{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T08:26:23Z","timestamp":1782894383313,"version":"3.54.5"},"reference-count":45,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T00:00:00Z","timestamp":1661385600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of School Health"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Concussion public policies have been developed to address the burden of concussions. The aim of the present study was to examine implementation compliance, barriers, and facilitators of Canada's first concussion public policy, Ontario's Policy\/Program Memorandum 158: School Board Policies on Concussion (PPM158).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An electronic survey was sent to 515 randomly selected elementary and high school principals across specific geographic, language, and publicly funded school types in Ontario. Data were analyzed using both qualitative and quantitative methods.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred and thirty\u2010five principals responded to the survey (26%). Concussion education was provided to teachers in 81% of schools, to students in 83%, and coaches in 79%. Additionally, 89% reported having a return\u2010to\u2010learn protocol in place and 90% reported having a return\u2010to\u2010play protocol. Implementation barriers included difficulties in providing concussion education to parents (42%), obtaining notes from physicians, and maintaining the volume of documentation. Eighty\u2010seven percent of respondents believed that PPM158 improves student well\u2010being.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Identified implementation barriers and facilitators can inform concussion policy practices to improve student well\u2010being. We recommend: (1) an appointed concussion policy lead at each school, (2) electronic documentation, (3) determining the optimal education format to improve parent\/guardian education, (4) fostering relationships between schools and health care professionals, and (5) student concussion education in every grade in Ontario schools.<\/jats:p><\/jats:sec>","DOI":"10.1111\/josh.13245","type":"journal-article","created":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T08:58:54Z","timestamp":1661417934000},"page":"14-24","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Concussion Public Policy in Elementary and High Schools in Ontario, Canada: A Cross\u2010Sectional Survey to Examine Implementation Compliance, Barriers, and Facilitators"],"prefix":"10.1111","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8480-3278","authenticated-orcid":false,"given":"Swapna","family":"Mylabathula","sequence":"first","affiliation":[{"name":"Temerty Faculty of Medicine University of Toronto  Toronto, Canada; Canadian Concussion Centre, Toronto Western Hospital, Toronto, Canada; Krembil Brain Institute Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Macarthur","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children Research Institute, Toronto, Canada; The Institute of Health Policy, Management, and Evaluation University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandhya","family":"Mylabathula","sequence":"additional","affiliation":[{"name":"Faculty of Kinesiology and Physical Education  University of Toronto Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Colantonio","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine University of Toronto  Toronto, Canada; The Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; Rehabilitation Sciences Institute, Department of Occupational Sciences and Occupational Therapy, Dalla Lana School of Public Health, University of Toronto Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid","family":"Guttmann","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine University of Toronto  Toronto, Canada; The Hospital for Sick Children Research Institute, Toronto, Canada; The Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Canada; Leong Centre for Healthy Children, University of Toronto Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles H.","family":"Tator","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine University of Toronto  Toronto, Canada; Canadian Concussion Centre, Toronto Western Hospital, Toronto, Canada; Krembil Brain Institute Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,8,25]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports\u20102017\u2010097699"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2013.06.018"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2016.10.067"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/HTR.0000000000000503"},{"key":"e_1_2_7_6_1","volume-title":"The Mental Health and Well\u2010Being of Ontario Students, 1991\u20132019: Detailed Findings from the Ontario Student Drug Use and Health Survey (OSDUHS)","author":"Boak A","year":"2020"},{"key":"e_1_2_7_7_1","unstructured":"Concussions in sport; 2013. Available at:https:\/\/www.canada.ca\/content\/dam\/phac\u2010aspc\/documents\/services\/publications\/diseases\u2010conditions\/PHAC\u2010concussion\u2010sport\u2010infographic_may8\u2010eng.pdf."},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2016.303154"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/PEDS.2014\u20103434"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1089\/NEU.2016.4765"},{"key":"e_1_2_7_11_1","doi-asserted-by":"crossref","first-page":"e0165116","DOI":"10.1371\/journal.pone.0165116","article-title":"Academic outcomes in high school students after a concussion: a retrospective population\u2010based analysis","volume":"10","author":"Russell K","year":"2016","journal-title":"PLoS One"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.4085\/1062\u20106050\u201049.3.30"},{"key":"e_1_2_7_13_1","unstructured":"Rowan's law: concussion safety; 2020. Available at:https:\/\/www.ontario.ca\/page\/rowans\u2010law\u2010concussion\u2010safety."},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889\u2010018\u20106232\u20109"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2017.304056"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/josh.12508"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/PHH.0000000000001128"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2017.07.003"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2019.08.016"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsem\u20102020\u2010000959"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.4085\/1062\u20106050\u2010529\u201017"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/jlme.12146"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1037\/rep0000155"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2012.02.016"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514521774"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.4085\/1062\u20106050\u201048.3.10"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1017\/cjn.2016.41"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports\u20102015\u2010094848"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40621\u2010020\u201000240\u20107"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/10598405211056646"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_7_32_1","unstructured":"Population Centre and rural area classification. Statistics Canada; 2016. Available at:https:\/\/www.statcan.gc.ca\/eng\/subjects\/standard\/pcrac\/2016\/introduction."},{"key":"e_1_2_7_33_1","unstructured":"Concussions\u00a0\u2013\u00a0Ontario Physical Activity Safety Standards in ducation. Ontario Physical and Health Education Association. Available at:https:\/\/safety.ophea.net\/concussions."},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1177\/1059840517702697"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513519073"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1177\/1059840520964925"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.7691"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsem\u20102016\u2010000215"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.51894\/001c.22067"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.4085\/1062\u20106050\u201052.3.06"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1177\/0009922814526979"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1515\/ijamh\u20102017\u20100070"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.4085\/1062\u20106050\u201028\u201018"},{"key":"e_1_2_7_44_1","unstructured":"High School RIO. Nationwide Children's. Available at:https:\/\/www.nationwidechildrens.org\/research\/areas\u2010of\u2010research\/center\u2010for\u2010injury\u2010research\u2010and\u2010policy\/injury\u2010topics\/research\u2010projects\/rio\/high\u2010school\u2010rio."},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016\u20102151"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1177\/0033354920988611"}],"container-title":["Journal of School Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/josh.13245","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/josh.13245","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/josh.13245","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T08:13:30Z","timestamp":1692519210000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/josh.13245"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,25]]},"references-count":45,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1111\/josh.13245"],"URL":"https:\/\/doi.org\/10.1111\/josh.13245","archive":["Portico"],"relation":{},"ISSN":["0022-4391","1746-1561"],"issn-type":[{"value":"0022-4391","type":"print"},{"value":"1746-1561","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,25]]},"assertion":[{"value":"2022-01-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-08-01","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-08-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}