Digital Opportunities for Outcomes in Recovery Services (DOORS): A Pragmatic Hands-On Group Approach Toward Increasing Digital Health and Smartphone Competencies, Autonomy, Relatedness, and Alliance for Those With Serious Mental Illness

Abstract

Digital health technologies such as smartphones present the potential for increased access to care and on-demand services. However, many patients with serious mental illnesses (eg, schizophrenia) have not been offered the digital health training necessary to fully utilize these innovative approaches. To bridge this digital divide in knowledge and skills, we created a hands-on and interactive training program grounded in self-determination theory, technology use cases, and the therapeutic alliance. This article introduces the need and theoretical foundation for and the experience of running the resulting Digital Opportunities for Outcomes in Recovery Services (DOORS) group in the setting of 2 programs: a first-episode psychosis program and a clubhouse for individuals with serious mental illness. The experience of running these 2 DOORS groups resulted in 2 publicly available, free training manuals to empower others to run such groups and adapt them for local needs. Future work on DOORS will expand the curriculum to best support digital health needs and increase equity of access to and knowledge and skills related to technology use in serious mental illness.

Physical health among people with serious mental illness in the face of COVID-19: Concerns and mitigation strategies

“…The use of smartphones to allow for video telehealth and for the use of mobile health tools to support emotional well-being and chronic disease management may be impeded by poor digital literacy and cognitive challenges. Recent advancements such as the Digital Opportunities for Outcomes in Recovery Services (DOORS) program [ 46 ] may overcome digital literacy gaps in this group and are key to successful use of digital health tools that aim to better physical health. Lastly, equitable access to smartphone and internet services are urgently needed to ensure people with SMI are not left behind when health systems adopt telehealth during and following the pandemic [ 22 ].…”

Psychiatric rehabilitation through teaching smartphone skills to improve functional outcomes in serious mental illness

“…Past iterations of DOORS have focused on wellness goals. Grounded in SAMSHA's Eight Dimensions of Wellness Model, the lessons taught participants how to use their smartphone towards these interconnected yet broad aims ( Hoffman et al, 2020 ). DOORS was run with a total of 8 groups in diverse settings from first episode psychosis programs to clubhouses offering care to patients with a range of psychiatric conditions.…”

“…To facilitate cumulative learning, DOORS has been adapted since its inception, detailed in Hoffman et al (2020) , to include eight distinct sessions. Each session centers around a theme or category related to phone use.…”

“…Digital Opportunities for Outcomes in Recovery Services (DOORS) is a digital literacy intervention designed to improve functioning among patients with SMI through introducing participants to smartphone skills in a group setting ( Hoffman et al, 2020 ). Social learning targets negative symptoms related to social drive and interest, and practicing using smartphones to make phone calls and send text messages, store contact information, write emails, and access online peer support makes building and maintaining relationships easier.…”

Videoconferencing-Based Telemental Health: Important Questions for the COVID-19 Era From Clinical and Patient-Centered Perspectives

“…Social determinants of health, such as cultural expectations about technology, digital literacy, economic factors, and comorbidities that affect the use of technology, may perpetuate inequalities [ 80 ]. Programs, such as the Digital Opportunities for Outcomes in Recovery Services (DOORS), have been developed to address low digital literacy in patients with serious mental illnesses [ 81 ]. This interactive training program helps patients learn safe smartphone usage, use technology to build wellness habits, and learn new skills through web-based resources.…”