NSW Statewide Brain Injury Telepsychiatry Service: A consultative telepsychiatry service model for people with brain injury in rural and regional New South Wales

The intervention is an ongoing consultative telepsychiatry service designed to improve access to specialist neuropsychiatric assessment and management for people with traumatic brain injury (TBI) living in rural and regional New South Wales. The service is implemented as an ongoing model of care rather than a time-limited intervention with a fixed number or frequency of consultations. Participants enrolled in the research study will undergo research assessments at baseline and 12 months; however, the frequency and timing of telepsychiatry consultations will be determined by individual clinical need. Telepsychiatry consultations are delivered via secure audio and video conferencing using an approved videoconferencing platform. Each consultation is led by a consultant psychiatrist, with participation from psychiatry trainees or registrars where relevant, and local clinicians involved in the participant's care. Consultations involve comprehensive clinical assessment, diagnostic clarification, medication review where appropriate, risk assessment, and collaborative development of management recommendations. Consultation duration will vary according to clinical complexity and individual need. The model prioritises consultation, shared care and capacity building. Specialist advice and recommendations are provided to support ongoing management by existing local treating teams rather than replacing these teams. Participants may receive one or more consultations during the 12-month study follow-up period, with any further consultations arranged according to clinical need. The overall telepsychiatry service will operate on an ongoing basis throughout the implementation and evaluation period. Delivery of the intervention will be monitored through routine service records, including referral, appointment and consultation records. These records will be used to document service utilisation, including the number and timing of consultations delivered, attendance at scheduled consultations, and whether consultations were completed or cancelled. As this is a clinically responsive service, adherence is assessed primarily through service engagement and uptake rather than completion of a predetermined number of sessions. The intervention also incorporates embedded education and workforce development activities for clinicians involved in the care of people with TBI and other forms of acquired brain injury (ABI). These activities are integrated into routine service delivery and are intended to build local knowledge and capacity in recognising, assessing and managing neuropsychiatric and behavioural presentations following brain injury. Education may include case-based discussion, clinical consultation and feedback, discussion of assessment and management approaches, and knowledge sharing regarding relevant neuropsychiatric presentations, risk assessment, diagnostic considerations and treatment strategies. Education and workforce development are delivered primarily through the telepsychiatry consultation process and associated case-based interactions between the consultant psychiatrist, psychiatry trainees or registrars, and local clinicians involved in participants' care. Additional education activities may be provided where appropriate as part of service implementation. These activities do not constitute a separate fixed training programme with a prescribed number of modules or sessions; instead, they occur on an ongoing and needs-responsive basis throughout implementation of the telepsychiatry service. The education component is led by the consultant psychiatrist, with involvement from psychiatry trainees or registrars as appropriate. It is directed primarily towards local clinicians and interdisciplinary teams involved in participants' ongoing care, although psychiatry trainees or registrars participating in consultations may also benefit from the embedded learning opportunities. Educational materials or resources may be shared where clinically relevant; no compulsory homework or standardised independent learning activities are required. Participation in embedded education and workforce development activities will be monitored through routine records of consultation attendance and, where applicable, attendance records for additional education sessions. The education component occurs concurrently with implementation and delivery of the telepsychiatry service and is embedded throughout the ongoing service model. Approximately 20 clinicians from brain injury medical and interdisciplinary support teams will also be invited to participate in qualitative interviews as part of the evaluation of the service, rather than as a component of the intervention itself. These interviews will explore clinicians' experiences and perspectives regarding implementation of the telepsychiatry model, including perceived accessibility, feasibility, acceptability, clinical utility, barriers and facilitators to implementation, and the impact of the service on local clinical capacity and care. Each clinician will participate in one online survey or semi-structured interview (depending on preference) of approximately 30 minutes. Interviews will be conducted with clinicians involved in, or affected by, implementation of the service and will occur during and/or following the implementation period. Participation and survey/interview completion will be documented for research purposes. These interviews do not provide training or form part of the clinical intervention. Participants will receive care through the telepsychiatry service as part of the implementation and evaluation of this model. Research outcomes will be assessed at baseline and 12 months and will examine service accessibility, feasibility, clinical impact, user experience and implementation outcomes.