvantaged to be able to get on their feet and stay on their feet, get training for good paying jobs with good benefits, get the necessary resources to provide stable, nurturing environments for their children, meet their needs for food and nutrition, a roof over their heads, and all the other things that young families need in order to create a good opportunity for their children to grow up. And so, strong families is the program, the one and only program that we, as the strong ACC, operate.
0:33:48 - (Mark Cruise): Everything else we do is focused on the long term capacity building and the five strategies I mentioned earlier. But strong families is meeting the needs of people today, and it's a program that's really a Tanith reform program. It's an experiment to use Tanith dollars to more effectively help families. And we were one of seven organizations across the state awarded this grant. Very grateful for that.
0:34:17 - (Mark Cruise): And so we have a whole team of people deployed across the ten counties of northeast Tennessee working side by side with families to help them achieve their goals. And so we can connect folks that are interested in that program as well. There's a whole page on our website devoted to strong families, northeast Tennessee, so folks can go and read up on that. There's even a form that they can fill out to apply for the program.
0:34:46 - (Mark Cruise): And so we encourage that if that's somebody, if that's something that folks who are listeners want.
0:34:53 - (Karen Schetzina): Wonderful. We'll definitely include that information in the show. Notes I've seen firsthand how strong families is helping families in our region right now, so we'll be sure to include that information. You have done a fantastic job today, Mark, helping us understand more about the strong, accountable care community, about the work of strong ACC Partners, about new opportunities that have already been created in our region as the result of the strong ACC.
0:35:30 - (Karen Schetzina): Like strong families. Is there anything else that you would like to add before we wrap up today?
0:35:39 - (Mark Cruise): I think it's two things. One is just a word of gratitude to the many organizations who stepped up to join this effort, who believe in what we're trying to do, who really are consciously wanting to not accept business as usual, but really sort of get out of their comfort zone and join with others to make things better for families and young people. And so just, I see evidence of this every day, everywhere I turn.
0:36:17 - (Mark Cruise): These people who are doing great work, but doing it collaboratively, it's just amazing to see. And I think it really is something that our region is becoming known for. We hear from people in Richmond and Nashville talking about the work that we've done to build this sort of bi state coalition of organizations across sectors that really have bought into this notion of collective impact, and it's really rewarding.
0:36:48 - (Mark Cruise): And the other is that we're stronger together. And that's our motto in the strong accelerated. We're stronger and we can be strong. And we are, as a region, strong and resilient and a proud people. We're resourceful people, and we have a lot of sort of pick ourselves up by the bootstraps mentality and neighbor, caring for neighbor. And that ethic, that belief, that principle is really embedded in the work of the strong ACC, where we believe that together we can be better, we can be stronger.
0:37:32 - (Mark Cruise): And so I'm very proud and honored to be a part of it and grateful for all those who have joined and look forward to some really exciting times ahead as we move the needle on some of these key metrics.
0:37:47 - (Karen Schetzina): Thank you again for talking with me today.
0:37:50 - (Mark Cruise): Mark, thank you so much for having.
0:37:52 - (Karen Schetzina): Me, Karen and I look forward to continuing this conversation with other strong ACC organizational partners in the coming weeks and months.
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