Care Arrangements Research Articles

Navigating the COVID-19 crisis: exploring care arrangements and gendered inequalities for migrant women in transnational families in Berlin

ABSTRACT The COVID-19 pandemic has precipitated a notable shift in care responsibilities, transferring them from institutions to families, with a pronounced impact on migrant women in transnational families who navigate both local and transnational care arrangements. This study explored how the pandemic affected women's care arrangements and exacerbated existing inequalities at the intersection of labour, migration, and welfare regimes. Following a qualitative methodology based on grounded theory and ethnography, this study analysed interviews with migrant women, their family members, and experts to understand their experiences with caregiving and transnational family dynamics during the pandemic, the costs and coping strategies related to gendered aspects of care, and the changing landscape of migration and care policies during the pandemic. This study scrutinised the intricate web of local and transnational caregiving structures, emphasising women's agency in negotiating care needs amid pandemic restrictions and constraints on access to formal social protection.

Transformations of transnational care in times of the pandemic: spotlights and future prospects

ABSTRACT The COVID-19 pandemic has exacerbated existing inequalities in care between mobile and immobile populations. It has highlighted the precarious situation of many migranticized individuals and their families worldwide, but it has also brought their situation into the public eye, providing opportunities for advances in social science understanding and policy reform. This Special Issue explores the interplay between transnational care arrangements, cross-border movement and mobility, and the production of social inequality in the post-COVID-19 world. The collected articles provide a comprehensive picture from different countries and fields, revealing three interrelated processes that reflect the complex dynamics during the pandemic: (1) the interruption of transnational care arrangements; (2) the reorganization of these arrangements; and (3) coping strategies to adapt to (post)pandemic immobilizations, restrictions, and modified patterns of care. In sum, this issue aims to contribute to the advancement of social science understanding and to benefit vulnerable populations.

‘I am afraid to fly there’: informal care in Polish migrants’ families immobilised by COVID-19

ABSTRACT This paper discusses the COVID-19 pandemic as a new external challenge to transnational family life that can undermine the care arrangements and intentions developed by the families of Polish migrants following the 2004 EU enlargement. The pandemic, associated lockdowns and travel restrictions raise questions about assumed transnationalism, building upon earlier concerns about taking for granted migrants’ cross-national mobility. Based on focus group discussions with Polish grandparents conducted in July 2020 and March 2021, we analyse the pandemic’s impact on intergenerational relations with both geographically close and distant kin. We point to perceptions of risks of COVID-19 associated with ethnicised stereotypes and evolving with time. While the pandemic caused temporary restrictions to mobility, it shows the immobilising side of “unsettling events”], the consequences of which, for privileged EU migrants, will unfold in time as their parents’ age and require personal care.

Associations between child protective services workers’ attitudes toward kinship foster care placement, sociodemographic characteristics, and job characteristics

ABSTRACT When necessary to separate children from their parents, placing a child with kin leads to better outcomes. Child Protective Services (CPS) staff attitudes toward kinship foster care placements are an understudied factor that may influence decision-making and vary based on staff characteristics. Using February 2023 survey data from 2,861 CPS staff and multivariate linear regression analyses, we assessed associations between staff’s sociodemographic and occupational characteristics and attitudes toward kinship placement. Gender, race, position, work unit, and employment duration with CPS were significantly associated with staff attitudes. Understanding how staff view kinship placement is an important step toward removing barriers to its use.

Payment rates and the stability of subsidized child care: Evidence from Minnesota's child care assistance program

Participation instability has been recognized as a major challenge in state child care subsidy programs and may undermine the benefits of these programs to the children and families they are intended to support. Payment rates – the maximum amounts that state subsidy programs will pay for child care in a given period – directly determine which providers are affordable to subsidized consumers and what schedules of care they can afford. Payment rates also affect the resources available to providers and their incentive to accept subsidies. This study examines the effect of payment rate increases on the stability of participation in child care subsidies and the stability of subsidized care arrangements. We study the impact of a major update to payment rates for the Minnesota Child Care Assistance Program, using monthly child- and provider-level administrative data and a quasi-experimental design. We implement a regression discontinuity design built on the state's method of setting county rates. We find strong evidence that higher subsidy payment rates lead to more stable subsidy participation and care arrangements. Thus, state-determined payment rates are a critical policy lever that affects access to care.

Factors Associated with Patient Activation in People with Heart Failure based on the Individual and Family Self-Management Theory: A Cross-sectional Study.

Patient activation (PA) is crucial for effective self-management of people with heart failure (HF). Clarifying factors associated with PA might be important to develop interventions to promote PA. This study aimed to explore Context factors associated with PA in people with HF. 268 patients were enrolled in a cross-sectional study (Median age=65 years). We surveyed variables based on Context factors of the Individual and Family Self-Management Theory (IFSMT), including demographic and disease factors, quality of chronic care, family function, and depression. Correlation analysis was conducted for data analysis, and path analysis was used to verify our hypothesis model about Context factors and PA. The median PA score was 51.10. Path analysis showed that age, educational level, living arrangement, device therapy, quality of chronic care, family function, and depression were directly or indirectly related to PA. The quality of chronic care mediated the associations between device therapy and educational level and PA. Age, educational level, living arrangement, and quality of chronic care affected family function and then affected activation. Depression mediated the relationships between the quality of chronic care, educational level, family function, and PA. This study increased the understanding of factors associated with PA in the HF population. When assessing PA in people with HF, those who are older, have a low educational level, living alone need more attention from healthcare professionals. Interventions focusing on improving the quality of chronic care, family function, and depression might help activate people to practice self-management.

Glymphatic system dysfunction and risk of clinical milestones in patients with Parkinson disease.

Glymphatic dysfunction may play a significant role in the development of neurodegenerative diseases. We aimed to evaluate the association between glymphatic dysfunction and the risk of malignant event/clinical milestones in Parkinson disease (PD). This study included 236 patients from August 2014 to December 2020. Diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index was calculated as an approximate measure of glymphatic function. The primary outcomes were four clinical milestones including recurrent falls, wheelchair dependence, dementia, and placement in residential or nursing home care. The associations of DTI-ALPS with the risk of clinical milestones were examined using multivariate Cox proportional hazards regression models. Then, logistic regression was repeated using clinical variables and DTI-ALPS index individually and in combination of the two to explore the ability to distinguish patients who reached clinical milestones within a 5-year period. A total of 175 PD patients with baseline DTI-ALPS index and follow-up clinical assessments were included. A lower DTI-ALPS was independently associated with increased risk of recurrent falls, wheelchair dependence, and dementia. Additionally, in 103 patients monitored over 5 years, a logistic regression model combining clinical variables and DTI-ALPS index showed better performance for predicting wheelchair dependence within 5 years than a model using clinical variables or DTI-ALPS index alone. Glymphatic dysfunction, as measured by the DTI-ALPS index, was associated with increased risk of clinical milestones in patients with PD. This finding implies that therapy targeting the glymphatic system may serve as a viable strategy for slowing down the progression of PD.

Foster care breakdown in adolescence: A retrospective view of young individuals on their experiences

Summary Placement with a foster family is one of the care arrangements available for children who cannot live at home. Many of those in foster care are teenagers. The complexity of the development during adolescence poses major challenges and may ultimately lead to what is known in the literature as “foster breakdown.” Most of the research in this area focuses on the point of view of social workers or foster parents. The current study examines this experience through a retrospective view of those who were teenagers at the time of foster care breakdown. To this end, semi-structured interviews were conducted with 14 Israeli young individuals (16–30 years old) who had experienced foster breakdown at various stages of adolescence. Findings The findings paint a complex and multidimensional picture of breakdown. While most of the interviewees described it as a sudden, unexpected event, closer examination revealed a dynamic process of collapse. This process comprised various factors, including those associated with the welfare system, the foster family, and characteristics related to the developmental stage of adolescence of the research participants. The combination of these factors led to the premature termination of the foster arrangement. Applications This study opens a window to the complex experience of foster breakdown in adolescence, an issue that has received very little research attention thus far. Understanding the dynamics of foster breakdown from the perspective of young individuals can improve professional foster care practices and policy and can benefit social workers in their work with foster families.

Child care for young children with disabilities.

More than half (56%) of Canadian children aged 0 to 5 years are in non-parental child care, but data on child care attendance among children with disabilities is limited. This study examines child care participation among young children with disabilities in Canada, with a focus on different disability types. Analyses were conducted on 1,189 children aged 0 to 5 years identified with disabilities from Statistics Canada's 2023 Survey on Early Learning and Child Care Arrangements - Children with Long-term Conditions and Disabilities. Rates of child care participation, difficulties finding child care, difficulties within child care, and whether parents reported that their child had ever been denied a child care space because of their condition were examined. Logistic regression models tested for differences in the main child care arrangement and difficulty finding child care based on the child's disability while controlling for sociodemographic variables. Among children aged 0 to 5 years with disabilities, 45% attended a daycare centre, preschool, centre de la petite enfance, or before or after school care as their main child care arrangement; 17% attended another type of child care, such as a family child care home or care by a relative; and 38% did not regularly attend non-parental child care. The parents of nearly half of children with disabilities reported difficulty finding a child care arrangement, particularly for children with emotional conditions. Close to 1 in 10 parents of children with disabilities who were using child care reported that their child had been denied a child care space because of their condition. These findings highlight the need for information to support inclusive policies, practices, and resources for children with disabilities within the Canada-wide early learning and child care system.

Bipolar disorder and early childhood trauma

Case Background There is a reported 48.8 million case of bipolar disorder (BD) world- wide. It can also be one of the most challenging disorders to manage clinically as patients often have poor medical compliance and numerous relapses throughout their lifetime. The etiology of this illness is still poorly understood, but it is recognized to compromise both genetic and environmental factors. Regarding the latter, abuse and instability in childhood and adolescence was reported as an important area of consideration in regard to the development and prognosis of bipolar disorder. We report here the case of a female who exemplifies the significance of early childhood experience in this disorder. Case Presentation Isabelle is a 21 year old, female, with a background history of bipolar disorder. She presented to the Cork University Hospital accident and emergency 2 weeks after discharge after a 4 week admission for a depressive episode. Isabelle was referred from the home-based team with an acute episode of mania and was detained involuntarily under the Mental Health Act. Her history is significant for childhood neglect, physical, emotional and sexual abuse, along with multiple foster care placements. She was managed as an inpatient with antipsychotics and a mood stabilizer before being discharged after a lengthy, arduous, admission. Conclusion Childhood trauma is an important consideration in BD. Therefore, practitioner awareness of the role of such trauma with regard to its etiology and prognosis is of great importance. It is also essential to the practice of preventive medicine. Patient Consent Obtained: Yes

A systematic review examining outcomes of children following permanency placements

Children in care have experienced adversities, including maltreatment prior to contact with the system, negatively impacting on their mental health outcomes. The type of placement and length of time in care are thought to be important and the child welfare system aim is to achieve a permanent decision for children that best supports their needs by establishing a stable familial network. Permanency decisions can include reunification, foster care, kinship care, adoption, and residential placements. This review aims to establish to what extent permanent placement type, maltreatment experienced, length of time in care and age at which permanency is achieved impacts child mental health outcomes. Following PRISMA guidelines, five databases (ASSIA, CINAHL, PsycINFO, Scopus and SocINDEX) and two registers (CENTRAL and TRoPHI) were systematically searched yielding six articles for inclusion in the study. Data were extracted and articles critically appraised utilising the Crowe Critical Appraisal Tool (CCAT). Papers reported mixed findings for permanent placement type and child mental health outcomes with little or no significant overall differences reported. Type of maltreatment experienced moderated the type of mental health symptomology reported. Difficulties in attachment and social relationships were reported for children placed older than two years, although confounding factors such as type of maltreatment likely reduce the strength of the association. Typically, children in permanent placements had better outcomes compared with peers in short-term or unstable placements. A lack of suitable validated and age-appropriate outcome measures and the existence of confounding factors impair our understanding of the interaction between pre-care adversities, the child welfare system itself and permanent placement outcomes.

8469 Endocrinologists Underutilize Virtual Care Services Resulting in Suboptimal Clinical and Financial Outcomes

Abstract Disclosure: D. Terry: Employee; Self; Valendo Health. Less than 150,000 Medicare patients with diabetes (PWD) receive billable telehealth and remote monitoring services, even though over 12 million PWDs are eligible for these services. This is a missed quality opportunity, as studies show that PWDs who receive these services experience reductions in A1C levels and improvements in TIR. It is also a missed financial opportunity for Endocrinologists, who are among the lowest paid specialists in the US. The economics of Endocrinology are important, because inadequate compensation is leading to access constraints when the diabetes population is growing, and care complexity is increasing. We analyzed billed virtual health claims for every Medicare PWD in 2022. The types of services we examined included: Chronic Care Management (CCM & PCM), Continuous Glucose Monitoring (CGM & RPM), Medical Nutrition Therapy (MNT), and Diabetes Self-Management Training (DSMT). When we looked by Endocrinologist by virtual care service type, we found the following levels of service delivery for Endocrinologists at the median levels of utilization:4.8% of eligible PWDs received remote Continuous Glucose Monitoring support.4.2% received virtual Chronic Care Management services.6.2% received virtual Diabetes Self-Management Support.<1% received Medical Nutrition Therapy This is clearly a missed clinical quality opportunity as a study published in JAMA in October 2023, Comprehensive Telehealth Model to Support Diabetes Self-Management, reported the following improvements for PWDs who received virtual care for 6 months:Mean change in A1C levels: Type 1: -0.6%; Type 2: -1.0%Mean TIR Improvement: Type 1: 16%; Type 2: 18% It is also a missed financial opportunity for Endocrinology practices. Each patient with diabetes is potentially eligible for $100 or more of virtual care services per month. We’ve looked at every Endocrinology practice in the US and many are missing out on over a million dollars of annual revenue opportunity. This is important as Endocrinology organizations everywhere, independent and hospital based, are struggling to retain the doctors & staff necessary to provide adequate access to care - leading to months of wait time to see an Endocrinologist. The prevalence of diabetes is growing significantly, while Endocrinologist capacity is shrinking. Value added and billable virtual care services create new opportunities for Endocrinologist to generate the revenue necessary to increase clinical capacity and improve access by creating diverse clinical teams led by Endocrinologists and supported by Diabetes Educators, Dietitians, and others with expertise in diabetes who can care for many more PWDs. Creating virtual care capabilities is also an early step in moving Endocrinology into Value-Based Care arrangements that reward providers for improving care and reducing costs rather than for generating more visits. Presentation: 6/1/2024

Preservice training perspectives among Florida foster parents

Relatively little is known about foster parent preservice training, particularly how foster parents perceive the helpfulness of preservice training. Given the high turnover of foster parents and research indicating that multiple demands are placed on foster parents, more attention should be paid to the preparation and support of new foster parents. The purpose of this study was to utilize an administrative data set from the state of Florida to examine foster parents’ perceptions of the type and quality of their preservice training in terms of feeling prepared to take on a foster care placement in their home. Almost one half of all participants were able to identify the name of the training completed. Of which, three of the trainings have some empirical support in published literature. Additionally, a little more than one half of participants indicated they felt prepared for their role as a foster parent, but almost one third indicated not feeling prepared for the role. Slightly more than one quarter of participants indicated supplementing their training with other resources. Results support the need for more rigorous evaluation of preservice training due to limited empirical support, attention to how training prepares foster parents to support the needs of the child and family following placement, and potential improvements to what is covered in preservice training.

Multidimensional patterns of early care and education access through a family centered lens

Despite evidence of the benefits of early care and education (ECE) for child development and family employment, the supply of providers is scarce and variable; leading many families with young children to experience limited and inequitable access. To examine the multidetermined nature of access, this study leverages a multidimensional, family-centered definition and a nationally representative sample of families of preschoolers from the Early Childhood Longitudinal Study – Birth Cohort to examine (1) patterns of access-related features present in preschool-age children's ECE arrangements, and (2) child characteristics, household circumstances, and care setting type that may be related to patterns of access. Latent class analysis model enumeration revealed five latent classes of children's nonparental care arrangements along features of accessibility: High Across Most Access Features (26.4 %), Single, Long-Term Provider (30.1 %), Limited Across Most Access Features (11.6 %), Low Affordability, Multiple Providers (10.1 %), and High Affordability, Recent Transition (21.8 %). These results suggested many children were in ECE that met multiple dimensions of access, with others in care arrangements that reflected trade-offs. Children were also differentially classified into types of ECE arrangements in relation to care setting type, race/ethnicity, income, household urbanicity, and parental employment. The implications of investigating ECE access as a multidimensional construct, and recommendations for how ECE providers and policy can more closely align with family needs are discussed.

Cracking the code: Exploring the inverse relationship between HCCs and hospitalizations in value-based care models.

40 Background: Payers increasingly use the Hierarchical Condition Categories (HCC) as a measure of patient severity, guiding assessment of outcomes, predicting costs, titrating reimbursement, and risk adjusting value-based care (VBC) arrangements. HCCs are assigned to patients based on diagnoses reported and coded in inpatient and outpatient hospitals, and physician practices. Conventional belief has been that higher HCCs correlate with increased hospitalizations and higher spending for patient care. However, the impact of hospitalizations on HCC coding practices remains largely unexplored. Methods: Using deidentified public use Enhancing Oncology Model (EOM) baseline episode files (between 2016 - 2020), we grouped episodes based on inpatient admissions (INP vs NoINP) and analyzed the two-way relationship with coded HCCs. Results: Of the 1,533,420 episodes, 89% had one or more HCC documented. Key distributions are provided in Table1. Mean HCCs were higher (T- test, p<0.0001) for INP episodes, with more (4 or more) HCCs documented per episode. Inversely, episodes with 0 and 1 to 3 HCCs had the same hospitalization rates. Conclusions: Our research aligns with anecdotal knowledge suggesting that hospitals demonstrate greater agility and proficiency in HCC coding, resulting in an increased measurement of patient severity. Coding practices in hospital settings usually involve comprehensive chart reviews, data curation in specialized registries, optimized coding workflows, coding staff specializing in risk-adjustment coding, etc. Similar practices are generally lacking in physician practices. Patients with more HCCs experience more hospitalizations, but the relationship is not linear and unidirectional. Although elevated HCCs for INP episodes support the expenditures linked to hospitalization, VBC efforts to reduce avoidable hospitalizations may result in an underrepresentation of patients’ HCCs when care is predominantly delivered in outpatient and physician office settings. The effectiveness of HCC coding in physician practices is apt for further exploration. The accuracy of risk-adjustment relies on the efficiency of HCC coding. We register our skepticism regarding the ability of HCCs to accurately represent the true severity of patients who are not hospitalized. Measure INP(n=461,316) NoINP(n=1,072,104) All(n=1,533,420) Mean Total Spend $69,939 $52,727 $57,905 Mean Hospital Spend $22,344 - $6,722 Mean HCCs 2.80 2.30 2.45 % of Episodes with HCCs 0 16% 19% 18% 1 to 3 50% 58% 55% 4 or more 34% 23% 26% 0(n=277,452) 1 to 3(n=853,942) 4 or more(n=402,026) % of Episodes with Hospitalizations 27% 27% 39%

Minimum wages and foster care placement disruption

AbstractWe examine the potential secondary impacts of raising the minimum wage in a jurisdiction on the efficiency of its foster care placement system. We employ the Adoption and Foster Care Analysis and Reporting System (AFCARS) restricted‐access dataset representing all children in the US foster care system for the years 2000–21. We calculate placement efficiency as the number of yearly moves experienced by a child in the foster care system, with a decrease in the number of placements interpreted as benefitting children both psychologically and behaviourally. This increase in stability benefits the foster parents and corresponds to a smaller financial strain on the public. After including various controls and state‐year fixed effects, our Tobit and Ordinary Least Squares (OLS) analyses find that increased minimum wages are significantly associated with lower levels of placement disruption. We take this as promising initial descriptive evidence for the secondary effects of the minimum wage on reducing the financial burden, and increasing the placement efficiency, of the foster care system.

Impact of trauma and placement in residential or congregate care on the criminalisation of children in England/Wales and Australia

Children in residential care have the most complex needs of all children growing up in Out-of-Home care (OOHC), due to complex trauma from pre-care experiences of abuse and neglect, inadequate therapeutic supports while in care and significant placement instability. Some argue that residential care settings are intrinsically criminogenic, as evidenced by significant over-representation of this cohort in youth justice. However, little is known about how children’s experiences of trauma, including removal from family and placement in OOHC, is viewed by lawyers and decision-makers in criminal cases involving children in care. Criminal justice decisions can have long-term ramifications for children in care and custodial sentencing can often be a precursor to ongoing incarceration into adulthood. This qualitative, cross-national study explored the impacts of trauma and placement in residential or congregate care on the criminalisation of children in England/Wales and Australia. In-depth interviews were conducted with 28 legal, youth justice and judicial stakeholders in England, Wales (UK), New South Wales (NSW) and Victoria (Australia). While there are considerable differences in the operation of child protection and youth justice systems between these jurisdictions, thematic analysis using NVivo14 identified. confirmed ongoing systemic factors associated with criminalisation identified in previous literature persists despite attempts to address these through policy and practice reforms. These factors include an absence of therapeutic supports, unstable and unsafe residential care placements, over-reliance on police to respond to minor incidents, increasingly punitive police responses lacking awareness of the impacts of childhood trauma and inappropriate use of custody as an ‘alternative’ placement. These findings suggest the similar systemic processes across these jurisdictions are likely to reflect deeply entrenched ideologies about ‘care’ and ‘protection’ that function to criminalise trauma. The implications of these systemic factors when children are exposed to formal criminal justice decision-making are considered.

Taking shared parenting seriously: a comparative study of how family policies accommodate shared physical custody in post-separation households

Shared physical custody (SPC) is a care arrangement following parental separation, whereby children alternatively reside with their mother and father. Very little is known about how family policies accommodate SPC, which is all the more unfortunate, as it represents a key opportunity to understand how family policies can efficiently facilitate shared parenting. To address this gap, this article presents a modest attempt at designing a new comparative family policy approach that considers SPC arrangements, by examining the extent to which Belgian, French and Italian family policies accommodate a more equal sharing of parenting post-divorce. In so doing, we encourage studies of defamilialization to take better account of the diversity of contemporary family forms. The theoretical section traces back key feminist debates around defamilialization and proposes to consider SPC arrangements as an ‘atypical’ family configuration that best illustrates contemporary tensions around defamilialization and gender equality. It also takes stock of the few studies of family policy and SPC to highlight key issues at stake. The analysis section starts with the main characteristics of the family law, welfare regime and family policies of the three countries. Then, we examine a selection of emblematic and national-level family policies from the following areas: (1) Family benefits; (2) Financial support to access to services; and (3) Tax measures. Our comparison focuses on three main criteria: scope; entitlement; and shareability of benefits between parents in the context of SPC. Our analysis reveals the variety of approaches to SPC in family polices across countries and policy areas, and the significant lack of support for a more equitable distribution of parenting within SPC. We conclude by highlighting the usefulness of taking SPC into account in reflecting on and evaluating the implementation of defamilialization policies, and by identifying some of the challenges to be met by future research.

Contact resolution among Veterans Crisis Line phone andtext contacts regarding Veterans Health Administration enrollees.

To expand access to suicide prevention and support services, the Veteran Crisis Line (VCL) added text capabilities in 2011. It is unknown whether the likelihood of a contact being terminated by the user varies by contact type. We aimed to assess whether contact resolution varies by contact type after accounting for Veterans' sociodemographic and clinical characteristics, contact risk, and reasons for contact. A retrospective cohort study of VCL phone and text contacts regarding identified VHA enrollees between 2016 and 2021 was performed. To examine differences in contact resolution between contact types, inverse probability of treatment weights were used to balance characteristics of text and phone contacts. Relative to phone contacts, text contacts were associated with 3.39 percentage point (PP) (95% CI, 3.27-3.50; p < 0.001) lower likelihood of receiving an emergency dispatch/welfare check, 2.65 PP (95% CI, 2.55-2.76; p < 0.001) lower likelihood of requiring arrangement for same-day care, and 9.47 (95% CI, 9.34-9.59; p < 0.001) PP higher likelihood of being terminated by the user. VCL text contact was associated with an increased likelihood of being terminated by the user. Further investigation is needed to understand the reasons for terminating contact for those who texted VCL.

Supporting decision-making for individuals living with dementia and their care partners with knowledge translation: an umbrella review.

Living with dementia requires decision-making about numerous topics including daily activities, such as advance care planning (ACP). Both individuals living with dementia and care partners require informed support for decision-making. We conducted an umbrella review to assess knowledge translation (KT) interventions supporting decision-making for individuals living with dementia and their informal care partners. Four databases were searched using 50 different search-terms, identifying 22 reviews presenting 32 KT interventions. The most common KT decision topic was ACP (N=21) which includes advanced care directives, feeding options, and placement in long-term care. The majority of KT interventions targeted care partners only (N=16), or both care partners and individuals living with dementia (N=13), with fewer interventions (N=3) targeting individuals living with dementia. Overall, our umbrella review offers insights into the beneficial impacts of KT interventions, such as increased knowledge and confidence, and decreased decisional conflicts.