An Evaluation of the Memorandum to Require Concussion Education in Ontario Schools

Introduction: Concussion is a type of traumatic brain injury that is common among children and youth. Concussions can cause multiple short-term problems but can also lead to a number of serious long-term consequences. Recent evidence suggests that concussions are becoming more common, especially in school-aged children. On March 19, 2014, the Ministry of Education of Ontario has issued a Policy/Program Memorandum (PPM) that prompts school boards to create and sustain a concussion policy. The effectiveness of the PPM has not yet been studied. Purpose: The primary objective of this study is to evaluate the effectiveness of the PPM by analyzing the different concussion prevention programs introduced in response to the PPM by the school boards. Methods: This will be a three-part study. The first part of the study will be a qualitative analysis of the concussion programs using questionnaire distributed to school boards. The second study will be a pre-post analysis of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) data to establish whether or not the policies had an effect on concussion incidence in an emergency department setting. The third study will survey high school physical education teachers, coaches and/or trainers about concussion policies and the PPM. Results: All 72 Ontario public school boards had a concussion protocol on their board's website by June 2016. The analysis of 8 years of CHIRPP data on concussions generally, and school based concussions specifically, revealed that the number of diagnosed concussions increased significantly subsequent to the introduction of PPM 158 while the number of suspected concussions decreased. For the final study, twelve teachers responded to the survey. All were aware of their board's concussion policy; 83% reported that they had received training and/or relevant education, 75% had a trained individual present at every game/practice, 83% noticed a difference in parental involvement, 100% reported changes in the way return-to-play (RTP) and return-to-learn (RTL) protocols are implemented at the schools and 92% agreed that there was a need for a government-mandated concussion law.