Clinical Training

During the first year, CAP fellows gain experience in several diverse clinical settings, including a state psychiatric hospital, Duke University Hospital, psychotherapy training (family therapy and individual cognitive behavioral therapy), and exposures to various outpatient clinics. Each year is divided into eight blocks, which are six or seven weeks each. 

Central Regional Hospital (Inpatient)

First-year CAP fellows rotate on child and adolescent units at Central Regional Hospital (CRH) in Butner, North Carolina. One of three state psychiatric inpatient facilities in the state, CRH serves a broad range of patients and their families from central and coastal North Carolina. At CRH, multidisciplinary teams comprising physicians, psychologists, social workers, nurses and behavioral specialists collaborate to treat children and adolescents. 

First-year fellows spend roughly one-half of their time working with latency-age children and one-half working with adolescents. Trainees work with patients with autism spectrum disorder, gender dysphoria, early onset psychosis, complex chronic medical problems and complex psychosocial problems, as well as mood and behavioral disorders.

Fellows work at CRH part time for two blocks.  A typical schedule is included below.

Duke University Medical Center (Pediatric Psychiatry Consult-Liaison Team)

Fellows also spend time rotating on the pediatric psychiatry inpatient consultation-liaison (C/L) service at Duke Children’s Hospital. Fellows round with multidisciplinary teams including psychologists and social workers in intensive care units and pediatric floors, develop into team leaders, and teach medical students and residents.  Over the course of the rotation, fellows develop expertise treating infant delirium, eating disorders and mood disorders, among other conditions. 

Fellows work at on the C/L service part time for two blocks. A typical schedule is included below.

Duke University Medical Center (Emergency Psychiatry)

Fellows gain experience in pediatric emergency and acute care psychiatry at Duke University Medical Center. Fellows work on the 5100 Behavioral Health Extension Unit with Child and Adolescent Psychiatry faculty and collaborate with nursing and case management on patient evaluations, treatment and dispositions. Fellows are involved of the care of patients experiencing mental or behavioral health crises, and enhance their skills in crisis management, safety planning and psychopharmacology. Fellows work with psychologists and residents to provide care for patients on this unit.

Fellows work on the 5100 Behavioral Health Extension Unit part-time for two blocks. 

A typical schedule is included below.

Duke University Medical Center (Ambulatory Experiences)

As of October 2024, we have created a new ambulatory rotation for two blocks that includes a variety of outpatient experiences that we feel are needed for robust training in child and adolescent psychiatry. These include outpatient pediatric neurology (epilepsy and sleep clinics), autoimmune brain disorders clinic, outpatient med/psych clinic, developmental-behavioral pediatrics clinic, and exposure to our collaborative care program.  

Fellows also have up to one day per week of protected time for scholarship or research projects. Fellows continue to see their psychotherapy patients as well.

Outpatient Psychotherapy Clinics

Fellows also develop psychotherapy skills in two outpatient clinics, the Psychosocial Treatment Clinic and the Family Studies Program. They receive weekly scheduled supervision and didactics alongside psychology pre-doctoral trainees.

The Psychosocial Treatment Clinic is a cognitive-behavioral therapy based clinic for children and adolescents with a variety of conditions. Fellows develop competency in both short- and long-term evidence-based psychotherapy with close supervision from teaching faculty.  This rotation occurs weekly for 12 months.

The Duke Family Studies Program and Clinic, an innovative training model that incorporates live-observed supervision facilitated by a two-way mirror and computer console feed. With teams of learners and weekly systems-based didactics, trainees acquire invaluable techniques and perspective on family system dynamics and pathology. This rotation occurs weekly for 12 months.

An example yearly schedule for a first-year fellow may be organized as follows:

Second-year CAP fellows devote their time to outpatient child psychiatry. Fellows benefit from core clinical experiences at the Child and Development and Behavioral Health Center (CDBH), Duke Autism Clinic, school based mental health (COPE program), and continue their psychotherapy training for at least ½ day per week.

Our program offers numerous elective opportunities that facilitate in-depth learning and give fellows the freedom to explore interests and develop expertise. In addition to the training experiences offered at the sites below, past fellows have pursued advanced psychotherapy training in Trauma Focused CBT, individual and family based treatment of eating disorders, and Parent Management Training. Fellows can also bolster their skills as clinician educators via advanced training and mentorship. Finally, many fellows dedicate time to pursuing research projects via a structured research elective.

A sample second year fellow schedule is included below, illustrating the amount of flexibility we ensure fellows have to pursue their individual interests:

Learn more about core and elective Duke training sites.

• Center for Child and Family Health
• Central Regional Hospital
• Child Development and Behavioral Health Center
• Child Trauma
• Duke ADHD Clinic
• Duke Autoimmune Brain Disorders Clinic
• Duke Center for Adolescent and Young Adult Substance Use Treatment
• Duke Center for Autism and Brain Development
• Duke Child and Adolescent Gender Care Clinic
• Duke Children's Evaluation Center
• Duke Children’s Hospital
• Duke Eating Disorders Clinic
• Duke Family Studies Program and Clinic
• Duke Integrated Pediatric Mental Health
• Pediatric Neuropsychology Program

There is no in-house overnight call. CAP fellows provide weekend daytime coverage at the Duke University Hospital System pediatric psychiatry consult-liaison and emergency department with direct supervision from a core faculty member for 6-7 weekends per year (including holidays). Fellows also provide phone coverage for two pagers (urgent concerns from the pediatric C/L team and clinic outpatients who have urgent concerns).