empowering families, changing children’s lives PARENT-CHILD EDUCATION PROGRAM
Purpose AVANCE, a 501(c)(3) nonprofit parent-child education and family support organization headquartered in San Antonio, contracted with the Intercultural Development Research Association (IDRA) to conduct an external impact evaluation of its signature Parent-Child Education Program (PCEP) for parents who graduated from the program between the years 1999 through 2006. The evaluation involved interviewing these participants by telephone and face-to- face from April to August 2013. The evaluation was designed to address the following overarching question: How does the AVANCE PCEP affect two-generation (parent-child) behavior change in the areas of education and socio-economic status? The evaluation was designed to answer this question from a variety of perspectives, which are presented in this summary. Intercultural Development Research Association 2
3 Report Card IDRA’s Impact Evaluation of AVANCE’s Parent-Child Education Program Research QuestionsEvident Yes 1.Did participation in AVANCE’s Parent-Child Education Program yield a positive return on the investment in early childhood education for at- risk families? 1.Did AVANCE’s Parent- Child Education Program provide educational support for parents and children? 1.Did AVANCE’s Parent- Child Education Program build economic competence through financial classes, information and other support to parents that helped toward getting better jobs or planning for longer-term financial stability? 1.Did AVANCE’s Parent- Child Education Program bolster the aspirations parents have for their children? 1.Did AVANCE’s Parent- Child Education Program create social capital by building parent’s strengths to complete their education and ultimately improve their own economic security and stability? 1.Did AVANCE’s Parent- Child Education Program promote and value parent’s voice to help to change the trajectory of their lives? 1.Did AVANCE’s Parent- Child Education Program participants seize opportunities to move up the economic and social ladder often breaking the cycle of intergenerational poverty?
Finding Highlights General Findings Young (below 30 years old), minority (98 percent Hispanic), economically distressed (37.1 percent earn less than $20,000 a year), and under-educated (60.8 percent did not complete high school) mothers constitute the majority of AVANCE PCEP participants. This external evaluation was based on a sample of 199 mothers who mirror the socio-economic, ethnic and educational characteristics of the AVANCE target population. Intercultural Development Research Association 4
Finding Highlights Knowledge of Child Development & Parenting Skills At 10.5 percent, the AVANCE families’ students had a lower high school attrition rate than the 33 percent statewide rate for Hispanic students in Texas, according to the 2012-13 IDRA Texas public school attrition study. Moreover, the AVANCE family high school attrition rate (10.5 percent) is lower than the Texas attrition rate for all students (25 percent). More than 93 percent of the mothers indicated that their children were school-ready when entering school. Of those, almost 91 percent credited AVANCE with helping them get their children ready for school. Intercultural Development Research Association 5
Finding Highlights Support for Two-Generation Education & Growth Mothers improved their education since graduating from AVANCE. The number of mothers with higher education degrees increased from six to 19, an improvement of 216.7 percent, while the number of mothers with less than high school education decreased from 103 to 81 or 21.4 percent. AVANCE provided important practical guidance through several activities to help mothers with the education of their children. Two of these activities were toy-making classes and field trips. Most mothers (95.3 percent) made toys that they used to instill in their children important concepts about the world, their sensory perception as well as their feelings. Many mothers (63.4 percent) also participated in field trips organized to acquaint them with the resources available in the community. Intercultural Development Research Association 6
Finding Highlights Employment & Income Levels At the time of their graduation from AVANCE, more mothers were employed (29.5 percent) than when they entered AVANCE (17.1 percent); the employment quality also was higher – 17.6 percent of the mothers’ employment was full time after graduating from AVANCE, compared to 6.2 percent at the time of entering in the program. The general trend toward employment improvement continued long after mothers left AVANCE. At the time of the interviews, the employed proportion had increased to 38.8 percent (compared to 29.5 percent when they graduated from AVANCE) – of these, 23.8 percent were full time (compared to 17.6 percent when they graduated from AVANCE). This continued increase shows lasting behavioral changes. Intercultural Development Research Association 7
Finding Highlights Homeownership & Entrepreneurship The data showed a clear trend toward increased homeownership and reduced renting and other arrangements from the time the mothers were at AVANCE to the present. Before graduating from AVANCE, 66.7 percent of the mothers rented their homes, and 11.5 percent had other arrangements. At the time of the interviews, these proportions decreased to 42.2 percent and 4.7 percent, respectively. Homeownership, on the other hand, increased from 21.9 percent before mothers graduated from AVANCE to 53.1 percent at the time of the interviews. More than half of the mothers (53.7 percent) were involved in their community since graduating from AVANCE. Mothers attributed AVANCE for helping them become leaders in their communities and for their increased involvement in their children’s schools and other community institutions, such as the church. Intercultural Development Research Association 8
Finding Highlights Barriers, Impact & Suggestions for Improvement Fewer than one third (29.0 percent) of the mothers indicated that AVANCE could have helped them better. They felt AVANCE had done everything they could to help. Participants in the face-to-face interviews were asked to expand on the barriers to participation, but the barriers they mentioned were dealing with their own personal situations (English proficiency, child care, etc.). When mothers were asked about the best thing AVANCE did for them and their families, three concepts permeated their answers: parenting, communication, and family relationships. The mothers indicated that AVANCE helped them not only be better parents but also how to communicate with their children and their husbands, which resulted in improved family unity, often saving their families from possible dissolution. Intercultural Development Research Association 9
AVANCE believes… Providing culturally appropriate parenting education, empowerment and community-building with early childhood development services to hard-to-reach families changes the trajectory of children’s lives. The families we serve have shown this is true. This report shares their experiences and is dedicated to them. Intercultural Development Research Association 10
Program Model Parenting Class – nine months of weekly classes, spanning 27 bilingual lessons Toy-Making Classes – making practical educational toys; becoming aware of the importance that children learn through play Community Resource Awareness – weekly information sessions presented by community professionals on topics ranging from family violence and prevention, to substance abuse prevention, health, nutrition, safety and life coping skills Early Childhood Education – language development, learning of basic concepts and skills, and social competence at the AVANCE PCEP site Home Visits – monthly visits to observe quality interaction between parent and child and gain better insights into the family’s conditions and needs. Individualized services, assistance with food, clothing, shelter, counseling and other economic needs. Other Support Services – from transportation, nutritious meals and referral to follow up Adult Literacy Classes – ESL and GED classes Skill-Building, Education & ResourcesHome Visits, Services & Classes Intercultural Development Research Association 11
Life-Changing For Alma, participation in AVANCE was a “life-changing” event. The classes and childcare AVANCE provided were essential factors in achieving her vocational dream to become a seventh grade science teacher. The respect she received in AVANCE transformed her parenting style and the lives of her family. Alma is now completing her master’s degree at a local university. Through her participation and the training she received from AVANCE, Alma learned the importance of reading to and spending time with her children, who have since received numerous honors. Her 7- year-old daughter reads at the fifth grade level, another daughter attends a prestigious middle school and her son has a scholarship for college. Learning about financial literacy helped her become a successful professional who already has a college fund for her oldest. Alma is a member of Dress for Success, giving back and inspiring others to succeed. She is also starting a community action project that targets Spanish-speaking parents and their high school-aged children in to learn financial aid procedures for college. Intercultural Development Research Association 12
Patricia’s youngest daughter just graduated from high school with honors and a full scholarship to a prestigious university; her oldest will graduate soon with a college degree in education. Patricia is continuing her own education to become a teacher. “ Education comes first. ” Mi experiencia fue algo maravilloso… “My experience was marvelous…I saw that.. you are never alone. The teachers were always there, ready to listen, and offer help and support. You can look at problems in a new way. I completely changed my life with my children, changed how I used to be, and now I give them quality, not quantity time, and I have taught them that education comes first.”
For years, María had sought out books that might help her with ideas on educating her three young children. AVANCE gave her an opportunity to attend classes on a variety of topics, like child care, child safety and parenting. She was able to learn this valuable information herself and to attend these classes with her husband, together as a couple. As an added bonus, María worked to complete her GED in addition to learning English and taking computer classes. AVANCE encouraged María to continue striving for progress, and she is still working on mastering English in preparation to enter college. She believes that her AVANCE experience has positively affected her children’s early learning and will continue to impact the dedication they have to doing their best in school. The family is proud to recognize their role as immigrants; they did not speak English when they first arrived. For María, education is an honor and a privilege they cherish. Drive Intercultural Development Research Association 14
Intercultural Development Research Association 15 School Readiness and Performance More than 90 percent (93.4 percent) of the mothers surveyed indicated that their children were school-ready when entering school, and 90.7 percent credit AVANCE for helping them get their children ready for school. Regarding their children’s performance in school, 87.8 percent of the mothers reported that their children were performing above average (good) or excellent (top of the class). Nearly 80 percent of mothers (79.4 percent) reported that some of their children received an award from their school, including Honor Roll, Perfect Attendance and Citizenship Award, among others.
Lorena with her son, a preschooler when she started the AVANCE program in 2003. Accomplishment Lorena was just looking for a place for her son to attend pre-school, but through the AVANCE program, she gained much more. Since participating in the program, she has secured legal status in the United States, full-time work and is going to college to pursue a degree in the field of child development. She said that her experience at AVANCE heightened her motivation to study and seek formal education. At AVANCE, she read books to her son and asked him questions about the story. His teacher informed her that the AVANCE pre-kinder class had prepared her son well and he was ready for kindergarten at age four. Intercultural Development Research Association 16
“The best thing AVANCE has done for me is that I am always encouraging my children to continue on, even when they are feeling down or discouraged.” Encouragement “Lo mejor que AVANCE ha hecho para mí es que yo siempre estoy motivando a mis hijos, aun cuando ellos se sientan desanimados.” Maria wanted a better life for her own children. With AVANCE’s help, she was able to achieve it. Intercultural Development Research Association 17
Extra-Curricular The majority of mothers, 75.8 percent, reported that their children were involved in extra- curricular activities at their schools, including intramural athletics, gymnastics and indoor sports; school band, choir and orchestra; baseball, basketball, football, soccer and volleyball teams; music appreciation and lessons; and academic and science clubs. Intercultural Development Research Association 18 Activities
Intercultural Development Research Association 19 Lower Attrition Rates AVANCE families’ students had a lower high school attrition rate, at 10.5 percent, compared to Hispanic students statewide in Texas (33 percent) and to all Texas students (25 percent), according to the 2012-13 IDRA Texas public school attrition study.
Norma continued to learn and is completing her GED and taking English classes. She credits AVANCE for her ongoing motivation to succeed. In 2002 Norma, from Mexico, enrolled for on-site activities and classes at AVANCE with her two children. She credits the program with improving her self- esteem and helping her children. Norma appreciates the education, security, communication skills and confidence the program gave her. As her confidence grew, so did her involvement in her children’s school, where she is now an active and proud volunteer at the bilingual program. As a graduate from AVANCE, Norma learned good parenting skills and the important habit of early reading to her children, which she continued to enjoy regularly during the week. The toy-making classes helped her use local resources to design and create crafts and educational toys that yielded big dividends in helping her children learn about the world around them. Confidence Intercultural Development Research Association 20
Intercultural Development Research Association 21 AVANCE provides important practical guidance through several activities to help mothers with the education of their children. Two of these activities are toy-making classes and field trips. Most mothers (95.3 percent) made toys, which they used to instill in their children important concepts about the world, their sensory perception as well as their feelings. Many mothers (63.4 percent) also participated in field trips organized to acquaint them with the resources available in the community. Educational, practical, affordable books and toys made by families SKILL BUILDING
Exactly one year after she arrived in the United States, Mónica joined AVANCE. Her outlook on life changed so much, and the experience made such an impact on her life, that Mónica believed in spreading the word. This kind of outreach and personal touch from others helped Mónica enroll in parenting skills while her young daughter enjoyed the early childhood development sessions. In working with AVANCE, Mónica strengthened her communication skills and developed a stronger relationship with her daughter’s teachers. Mónica soon became an active volunteer in afterschool activities. At AVANCE, she also began money management and financial classes. She started saving money early and taught her daughter to do the same. Her daughter has her savings account now and wants to go to college to pursue a career in business. “Participants should promote the program by spreading the word to others.” Impact Intercultural Development Research Association 22
Empowerment Using a renowned two-generation model, AVANCE empowers families to break the cycle of poverty by fostering parenting knowledge and skills that directly impact children’s development, while also providing the early education necessary for children’s long-term academic and personal success. Intercultural Development Research Association 23
Intercultural Development Research Association 24 Improved Education Educational attainment increased. Among mothers who did not have a high school diploma before AVANCE, 59.1 percent obtained a GED; 18.2 percent obtained a vocational or technical diploma; 13.6 percent completed high school; and 9.1 percent earned a degree in a community college. For those with high school before AVANCE, 43.8 percent obtained a vocational or technical certification and the other 56.3 percent obtained a degree in a community college (25.0 percent) or university (31.1 percent).
AVANCE works not only to advocate for parents, but also to mentor parents so they can effectively navigate social systems and become leaders themselves. In addition, AVANCE actively engages local school districts and legislators to promote an agenda for early childhood education and support services for low-income parents. From Advocacy to Self-Advocacy Intercultural Development Research Association 25
Linda was going through a depressive time when someone knocked on her door inviting her to join AVANCE. She thought it would be good to get out of the house. From her first day, she immediately liked the program and plunged into the parenting, nutrition, early childhood development classes and marital sessions. Soon, Linda moved out of her depression as she began to see the positive transformation within her family. As she interacted with peers, Linda’s daughter learned important pre- school skills, the alphabet, and how to color and use scissors. She was well prepared for school. Linda learned about social programs that could benefit her entire family, such as how to locate a doctor and apply for Medicaid. AVANCE classes and guest speakers helped build her sense of self-worth. Now Linda wants to get a master’s degree in sociology and help other families in the community who are losing their Latino roots and traditions. She continues to be actively involved in her children’s education by volunteering and meeting with teachers at least once a week. Linda highly recommends AVANCE and was grateful for the support that helped her climb out of depression and improve herself as a mother and as a human being. Intercultural Development Research Association 26
When María was preparing for her citizenship classes, she first learned about AVANCE. The parenting program provided moral support, assistance, transportation, information and opportunities to do activities with her child. Because she had to work two jobs, María had been previously unable to further her own education and complete high school. Now she is moving forward in lifelong learning and enrolling in classes to learn English. AVANCE helped María build her “character and self- esteem,” resulting in an improved sense of self- assurance and becoming “a better human being in general.” She made a radical break from her past. She emerged stronger, rejecting her prior abusive relationships and learning who she was in reality and how accomplished she could be on her own. AVANCE also taught her she could support her children as a successful single parent. María now helps others whenever she can through her involvement in PTA. Self-Assurance
Even as a busy mother of seven, Martina attended parenting classes, made toys, went on field trips and participated in nutritional and educational programs for babies. She is proud that her children found a love for reading because of this program. Pride Intercultural Development Research Association 28
Intercultural Development Research Association 29 Higher Self-Esteem Nearly 90 percent (88.1 percent) of the mothers indicated that their participation in AVANCE helped them build their self-esteem. Did your participation with AVANCE build your self-esteem?
Growth The AVANCE classes Erika attended were so good that she didn’t want them to end. Erika credits the classes for learning skills needed for the proper growth and development of her three children and the advancement of her family. Nutrition class and budgeting helped her plan and support her family’s daily expenses with healthy meals. With increased facility, Erika now meets regularly with her son’s teachers, helping reinforce the importance of school and home partnerships. She and her family regularly access resources available in their community to help her children succeed. Together they visit the local library and Erika reads to them 30 minutes every night. The circle of support from AVANCE helped Erika learn English and get her GED. She is now looking forward to getting a post-secondary education. The family opened a savings account and is saving weekly for their children’s college education. Intercultural Development Research Association 30
Transformation Reading has become a tradition in Sandra’s home. She earned her GED and is on her way to attaining a bachelor’s degree with hopes to earn a master’s degree. As an immigrant with no formal secondary education, Sandra felt limited in both opportunities and possibilities. Because of her participation in AVANCE, her capacity and self- esteem grew, and with it, she began feeling valued and appreciated within her own family as a woman, wife and mother. AVANCE taught her concrete skills to improve her children’s literacy and develop lifelong positive learning habits. Through AVANCE support and promotion of community resources, the family lifted itself from dire economic stress and government assistance to independence, home ownership and self-sufficiency. A love of learning and college became a given for this family, who is giving back to their community through their support of other children and families in similar circumstances. Intercultural Development Research Association 31
AVANCE opened new horizons and helped Norma “see the light at the end of the tunnel.” As a mother of five, Norma recalls that when she came to AVANCE, she felt young and inexperienced; she had been charged with child endangerment, almost losing her two older children. AVANCE welcomed her with kind hearts; her teachers were open-minded and did not judge her. Through early childhood development classes and participation in the infant daycare program, she became a better mother as she learned how to understand and be patient with her children and show “grace toward them.” AVANCE helped her recognize that she is her children’s first teacher. Norma’s self-esteem and outlook on life improved dramatically. She eventually got her GED and now works in epidemiology. She has a renewed sense of hope and is actively involved in her church and community, working on environmental issues. Intercultural Development Research Association 32
Intercultural Development Research Association 33 Improved Education Mothers improved their education significantly since leaving AVANCE (p < 0.01); the number of mothers with higher education degrees increased 216.7 percent, while the number of mothers with less than high school education decreased by 21.4 percent.
Rocío is a recognized leader in her community and credits AVANCE for giving her strong preparation and practical skills that are “very useful for herself and her family, relatives and friends.” AVANCE encouraged a love of reading that continues with her other children. Before AVANCE, she read to them in Spanish, now they read books together in both English and Spanish. This love of reading extended to the whole family and is reflected in her son’s desire to be in theater and act out stories. Rocío was encouraged to further her own education and become more involved in her children’s school, community and the PTA. At AVANCE, Rocío’s self-esteem and self-confidence grew along with communication skills within her family. AVANCE also helped her manage the family’s finances. Rocío applies powerful leadership skills in looking out for others in her community such as helping with a petition to improve their local streets. Learning to Lead Rocío completed her GED and entered community college. Now she looks forward to entering a university in the United States.
Intercultural Development Research Association 35 Community Involvement More than half of the mothers (53.7 percent) were involved in their community since graduating from AVANCE. Mothers were involved in a diverse of ways: 46.3 percent were involved with their children’s school; 20 percent with their local church; 10.5 percent continued to be involved with their local AVANCE chapters; 7.4 percent with their communities by informally interacting with their neighbors; and a few with their local libraries, nursing homes, and through United Way or the HIPPY program.
Goals AVANCE opened doors for Claudia, who came from Mexico unable to speak English and with a limited education. Through her experience at AVANCE, she deepened her relationship with her children and completed a GED. AVANCE was instrumental in helping Claudia set her own attainable goals and take nursing classes to become a registered nurse. Through her partnership with AVANCE, her children acquired oral language skills and social development to create the structures and routines necessary for a strong educational foundation. Claudia understood the importance of reading early and showing interest in grades and accomplishments in school. Her children are doing well in school, and Claudia and her husband now own a successful business. Her family has set goals, and they focus on working together to achieve their dreams for a positive future and a better life. Intercultural Development Research Association 36
Intercultural Development Research Association 37 Increased Entrepreneurship Business ownership increased after attending the AVANCE program. About 17.8 percent of mothers have at some point started their own business and 14.1 percent still had them at the time of the interviews.
Intercultural Development Research Association 38 Increased Home Ownership Before leaving AVANCE, 66.7 percent of the mothers rented their home, and 11.5 percent had other arrangements. At the time of the interviews, these numbers decreased to 42.2 percent and 4.7 percent, respectively. Homeownership, on the other hand, increased from 21.9 percent before mothers left AVANCE to 53.1 percent at the time of the interview.
Resolve During home visits and in the AVANCE parenting classes, Nancy learned how to tap into her own calmness and resolve in parenting her children. Nancy proudly attributes the success of her current work as a nanny to the classes she took at AVANCE. She wished the AVANCE classes would expand to work with adolescents as well so she could pay forward her knowledge by serving her community and influencing the lives of other children through her work. Nancy began volunteering at school and helping the teacher work with groups, using creative play, flash cards to teach math skills and translating in English for Spanish speaking students. The knowledge and skills she learned through AVANCE was passed on to others as Nancy helped others, visiting with struggling friends and helping motivate them. Intercultural Development Research Association 39
“AVANCE can be lifesaving…the staff is caring and passionate!” As a 17-year-old mother who felt isolated and alone, Elizabeth and her baby were living in the invisible margins of society. Through AVANCE’s personal touch and persistence, Elizabeth became part of a new family of support, receiving help with financial aid paperwork and personalized attention to recognize her own potential. Elizabeth credits AVANCE with learning the importance of reading to her children as critical for their literacy development. Now, her three children are all doing well in school. Her daughter, Emily, will enroll in college soon, and Elizabeth is completing her bachelor’s degree from the University of the Incarnate Word. The personal touch and loving persistence of AVANCE staff have created a lifelong legacy that keeps on giving. Elizabeth is also a coordinator of Home-Based Services for Early Head Start. Determination Intercultural Development Research Association 40
“AVANCE opened doors for the entire neighborhood.” In Mexico, Irene already had her high school diploma and was working as a CNA. She learned about AVANCE through a flier that was distributed at her eldest daughter’s school and enrolled in the literacy, ESL, parenting and toy-making classes. She was glad that AVANCE provided transportation. Through her participation, Irene learned about health issues and new techniques in sewing with a machine, not just by hand. Her self-esteem and confidence increased dramatically. New supportive friendships and encouragement from AVANCE eventually led Irene to renew her CNA license and evolve in many areas of her life. Irene attributes her daughter’s love of reading and learning to her early participation in AVANCE. Intercultural Development Research Association 41
Intercultural Development Research Association 42 Increased Employment More mothers (29.5 percent) were employed than before participating in AVANCE programs (17.1 percent). Furthermore, the employment quality was higher – 17.6 percent of the mothers’ employment was full time after leaving AVANCE, compared to 6.2 percent before entering the program. The general trend toward improved employment continued long after mothers left AVANCE. At the time of the interviews, unemployment had decreased to 56.5 percent and employment increased to 38.8 percent; of these 23.8 percent were full time.
María learned about AVANCE at her son’s school where the program was operating. Working with AVANCE, helped María realized that her place was not only in the home, but also helping others. Because of the strong foundation from AVANCE, María was mastering English and aspired to get her GED. She began to volunteer and received training that ultimately led her to becoming a certified volunteer in her school district. Through the AVANCE programs, she gained confidence that empowered her to discover her potential and do what she wanted most. In reflecting on her experience, María explained that all of her children benefitted from AVANCE, not just her 6-year- old who had been in the program. AVANCE had a profound influence on relationships at home, “It was very beautiful, and I won’t forget it.” Empowerment The impact of Maria’s participation continues as she advocates for another son in high school and collaborates with teachers in encouraging him to stay in school and excel in rigorous classes. Intercultural Development Research Association 43
Intercultural Development Research Association 44 Less than a third (29.0 percent) of the mothers indicated that AVANCE could have helped them better. What they wanted was for the program to last longer or allow participants to repeat it. They wanted more classes and more activities; and they wanted them to be offered more often and in more convenient timeframes. A Call for More If “Yes,” How could AVANCE have helped you better? (Selected Representative Answers [repeated comments n times]) If people could attend more days of the week that would be great.  If I could have gone back to the program rather than only being able to attend once.  If the classes that are now offered were available then I would have taken advantage of attending.  If they had evening classes, I would have kept going. It would have been nice if they would have had the program longer and provide more English. Longer program, more activities and classes.  I would have liked to attend more days rather than just one [day of the week]. I would increase the participation time. It was too short. That anyone can participate in their program even if they don't have children because it is a great program to help with GED and other classes offered by AVANCE. They did not have all the classes that the other centers had. They were too far to attend from my house. I would have liked to keep going but the program was only for a year.
Giving Back As a mother of four with children ranging four months to four years, Diane sought assistance from AVANCE to help with her second child, who had a hearing impairment. Through her involvement in a partnership between AVANCE and Palo Alto College, Diane participated in the “Untapped Potential” program. This program helped her acquire job skills that ultimately landed her a job with the Housing Authority. Her husband participated in the Fatherhood program, which also made a positive impact on their lives. All four of her children are AVANCE graduates, and the program left such a good impression on her children, that as parents, they too have participated in the parenting programs. Strengthening her communication skills through the program, Diana credits AVANCE for her increased involvement in the community. She volunteered a with the residence council in her community, where she had held positions as secretary and parliamentarian. Diane multiplied the impact of AVANCE by giving back to her community, helping people who were homeless to find shelters and resources. Diane’s family has been involved for over two generations with AVANCE. Now she is giving back. Intercultural Development Research Association 45
Excerpts of Case Studies from AVANCE Parent-Child Education Program External Evaluation Technical Report. This report and the study were conducted for AVANCE by the Intercultural Development Research Association, 2013. Permission was granted by participants to AVANCE and IDRA to share their experiences and stories. 5815 Callaghan Road, Suite 101, San Antonio, Texas 78228 210-444-1710 www.idra.org 118 North Medina Street San Antonio, Texas 78207 Office: 210-270-4630 Fax: 210-270-4636 Email: firstname.lastname@example.org For more information…