Boston Medical Center’s Immigrant and Refugee Health Center (IRHC) is adding another facet to its mission, “until immigration status no longer affects health”: training current and future practitioners in the areas of culturally responsive care and trauma work. At the helm is Training Director Sandra Mattar, PsyD. While her role may be new, Mattar is a seasoned expert in trauma- and culturally-informed mental health care whose breadth of experience spans two decades. From developing coursework in trauma psychology and supervising students of the Center for Multicultural Training in Psychology to serving as a founding member of the Division of Trauma Psychology at the American Psychological Association (APA) and co-authoring the APA’s Race and Ethnicity Guidelines in Psychology, Mattar’s career has been rooted in a deep commitment to patient-centered care and health equity—key attributes to the program she leads at the IHRC.

Mattar recently sat down with BMC’s Office of Development to discuss what her role as training director entails and how it elevates the IRHC’s commitment to delivering hope, healing and the best, whole-person care possible to refugees, immigrants and asylum seekers.

Boston Medical Center (BMC): Can you tell us about your background as it applies to being the training director for the IRHC?

Sandra Mattar, PsyD (SM): My strength is around training—not only around trauma, which is necessary at the clinic—but also on how to be a culturally responsive provider. This role is perfect for me because not only do I enjoy supervising, but it brings together my expertise in trauma and multiculturalism. I’d like to share that with as many students as I can.

I am very familiar with the psychology of immigration and the psychology of being an exile—moving from one place to another, being uprooted, the idea of belonging, the idea of acculturation (defined by the APA as “the processes by which groups or individuals adjust the social and cultural values, ideas, beliefs and behavioral patterns of their culture of origin to those of a different culture”). I am familiar in part because I am an immigrant myself and I am the daughter of Lebanese immigrants in Venezuela. I grew up with an understanding of what it means to be the “other.” That made me very interested in the psychology of immigration and acculturation.

I also have an interest in psychological trauma—trauma has a significant impact on people’s lives and diagnoses are often more related to trauma than anything else. The population we work with at the Immigrant and Refugee Health Center has a lot of history around trauma. Most of the people we see are victims of torture. And they are not only victims of what’s traditionally known as torture, they’re victims of torture in other ways. For example, in Central America, there are gang-related threats and killings which is a form of torture.

BMC: Why is this role so important for IRHC patients?

SM: Working with refugees requires very specific skills because you have to learn about the psychology of immigration, the psychology of acculturation and the psychology of becoming an exile. You have to be very trauma-informed since a majority of patients are diagnosed with post-traumatic stress disorder. Training to be the best providers for patients is not just about providing care at a hospital. It requires an understanding of the entire context of their lives, like how federal policies could impact them.

Also, there is a concern of secondary trauma or vicarious trauma for providers. It’s not easy to work with this population. You’re hearing about stories of torture every day—it’s emotionally draining and can impact one’s view of the world and leave them feeling numb. Providers need to learn special skills to learn how to recognize and process these experiences.

BMC: What are your objectives as training director?

SM: What I would like to see is to see is a goal-oriented and systemized approach toward developing specific skills to work with refugees—particularly trauma-informed care and cultural responsiveness as well as self-awareness and how to avoid vicarious trauma. Ultimately, this will benefit our patients. Appropriate care is not just a simple mental health care—it is focused on refugee work, on trauma work and on cultural work.

BMC: How does training our providers in this manner contribute to health equity?

SM: Generally speaking, providers are trained according to a biomedical model—they are trained to diagnose and treat the diagnosis. That creates “tunnel vision” where they’re not seeing or understanding the entirety of a patient nor their lives. However, especially with this population of patients, the power of connection is vital—it can be healing, nurturing and positive for the patient. Having the cultural skills to engage the patient affords a “golden moment” that translates into the patient coming back [for their care] or adhering to treatment. If that doesn’t happen, it can create huge health disparities.

The questions become, ‘How do you train people to trust the provider? How do you work with a patient so that they can trust you?’ I aim to train my students to understand the patient’s context and how to align their own cultural variables with the patient’s cultural variables so they can connect. Through that connection, they can build trust.

BMC: What are some other ways the IRHC is integrating cultural responsiveness?

SM: We can be more culturally responsive by having more contact with the community and engaging patients in more decisions we make as a hospital. For those reasons, we are developing patient advisory council at the IRHC. These are patients who have already been through treatment, are doing really well and can provide an invaluable perspective to us in terms of how we’re doing. Giving them the respect they deserve by being part of this council is a great example of being committed to the patient and changing the way we operate at the clinic based on patient (or former patient) feedback.

BMC: What does a “day in the life” look like for trainees?

SM: Trainees spend two days a week at the clinic: One day is for seeing patients and the other is for supervision with me and [Lin Piwowarczyk, director of BMC’s Boston Center for Refugee Health and Human Rights]. They are involved with presenting and assigning new clinical cases. They also learn an important skill unique to caring for refugee patients: how to write clinical affidavits. These outline a patient’s history and diagnosis as it pertains to why they are seeking asylum. The report carries a lot of weight in a judge’s decision whether to grant asylum or not.

BMC: Can you share a bit about some of your latest work?

SM: We recently started an anti-racist series where we do training around how to be more culturally responsive and how to engage in self-awareness. We will be doing work on vicarious trauma and how to recognize it in order to prevent burnout.

In addition to supervising their work and training them how to work with refugees, it’s also very important to me to help develop trainees’ careers. When I write papers, students are co-authors. We just submitted our proposal for the North American Refugee Conference, which is one of the most important global conferences around refugees and our proposal was accepted. Three of my students and I will be presenting at the conference. We are also in the process of submitting a scholarly article about how to do training in refugee clinics.

BMC: What has been a rewarding moment in your work with the IRHC so far?

SM: A client used a metaphor about his life in the United States where he said it feels as if he’s jumping from a plane with a parachute but he doesn’t know what it’s going to be like when he lands. He said he is supposed to feel happy, like everyone when they touch the ground, but he can’t still see that yet. I told him that he will get there because he’s chosen to trust and have faith in me and everyone at the IHRC. We’re able to give him— and all our patients—hope that they will land on their two feet.