Minister’s Year Three Progress Report on Rowan’s Law (Concussion Safety), 2018

Minister’s message

Our government’s commitment to athlete safety, health and well-being is as strong as it’s ever been. I am reminded at this time of year, when we’re commemorating Rowan’s Law Day, of how far we have come towards this goal.

In fall 2020, we were in the middle of the COVID‑19 pandemic when we released the previous Rowan’s Law progress report. Since then, thanks to the measures our government has put in place to keep Ontarians safe, we have weathered the severe impact of the pandemic on the sport sector and can finally see a glimmer of light at the end of the tunnel.

While we continue to take a cautious approach to public health measures needed to see us through the pandemic safely, it is with a renewed feeling of optimism that we see our province gradually and carefully reopen. As spring turned into summer this year, it truly warmed my heart to see the children of Ontario filling our parks and playgrounds wearing the cheerful colours of their soccer and baseball uniforms, excited to get back to the sports they love.

Last year, I met with ministers responsible for sport and recreation from across the country to advocate for a clear and consistent approach to concussion safety no matter where an athlete is lives in Canada. I was joined by Tim Fleiszer, Executive Director of Concussion Legacy Foundation Canada, and NHL Hall of Famer Eric Lindros, who supported me in making a direct appeal to advance concussion safety across the country. I am proud to say that many of my colleagues from across the country expressed their appreciation for the work done in Ontario, and that the concussion resources and tools developed by my ministry would be a great starting point for their own efforts.

I would also like to take this opportunity to thank the members of the Rowan’s Law Advisory Committee and Concussion Working Group for their continuing support and guidance on implementing Rowan’s Law. Ontario is a world leader in concussion safety thanks to their efforts and the efforts of our many ministry and community partners, sport organizations and individual advocates who offered their dedication, commitment and passion towards concussion safety. I am happy to report that by March 2022, we will have implemented more than 80 per cent of the recommendations from the Rowan’s Law Advisory Committee.

It is up to all of us to ensure the benefits of sport are delivered in a safe and inclusive environment. I am confident by working together, sport in Ontario will once again thrive, bringing with it the social and individual well-being we all desperately need.

Concussion awareness and prevention will continue to be a priority in the sport sector as our government broadens its focus on athlete safety to address other physical and psychological harms, particularly ensuring athletes battling with mental health issues are supported and not left to deal with these challenges in silence. When Ontario hosts the 2022 Canada Games, our aim will be to make the Games the safest in Canadian sport history, welcoming athletes, coaches, trainers and officials from across the country to an inclusive, safe and vibrant sport environment.

In the coming months, building on the successes won through the implementation of Rowan’s Law, I know that together with our partners we will lead the charge in addressing maltreatment in sport quickly and collaboratively, and ensure the Ontario sport environment is safe, inclusive and allows our athletes to reach their full potential.

Honourable Lisa MacLeod
Minister of Heritage, Sport, Tourism and Culture Industries

Rowan’s Law

Rowan’s Law (Concussion Safety), 2018 (“Rowan’s Law”) is landmark legislation, the first of its kind in Canada.

Thanks to the hard work, determination and dedication of Rowan Stringer’s family, the Rowan’s Law Advisory Committee, countless sport organizations, schools, coaches, volunteers and administrators, Ontario is now a world leader in concussion safety.

Rowan’s Law has changed the culture of sport in Ontario. Every athlete is safer because players, students, coaches, officials, team trainers, educators, spectators, and families better understand the vital role they play in recognizing the signs and symptoms of a concussion and reducing the pressure to continue playing with a head injury.

Since September 2017, the Government of Ontario has worked to address the 21 recommended action items brought forward by the Rowan’s Law Advisory Committee in response to the Rowan Stringer Coroner’s Inquest Jury Recommendations.

Rowan Stringer

Rowan was a 17-year-old, grade 12 student athlete when she died in May 2013 from a condition known as second impact syndrome – swelling of the brain caused by a subsequent injury that occurred before a previous injury has healed.

Rowan’s Law was named in her honour.

Rowan’s Law has increased awareness, prevention, detection, and management of concussions.

Rowan was a competitive and keen athlete who was a true leader. Her legacy continues to be a catalyst for change across Ontario, throughout Canada, and around the world.

Rowan’s Law implementation

Year one:

September 2018 to September 2019

Eleven Recommendations completed:

• July 1, 2019: Sections of the Act and Regulation came into force: mandatory education, codes of conduct and Minister’s progress reports (in force September 25, 2019); Related amendments to the Education Act proclaimed (Recommendation #1)
• Evaluation of PPM 158 in schools (Recommendation #4)
• Codes of Conduct (Recommendation #5)
• Annual concussion training for coaches (Recommendation #8)
• Coach’s tool kit (Recommendation #11)
• Teacher candidate exposure to concussion awareness (Recommendation #12)
• Concussion website (Recommendation #13)
• Sustained marketing and awareness campaign (Recommendation #14)
• Annual concussion awareness education event in schools (in PPM 158) (Recommendation #16)
• Established mandatory concussion education for relevant school staff (in PPM 158) (Recommendation #17)
• Creation of Concussion Partners Committee (Concussion Working Group) (Recommendation #21)

Year two:

September 2019 to September 2020

Two Recommendations completed

• Updated PPM 158 for School Boards (tied to amendments made to the Education Act as part of Recommendation #1)
• Develop concussion education modules for students for delivery in schools (Recommendation #15)

Year three:

September 2020 to March 2022

In-progress

• January 1, 2022: Remaining sections of the Act and Regulation pertaining to removal-from-sport & return-to-sport are expected to come into force (Recommendation #1)
• By March 2022, minimum safety standards for fields of play (Recommendation #6)
• By March 2022, concussion spotter at all games and practices (Recommendation #7)
• By March 2022, enhanced professional development for health-care professionals (Recommendation #18)
• Ongoing: Work with Federal-Provincial/Territorial (F-P/T) partners towards achieving a national harmonized approach to concussions in school/non-school environments (Recommendation #19)

Work-in-progress

To date, Ontario has completed 13 of the 21 recommendations put forward by the Rowan’s Law Advisory Committee.

By March 2022, the number of completed recommendations will be 17. The following four recommendations are set to be implemented by March 2022.

1. Enhancement of concussion education for health care professionals
   
   By March 2022, the Ministry of Health will share a health care provider fact sheet that provides an overview of the Rowan’s Law legislation for health care providers, and a snapshot of existing concussion resources from reputable sources that can be utilized by health care professionals. The fact sheet will help to ensure that physicians and nurse practitioners are equipped with appropriate resources to support them in concussion assessment and clearance.
2. Minimum standards for fields of play
   
   By March 2022, the government will release best practice guidelines and tools for inspecting various fields of play to enhance safety in sport in Ontario. The toolkit is an opportunity to educate and raise awareness about safe fields of play for all sports.
   
   The guidelines are being designed based on existing tools developed for schools by Ophea on how to inspect indoor and outdoor fields of play, and suggested steps to take if the field is deemed unsafe to play.
3. Minimum requirements for higher-risk sports
   
   By March 2022, the government will release best practices and tools for the implementation of a “concussion spotter." The concussion spotter is a designated role for at least one person, in addition to coaches, with specific training in concussion identification and management at all games and practices in higher-risk/contact sports.
4. Working with Indigenous partners to support goals of increased safe participation in amateur sport and concussion management
   
   MHSTCI continues to engage with Indigenous Sport & Wellness Ontario (ISWO) — the designated Provincial/Territorial Aboriginal Sport Body (P/TASB) for Ontario, serving all Indigenous Peoples across the province. Our goal is to develop a culturally relevant approach to disseminating information about Rowan’s Law and concussion safety in sports to Indigenous communities. The government also continues to explore opportunities for engagement with Indigenous health care services, Indigenous education organizations and other organizations to raise awareness about concussions and concussion safety in sport.

Work under consideration

The remaining four recommendations will continue to be under consideration.

Due to the scope and complexity of these items and challenges related to the pandemic, MHSTCI will continue to work with ministry partners to explore opportunities to advance these recommendations.

1. Amateur sport delivery partners should collect and report concussion incidence data
   
   MHSTCI continues to explore best practices and options for the collection and reporting of data regarding incidents of concussion within sport organizations.
2. Ministry of Health to collate and share concussion incidence data annually
   
   The Ministry of Health continues to explore options to leverage existing national surveys to obtain more accurate concussion incidence and prevalence data for children and youth in Ontario. As part of this effort, the ministry continues to review concussion and/or head injury data from existing health databases that can potentially be shared on an annual basis.
3. Investment in electronic data collection/sharing tool about incidents at field of play
   
   The government continues to assess the feasibility of building or acquiring an electronic data collection/sharing tool for sport organizations to report concussion incidents at the field of play.
4. Ministry of Health should introduce fee codes in OHIP schedule of benefits for concussion assessment and management
   
   The Ministry of Health has reviewed the need for OHIP to introduce specific fee codes to compensate physicians for concussion assessment and management and determined there are existing fee codes within the Schedule of Benefits for Physicians Services that should be used. The Ministry will continue to highlight the use of the existing codes within applicable communication materials specific to the Rowan’s Law initiative.

Because of Rowan’s Law

Annual Rowan’s Law Day

In honour of the memory of Rowan Stringer, “Rowan’s Law Day” is commemorated on the last Wednesday in September to raise awareness about concussions in sport.

School board policies

School boards across Ontario are required to have concussion safety policies with mandatory requirements regarding concussion awareness, concussion codes of conduct, training for school board staff, and removal and return protocols, including a process to document and track a student’s progress from the removal from an activity due to a suspected concussion, to the return to learning and to physical activity. Concussion safety training is available to teacher candidates through faculties of education.

Leadership and influencing change

All Provincial and Territorial Ministers responsible for Sport have followed Ontario’s lead and now have a concussion awareness day/week in September.

Rowan’s Law has made Ontario an international leader in concussion safety and ensured that sport organizations and schools delivering activities in 65 sports (including their parasport equivalent) are putting consistent concussion requirements for amateur competitive athletes in place. Rowan’s Law will continue to change the conversation around concussions and act as the cornerstone for safe sport in Ontario for all athletes.

Access

Everyone in Ontario has free access to Ophea’s Ontario Physical Activity Safety Standards in Education, including a concussion protocol considered to be the minimum standard for risk management practices related to concussions within Ontario school boards. The Ontario government’s website also contains concussion awareness resources available in multiple different languages.

Coaches

Rowan’s Law requires that all coaches and team trainers review one of the government-approved concussion awareness resources and concussion code of conduct every year before serving in a sport organization or at a school.

Legislation

The first of its kind in Canada, Rowan’s Law is groundbreaking legislation that puts the health and safety of athletes first. Rowan’s Law is a foundation for sport safety that Ontario will continue to build on.

Culture shift

All sport organizations are required to have a code of conduct, and effective January 1, 2022, removal from and return to sport protocols for their athletes.

Awareness

Concussion awareness will be promoted through resources like videos, e-modules, information provided on the Ontario government’s website on Rowan’s Law and concussion safety and through the annual Rowan’s Law Day.

Enhanced athlete safety

He went up, came down on the floor. A player came down on top of him, knocking his head to the hardwood. It was observed, [he was] taken off, signs of a possible concussion, stayed out, and then I followed the protocols...

At that point, Bleich was diagnosed with a concussion. Bleich’s son missed four weeks of school as a result of the concussion and did not return to play with his school’s team. He is fully recovered now and began skills practice with the Pelham Panthers on August 1. Observing concussion protocol is the most important factor in successfully dealing with youth concussion. Bleich’s experience and knowledge as a coach, player and Pelham Panthers Basketball Association’s (PPBA) administrator equipped him to provide an appropriate response to his son’s injury. From “Special Report: Rowan’s Law – Concussion management and your child” by John Swart

Impacts of Rowan’s Law

Rowan’s Law has impacted our organization, community and our athletes in many ways.

Our athletes have been able to learn and see the importance in being honest about any concussions or uncommon symptoms they are experiencing. They realize the importance of sharing rather than keeping it to themselves to avoid the possibility of getting hurt further.

Staff members of our organization and our coaches work together to build an environment that athletes and their parents can feel safe in. Our athletes, community, and members of our organization understand that this commitment is for the betterment and overall safety of everyone who is playing field hockey and involved in Field Hockey Ontario.

Shauna Bookal, BSM, PDIP, MS, (She/Her), Executive Director, Field Hockey Ontario

As a PSO we have ensured that we are aligned with requirements set out in Rowan’s Law, and we will continue to make it an annual priority in our organizational objectives. By doing so, we can be confident that we are taking steps to protect our members and help them be involved in sport for as long as they want to participate.

Mary Dwyer, Executive Director, Ontario Artistic Swimming

Rugby is well positioned for concussion management with Recognize and Remove procedures previously codified in World Rugby’s Laws of the Game. Inspired by Rowan’s Law, Rugby Ontario introduced the Blue Card Protocol. In addition to traditional yellow and red cards for discipline, officials show the blue card to a player suspected of sustaining a concussion. The Blue Card Protocol formalizes and enhances the established procedures that prioritizes player welfare through a recognizable signal and integrated reporting system. Piloted in the top senior men’s and women’s leagues in 2019, the Blue Card will be implemented in all rugby activities in 2022.

Myles Spencer, Chief Executive Officer, Rugby Ontario

Rowan’s Law is having a positive impact on the OWHA, its participants and stakeholders, by creating and maintaining awareness of the importance of both personal safety and accountability for the safety of others. “It is a powerful tribute to Rowan Stringer that she is the real face to this law and that her life has led directly to the health and safety of so many others.

Players, team staff and parents see that the Law is more than a campaign and that they need to educate themselves and take action. In our opinion, Rowan’s Law is succeeding in concussion awareness and safety and its impact is even greater in promoting the importance of caring about the physical and mental health of teammates and others in sport. Rowan’s Law puts sport and life in perspective and enhances the strength of sport on life.

Fran Rider, Order of Canada, Order of Ontario, President, Ontario Women’s Hockey Association

Safe sport: The next chapter

Rowan’s Law has made Ontario a leader in concussion safety and has established a foundation for safe participation in sport.

It is our collective responsibility to build a safe and supportive sport environment for Ontarians of all ages and abilities.

Promoting safety and excellence in sport stands as a key commitment in the Ministry’s COVID‑19 pandemic vision for recovery: Reconnecting Ontarians: Re-emerging as a Global Leader. Rowan’s Law is an important first step toward Ontario’s overarching goal to revolutionize our sport culture.

Ontario will continue to build on the progress of Rowan’s Law by working to eliminate all harm in sport — both physical and mental. Maltreatment and abuse in sport can take many forms, such as verbal harassment, bullying and hazing. Any form of maltreatment can lead to physical and/or psychological trauma, and the Ontario government is resolute in our determination to end it. Maltreatment in sport cannot be tolerated, and everyone — parents, coaches, trainers, sport organizations, as well as fellow athletes — has a part to play in exposing and remedying harm wherever it occurs.

To reach this goal of a safer and more positive sport experience, Ontario will collaborate with sport system partners to improve upon our culture of sport safety. One of the first steps will be developing evidence-based solutions that are athlete-driven and consistently applied across the province. No athlete should be subject to physical or mental harm when participating in sport and all athletes should be comfortable speaking up when they are feeling unsafe.

Rowan’s Law: Concussion working group

The Rowan’s Law Concussion Working Group was established in response to one of the recommendations contained in the Rowan’s Law Advisory Committee Report.

Its mandate is to provide advice to the Ontario government in implementing the remaining recommendations of the Rowan’s Law Advisory Committee.

Members were invited to participate because they have knowledge, expertise and/or experience in injury prevention, public health and/or amateur competitive sport.

The Ministry thanks the members of the Rowan’s Law Concussions Working Group for your significant contributions and dedication to the health and safety of all Ontario athletes:

• Todd Anderson, MMA referee and Police Sergeant with the Regional, Municipality of Niagara
• Kent Bassett-Spiers, CEO, Ontario Neurotrauma Foundation
• Dr. Daniel Cass, Executive Vice President and Chief Medical Executive, Sunnybrook Health Sciences Centre
• Warren Hoshizaki, Director of Education, District School Board of Niagara
• Paul Hunter, Senior Director of Community Rugby & Development, Rugby Canada
• Susan Kitchen, Former Executive Director, Coaches Association of Ontario
• Jennifer Knox, Vice President, Ontario Federation of School Athletic Associations
• Eric Lindros, Retired NHL great and advocate for concussion research, care and awareness
• Louise Logan, Former President & CEO of Parachute Canada, a national charity dedicated to preventing injuries
• Chris Markham, Executive Director & CEO, Ophea
• Fran Rider, President/CEO of the Ontario Women’s Hockey Association
• Dr. Rosana Salvaterra, Medical Officer of Health, Peterborough Public Health
• Gordon Stringer, Rowan Stringer’s father
• Dr. Charles Tator, Leading educator and researcher dedicated to neurosurgery and the study of injury prevention and recovery from concussions
• Elisabeth White, Advanced Practice Nurse, The Hospital for Sick Children, with a role of educating the public on traumatic brain injury

Rowan’s Law: Action items status