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The National Ambulatory Care Reporting System says approximately 46,000 children and youth, aged 5 to 19, were diagnosed with concussions by emergency departments in 2016-17.Fred Lum/The Globe and Mail

The repeal of a controversial sex-ed curriculum by the Progressive Conservative government in Ontario last summer took with it any explicit mention of concussions. Documents recently filed in a provincial tribunal show that bureaucrats at Queen’s Park were warning of the removal in e-mails and at least one briefing meeting by mid-July.

“As mentioned at this morning’s .... briefing, the section on concussions is not in the 2010 version of the curriculum, although there is a brief mention of head injuries,” Melissa Molson, an assistant deputy minister of health, social, education and children’s policy wrote in an e-mail to colleagues on July 18. (The 2010 version is being used in Ontario schools in the interim while the government undertakes consultations on rewriting a sex-ed curriculum among other issues.)

Her e-mail was included among exhibits submitted for a challenge of the interim curriculum before the Human Rights Tribunal of Ontario. Lawyers for an 11-year-old transgender girl have argued their client is subject to unequal treatment, as the provincial curriculum no longer includes the word “transgender.”

It also no longer includes the word “concussion.”

Concussions – injuries caused by a hit to the head or the body, which can jostle the brain inside the skull – have been a focal point for the Ontario government in recent years. Thousands of concussions are being reported across Canada. The National Ambulatory Care Reporting System says approximately 46,000 children and youth, aged 5 to 19, were diagnosed with concussions by emergency departments in 2016-17.

Ontario’s Ministry of Tourism, Culture and Sport announced a province-wide awareness campaign about concussion safety in September. Last spring, the province also passed a piece of concussion safety legislation called Rowan’s Law – named for a 17-year-old rugby player who died after multiple concussions. It includes provisions such as an annual review of awareness resources and protocols for when amateur athletes should leave sports activities and return to them. The government has pointed to that legislation, championed by then-MPP Lisa MacLeod, as an example of its leadership in concussion management and prevention.

Ms. MacLeod is now Minister of Children, Community and Social Services in Premier Doug Ford’s cabinet. Her office said despite the curriculum change, “supplementary resources” provided to school boards, teachers and students along with the contents of the interim curriculum gave them confidence that students would be properly educated on “head-injury awareness.”

“Students in all grades learn how to participate safely in physical activity and create a safe environment for themselves and others,” communications director Kayla Iafelice wrote in an e-mail to The Globe and Mail, saying the interim curriculum also includes portions addressing “concussion-related” injuries.

The interim curriculum currently offers information about helmets in younger grades, and a prompt about situations leading to injury or death in Grade 8, giving as an example “head injuries in contact sports.” It lists protective gear, “especially helmets,” as methods of risk reduction. Though the word “concussion” is no longer in the document, the submitted exhibits note that omission in the curriculum didn’t amount to a “government prohibition” on teaching about any particular subject.

Ontario also has a memorandum called PPM 158, which lays out the expectation that schools have a concussion policy and provides direction on strategies for prevention, identification and management. That PPM is in the process of being updated to align with Rowan’s Law, Ms. Iafelice noted, and a research project is underway to inform possible policy revisions.

The PPM makes concussion learning mandatory, “regardless of the HPE [health and physical education] curriculum,” said Toronto District School Board spokesperson Ryan Bird. Valerie Dugale, at the Elementary Teachers’ Federation of Ontario, also noted the concussion learning exists separately from the curriculum.

Michael Hutchison, director of the concussion program at the University of Toronto’s MacIntosh Sport Medicine Clinic – who suffered two concussions himself while playing university-level sports – said he sees a “tremendous amount” of progress made in concussion education in Ontario, citing both PPM 158 and Rowan’s Law. He floated the idea that the government may be shifting resources or terminology to ensure consistency in their message. But even if that’s their intention, he said, “I still think concussion education and education on any initiative is a multipronged approach.

“If you have multiple touch points so to speak, delivered within the curriculum, delivered outside through certain policies and through Rowan’s Law, then I don’t think replication of that information is harmful,” he said. New information is constantly emerging about concussions, but he said he still believes “broad-stroke, fundamental education” has a purpose, “at all levels of the curriculum.”

Concussion research PhD candidate Sandhya Mylabathula agreed. While she believes the continued existence of PPM 158 and the Rowan’s Law recommendations are “promising,” she urged for more to be done. “Additional materials on concussions are warranted in the curriculum and the school system for both elementary and secondary levels,” she wrote in an e-mail.

The Ministry of Education declined to answer questions about the curriculum changes, citing court involvement. When asked whether explicit references to concussions will be re-inserted into future curriculum, spokesperson Sandra Zeni said the government was currently analyzing feedback from its consultation period. Ms. Iafelice said the government has heard from “many participants” on the issue of “head-injury education." An update is expected sometime in winter 2019.

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