Everyone has an inner RAINBOW

Hey all,

Back in graduate school, I completed my dissertation on Multicultural Identity Development. My chair, Dr. Mark Rosenblatt urged me to create my own minority identity development model. But at that time, it seemed like an overwhelming task and I was too scared of thinking outside the box. So, I attempted to improve someone else’s work. Dr. Pamela Hays had already come up with the very thorough: ADDRESSING Model. Using the word ADDRESSING as a mnemonic, each letter represents a category of social diversity. Here is her work:

Age

Developmental and acquired Disabilities

Religion

Ethnicity

Socioeconomic status

Sexual orientation

Indigenous heritage

National origin

Gender

Like I said, for the time (this was 10+ years ago) it was very inclusive. However, I saw few ways in which it could be expanded to incorporate LGBT+ people. Therefore, for my project, I simply expanded a few items within her existing framework.

Here is Chandler’s LGBT+ Adapted ADDRESSING Model:

Age & Generational influences

Disorders

Disabilities

Religion & spiritual orientation

Ethnicity, race & Culture

Socioeconomic status & education

Sexual identity (see chart)

Ideology

Nationality & Indigenous heritage

Gender identity (see chart)

---

Also, I expanded the Center for Gender Sanity’s Diagram of Sex and Gender:

Here’s a slightly expanded model, called:
Dr. Chandler’s Complete Sexual Identity Model:

You can also see it referenced in this YouTube video, or in the embedded video at the bottom of this post…

For many years after graduation, I was presenting those expanded ADDRESSING & Sexual Identity Models to encourage corporations, agencies, therapists, and individuals to be more inclusive and accepting of diversity all over the country.

Then, a day after presenting at the Southern PFLAG Conference in New Orleans, it hit me. Here I am presenting this wonderful information but highlighting other people’s work. I revisited the idea of coming up with my own model. Once I sat down, I realized it was right in front of me, all along. The categories are similar to Dr. Hays’ work. BUT, I MADE MY OWN MODEL:

Chandler’s RAINBOW Model (of course, that’s the name!)

Race: ethnicity, culture, family structure and spoken/written language(s)

Age and generational influences

Inherent and Acquired Disorders, Diseases and Disabilities: physical, neurological, mental, psychological, emotional, and behavioral

Nationality & Indigenous heritage: immigration status

Belief systems: religion, spirituality, political ideology, how you perceive others, the world and yourself

Orientation: complete sexual identity including: sex, gender identity, gender expression, gender expression attraction, practices, and sexual identity (see chart above)

Work status: socioeconomic status, education, employment/career, class, housing, safety, food security, life experience and income level

There you have it! Chandler’s RAINBOW Model in a nutshell. It is a handy mnemonic to trigger each category of diversity. Further, it is a way to do some much needed introspection about our privileges, biases, and stigmas. Just like with people, when utilized correctly there are no 2 RAINBOW’s alike. Once you’ve had a chance to identify, understand and accept your RAINBOW, you can begin working towards positive changes of accepting other’s RAINBOWs.

Watch my latest training for more information and as always, sharing is caring!!

Dr. Jon Chandler

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Your Kid’s a Liar

In today’s political climate, it seems everyone lies. They even have a website to show just how much each presidential candidate actually lies. So, you are probably wondering why people lie and if there is ever a good time to lie? The answer is a little more complicated than you might think. See, none of us are perfect. We cannot expect our children to be, either. If you want your child to be more like Hillary, Barack, and Bernie, and less like Trump, Pence, and Ryan… keep reading.

Liar, Liar Pants on Fire

First let me say,  ALL kids lie. But everyone lies for different reasons. Yes, there are reasons people lie and if we can figure out the WHY, we can usually nip it in the bud. Some children with ADHD, ODD, and other behavioral disorders lie as a symptom of their disorder. That is not to excuse the behavior, it is just a reality. Their tendency to make mistakes has them thinking they need to cover it up — kids with these issues are especially prone to fibbing. How should you respond when you catch your children in a lie? The most important thing you can do as their parent is to be proactive, not reactive. I’ll expound on this more later. Use the tips below to help your child recognize the importance of telling the truth, and nothing but the truth.

Lying, a mental health symptom?

The impulse to tell lies does not make your kiddo a bad person, nor is it evidence of a character flaw. They are not inherently bad, so don’t start picturing their future jail cell. It can be a byproduct of ADHD, or ODD, or Bipolar Disorder. But as with other symptoms of these disorders, it usually improves with medication. But even with pharmacotherapy, your kid may need some extra coaching to understand the importance of telling the truth.

Make Consequences Clear & Consistent

Some kids tell lies out of feelings of insecurity, concocting fanciful stories in an effort to make themselves seem cooler to other kids. If this is your kid’s reasoning, punishing them could be counterproductive. Instead, make sure they understand what will happen if they get caught in a lie. The downside of telling a lie — even a really small one — may be obvious to us, but kids need to be reminded that lying usually causes more problems than it eliminates.

Teach the 1-2-3 Method

If your kid suffers from any of the disorders we mentioned earlier, they may be prone to blurting out answers to questions. Because they have not thought out the question, the “answer” could range from semi-true to liar-liar-pants-on-fire. Teach them they do not need to be the first one to answer and the answer does not have to be instant. Have them think about the question as they count to 3, “1, one thousand, 2, one thousand, 3, one thousand.” If they come up with the correct, truthful answer, they may answer the question. This is ensuring your kid knows that answering truthfully and accurately is more important than a timely response. 

Be Proactive, not Reactive

If your child says something you know to be untrue, stay calm. Reacting angrily, or with obvious dismay, or disgust, will only make your child feel the need to tell additional lies to defuse the situation. This is actually a survival technique. They fear they are in danger (not that you have beaten them but that they are in trouble) and want to get out as quickly as possible. Be proactive. Give them a free get-out-of-jail card by allowing them another chance to come clean without repercussion.

KidiFact

Give your kid the opportunity to reconsider their answer. Allow them one free get-out-of-jail card with another chance to come clean without consequences. “I’m not sure that’s exactly how things went. Do you want to try again? You get 1 free do-over…” This teaches children to 2nd-guess a misleading answer.

Honesty is Always the Best Policy

You will notice that children often lie to cover up mistakes, or misbehavior. This can be tempting to hand down a bunch of consequences. But working towards increasing positive behavior, studies show, is more reinforcing. Therefore, “catch them being good” and reward them for their honesty. This will make it more desirable to tell the truth, thereby decreasing dishonesty.

Teach Acceptable Lies

Explain the socially appropriate use of very small lies to prevent undue harm to others. For example, if they received a gift they did not like from someone in their class. Ask which response they would most likely give:

A. “Aww man.”
B. “I don’t like that kind of toy.”
C. “Thank you for the thoughtful gift.”

If your child (naturally) picks C, give them a high five! Be sure to explain why that was the correct choice for the situation. If they answer with A or B, explain how the friend’s feelings might be hurt. Furthermore, that it is not harmful to lie to save someone’s feelings in certain social situations. Emphasizing that this is the only acceptable exception.

Let’s Review, when your kid lies:

1. Stay cool
   -Understandably, it’s hard to stay calm when it seems so easy for your kid to lie. Especially, right to your face!! Rather than taking it personally, remember their behavior is about them, not you! If you constantly lecture, or lose your cool, your child will not feel safe to tell the truth. Recall how their survival instinct kicks in.
   
2. Get to the Root of the Problem
   -Lying isn’t the real issue, we all lie for a reason. We may not agree with their reason but we have to understand it made sense to them. Kids with behavioral disorders tend to lie to cover up what they view as shortcomings. They usually have an unwavering desire to be normal. If we can make them feel normal about some of their faults, they will be more honest with us. Additionally, if we can improve their impulse control, they will not feel the “need” to lie.
   
3. Level with Them 
   -Say, “Jackson, I know you fibbed because you made a mistake and wanted to cover it up. You might have felt like you were out of control, so you panicked and made up a tall tale. I’m not angry with you – I want to help. Just so you know, your lying does not make me love, or like you any less, but it does mean I will have a hard time trusting you. I’d like to give you a chance to earn it back. But this is a one-time deal.”
   
4. Come up with a Safe Word
   -We already talked about how giving a consequence for every lie won’t change things in the long run. Kids do not always know how we are going to respond when they tell us of their errors. If you remain calm and open no matter what your kid says to you, they will likely tell you everything. Even things you probably could have lived your whole life without knowing. LOL. So, in my house we say “Sesame” to signal someone is about to open up and we might not like what comes out.

Page 2-Medical Apps that Save Time & Lives

Take a look at RxP’s 2nd page of apps:

The following Medical apps are listed:

• Interactions: UPDATE-Don’t bother, already removed from iPhone!
  • When I started making these reviews, I decided to clean it up a little. So I deleted Interactions and a few other apps. Interactions started out being a pretty easy to use, bare bones, drug interaction check. However, an update (or lack there of) made it where you can only search generic medications. Additionally, I don’t trust that it is entirely accurate in its findings. I wouldn’t even bother with this one. See below:
    

    

    

     

    

• WebMD:
  • Now, I’m sure almost everyone (whether you are in the medical field, just curious, or a hypochondriac) has heard of and probably uses WebMD on a regular basis. It’s a great app and comes in handy when a patient tells me they have a rare disease, or medical disorder. Helps the user with Symptom Checker, Med Reminders,  Conditions, Rx, First Aid Info, Local Health Listings, Medical terms, and Tests and Procedures.
  • Also, from the link above you will find every WebMD app available. WebMD Pregnancy & WebMD Baby were particularly helpful when my wife was pregnant and we had our son!
  • **Bonus: They recently teamed up with Walgreens to allow a quick scan of your bottle to refill, or transfer meds to your nearest Walgreens, right inside the app! Of course, you could use the Walgreen’s app for a few more features.
    

    

     

•   MDLinx Oncology Articles:
  • I realize Oncology articles, while interesting, seem unrelated to psychology, or medical psychology. However, I decided to download this app in order to learn more information about cancer and their treatments because #CancerSucks. Furthermore, I currently have patients (and friends) in recovery from various forms of cancer. This app provides access to the latest medications, treatments, and trials.
    (Dedicated to my buddy, Scott, who lost his battle to cancer in 2014.)
  • For a bonus, go over to MDLinx.com was extremely helpful when I was studying for the Medical Exam (PEP). It gives you a free, board-like examination to prepare for whatever board you are taking. They are the same makers of The Smartest Doc board prep, just select your specialty and voila! You’re on your way to a few practice tests.
• Psychiatry: UPDATE: Don’t bother with this one, either.
  • This app is pretty limited. I only realized that after I downloaded it. It wants you to buy the videos? I was initially curious but that is gone, now. I will likely delete this one, as well.
    

    

• LactMed:
  • This app has come up recently on the LAMP (Louisiana Academy of Medical Psychologists) listserv. At times during our practice, we have a patient who becomes pregnant, or a new patient comes in with pregnancy-onset depression, or with post-partum depression, or psychosis. Therefore, we have a dilemma of wanting to help the patient maintain, or gain their stability while not endangering the fetus/child. The reality of it is that there just aren’t that many studies done with pregnant women and psychotropic medications. You can guess why that may be… who wants to put their unborn child at risk? That said, the studies that have been conducted have mixed results. Therefore, the FDA assigns a category based on how the medication has been (and if) studied and their effects, see below:
    
  • Therefore, a prescriber has to weigh the risks vs. the benefits (Risk-Benefit Ratio) and analyze the situation with the patient in order to come to a consensus about whether to continue with the current medications, change to “safer” medication(s), or taper off all medication(s). This can apply when the mother is breastfeeding, as well. As some medications will pass through the mother’s milk. LactMed provides a lot of valuable information to assist with the decision process.

    

    

    

    
    

    

    

    

    
    

     

• Mango Health:
  • Now, this app is cool. It’s extremely user-friendly so I frequently recommend it to patients to set reminders for their medications. Especially, those who are required to take their medication(s) more than once per day and/or take multiple medications. It uses a “token economy” (a Cognitive Behavior concept) to reward you when you take your meds! Highly effective when dealing with teens and other non-adherent patients.
    

    

     

    Stay tuned…

• Psychiatry Lite
• NCSBN’s Rx Flashcards
• Mastering Psychiatry

Medical Apps that Save Time and Lives

Yesterday, I told you about Epocrates. It has been a god-send since I started using it. **See my original post to see what I like and dislike about that particular app**

Today, I want to tell you about a few (okay a lot of) other medical apps I use on a regular basis. Most of them are free, so why not?! Here are some screenshots of my iPhone’s RxP (Rx=Medical Psychologist) Medical App folder.

From this

As you can see, I have collected quite a few. I would say they are pretty much in order of importance from left to right screenshots. Inside each screenshot, I tend to position the apps I use more frequently in the middle and corners. Don’t ask me why, it’s just how my brain works. (And yes, that’s my little boy in my background image. He just turned 1!)

The 1st page (far left screenshot) you will see:

• Rx Shortages:
  • This is extremely useful when you are attempting to prescribe a slightly rare medication because you can save yourself  and your patient a lot of time (and money) by making sure there is not a shortage in your area. A little more user-friendly than theFDA Drug Shortage app listed below.

    

• Epocrates:
  • See my previous post about why I use Epocrates on a daily basis.
• FDA Drug Shortages:
  • Similar to Rx Shortages but shows a slightly different view of drug shortages in your area and is run by FDA. That is both a blessing and a curse, as it is both exhaustive and cumbersome.

    

• About Herbs: or Herbal Guide on Google (Disclosure: I have not used, yet!)
  • This used to be a great app but is currently buggy and I can’t even open it, at the moment. Ugh! When it was working, it showed most OTC herbal remedies that can be used for mild (to moderate) mental health issues.
• MPR:
  • Basic, but user-friendly and free.
• Formulary: At quick glance there does not seem to be an equivalent Google app (please correct me if I’m wrong.)
  • A very useful app for checking if a particular insurance will approve a medication you are thinking about prescribing. This is extremely important for working with patients with Medicaid! (About 95% of my caseload.) Downfall is that it is not always 100% accurate.

    

• MobilePDR:
  • This is a highly useful app and competes with Epocrates pretty well.

    

• LabGear: (there are a few Lab Value app on Google but I have not tried any.)
  • This is one of the only apps for which I paid. It was a whopping $2.99, or you can bundle it with a few other Medical apps to make each one cheaper. I highly recommend purchasing it as it is invaluable when analyzing Lab Values and explaining them to your patient.

    

• PocketRx:
  • This is app is pretty cool. It’s a lot like the MobilePDR, MPR, and Epocrates. However, what I think sets it apart is the ability to have make a “Med Box.” In the med box, you can add your Patient’s medications. It will show you: Interactions, Precautions, and Side Effects. That’s not even the best part! It will also save the profile for later reference. That is a huge time saver!
    

    

    

    Click the Back button to go the Epocrates Review. Or if you’re ready to see the Next page of Medical Apps, press NEXT!

    

Q: What’s the difference between a psychologist, a psychiatrist and a medical psychologist?

Haha, there has to be a joke in there somewhere!!
But, for real, this is a common question I’m asked when I tell people about the psychopharmacology program.

A: The simple answer is:

“not very much” and “a whole lot” …read on.

A: The complicated answer is:

A psychologist has a minimum of the following:

• BA in clinical psychology, sociology, or related field
• MA in psychology (can be obtained interim)
• Supervised by licensed clinician for 1500 pre-doc hours
• Doctorate in psychology (Either PsyD, or PhD, EdD, etc.)
• Sup. by licensed psychologist for 1500 post-doc hours
• Successful passing of the National Exam
  • In the United States that is the Examination for Professional Practice in Psychology, or EPPP
• Successful passing of the State Ethical Exam
  • In California it is the California Psychology Supplemental Examination, or CPSE
• Accepted application and initial fee to State of licensure
  • California Board of Psychology, or CA BOP

source: 
Please also refer to my other post discussing the requirements that a licensed psychologist must meet prior to licensure.

A psychiatrist has a minimum of the following:

• BA in psychology, or a related field
• MD from medical school completion
• Residency completion
• The United States Medical Licensing Examination USMLE is a multi-part professional exam sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME)
• Passing of the State medical board
• Accepted application and initial fee to State of licensure

sources: 
-Cloud, J. (2010). Psychology vs. Psychiatry: What’s the Difference, and Which Is Better? Time.  
-http://www.usmle.org/ 

Okay, here is where it gets a bit confusing…

A Medical Psychologist can be a:

1-highly trained and licensed psychologist
WHO CAN PRESCRIBE PSYCHOTROPIC MEDICATIONS: 

• With a Postdoctoral Master of Science in Psychopharmacology
• Licensed psychologist by the Louisiana State Board of Examiners of Psychologists 
• Licensed Medical Psychologist from the Louisiana State Board of Medical Examiners
• Who prescribes psychotropic medications with consultation for the 1st 3 years, in Louisiana

OR

2-highly trained and licensed psychologist
WHO CANNOT PRESCRIBE ANY MEDICATIONS 

• With a Doctorate in Psychology
• Board Certified Speciality from the American Board of Psychological Specialties, 
  • A Division of the American College of Forensic Examiners

sources:
upon request.

CONCLUSION:
The lines between psychiatry and medical psychology are becoming blurred. Though, they are admittedly VERY different fields with different qualifications and degrees. It is this author’s belief that the blur happens from a variety of sources: depictions on television and other media outlets, misinformation, miseducation, interpretation and perception. But, the most important blur is occurring due to the nation-wide scarcity of prescribers, in general! You may have noticed the increasing amount of Nurse Practitioners, Physician’s Assistants and dun-dun-dun-dun-duuuuun… Medical Psychologists!

Some people prefer to call a psychologists who can prescribe a “prescribing psychologist” in Louisiana, New Mexico, Guam, Native American territories, and some state and Federal departments (currently the only places said professional can prescribe.) Makes sense, but in Louisiana, many entities, (including the ones who license folks) call a psychologist who can prescribe psychotropic medications a “medical psychologist” even using the suffix “MP.” ex-Jen Chandler, PsyD, MP

Other similar names have popped up over the years, including: psychopharmacologist, pharmacopsychologist, pharmacology psychologist, psychology pharmacologist, prescribing psychologist, RxP, and as discussed medical psychologist. In my opinion, the varying names for this practice may highlight the general disorganization of the field of psychology. Historically, we have not been our own best advocates…

Hope this clears up some misinformation, or confusion. Thanks for reading.

Sharing is caring,
Dr. Jen Chandler

I started this blog because…

I want to hold myself and other  colleagues accountable for learning and implementing the material we are learning in our Post-doc Master of Science in Clinical Psychopharmacology so that we will pass the Psychopharmacology Examination for Psychologists (AKA PEP) the first go-round.

Here is a brief introduction to what the heck all that means!

A Post-doc Master of Science in Clinical Psychopharmacology is a post-doctoral degree that can only be obtained when the following prerequisites have been met:

• Licensed clinical psychologist
  • BA in clinical psychology, sociology, or related field
  • MA in psychology (can be obtained interim)
  • Supervised by licensed clinician for 1500 pre-doc hours
  • Doctorate in psychology (Either PsyD, or PhD)
  • Sup. by licensed psychologist for 1500 post-doc hours
  • Successful passing of the National Exam
    • In the United States that is the Examination for Professional Practice in Psychology, or EPPP
  • Successful passing of the State Ethical Exam
  • In California it is the California Psychology Supplemental Examination, or CPSE
  • Accepted application and initial fee to State of licensure
    • California Board of Psychology, or CA BOP
• Preferred to be actively practicing as a psychologist
• Time, dedication and money for the course work ahead
• Passing of the Psychopharmacology Examination for Psychologists, the PEP
  • In Louisiana, it is required to become licensed as a psychologist and medical psychologist, and
  • Consult with a medical doctor, psychiatrist, or medical psychologist for 3 years

I hope this gives you a helpful introduction to the field of medical psychology, prescribing psychology, psychopharmacology, or otherwise known as pharmacopsychology — more on this next time!

Thanks for reading!
Sharing is caring,
Dr. Jen Chandler

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