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Running Head: Residential Fires
Residential Fires
Russell T. Jones
And
Thomas H. Ollendick
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Virginia Polytechnic Institute and State University
Chapter in A. M. La Greca, W. K. Silverman, E. Vernberg, & M. C. Roberts (Eds.) Helping
Children in Disasters: Integrating Research and Practice (2002). Washington, DC: APA Books.
The authors may be contacted at the Department of Psychology, Virginia Polytechnic Institute
and State University, Blacksburg, VA.
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National statistics suggest that 1 in every 5 families will experience a fire in their homes
at some point in time and that a significant minority of families will experience repeated fires. In
1997, it was reported that 500,000 residential fires occur each year resulting in approximately
5,000 deaths and 21,000 injuries (Greenberg & Keane, 1997). Burn injuries resulting from
residential fires in the U.S. are estimated at 600,000 to 750,000 incidents per year (Snyder &
Saigh, 1984), and are the third leading cause of death for children (Tarnowski, 1994). Those
most likely to be injured by fire are children and adolescents, particularly those from low-income
families (Tarnowski, 1994). According to Stoddard, Murphy, and Beardslee (1989), 25% to 35%
of burn-injured children develop Post-Traumatic Stress Disorder (PTSD), and over 50 percent
display significant PTSD symptoms. This may be due to the fact that poorly educated, low
income, and minority families live disproportionately in substandard housing. Unfortunately,
research has not yet disentangled the relations among these demographic variables. Although a
number of research investigations have studied fire emergency responding (Holmes & Jones,
1996; Jones, 1980; Jones, Ollendick, & Shinske, 1989; Jones, Van Hasselt, & Sisson, 1984;
Randall & Jones, 1994), few have examined the potentially deleterious consequences of fire
emergencies on children and their families.
Definition of the Event
Residential fire can be conceptualized as either a technological disaster (man made) or a
natural disaster (act of God), as in the case of wildfire. Characteristics of the fire often include:
powerful impact, unpredictability, low controllability, threat, terror, and horror. Although
several of these characteristics are also associated with natural disasters (Foa et al., 1989; Jones
& Barlow, 1990), the fact that residential fires usually occur in isolation may lead to greater
levels of psychological distress (Bernstein, 1990).
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Characteristics that are somewhat unique to fire have been shown to be correlated with
survivors' functioning. These include exposure to noxious fumes, toxic gases, fire appearance
(Bickman, Edelman, & McDaniel, 1977), and potential for severe harm and injury (Bickman et
al., 1977; Phillips, 1978). Perhaps the best way to define the event is through “the eyes of a
child.” Below is a quote from a transcription of a child’s report when returning home following
a fire:
Child: “When we got to the house, the street was covered with fire trucks. I couldn’t
really see the house because of all the smoke, the wind blew the smoke and it drifted back. I saw
how a big chunk of the house was gone. I still wasn’t upset at that point, I was really shocked. It
was too much like a bad dream story and I would wake up from it any second. Almost
everything was gone. There was still smoke, and everything was covered in black soot or tar.
Our pets had all died.”
Review of the Literature
Although little attention has been given to the study of consequences of fire with
children, adolescents and their families, we will provide an account of the extant studies.
One of the initial studies examining the impact of residential fire on children was carried out by
Krim (1983). Symptoms including inability to eat or sleep, nervousness, anxiety, depression,
and denial were reported. It is interesting to note that many of these reactions parallel those
resulting from more large-scale disasters such as floods and hurricanes reported in the disaster
literature. The mental health state of mother and child was significantly related to the extent of
damage or loss incurred. Though these data are preliminary in nature, they shed some light on
the mental health consequences of fire. We found similar effects in one of our early studies.
Between March, 1987, and January, 1988, an initial pilot study targeting 20 survivors of
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residential fires was carried out by Jones and Ribbe (1991). Eight children and adolescents (ages
4 to 15 years) and 12 adults (21 to 68 years) served as subjects. During individual interviews, a
child and adult version of the Fire Questionnaire (Jones & Ribbe, 1990) was employed to obtain
participants’ experiences. Information concerning the individual’s behavior prior to the fire (i.e.,
location in the home, time of fire), behavior during the fire (i.e., panic, cognitions, fear of injury),
and consequences of the fire (i.e., loss, injury, depression) was obtained. Findings from this
study illustrated two important points: (a) that an individual’s psychological reaction to
residential fire can be reliably documented, and (b) that several symptoms related to PTSD were
expressed by the fire survivors.
Based on these findings, Jones and Ribbe (1991) next studied 25 male adolescents who
were residents in a dormitory that burned and compared them with 13 adolescent males who
were not residents of the dormitory. Using selected portions of the Diagnostic Interview for
Children and Adolescents, Revised Version (Reich & Welner, 1990) and the Horowitz Impact of
Events Scale (Horowitz, Wilner, & Alvarez, 1979), the consequences of this fire were
determined. Two primary findings were documented. First, and somewhat unexpectedly, stress
symptomology as measured by the Horowitz’s scale proved substantial in both groups even fourmonths post-disaster. Second, significantly greater levels of PTSD symptoms as determined by
the diagnostic interview were reported by those adolescents whose dorm was burned versus
those whose dorm had not burned. Additionally, assessment of premorbid functioning with
reference to several disorders, including oppositional defiant disorder, conduct disorder,
overanxious disorder, and major affective disorder, past and present, revealed no significant
differences between the two groups. However, at one-year follow-up, significant drops in PTSD
symptoms in both groups were observed.
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Using a similar methodology, elevated levels of PTSD symptomatology were evidenced
between a group of children whose homes had been destroyed by wildfires and a group whose
homes were unaffected. Both groups of individuals lived in the same city (Jones, Ribbe, &
Cunningham, 1994). No significant differences were obtained between the two groups and the
number of symptoms reported for ODD, CD, OAD, past or present MAD and PTSD. However,
significant differences in number of PTSD criteria met were found, within those losing their
homes meeting more criteria. Of the group of children who had lost their homes, two met the
criteria for PTSD, while one of the children from the control group met such criteria. Results
from this study were consistent with earlier reports, suggesting that varying degrees of
psychosocial distress do indeed result from fire-related disaster.
Greenberg (1994) examined 12 children, aged 6 to 17, all of whom had been involved in
separate residential fires. Consistent with Heider’s attribution theory, children sought reasons for
the fire. They attributed responsibility of the fire to others, particularly neighbors. While actual
diagnostic assessments were not administered, symptoms of anxiety, depression, sleep
disturbance, hyper-alertness, guilt and lack of concentration were reported. Unfortunately, no
measure of degree of intensity of these symptoms was obtained. All children reported fear of the
fire, as well as apprehension of another fire occurring in their home. Nine of the 12 children
reported withdrawing from regular activities and friends. Half of the parents rated their child’s
adjustment following the fire as “not normal”. Based on children’s perception of their parent’s
reaction to the fire, they desired to “protect” their parents. That is, nine children reported that
they knew how worried their parents were, while six indicated that they (their parents) were not
“handling things well”. In summary, these data also suggest that children and adolescent
experience varying levels of distress following fire disaster.
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More recently, March et al. (1997) employed a population-based sampling strategy to
assess the impact of an industrial fire on 1,400 children and adolescents. Nine months following
a major fire at a chicken processing plant where 25 people were killed and 56 workers were
seriously injured, posttraumatic symptomatology (PTS) was obtained using the Self-Reported
Post-Traumatic Symptomatology modeled on the Frederick Reaction Index (Frederick, 1986;
Pynoos et al., 1987). Additionally, measures of depression using the Children's Depression
Inventory (Kovacs, 1985), anxiety using the Revised Children's Manifest Anxiety Scale (
Reynolds & Paget, 1981), locus of control employing the Nowicki-Strickland measures
(Nowicki & Strickland, 1973) and features of attention-deficit hyperactivity disorder and
oppositional defiant disorder using the Hyperactivity Index from the Conners Teacher Rating
Scale (Conners, 1995) were employed. Results demonstrated that PTS and co-morbid
internalizing and externalizing symptoms were directly related to levels of exposure, that race
and gender had variable effects on risk for PTS and co-morbid symptoms, and that PTS was
positively correlated with co-morbid symptoms.
Shortcomings of Existing Literature
Notwithstanding these reports from both the child and adult literature, there are many
shortcomings in fire disaster research. One shortcoming is the failure to consistently account for
survivors’ pre-morbid psychopathology. Evidence indicates that children with psychiatric
disorders before a residential fire are more likely to develop PTSD symptomology (Patterson et
al., 1993), and are more likely to be burn victims (Tarnowski, 1994). In fact, reported estimates
on the prevalence of previous psychiatric illness among burn patients range from 28% (Brezel,
Kassenbrock, & Stein, 1988) to 75% (Davidson & Brown, 1985). Not only are individuals with
pre-morbid psychopathological disorders at a higher risk of sustaining burn injuries, they are also
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more likely to have longer, more extensive recovery periods which could affect their overall
adjustment (Patterson, Everett, Bombardier, Questad, Lee, & Marvin, 1993). Furthermore,
females are at a greater risk for maladjustment than males (Pruzinsky & Doctor, 1994).
Therefore, assessment of levels of pre-morbid functioning is important.
Another significant shortcoming is that children’s reactions to fires and other disasters are
frequently not obtained from children themselves; rather, parents typically report on their
children’s distress (Green, Grace, Crespo da Silva, & Glesner, 1983). These reports are
problematic because parents often underestimate the level of distress experienced by their
children (Earls, Smith, Reich, & Jung, 1988). Thus, there is a need for direct reports from child
survivors themselves.
Two related shortcomings stem from the lack of standardized assessment instruments
when assessing survivors of disasters (McNally, 1991) and the lack of a theoretical model to
guide investigations in the disaster area (Green et al., 1991; Jones et al., 1994). These latter
issues will be considered in some detail in the sections that follow.
Conceptual Models
A glaring omission in the literature is a comprehensive, conceptually driven, theoretical
model of the consequences of fire across the lifespan. Disasters afford unique opportunities for
theory development inasmuch as they typically have an immediate onset and are relatively short
in duration (Green, 1993; Solomon, 1989). In our work, we have employed two models to guide
our thinking during the development, as well as the conduct of our present investigation; namely,
the Psychosocial Model of Disaster (Korol, Green, and Grace, 1999) and the Conservation
Resource Model (Hobfoll, 1989). Each model will be discussed in turn below.
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In the Psychosocial Model of Disaster adopted by Korol et al. (1999), four primary
factors were identified and hypothesized to interact to determine both short-term functioning and
long-term adaptation to the "traumatic event". These factors included: a) characteristics of the
stressor (i.e., loss, life threat), b) cognitive processing of the event (i.e., magical thinking,
appraisal), c) individual characteristics of the child (i.e., age, sex), and d) characteristics of the
environment (i.e., reactions of family members). We felt that the strength of this model was its
attempt to conceptualize and account for child and adolescent functioning following major
disasters. Unlike previous models in the disaster literature where adult reactions to disaster were
examined, the Korol et al. model employed a developmental perspective in which children’s
reactions could also be explored. Empirical support for each characteristic based on earlier
findings in the general child disaster literature as well as some of our own efforts will be briefly
discussed next.
Characteristics of the Stressor
Among several important factors which fall under this heading are exposure to the event,
degree of displacement resulting from the event, amount of physical disruption, as well as degree
of life threat and bereavement (Korol et al., 1999). Perhaps the most objective factor is
exposure. Exposure has been found to be significantly related to heightened levels of
psychological distress in several studies (La Greca, Silverman, Vernberg & Prinstein, 1996;
Pynoos et al., 1987) supporting a dose-response relationship.
Cognitive Processing of the Stressor
Cognitive processing of the stressor is viewed as a primary factor hypothesized to impact
short-term response and long-term adaptation to the fire. One of the major aspects of the "stress
response" articulated by Green (1990) is the perception and the immediate appraisal of the event.
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Although this variable may be difficult to assess in younger children due to developmental
limitations, the need to explore this relatively ignored aspect of children's cognitive functioning
is obvious. Evidence suggests a meaningful role of coping processes in mediating child and
adolescent functioning across a variety of conditions (Compas, 1993; Folkman & Lazarus,
1985). Earlier work in our lab suggested that appraisal of the “changeability” or secondary
appraisal of a situation may influence performance as well (Randall & Jones, 1994).
Individual Characteristics
Literature on natural and technological disasters dating back some years indicate that
reactions to traumatic events vary across age. The degree of distress exhibited by preschoolers is
consistently lower than that observed at other developmental levels. Children and adolescents
report a variety of symptoms including traumatic anxiety reactions, nightmares, and sleep
disorders (Newman, 1976), specific fears (Milne, 1977), and anxiety and depression (Burke et
al., 1986). Several investigators have maintained that an adolescent’s symptomology is often
more similar to adults than to younger children (D. G. Ollendick & Hoffman, 1982; Terr, 1985).
With respect to PTSD symptoms, early reports suggested that there were no differences
among youths of varying developmental levels (Terr, 1981). Terr (1983) maintained that distress
was relatively independent of age. Later reports suggested that there was variability across
preschoolers, school-aged children and adolescents (Eth & Pynoos, 1985). Internalizing
behaviors including somatic complaints and separation anxiety were more likely to be reported
among preschoolers, whereas actual symptoms of PTSD were reported among school-aged
children. Lyons (1991) found that adolescents reported extreme levels of both internalizing and
externalizing behaviors. They also reported increased levels of anxiety, dysphoria, aggressive
behavior, acting out, substance abuse and decreased energy (Eth & Pynoos, 1985). More
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recently however, researchers have reported that posttraumatic symptomology in children and
adolescents closely resembles that of adults (Earls et al., 1988; March, 1990; March & AmayaJackson, 1994).
With reference to gender, several reports have documented the fact that females are more
likely than males to develop the full PTSD syndrome (Breslau et al., 1991; Helzer et al., 1987).
However, Korol (1990) suggests that there may exist an age by gender interaction with middle
age boys and adolescent girls showing more total PTSD symptoms and intrusion symptoms than
boys and girls in other age groups. Explanations for these gender differences are yet to be
clearly ascertained in the child disaster area.
Characteristics of the Environment
Indeed, the role of the environment has been shown to have a major impact on
individuals’ functioning during and following disasters. Specifically, parental reactions and
family cohesiveness following traumatic events impact children's functioning. Children's
reactions to traumatic events may be more a function of their parents' reactions (typically the
mother), than the event itself (Kinston & Rosser, 1974). McFarlane (1987) reported that
mothers' reactions to disaster were better predictors of children’s PTSD than children's direct
exposure to the disaster itself. Melamed and Siegel (1980) also reported that parental anxiety
was correlated with poor adjustment of children. Similarly, Pynoos et al. (1988) stated that
children were likely to respond similarly to adults in both the nature and frequency of grief
reactions up to one year following the incident. Similar findings were also observed by other
investigators (Jones et al., 1991; Korol et al., 1991).
Regarding family cohesiveness, a small number of studies have examined dimensions of
family structure to determine its impact on children's post-disaster functioning. McFarlane
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(1987) showed a relatively strong correlation between family functioning and children's
psychopathology eight months following bushfires in Australia. Similarly, Green et al. (1991)
found a meaningful contribution of family atmosphere on children's post-disaster functioning.
An additional characteristic of the environment is social support. One reason that some
individuals may not develop PTSD or related symptomology is that they have a strong social
support network. Families are usually the most utilized source of support available to trauma
victims both at the time of impact and after the disaster (Kaniasty, Norris, & Murrell, 1990). A
strong social support network may act as a buffer to post-disaster distress. The Stress Buffer
Model presented by Kaniasty and Norris (1993) suggests that social support protects disaster
victims from the negative consequences of stressful conditions. When faced with stress, people
have a greater tendency to affiliate with others that may offer support. However, when expected
help is not received, greater resentment is felt toward relatives and friends than toward strangers
(Kaniasty et al., 1990).
In summary, because of the wealth of findings supporting the need to examine these
characteristics we initially adopted this model. We set out to determine the exact nature of the
relationship among these factors as well as their short and long-term impact on the recovery of
fire survivors.
Development and Application of a Conceptual Model for Understanding Children’s Reactions to
Residential Fires
While loss, a major contributor of psychological distress, had been examine earlier, it was
often quite narrowly defined. For example, Green (1990) and Korol et al. (1991) defined it as
sudden loss of a loved one. In an attempt to obtain a more robust measure of loss we adopted the
Conservation Resource Model (COR) of Hobfoll (1989). This model, which focuses on critical
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social and personal characteristics, provided us with a more comprehensive means of assessing
loss. Hobfoll maintains that resources are conceptualized as tools that facilitate successful
interaction with the environment. The absence of such tools will result in acute negative
emotional experiences. Additionally, prolonged emotional distress will occur if losses are not
effectively compensated through individual, social, and community-wide efforts.
The four categorical types of loss for adults include objects (e.g., car, home, possessions),
conditions (e.g., employment, marriage, parenthood), personal characteristics (e.g., sense of
meaning and purpose, self-esteem and self-efficacy), and energies (e.g., knowledge/skills,
money, and time. Similar categories were devised for children in a modified scale for youngsters
Scale (Freedy, Shaw, Jarrell, Masters, 1992). Therefore, the Conservation of Resource Model
was employed which enabled us to examine loss from both adults’ and children’s perspectives.
Based on recent work of La Greca and her colleagues (1996) we have proposed the
following model (see Figure 1). They maintain, as we do, that predictors of response to trauma in
children include preexisting child characteristics (i.e., ethnicity, gender, age). Additionally, the
amount of exposure to the traumatic event, degree of life threat during the event, amount of
property loss and disruption following the event are also hypothesized to predict outcome.
Lastly, efforts to process and cope with the event, and characteristics of the post-disaster
environment (i.e., major life events and social support from parents friends, classmates and
teachers) may also affect post-disaster functioning.
More specifically, consistent with Baron and Kenny (1986), we view coping and social
support as quantitative variables that affect the direction and strength of the relation between the
independent variable (the fire) and the dependent variable (distress). That is, following the event,
the fire affects the moderators of coping and social support which then influences the outcome.
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Although not depicted here, we also maintain that these moderators impact the recovery
process following the fire. We feel that solid theoretical arguments can be made for these
relationships. For example, regarding coping, we hypothesize that increased levels of exposure
to and loss resulting from the fire will lead to elevated levels of avoidance coping and
subsequently greater levels of distress. Females are hypothesized to exhibit greater levels of
avoidance coping and are at greater risk for elevated levels of distress than males. A primary
goal of this investigation is to examine these and related hypotheses.
We also contend, as articulated by Holmbeck (1997), that each aspect of the coping
process (i.e., appraisal, coping self-efficacy, and coping), may be viewed as moderators. That is,
when fire survivors are asked to indicate their levels and types of coping for example, in direct
response to the fire (i.e.,“ how did you cope with the fire?”), coping is being conceptualized as a
moderator. Similarly, when respondents are asked, “ how do you generally cope with difficult
situations?”, coping is again viewed as a moderator. This relationship also exists with the
variable of social support where measures of support, in direct and general response to the fire
are conceptualized as moderators. Our goal is to empirically test portions of this more refined
model.
With this model in mind, we would like to describe the sample of children and families
participating in our large-scale NIMH-funded project on residential fires. To date, we have
interviewed 100 families. Names and addresses of families are obtained from a variety of
sources, including fire departments, schools, mental health centers, hospitals, newspapers, and
the American Red Cross. Participants are recruited from a 4-state area: Virginia, West Virginia,
North Carolina, and South Carolina. We have recently added a new site in the Atlanta, Georgia
area. If the family includes a child or adolescent between 7 and 17 years of age, the parent is
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contacted by letter (or phone) and requested to participate in the study. Only one child or
adolescent in each family is targeted for inclusion. If there is more than one child or adolescent
in the family, the child whose birth date is closest to the date of the fire is selected. Additional
inclusion criteria for the children are average intellectual ability (documented by schooladministered ability tests) and that children actually reside in the home with the caregiver.
However, absence from the home during the actual fire does not preclude participation. Many of
the children may be in school, church, camp, staying at a friend’s house, or attending other
activities during the time of the fire. Furthermore, families in which a member dies during the
fire or receives serious burns or injuries are included. Families whose homes are burned as a
result of documented arson are not included in the study, due to potential litigation in such cases
(see Table 1 for a summary of relevant demographics).
The average and median age of the children was 12.0 years. Fifty-four per cent of the
children were girls and 46% were boys; 54% of the children were at home at the time of the fire.
Approximately 30% thought they would die during the fire; 10% saw some member of the
family get hurt or burned and another 10% lost a family pet in the fire.
All in all, the residential fires ranged considerably in the extent and amount of loss. The
experiences of the children and their parents varied extensively as well. Furthermore,
characteristics of the families varied widely and, as a result, we believe a representative sample
of families experiencing residential fire was obtained. The project is still ongoing with the
ultimate goal of recruiting 150 families.
Methods of Assessment
Methods of assessment closely followed our theoretical model examining four primary
factors in the prediction of both short- and long-term outcomes of residential fires. Multimethod
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assessment (Ollendick & Hersen, 1984, 1993) was used to assess each of the four factors: 1)
characteristics of the stressor, 2) characteristics of the children, their parents, and the family
network, 3) characteristics of the environment (e.g., reactions of family members, community
support), and 4) the child’s cognitive processing of the fire trauma. Measures used to assess each
of these factors represent an optimal assessment package in that the emotional and behavioral
responses of the children to the fires were systematically captured. Additionally, the assessment
of parents, teachers and peers were obtained. Instruments engaged to assess each of the four
factors are briefly described.
Characteristics of the Stressor
The stressor itself was measured in two primary ways: exposure to the fire and loss
associated with the fire. To measure degree of exposure, we devised the Fire-Related Traumatic
Experiences questionnaire. In a semi-structured interview, children responded to questions about
whether they were at home during the fire, whether they actually saw and experienced the fire,
how close they were to the fire, did they get hurt/burned during the fire, did they think they
might die during the fire, and did they see other people (e.g., brothers, sisters, aunts) or their pets
get hurt/burned during the fire. This measure was designed to obtain a direct index of exposure
to the stressful event.
Loss was measured through a modified version of Freedy’s Resource Loss Scale (Freedy,
et al.,1992). It included factors labeled object loss and personal resource loss and tapped a wide
range of events. Children appeared to understand the concept of loss and to provide us a rich
array of comments about specific losses and how those losses affected their lives.
Characteristics of the Children.
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Demographic variables such as age, sex, ethnicity, family structure, and socioeconomic
status of the families were obtained from the parents. In addition, structured diagnostic
interviews were conducted with the children and their parents to determine pre-existing
psychiatric disorders, which might make the children more vulnerable to adverse reactions to the
fire. For this purpose, the computerized versions of the Diagnostic Interview for Children and
Adolescents-Revised (Reich & Welner, 1990) were used. Parents and children (8 years or older)
were interviewed separately, but concurrently. Interviews took between 1 and 1½ hours to
complete. From this interview, we obtained both current and past DSM-IV diagnoses of major
anxiety and affective disorders, as well as disruptive behavior disorders such as oppositional
defiant disorder and conduct disorder.
In addition to these variables, children’s attributional style was measured through the 48item Children’s Attributional Style Questionnaire (Kaslow, 1978). This well-validated
questionnaire was used to obtain measures of internal, stable, and global attributions for positive
and negative events that occur to the child.
Characteristics of the Environment
In this domain, we obtained measures of psychopathology in the parents, family
environment, parenting styles, and social support from peers, teachers, and parents. Two
measures of parental psychopathology were obtained: a symptom checklist and a diagnostic
interview conducted with the parents themselves. The Brief Symptom Inventory (Derogatis,
1983) assessed the intensity of nine psychological and somatic symptoms and was used as a
measure of current psychological distress in the parents. The Anxiety Disorders Interview
Schedule (Di Nardo, Brown, & Barlow, 1994) was used to obtain a measure of current and past
psychiatric disorders in the parents. Only the PTSD and Specific Phobia modules were
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administered. Psychopathology in the parents was obtained inasmuch as earlier studies have
suggested that parental disorder may serve as a vulnerability factor for their children. We set out
to determine the impact of parent psychopathology on the child’s adjustment subsequent to the
fire.
Family environment was measured by the Family Environment Scale (Moos & Moos,
1981), designed to assess interpersonal relationships and basic organizational structure related to
different facets of the family environment (i.e., cohesion, expressiveness, conflict, control).
Overall, it provides an evaluation of the emotional supportiveness and control in the family
environment.
Parenting style was used to assess styles of parenting following traumatic experiences,
adapted from McFarlane’s (1987) work with children who survived bush fires.
Finally, support was measured by an abbreviated Social Support Scale (Dubow, 1989)
and by three additional support items designed specifically for this study. The Dubow scale
provided an index of general support from parents, teachers, and friends, whereas the remaining
three items provided an index of support regarding the fire.
Children’s Cognitive Processing
Primary and secondary appraisals were measured by items on a Fire Questionnaire
designed for this study. Similar items have been used in other trauma research.
Coping was measured in three ways. First, a Coping Efficacy questionnaire was devised,
modeled after one used by Ayers, Sandler, West, & Roosa (1996). Coping was also measured
through the “How I Coped Under Pressure Scale” designed by Ayers and colleagues (1996).
This 45-item scale possesses 11 factors measuring coping dimensions such as direct problem
solving, expressing feelings, avoidant actions, cognitive avoidance, problem focused support,
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and emotion focused support. In response to the various items inquiring how much the child
engages in particular actions, children respond with “not at all,” “a little,” “somewhat,” and “a
lot.” Finally, coping was measured through a Religious Coping Activities Scale (Pargament,
Ensing, Olsen, Reilly, van Haitsma, & Warren, 1990). Thirty-two items were included in this
scale.
Measures of appraisal and coping were obtained to determine the child’s appraisal of the
fire and how he or she coped with the fire itself. Previous research has suggested that such
cognitive dimensions are related to adjustment following trauma.
Outcome Measures
Multiple measures from different informants were used to measure responses to the fire.
First, the computerized version of the Diagnostic Interview Schedule for Children and
Adolescents was used to obtain current disorders (as well as past disorders). Separate but
concurrent interviews were conducted with the child and her or his parents. In particular, we
were most interested in the presence of major anxiety and affective disorders in the children as a
result of the fire (e.g., PTSD, Specific Phobia, Separation Anxiety Disorder, Major Depressive
Disorder).
In addition, both parent and teacher-completed measures of behavior were obtained using
the Achenbach (1991) Child Behavior Checklist. This 118-item behavior problem checklist
provides measures of both internalizing and externalizing behavior problems. We were
particularly interested in the anxiety/depression, somatic, and social withdrawal scales.
Various self-report measures were also administered, including the 15-item Children’s
Reaction to Traumatic Scale (Jones, 1996), the 37-item Revised Children’s Manifest Anxiety
Scale (Reynolds & Richmond, 1985), the 80-item Fear Survey Schedule for Children-Revised
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(Ollendick, 1983), and the 27-item Children’s Depression Inventory (Kovacs, 1985). These selfreport measures have been used frequently in trauma research and provide the child an
opportunity to express a variety of negative mood states associated with the trauma. For the
most part, they are highly reliable and valid instruments.
Finally, archival data from a variety of community sources were obtained. School
records were examined, as were physician visit records in an attempt to obtain indices of
academic, social, and health functioning. These measures were envisioned to provide us a direct
measure of outcomes that might be viewed as secondary to the experience of trauma.
Reactions of the Children to Residential Fires
Both qualitative and quantitative responses were obtained from the children and their
parents. Qualitative information was obtained during the Fire Questionnaire interview,
conducted separately with the children and the parents. Approximately 30% of the children felt
they should have been able to do something to prevent the fire from occurring and 18% felt the
fire was their fault. Moreover, 16% of the children felt they could have done more to stop the
fire. A full 85% reported they had never experienced anything as bad as the fire and 22%
reported that they had not been trained in fire safety skills. Clearly, a significant minority of the
children reported a negative reaction to the fire. In reference to primary appraisal, 49% felt a lot
of fear at the time of the fire, whereas another 27% felt at least some fear; in reference to
secondary appraisal, only 6% felt they could control the fire “a lot” and another 24% felt they
could control the fire “some.” Basically, these findings suggest that the fire was perceived by the
children as an uncontrollable event. Coping strategies varied, and no one strategy appeared to
characterize the children. They reported both problem-focused and emotion-focused coping
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strategies, with some of them using religious coping more so than others. In general, the
children felt their coping efforts subsequent to the fire had worked quite well.
Quantitative information on outcome was obtained from the various standardized
instruments. On the Children’s Reaction to Traumatic Events Scale (Jones, 1996), the mean
response for both the total score (22.80) and the avoidance score (13.19) placed the children in
the moderate range of distress. On both of these indices, scores ranged considerably with about
one-half of the youngsters being in the severe range of distress. Items such as “I kept seeing it
over and over in my mind,” “I tried not to talk about it,” and “I tried not to think about it” were
endorsed frequently by the children. Although mean scores on the self-report measures of fear,
anxiety, and depression did not differ from normative means, the range of scores varied
considerably on these measures. For example, one-third to one-half of the children scored in the
clinical range on these measures (greater than one standard deviation above the normative
means), suggesting heightened levels of negative affectivity in a subset of our children.
On the Diagnostic Interview for Children and Adolescents, children reported heightened
levels of both depression and post-traumatic stress disorder symptoms, although only 10 children
(10%) met criteria for Major Depressive Disorder and 9 children (9%) met criteria for PTSD.
Still, the average child reported 2.6 symptoms of depression (range of 0 – 9) and 2.3 symptoms
of PTSD (range of 0 – 15). On the parent Diagnostic Interview for Children and Adolescents,
similar rates of symptomatology and diagnosis were obtained. However, on the Child Behavior
Checklist, both the Internalizing and Externalizing T-scores centered around 50, although once
again considerable variability was present.
Inasmuch as our theoretical model proposed the role of parental and familial factors in
moderating child outcomes following a residential fire, we also examined family environment,
22
parenting practices, and parent psychopathology. On the Family Environment Scale, as reported
by the parents, none of the scales were in the clinical range when compared to normative means.
However, the cohesion, conflict, and control scales were marginally elevated. Basically,
responses on these scales suggest that the families reported issues surrounding being cohesive
and, at the same time, experiencing conflict and lack of control. These differences were not
significant, however. The nature of these issues may be reflected in the parenting style reports of
the parents. On this measure, a significant number of parents reported heightened levels of
vigilance and concern about their children. In response to the question, “Since the fire, do you
worry more about the possibility of harm coming to your children?”, 29% responded “some
more” and 40% indicated “a lot more.” Similarly, to the question, “Since the fire, do you need to
know where your children are more than before?”, 13% reported needing to know “some more”
and 42 % indicated needing to know “a lot more.” We hypothesize that this need to know more
about the child’s whereabouts and to have more worry about harm befalling them serves to
produce conflict and control in the family. At the same time, it is conjectured that this
heightened vigilance is perceived by the parents as engendering a tight knit and close family,
resulting in reported levels of enmeshment. Of course, these speculations await empirical test
and scrutiny.
Finally, we anticipated heightened levels of psychopathology in our parents.
Unexpectedly, such was not the case. However, trends suggesting a heightened global severity
index on the Brief Symptom Inventory were noted (T-score of 59.4, approaching one standard
deviation above the normative mean). Still, a range of scores was evident with some of our
parents clearly in the clinical range (e.g., T-scores of 80).
23
The overriding conclusion to be drawn from our qualitative and quantitative findings is
that children and their parents respond in a highly variable manner to the fire. We are currently
undertaking hierarchical regression analyses in an attempt to understand these differences and to
relate them to outcome. Already, however, we know that some myths will fall by the wayside.
For example, it does not appear to make a difference whether the family was home or not during
the fire; nor does it seem to matter whether the home was a total loss or not, nor for that matter
whether the loss was extensive in dollar amount. It is seeming to us that response to residential
fires is highly idiosyncratic and highly subjective; that is, a person living in a trailer and working
at a nighttime job during the evening fire may well experience the same “subjective” loss as a
person living in a $200,000 home and asleep in the home at the time of the fire. Although both
homes might be a total loss, both parents and their children might respond similarly. In short,
our work is cut out for us. There are no easy answers here and reactions to residential fires are
not easily captured, nor understood at this time.
Preparatory or Post-disaster Coping Material
Although a number of efforts have been made by several groups and agencies targeting
functioning prior to residential fire (i.e., FEMA, NFPA, American Red Cross), no published,
empirically supported interventions have targeted survivors of residential fire. However, some
of our preliminary efforts examining fire survivors have been encouraging. Prior to presenting
some preliminary findings from another pilot study, we would like to provide a brief overview of
a program of research that served as the conceptual and empirical foundation of this effort.
In an attempt to improve upon a strategy shown to enhance children’s substance-refusal
behavior (Corbin, Jones & Shulman, 1993), as well as the reduction of fire related fears, a
strategy entitled Rehearsal-Plus (R+) was devised. This strategy, developed by Jones (Jones &
24
Randall, 1994), was based on both behavioral and cognitive conceptualizations where specific
skills are fostered through use of behavioral techniques (i.e., modeling, positive reinforcement)
and knowledge is enhanced through manipulation of cognitive processes (i.e., beliefs). Its major
elements consist of: 1) a behavioral component where behavioral techniques are employed to
foster desired skills which are subsequently rehearsed, and 2) a cognitive component, where
elaborative rehearsal is used to modify specific cognitive processes (i.e., expectations, beliefs,
appraisals, attributions) which in turn enhances learning, retention, and appreciation of such
skills (Craik & Watkins, 1973). Although the initial version of the R+ procedure was similar to
other stress-reducing strategies, such as stress inoculation, there were several important
distinctions. Although stress inoculation is typically a general procedure including components
of deep muscle relaxation, self-statements, construction of a hierarchy, and presentation of
educational information, the R+ strategy targeted specific stimuli (i.e., chains of behavioral
responses, fire related-fear) and elaborative rehearsal in which a developmentally appropriate
rationale was provided to enhance behavioral and cognitive functioning.
One of its primary goals was to integrate the behavioral and cognitive components during
training. Unlike a number of behavior change procedures that have employed cognitive aids in
introducing new information that often are not accompanied by governing conceptual schemes
(Rosenthal & Downs, 1985), the R+ procedure was clearly derived from behavioral and
cognitive conceptualizations. Indeed a series of preliminary studies stemming from this
framework have shown desired outcomes (i.e., Hillman, Jones, & Farmer, 1986; Jones,
McDonald, Fiore, Arrington, & Randall, 1990; Jones, Ollendick, McLaughlin, & Williams,
1989; Williams & Jones, 1989). Therefore, we felt survivors of fire may benefit from this
25
procedure. Hence, two child survivors of a residential fire were treated using the R+ strategy in
combination with systematic desensitization and deep muscle relaxation.
Participants in this study were an 11-year-old male (John) and his 7-year-old sister (Jane),
both from a white middle-class family. The family of five was forced to relocate while repairs
were being made to their home following an early morning fire. The mother reported that her
son, John, was experiencing difficulty resulting from the fire, including reports of nightmares
and flashbacks of the fire. In addition, increased levels of anxiety were noted when he was in the
presence of various fire-related stimuli (i.e., sounds of sirens and emergency scenes on
television).
A multi-method assessment strategy was used for both him and his sister prior to and
following treatment. Primary assessment instruments consisted of The Fire Questionnaire (Jones
& Ribbe, 1990), the Children’s Depression Inventory (Kovacs, 1985), the Horowitz’s scale
(Horowitz et al., 1979) and the diagnostic interview (Reich & Welner, 1990). Additionally, the
Fire Emergency Behavioral Situations Scale (Jones, 1988) to assess emergency functioning was
employed. Generally, elevated levels of distress were noted in both children at pre-testing.
Physiological assessment of heart rate and GSR in response to fire-related stimuli was also
obtained. While John’s reactivity was greater than Jane’s, both showed marked increase within
this modality. Unfortunately, post-treatment physiological data were not collected.
Formal treatment consisted of eight weekly, 50-minute sessions at the Child Study
Center. The major components of this treatment package design were the R+ strategy, deep
muscle relaxation, and systematic desensitization. While all three components were
administered to John, Jane received only R+.
R+ (Re-Processing the Event)
26
Briefly, components of the R+ strategy were enlisted during the first two sessions where
the primary focus of treatment was to lessen the children’s immediate fear and anxiety of fire. A
goal of the cognitive component was to provide the children with valid and adaptive ways of
thinking (re-processing) about the event (i.e., you should not feel guilty for actions during the
fire, its okay to be upset and to discuss your feelings). Therefore, an opportunity was provided
for each child to discuss the event during which time they were assisted in their re-processing of
it at developmentally appropriate levels. We found in earlier studies that this strategy led to
meaningful ways of coping with fire-related fears.
We assisted them in “challenging” several perceptions and beliefs related to their
functioning during and following the fire. For example, both children initially reported that: 1)
they should not be afraid or upset shortly after the fire, 2) they should not discuss their
experiences with their parents and others, and 3) they should avoid situations and “things,” that
remind of the fire. Additionally, John reported that he should feel guilty for not acting more
appropriately during the fire (assisting others out of the house etc.). Given that one of the goals
of the R+ procedure was to modify maladaptive cognitions, we provided them with more
adaptive ways of thinking about this event. For example, they were told that it was “okay and
normal” to be scared shortly following a fire and that it was okay and helpful to discuss their
feelings and experiences with their parents and others. They were also encouraged to not
inadvertently reinforce their fears by avoiding fire-related stimuli. In fact, they were told to visit
their home (accompanied with a parent) while it was being repaired.
To further process the event, they were allowed to draw pictures of fearful scenes related
to the fire and encouraged to discuss their thoughts and feelings. Following this phase of
treatment, given that Jane consistently stated that she was not experiencing any symptoms of fear
27
or anxiety at this point, John became the targeted subject. The following steps were taken to
treat his problem behavior. Consistent with Barlow and Lehman’s (1996) recommendation to
treat specific symptoms, each of John’s symptoms was targeted. Lessening symptoms of
avoidance of fire-related stimuli (including fear of returning to the burned home), flashbacks,
hyper-arousal, hyper-alertness, sleeping difficulties, and sensation of smelling smoke in the
absence of fire became the focus of this phase. Also, general anxiety surrounding fire-related
stimuli portrayed on television, storms, hearing sirens in route to and from school, and
evacuation fire drills at school were targeted. A 14-item, thematic hierarchy comprised of the
aforementioned symptoms was devised with John over a 3-week period. Subjectives units of
distress ratings (i.e., a 10-item subjective units of distress scale) were obtained for each scene.
Deep Muscle Relaxation
Deep muscle relaxation was initiated where John was individually trained in deep muscle
relaxation over a 3-week period. The relaxation script for children devised by Ollendick and
Cerny (1981) was used to ensure developmentally appropriate wording and behavior. His
parents were allowed to observe the first session in order to learn the procedure. They were
given a homework assignment to practice the relaxation at least four times a week with John.
Systematic Desensitization
The third component of treatment was systematic desensitization proper where John was
first relaxed and presented with scenes from the previously constructed hierarchy. This phase
extended for two sessions. SUDS ratings indicated that a high level of effectiveness was
achieved with this procedure.
R+ (Development and Retention of Skills)
28
The final aspect of treatment focused on development and retention of fire evacuation
skills. The rationale for this training was primarily based on John’s report that he had “feelings
of guilt for not knowing what to do during the fire.” He stated that he “panicked”. For example,
shortly after discovering the fire, he ran up stairs to warn his sisters who were asleep. He then
immediately returned to the living room and sat in the middle of the floor and cried. Therefore,
it was reasoned that mastery of appropriate skills would greatly enhance his sense of efficacy in
the event of another fire as well as in related stressful situations. Both John and Jane were taught
the steps necessary to evacuate a burning house. Consistent with the R+ strategy, following a
behavioral demonstration of each step, they were allowed to behaviorally practice them.
Subsequent to appropriate demonstration of each, rationale was then provided. Training took
place over four sessions.
While no objective assessment of children’s cognitions were obtained, the employment of
the cognitive component during the initial two sessions appears to have led to meaningful ways
of processing and coping with the fire and resulting trauma. A goal of the cognitive component
was to provide the children with valid ways of thinking (re-processing) the event.
With regards to symptom reduction, several interesting findings were obtained. While
neither John nor Jane endorsed clinically significant levels of depression at pre-test, Jane showed
a drop from 9 at pretest to 0 at post-test and John’s initial score of 6 dropped to 4. As
hypothesized, results on the Horowitz’s scale showed extremely significant drops across both
children (John Pre-test scores of: Intrusion: 31, Avoidance: 23 Total 54; at post-test dropped to:
Intrusion: 0, Avoidance: 0 and Total: 0). Jane evidenced similar drops (Pre-Test: Intrusion: 25,
Avoidance: 23, and Total: 48 versus Post-Test: Intrusion: 0, Avoidance: 0, and Total: 0).
29
Concerning PTSD scores, both children demonstrated significant drops across each
symptom cluster. Jane’s scores were as follows: Pre-Test: Reexperiencing 6, Avoidance: 4,
Increased Arousal 4; Total: 14 versus: Post-Test: Reexperiencing 0, Avoidance:0, Increased
Arousal 0; Total: 0. John also reported significant drops in PTSD symptomology. Specifically,
Pre-Test: Reexperiencing 6, Avoidance: 5, Increased Arousal 4; Total: 15 versus: Post-Test:
Reexperiencing 1, Avoidance:0, Increased Arousal 0; Total: 1. As hypothesized, post-test scores
evidenced significant increases in both appropriate evacuation skills and in providing rationales
for each child. Although not objectively assessed in this investigation, the increase in behavior
and knowledge may have led to increases in self-efficacy.
A major shortcoming of this pilot study is that one cannot separate out the relative impact
of each component (DMR, SD, and R+) of treatment on outcome. Additionally, it is not clear
why Jane evidenced drops in symptomology initially reported at pre-test, given that she did not
receive two components of the treatment package (DMR & SD) hypothesized to change
behavior. Also, a question is raised concerning the reliability and validity of assessment of this
nature with young children below the age of 8. Results for John on the other hand are more
encouraging. Nonetheless, as an initial attempt at treating survivors of fire, this treatment
package seems like a potentially plausible first step and one worth examining in a more
controlled manner.
Summary
In summary, we have attempted to highlight the potentially deleterious consequences of
fire emergencies on children and their families. Although our preliminary findings do not
provide a clear picture of the nature nor course of these consequences, we do feel that important
in roads into this understudied area are being made. The important next step, intervention, is yet
30
to be systematically explored. However, our data set and early intervention efforts may provide
insight into this domain.
31
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Table 1. Relevant Demographics and Identifying Information
Families
N = 100:
48% European-American
42% African-American
3% Hispanic American
2% Biracial/Other Ethnic Background
Income: Median = $20,000
55% headed by single parents
53% did not complete high school
51% of mothers were home during fire
49% of mothers were not home during fire
Dwellings: 10% condominiums/townhouses; 25% apartments; 13% trailers
49% own; 51% rent
Degree of Damage: 50% completely destroyed
Dollar Loss: a few thousand to over $100,000
61% of families had minimal insurance coverage
42
Appraisal
Coping Efficacy
Coping
Exposure/Loss
x
Moderators
Demographics
Negative Life Events
Parental Functioning
Family Enviornment
Outcome
Psychological
Distress
Social
Support
43