Canadian District Goes to School on Concussions

The New York Times

Jeff Z Klein

October 2013

BURLINGTON, Ontario — For decades, schools across North America have taught about public health issues like the dangers of tobacco and drug abuse. But this academic year in one large Ontario school district, students are learning about a newly identified public health concern: concussions.

Last month, the Halton District School Board, near Toronto, started immersing its more than 4,000 ninth graders in a detailed course on concussions and other traumatic brain injuries. District schools are also teaching modified versions of the curriculum to some students in third and sixth grades. It is believed to be the first course of its kind to be taught across an entire school district in Canada or the United States.

“If we’re going to change the culture around concussion like we changed the culture around smoking and around drinking and driving, we need to get at our next generation of kids,” said Joanne Walsh, who helped devise the program as the school board’s health and physical education coordinator, along with Dr. Paul Echlin, a researcher on traumatic brain injury in hockey, football and other youth sports.

Joanne Walsh helped devise the school board’s concussion course. Credit Aaron Vincent Elkaim for The New York Times

The Halton school board hopes that its curriculum, formally called the Halton Student Concussion Education Project, becomes a model for schools across the continent. Formulated partly in response to a provincial government mandate for school districts to set concussion policies, Halton’s curriculum is available on the Internet.

It is “interactive, validated, modifiable and, most important, free to any board of education,” said Echlin, who published a paper about the Halton program on Friday in The Journal of Neurosurgery.

The Halton curriculum includes online modules that take students through question-and-answer sessions on topics related to concussions.

The sessions describe symptoms that may indicate a concussion, how to care for someone with a suspected concussion and how to navigate the challenges of recovery.

The online teaching tools also provide links to video reports on concussions and other traumatic brain injuries from sources like “60 Minutes,” the National Athletic Trainers Association and The New York Times’s series on the N.H.L. enforcer Derek Boogaard.

The Halton effort is the latest and most extensive in a series of concussion safety initiatives at schools across the continent since Washington State enacted the Lystedt Law in 2009.

That law, named after a 13-year-old who sustained a serious brain injury during a football game, mandates that athletes suspected of having concussions be removed immediately from games, along with guidelines for their safe return to play, and requires education about concussions for coaches, players and parents.

Forty-eight states and Washington, D.C., have similar versions of the law, but the education provision is often not rigorous.

“In essence, all you have to do to is supply athletes and parents with an 8 ½-by-11 sheet of paper on the dangers of concussion, and you’ve complied with the law in most places,” said Lindsey Barton Straus, a lawyer and director of research for the youth sports safety organization MomsTeam. Straus has kept a detailed running tally of states’ versions of the Lystedt Law.

Arizona, which requires all student-athletes to take a concussion course, is considered perhaps the most advanced state in this type of education.

Halton’s 61,000 students include a number of elite-level athletes, most visibly in hockey. Burlington and Oakville, the two largest cities in the district, have produced about two dozen N.H.L. players and many others who have skated in the major junior and professional ranks.

When pilot versions of the concussion curriculum were taught to selected classes last year, hockey was often the first point of reference for students.

“A lot of my students had seen Sidney Crosby and other players on TV, and it was almost like a badge of honor to have a concussion,” said Andrea Cavaco, who taught a version of the course to her sixth graders at Emily Carr Public School in Oakville.

The 11- and 12-year-old hockey players in her class, many of whom trained for their sport before and after school, saw their concussions as putting them at the same exalted level as their N.H.L. heroes.

“I was surprised that they had essentially received the same message I got when I was growing up,” Cavaco said — to stoically shake off a head injury and play through it.

But her students’ attitudes changed drastically during the year, she said. She was coaching her school’s boys’ team at a volleyball tournament for fifth and sixth graders when one Carr boy hurt his head but stayed in the match. His teammates refused to resume play until he left the court.

“They would not get off the bench,” Cavaco said. “It had nothing to do with me; it had to do with their learning. In essence, they were willing to forfeit the game because one of their teammates hadn’t reported his head injury.