About our programSince individuals with serious mental illness (SMI) are at high risk of digital exclusion due to low digital literacy, our team created DOORS: a digital literacy training program. DOORS is a community-created, research-backed digital literacy training program that teaches essential laptop and smartphone skills through distinct learning modules, PowerPoints, and handouts. Consisting of eight core learning modules, the program is designed to be hands-on, interactive, and adaptable to a specific person/population. We are grateful for the support of the Sidney R. Baer, Jr. Foundation for supporting this work.
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Teaching and Assessing Digital Literacy
Our lab has created a one page digital literacy assessment called the Technology Use Survey that quickly assesses a client’s baseline digital needs and literacy. We have also created a Module Matching Guide that guides survey results and determines which DOORS modules a client/group would benefit most from. These tools are designed to be delivered before initiating digital literacy training to enable proactive tailoring of the DOORS curriculum.
Digital Navigator Role in DOORS
The primary role of a Digital Navigator within DOORS is to assess and teach digital literacy skills. The DOORS portion of the manual provides the guidance necessary information for a Digital Navigator to conduct DOORS sessions. An outline is provided for each of the eight modules in which a script and tips are provided for conducting a DOORS class. The appendices contain all materials that can be printed and used in a DOORS session. This includes smartphone and computer versions of the session surveys, handouts, and any other worksheets used in each module.
The Need
Amplified by the COVID-19 pandemic, reliance on digital tools to deliver healthcare and participate in research has increased exponentially. Technology use is now recognized as a social determinant of health. While digital tools can increase access to care and expand research methods, individuals in underserved populations, such as people experiencing addiction, are largely “digitally excluded” and subsequently underrepresented in research data that utilizes remote assessments/technology. This phenomenon has been coined “The Digital Divide." To address digital health inequalities and increase the representation of marginalized communities in research, it is important to implement practical programs/solutions that target the fundamental mechanisms of digital exclusion. In a 2024 report, Sit et al., noted that healthcare workers need ongoing education in mental health and digital tools to fully support patients and connect them with additional resources. Our Digital Navigator training aims to bridge this gap between healthcare workers and digital tools to foster digital inclusion for all.
With over seven years of experience running digital equity programs at community sites, our team has gained critical perspective on how to tangibly increase access to digital health resources for individuals in underserved populations. While tele-health, remote monitoring, and digital mental health interventions are the primary avenues for leveraging technology, particularly for individuals with SMI, we recognize there are barriers to accessing these services. Our ultimate goal is to reduce barriers for patients getting treatment for their mental health by helping them meaningfully engage with technology and harness digital tools toward their recovery.
With over seven years of experience running digital equity programs at community sites, our team has gained critical perspective on how to tangibly increase access to digital health resources for individuals in underserved populations. While tele-health, remote monitoring, and digital mental health interventions are the primary avenues for leveraging technology, particularly for individuals with SMI, we recognize there are barriers to accessing these services. Our ultimate goal is to reduce barriers for patients getting treatment for their mental health by helping them meaningfully engage with technology and harness digital tools toward their recovery.
Assessable and Scalable
As digital mental health interventions/assessments gain prominence, it is important to create sustainable digital equity tools that can be shared and replicated at scale. Our Digital Navigator Training, mental health app database (MINDapps), and digital literacy education program (DOORS) are designed for dissemination at scale. To extend the capacity of these programs/solutions and promote uptake by other teams/community partnerships, we have developed training/dissemination materials for each initiative.
Client testimoniesI am overwhelmed by your kindness and generosity. I am an absolute novice who learned from you the initial steps so that I am less intimidated by the technology. They’re tricky, but I am moving forward slowly. Thank you for presenting such an informative and enjoyable course. I was really interested in how you merged health issues with smartphones. I found out that smartphones can really enhance one’s health and mental health. This is good education for people who do AND don’t have a smartphone. Good for all people, disabled or well/healthy. |
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Curriculum Overview
Our multi-session curriculum engages group learning and problem solving to equip participants with digital skills and online resources that are easy to access, appealing to use, and relevant to daily life.
Available for both smartphones and laptops, each session is equipped with slides and handouts.
Available for both smartphones and laptops, each session is equipped with slides and handouts.
Session 1: The Fundamentals
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Module 1 introduces clients to digital technology and its functions in everyday life. This module overviews the anatomy of devices and the basic gestures we use to interact with them. Clients learn how to make their devices more comfortable by adjusting the brightness, changing font size, and adjusting volume. Participants will also learn how to connect to Wi-Fi. Common symbols are introduced and interwoven throughout the session. Any participant who does not currently own a smartphone or laptop is guided through governmental resources to determine their eligibility for receiving a free digital device. This session is integral for teaching clients with low baseline digital literacy, as it develops essential skills for learning more advanced skills in future sessions. The smartphone version of this module teaches participants to make a phone call.
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Session 2: Accessibility
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The second module teaches participants how to customize their devices to accommodate their preferences. This module is inherently more personalized as participants may only be interested in a few specific features. Through group discussion, participants are encouraged to think of a few things they may want to change about their device or that they have previously changed on other devices. Participants are then shown how to find the accessibility settings on their devices. The session guides participants through three categories of accessibility settings: vision, hearing, and interaction. For smartphones, participants are directed to exit the accessibility settings section to access voice typing settings. For computers, participants are directed to additional mouse settings outside of the accessibility section to change the speed of their mouse. The session concludes by asking participants if there is anything else they would like to change about their device. Facilitators may use any leftover time to address those questions and anything that was not covered in the session. This module promotes engagement with devices by removing any barriers clients may face when using their devices.
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Session 3: Navigating the internet and online safety
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The third module teaches participants how to use the internet safely. The session starts with an open discussion about participants’ current internet use. The session then introduces tools for finding information and how to search for topics on Google. To ensure participants can navigate the internet safely, we emphasize the importance of identifying scams. The latter half of the session focuses on common signs of scams and what to do when a message may be a scam. This includes an activity where participants are shown various messages and asked to identify clues signifying whether it is a scam. With these practical tools, they will be better equipped to evaluate online information and messages critically. While the instant access to information provided by the internet encourages engagement and awareness, it also presents risks, such as exposure to scams. Navigating this landscape is key to using devices safely, and this session focuses on building those skills.
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session 4: communicating via messages
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The fourth module focuses on using our devices to communicate through e-mail and text messages. For smartphones, this session begins with discussing what text messages are and how to send one. For laptops and smartphones, participants are first shown the functions and anatomy of e-mail. Participants are then taught how to write and send emails, including common e-mail etiquette and attachments. For smartphones, this also includes learning how to use the camera function on their device to take and send a photo. Those with limited digital literacy skills might not be aware of or feel comfortable using all the social features available on their devices. With few ways to connect with others, participants have a limited ability to initiate social interactions and engage in their communities, which in turn heightens their risk of feeling isolated and lonely. Furthermore, they may be unable to view or respond to important email correspondence, for example, with their medical provider, leading to disadvantages in accessing treatment. This session works to mitigate this disparity and shows participants how they can use their devices to socialize with loved ones and friends in casual settings, as well as more professional written communication.
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session 5: communicating via video call
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The fifth module builds on the written communication skills learned in the last session and teaches participants to make video calls via Zoom and, for smartphones, Facetime. Hands-on activities and ample one-on-one instruction ensure that all participants benefit from these two skills. The session begins with discussing what video calls are and what we can use them for, such as seeing a healthcare provider or contacting loved ones. Then, participants are guided through creating a Zoom account and joining a Zoom call. Participants are also taught the function of the various Zoom buttons and video call etiquette. For smartphones, the session proceeds to teach participants how to make video calls via Facetime for iPhone or Google Duo for Android. This session can be divided into two if the baseline digital literacy of the group is low as both skills are complex and require multiple steps to be completed. This module helps to promote participants’ ability to communicate with professionals and extend their communication means with family and friends, thus expanding their ability to attain employment, receive important notifications, and advocate for themselves.
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session 6: staying organized
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In the sixth module, participants are shown how they can use their devices to manage their responsibilities. The session begins with a discussion centered around daily routines and responsibilities, allowing staff and fellow participants to understand how using digital organization tools might be useful for their day-to-day lives. To sustain engagement throughout the session, it is important that participants feel they are learning about resources that are directly applicable to their expressed needs. Then, participants are shown how to plan an event on Google Calendar or the Calendar app, setting its title, date, time, and whether it is a repeated appointment. For smartphones, the Maps app is then introduced, and participants learn how to reach a desired destination and favorite commonly frequented locations. Lastly, Notes or Google Documents are introduced as a way for participants to write down anything of interest or importance, including to-do lists and journaling. After each resource is discussed, hands-on activities allow participants to gain familiarity with each resource and determine if the resource meets their needs. Access to a device can promote ease of access to a wide variety of organizational tools in an instant. These tools can reduce the burden of needing to remember commitments or daily tasks and allow patients to navigate their surroundings easily and accurately.
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session 7: expanding your knowledge via youtube
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The seventh module focuses on helping patients use the internet to discover and consolidate new skills, as well as for entertainment. This session begins with downloading the YouTube app for smartphones or navigating to the YouTube website for laptops. Participants are then shown how to navigate the YouTube homepage, view their watch history and use the search bar. After opening a video, participants are taught how to use the video player, as well as the meaning of the various symbols. This module provides participants with skills and knowledge to apply to other media players. For laptops, participants are also shown how to make and view bookmarks by having them bookmark a video they are interested in. Platforms like YouTube can help participants seek new skills or review old skills, such as those learned in this course. This session aims to give participants the tools to expand their knowledge and seek entertainment on their own for free.
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session 8: well-being and fun
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The eighth and final module encourages participants to use their devices for well-being and fun in two ways: through patient portals and music-listening platforms. The session begins with a discussion of patient portals, where the benefits of portals and their real-world applicability are emphasized. A hands-on activity facilitates participants’ enrollment in their patient portal. Once participants are signed into their portal, they can navigate to a few common functions. By teaching participants how to use their patient portals, this module aims to increase their access to healthcare services. The second part of the session begins with a group discussion of the benefits of listening to music and how participants have listened to music before. Participants are introduced to Spotify and guided step-by-step on how to sign up for it. Participants are also shown how to play a song and add songs to a playlist. This section wraps up with a discussion of other streaming services participants may be interested in. By showing participants how to use their smartphones to have fun, this session will also promote their engagement and consistent use of their devices after DOORS instruction ends. The session concludes with a discussion of what skills participants have learned, and they are encouraged to come up with goals for the future.
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Please fill out this form if interested in full access to DOORS and receive password
Community Partnerships
The Division of Digital Psychiatry lab at the Beth Israel Deaconess Medical Center (BIDMC) recognizes the importance of communication between all parties to implement any digital equity initiative successfully. We have developed internal communication platforms and techniques that facilitate inclusive discourse and promote real-time program adaptation/improvement. Throughout the program, all stakeholders (patients, community health workers, clinicians, etc.) are encouraged to reach out to an expert member of the Digital Psychiatry team to troubleshoot technical issues, clarify questions, and provide general support.
The overarching goal of this program is to bridge communication gaps and reduce harm and bias by ensuring transparent dissemination of research findings and fostering robust community engagement. By prioritizing thoughtful and ethical communication, the program seeks to effectively share research protocols, findings, and safety measures with the community while centering their voices and needs.
The overarching goal of this program is to bridge communication gaps and reduce harm and bias by ensuring transparent dissemination of research findings and fostering robust community engagement. By prioritizing thoughtful and ethical communication, the program seeks to effectively share research protocols, findings, and safety measures with the community while centering their voices and needs.
Bowdoin street health center
To increase digital equity personnel and staff, our team has employed a full-time Digital Navigator (DN) at Bowdoin St who is stationed there three times per week and has hosted three Digital Navigator Training sessions in which community health workers, clinical staff, patients, peer advocates and other interested parties attended. By educating existing staff on how to increase digital literacy (DOORS) and promote digital health resources (MINDapps), we have multiplied the program's ability to reach distinct community members.
center club boston
Center Club is the oldest and largest clubhouse in New England for people with psychiatric disabilities. Center Club awarded our team the 2023 Public Service Award for our ongoing DOORS groups.
Edinburg genter
The Edinburg Center provides an array of innovative services which promote personal growth and independence, foster hope and enhance the quality of life for the people and communities served. Our team has facilitated Edinburg Center's members in obtaining free digital devices.
Digital Navigator Training
Our team has developed and successfully executed a 1-2 day Digital Navigator Training Program to empower peer advocates and existing health workers to promote digital equity within their communities. A digital navigator is a “member of the clinical team, whose goal is to support the uptake and implementation of technology into care”. While the digital navigator role is flexible in nature, different iterations include teaching digital literacy, connecting patients to online resources, and troubleshooting technology. Designed to be an introductory level role in healthcare, it leverages the innate technological knowledge of young people and expands the digital equity workforce. Of note, no formal degree is required to be a digital navigator, further reducing barriers to expanding the mental healthcare workforce.
Training Materials
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We have created a Digital Navigator training manual that compiles all the materials associated with the Digital Navigator role developed by our lab. The manual includes: how to assess digital literacy and run digital literacy sessions (DOORS), how to run a virtual Digital Clinic, and an in-depth explanation of the MINDapps app rating framework and how to navigate the database with clients/patients.
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Full Access to DOORS Materials Request
Please fill out this form to request full access to our DOORS program materials (manual, slides, handouts, etc...)
Relevant Publications
Alon, N., Perret, S., Cohen, A., Partiquin, M., LeMelle, S., Boyd, C., Aguilera, J., Reat, C., Hough, E., Walsh, J., Dwyer, B., Hogan, J., Smith, A. H., & Torous, J. (2024). Digital Navigator Training to Increase Access to Mental Health Care in Community-Based Organizations. Psychiatric services (Washington, D.C.), 75(6), 608–611.
Alon N, Perret S, Torous J. Working towards a ready to implement digital literacy program. Mhealth. 2023 Sep 4;9:32. doi: 10.21037/mhealth-23-13. PMID: 38023777; PMCID: PMC10643183.
Camacho, E., & Torous, J. (2023). Impact of Digital Literacy Training on Outcomes for People With Serious Mental Illness in Community and Inpatient Settings. Psychiatric Services, 74(5), 534–538. https://doi.org/10.1176/appi.ps.20220205
Rodriguez-Villa, E., Camacho, E., & Torous, J. (2021). Psychiatric rehabilitation through teaching smartphone skills to improve functional outcomes in serious mental illness. Internet Interventions, 23, 100366. https://doi.org/10.1016/j.invent.2021.100366
Hoffman L, Wisniewski H, Hays R, Henson P, Vaidyam A, Hendel V, Keshavan M, Torous J. 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. J Psychiatr Pract. 2020 Mar;26(2):80-88. doi: 10.1097/PRA.0000000000000450. PMID: 32134881; PMCID: PMC7135933.
Alon N, Perret S, Torous J. Working towards a ready to implement digital literacy program. Mhealth. 2023 Sep 4;9:32. doi: 10.21037/mhealth-23-13. PMID: 38023777; PMCID: PMC10643183.
Camacho, E., & Torous, J. (2023). Impact of Digital Literacy Training on Outcomes for People With Serious Mental Illness in Community and Inpatient Settings. Psychiatric Services, 74(5), 534–538. https://doi.org/10.1176/appi.ps.20220205
Rodriguez-Villa, E., Camacho, E., & Torous, J. (2021). Psychiatric rehabilitation through teaching smartphone skills to improve functional outcomes in serious mental illness. Internet Interventions, 23, 100366. https://doi.org/10.1016/j.invent.2021.100366
Hoffman L, Wisniewski H, Hays R, Henson P, Vaidyam A, Hendel V, Keshavan M, Torous J. 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. J Psychiatr Pract. 2020 Mar;26(2):80-88. doi: 10.1097/PRA.0000000000000450. PMID: 32134881; PMCID: PMC7135933.
