Discover Public Health

Transcription

1 Programs & Services

2 Discover Public Health At Public Health - Dayton & Montgomery County, our mission is to lead and innovate by working with the community to achieve the goals of public health: prevention, promotion, and protection. It is in that spirit that we invite you to discover the many programs and services that we offer. We are here to serve you and we look forward to partnering with you to improve the health of our community. For more information call Jim Gross, MPH Health Commissioner

3 CONTENTS Environmental Health and Safety: 2-7 Air Pollution Control (RAPCA)... 3 Bed Bugs... 3 Childhood Lead Poisoning Prevention (CLPP)... 3 Construction and Demolition Debris Disposal... 3 Food Protection... 4 Hotel and Motel Inspection... 4 Manufactured Home and Campground... 4 Mosquito and Vector Control... 4 Nuisance Abatement... 4 Plumbing Inspection... 4 Private Water and Sewage Treatment... 5 Rabies Control... 5 School Inspections... 5 Smoke-Free Workplace... 5 Solid and Infectious Waste... 5 Source Water Protection... 6 Swimming Pool Inspection... 6 Tattoo Establishments... 6 Health Promotion and Disease Prevention: 8-15 Children with Special Healthcare Needs (BCMH)...9 Communicable Disease Reporting...9 Community Health Outreach...9 Creating Healthy Communities...9 Dayton Council on Health Equity Diabetes Education Emergency Preparedness Epidemiology GetUp Montgomery County Healthy Mommy - Healthy Baby Home Care Lupus Education Pediatric Physical Therapy Prenatal Health Public Information Speakers Bureau Tobacco Education Violence Prevention Vital Statistics (Birth and Death Records) Clinics: Adolescent Health Services CADAS: Center for Alcoholism and Drug Addiction Services Community Child Health Centers HIV/AIDS Prevention Immunization Action Program Immunization Clinic Sexually Transmitted Disease (STD) Clinic Tuberculosis (TB) Women s Health Women, Infants, and Children (WIC) Public Health - Dayton & Montgomery County

4 2 Environmental Health and Safety

5 Environmental Health Services All offices are located at: The Closed for lunch from 11:30 am - 12:30 pm The Division of Environmental Health conducts a variety of programs collectively focused on protecting the general health and safety of residents by monitoring and controlling environmental risks from our air, food, water, and waste disposal through inspection programs and educational outreach to many local businesses and homeowners. We provide information to the consumer to help them make healthy and safe choices. Inspection reports for food establishments, school buildings, hotels and motels, correctional facilities, RV parks, manufactured home parks, swimming pools and spas, and tattoo operators are available online at www. phdmc.org or by calling Air Pollution Control (RAPCA) RAPCA is the Regional Air Pollution Control Agency that covers Clark, Darke, Greene, Miami, Montgomery, and Preble Counties. We work through local health departments to protect citizens from the adverse effects of air pollution. RAPCA enforces federal, state, and local air pollution control regulations and implements the state s industrial permit system. Our programs and services include air quality monitoring, air pollution forecasting, pollen and mold reports, indoor air quality, field work and enforcement, facility inspection, and industrial permits. We regulate removal of asbestos during building renovation and demolition. More information is available at RAPCA.org. Bed Bugs (to report bed bugs in a school, hotel or motel, restaurant or grocery store) (to report bed bugs in a home or apartment) Public Health provides educational outreach and awareness through community presentations and by responding to individuals with bed bug questions and problems. We provide information to help identify and prevent bed bugs, as well as options to deal with infestations. Childhood Lead Poisoning Prevention The Childhood Lead Poisoning Prevention (CLPP) Program provides testing and assessment of home hazards to prevent young children from becoming lead poisoned. Lead that is ingested is particularly harmful to the developing brain and nervous system of unborn and young children and can cause irreversible effects including learning disabilities, mental retardation, coma, and in extreme cases, death. CLPP provides case management for families with lead poisoned children. Construction and Demolition Debris Disposal The Construction and Demolition Debris Program inspects all open and closed construction and demolition debris landfills within Montgomery County to ensure that disposal methods protect the environment and the public s health. Construction and demolition debris must be disposed of in a facility licensed and inspected by Public Health or the Ohio Environmental Protection Agency. Public Health - Dayton & Montgomery County 3

6 Food Protection The Food Protection Program oversees the licensing and inspection of all restaurants, grocery stores, vending machines, mobile food operations, and temporary food operations. Sanitarians inspect licensed food service operators and retail food establishments for proper food storage, handling, preparation and serving. Depending on the type of facility, inspections occur from one to four times per year, not including follow-up inspections. We conduct reviews of all new and remodeled facilities within Montgomery County. Online Inspection Reports are available at under Quick Links. Anyone planning to begin construction of a new restaurant or grocery must submit plans to Public Health for the work to be completed. Plans are also required for any substantial alterations. Public Health works hand in hand with local building and other inspection authorities to ensure that all applicable code requirements for facilities and equipment are met. Hotel and Motel Inspection The Hotel and Motel Program provides the licensing and inspection of all Montgomery County hotels and motels along with other facilities used by transient guests for sleeping. Public Health licenses over 6,500 rooms to ensure that all visitors will have a safe and sanitary accommodation, free of nuisance conditions. Online Inspection Reports are available at under Quick Links. Manufactured Home and Campground The Manufactured Home and Campground Program provides licensing and inspections of all manufactured homes, campgrounds, and related facilities within Montgomery County. Inspections ensure general environmental health concerns are met, such as spacing, tie-downs, protection of water connections, and adequate facilities for sewage disposal. Online Inspection Reports are available at under Quick Links. Mosquito and Vector Control The Mosquito Control Program protects Montgomery County from mosquito-borne diseases through regular trapping and species identification. The local mosquito and tick populations are monitored, tested, and controlled. If samples test positive for disease, Public Health notifies residents in the immediate area of the findings and provides education on how to protect themselves. Nuisance Abatement The Nuisance Abatement Program investigates complaints about trash, rodents, mold, and gross unsanitary conditions at commercial properties countywide and at residential properties in unincorporated areas of Montgomery County. Plumbing Inspection The Plumbing Inspection Program ensures that all plumbing installed during construction of a new or renovated building is installed under permit by knowledgeable craftsmen in accordance with applicable codes. Properly installed plumbing systems protect the public s health by preventing bacterial or chemical 4 Public Health - Dayton & Montgomery County

7 contamination of the public water supply caused by accidental backflow as well as by preventing exposure to discharge from improperly installed wastewater drainage systems. The plumbing program is responsible for on-premise sewer and water systems in many areas of the county. This program provides oversight of the installation of plumbing systems in all areas of Montgomery County except for the cities of Centerville, Dayton, Oakwood and Kettering. Plumbing contractors and in limited cases, homeowners, may apply for permits to install plumbing systems in new or remodeled construction. We typically respond to inspection requests within 24 hours. Plumbing contractors who have work inspected by Public Health must be registered with Public Health. Plumbing system plan approval is required for new or substantially altered commercial work, including multiunit apartments. Private Water and Sewage Treatment The Private Water System and Household Sewage Treatment System Program ensures that septic systems and private wells are designed and installed under permit and in accordance with state and local regulations. Public Health also investigates sewage nuisance complaints and consults with homeowners on replacing their septic systems. Rabies Control The Rabies Control Program quarantines dogs, cats, and ferrets involved in biting incidents to ensure that the animal did not transmit rabies to the victim. Biting animals are not released from quarantine until we receive proof of rabies vaccination from a veterinarian facility registered with Public Health. Local regulations require that all dogs, cats and ferrets be vaccinated for rabies. Laboratory tests of wild animals are also conducted when necessary. School Inspections The School Inspection Program helps schools identify conditions that may harm the health of students, school staff, and building occupants. Inspections include all areas of the school building and grounds, and account for environmental concerns, food service, playground safety, swimming pools, and indoor air quality. Online Inspection Reports are available at under Quick Links. Smoke-Free Workplace Ohio s Smoke-Free Workplace Program ensures that all work environments in the state are completely smoke-free. Public Health responds to complaints regarding smoking in any workplace in the county. We work with business owners to ensure compliance and protect employees and patrons from the health hazards of secondhand smoke. Solid and Infectious Waste The Solid and Infectious Waste Program ensures that waste materials are disposed of in compliance with state regulations and in a manner that protects the public s health and the environment. Staff regularly inspect all municipal solid waste landfills and transfer stations, compost operations, scrap tire businesses, and generators of infectious waste. Open dumping sites are monitored and complaints are investigated. We sample selected private wells near disposal sites to monitor ground water quality. We also investigate reports of open dumping. Public Health - Dayton & Montgomery County 5

8 Source Water Protection The Source Water Protection Program (formerly Well Field Protection) reduces risks to the public water supply by regulating the quantity and use of chemicals by businesses located in the Multi-Jurisdictional Source Water Protection Area. This is accomplished through chemical inventory reviews, periodic facility inspections, and financial incentives to businesses. Public Health staff also provides technical assistance to officials of Harrison Township, the cities of Riverside, Vandalia and Huber Heights. The City of Dayton operates a parallel program within the Dayton corporation limits. Swimming Pool Inspection The Swimming Pool and Spa Program consists of licensing and inspecting all public and municipal swimming pools, whirlpools, and special use pools within the county. We inspect design, operation, safety, and maintenance items, as well as water quality parameters of clarity, alkalinity, chlorine levels, and overall ph. Tattoo Establishments Public Health licenses and inspects tattoo and body piercing establishments within the county to ensure compliance with state and local regulations. Inspectors verify requirements for operator and artist training along with routine performance tests of sterilization equipment to eliminate the potential for bloodborne disease transmission. In addition, all complaints of unlicensed tattoo artists operating out of homes are investigated. Online Inspection Reports are available at under Quick Links. 6 Public Health - Dayton & Montgomery County

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10 8 Health Promotion and Disease Prevention

11 Children with Special Healthcare Needs BCMH (Bureau for Children with Medical Handicaps) Public Health s Children with Special Healthcare Needs Program (BCMH) provides assistance and case management to children under the age of 21 who have specific health needs primarily chronic illnesses. Nurses provide in-home assistance with connecting children to appropriate medical care, including needed diagnostic and treatment services. Participants must meet medical and financial eligibility criteria. Job Center, Suite South Edwin C. Moses Blvd. Dayton, Ohio Communicable Disease Reporting The Communicable Disease Reporting Program monitors the occurrence of contagious illnesses within Montgomery County. Our team gathers reports of diseases in the community, interviews people associated with the outbreak and conducts follow-up investigations to determine the source of infection. We make recommendations for the treatment of cases and preventive treatment of contacts, educate the public about disease transmission, and provide timely and accurate information to the community to avert outbreaks. We work closely with hospitals, physician offices, urgent cares, schools and daycares in Montgomery County to help prevent and control the spread of diseases and protect the health of our community. lower level Community Health Outreach The Community Health Outreach Program promotes health and disease prevention in the community. The program provides links to community resources through health screenings, education and referrals. Educational programs for children include: dental, proper hygiene, hand washing, nutrition, self-esteem and head lice. Programs for adults include: hypertension, diabetes, cholesterol, congestive heart disease, osteoporosis, and pandemic influenza preparedness. Creating Healthy Communities The Creating Healthy Communities Program aims to reduce rates of heart disease, stroke, cancer, diabetes and chronic lower respiratory disease among Dayton residents by addressing risk factors such as nutrition, physical activity and tobacco use. The program works with communities, schools, worksites, and healthcare professionals to create plans to reduce risk factors for chronic disease. We support policy changes that result in healthier food and vending choices, smoke-free spaces, safe walking routes, and increased physical activity throughout the community. We also provide education and resources for quitting smoking, weight management, and exercise programs. Public Health - Dayton & Montgomery County 9

12 Dayton Council on Health Equity The Dayton Council on Health Equity is Montgomery County s Local Office of Minority Health. The program s goal is to eliminate disparities in health outcomes in minority populations and to advance health equity. A community-based Advisory Council provides strategic direction and is engaging the community to address factors that contribute to poor health outcomes. These include behavior and lifestyle choices, access to healthcare, poverty, education level, cultural awareness, language barriers and other socioeconomic factors. Diabetes Education Diabetes Education offers health and nutrition classes to residents of Montgomery County who are living with diabetes, or at risk of diabetes. The program teaches residents how to prevent and successfully manage the disease. This program is certified by the American Diabetes Association. Public Health works closely with many community partners through the Montgomery County Diabetes Coalition, which addresses the many aspects of living with and preventing diabetes. Dr. Charles R. Drew Health Center 1323 West Third Street Dayton, OH Public Health - Dayton & Montgomery County

13 Emergency Preparedness The Emergency Preparedness Program is tasked with preparing Public Health, its partners and the community to respond to adverse events that affect the public s health. Activities are planned in cooperation with the public, healthcare and safety organizations in Montgomery and surrounding counties ensuring the West Central Region of Ohio is ready for emergencies. Cooperative efforts with community, business, healthcare, security and safety organizations have been enhanced to deal with any emergency. We develop agreements with adjoining counties and healthcare organizations to strengthen the regional ability to provide mutual aid. We also perform simulated Emergency Response training exercises annually with our regional partners to prepare for an actual incident. Epidemiology Our Epidemiologists analyze and translate data for practical public health application. Public Health uses this information to make population-based decisions that impact the community. Our work includes analyzing chronic disease rates and trends, identifying ideas to improve systems-level policies, and communicating with medical practitioners about infectious disease outbreaks. We support community and partner agencies in their grant applications, assist with technical expertise in defining community-based public health problems, and propose and evaluate interventions. We also help develop agency response plans for biological threats and outbreaks. GetUp Montgomery County GetUp is a community-based initiative to combat obesity and promote healthy lifestyle choices for children and families in Montgomery County. Public Health is encouraging everyone to do their part by choosing to live the Almost None lifestyle every day: Eat 5 servings of fruit and vegetables Limit your leisure screen time to less than 2 hours (TV, video games, computer and texting) Get at least 1 hour of physical activity Drink almost no sugary beverages Obesity is a major problem both locally and across the country. The odds of suffering from diabetes, heart disease, and many other health-related issues go up drastically for people who are overweight or obese. Public Health - Dayton & Montgomery County 11

14 Healthy Mommy - Healthy Baby Healthy Mommy - Healthy Baby helps to reduce the number of low birth weight babies, infant deaths and sickness within the ethnic communities of Montgomery County. The program is designed for low income, uninsured or underinsured females in their first three months of pregnancy. Others at risk for poor pregnancy outcomes are also eligible. Our staff conducts regularly scheduled home visits, educating parents on prenatal and postpartum care, as well as toddler health and care through age two. We also offer an education support group for fathers. Our staff helps clients understand health education received from clinics and social service agencies, and monitors the health status of the expectant mother and newborn. We reinforce positive changes in health behaviors and make referrals to various agencies for assistance. Dr. Charles R. Drew Health Center 1323 West Third Street Dayton, OH Home Care The Home Care Program is a Medicare certified program that provides skilled nursing, physical therapy, occupational therapy and speech therapy. Our focus for adults is to provide skilled home care services to those who are uninsured or underinsured. Monday - Sunday: 8 am - 4:30 pm Lupus Education This program promotes awareness among Montgomery County residents and provides information, education and support to Lupus patients, and their family and friends. Persons having Lupus, family members and friends are encouraged to attend our Lupus Support Group meetings. Call our 24-hour hotline ( ) for meeting dates and times. Dr. Charles R. Drew Health Center 1323 West Third Street Dayton, OH Pediatric Physical Therapy The Pediatric Physical Therapy program serves children from birth to 36 months. The program provides physical therapy services for infants and toddlers with diagnosed and potential developmental disorders. The physical therapist coordinates care with Help Me Grow/Brighter Futures and assists in the administration of standardized assessments to establish program eligibility as needed. 12 Public Health - Dayton & Montgomery County

15 Prenatal Health intake # for all locations A healthy mother is more likely to have a healthy, full-term baby. The Prenatal Program sees pregnant women from Montgomery County, beginning just after the 9th week of pregnancy and continues to follow them until they are approximately 36 weeks gestation (about 8 months). Costs are based on a sliding fee scale and insurance is accepted. Clients who are deemed to be high-risk are transferred to high-risk OB care in the community. Mothers can choose to give birth at any of the delivering hospitals in the area. Public Health maintains a good working relationship with providers in all of these facilities. Dr. Charles R. Drew Health Center 1323 West Third Street Dayton, Ohio Monday, Tuesday and Friday: 8 am - 4:30 pm 2nd and 4th Thursday: 8 am - 4:30 pm Southview Children and Family Services 25 Thorpe Drive Dayton, Ohio West Carrollton Center 13 Central Avenue West Carrollton, Ohio Public Health - Dayton & Montgomery County 13

16 Public Information and Information & Referral Public Information provides accurate, timely messages to citizens so they can make informed decisions about health-related issues. We communicate through the news media, print materials, our website ( and social media to make sure the community is informed, protected, and able to take advantage of Public Health s programs and services. Information and Referral is a service provided to all residents of Montgomery County. Our friendly and knowledgeable staff answers questions about our many programs and services, and will refer callers to outside agencies if they need additional help. Speakers Bureau Our agency gives free presentations throughout the community on our many programs and services dealing with preventing the spread of disease, promoting healthy behaviors, and protecting the environment. Call for more information and to schedule a presentation for your group or organization. Tobacco Education Tobacco Education strives to improve the health of Montgomery County by reducing tobacco use among youth and adults. Our comprehensive tobacco control program includes education about tobacco prevention and smoking cessation. Violence Prevention Our Violence Prevention Program teaches residents how to settle conflicts peacefully. Our staff makes presentations in schools, correctional facilities, and various organizations throughout the community. By raising awareness and promoting nonviolence, we are making Montgomery County a safer place to live. We work with any type of organization and counsel individuals in a group setting. Dr. Charles R. Drew Health Center 1323 West Third Street Dayton, OH Vital Statistics (Birth and Death Records) Birth and death records for people born in Montgomery County, Ohio may be purchased in multiple ways, including on-site. Call or visit our website at for guidelines, pricing, and payment options. 14 Public Health - Dayton & Montgomery County

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18 Clinics 16 Public Health - Dayton & Montgomery County

19 Adolescent Health Services (use # s listed below) Public Health services for adolescents are available at multiple location: Community Child Health Centers (p.17): Primary care, acute care (sick) and well-child visits (physical exams, immunizations) Reibold STD Clinic (p.19): STD diagnosis and treatment Women s Health Services (p.20): Pregnancy prevention Prenatal Health Services (p.13): Pregnancy testing CADAS - Center for Alcoholism and Drug Addiction Services CADAS provides alcohol and drug addiction treatment through Outpatient and Residential programs to Montgomery County residents to assist in the recovery from the devastating impact of active addiction. In addition, CADAS provides prevention services to Montgomery County parents of preschool children. Some prevention services are provided in the parents home. Whether in outpatient or residential care, clients participate in individual and group counseling, lecture and discussion groups, family counseling, and other services. Clients are encouraged to participate in a variety of community supports including Alcoholics Anonymous and Narcotics Anonymous. One Elizabeth Place Southeast, 3 rd Floor, Dayton, OH Residential Treatment Open every day 24 hours a day Outpatient Services Monday - Thursday: 8 am - 9 pm Friday: 8 am - 4:30 pm Prevention Services Community Child Health Centers Public Health operates three community-based health centers that provide comprehensive pediatric health services to Montgomery County families. The program serves children from infancy to age 16, in families that have low household income, are uninsured, or have difficulty finding affordable health services. The Community Child Health Centers goals are to provide high-quality care to families in need, and to promote lifestyle choices to increase healthy outcomes for families with children. Services provided include: well-child care and physicals, immunizations, illness and injury treatment, nutrition and exercise programs, and social services counseling and referrals. Hours apply to all locations Monday, Wednesday - Friday 8 am - 11:45 am and 12:45 pm - 4:30 pm Tuesday 10 am - 1:45 pm and 2:45 pm - 6:30 pm Child Health Center - East 25 Thorpe Drive Dayton, OH (937) Child Health Center - South 31 North Locust Street West Carrollton, OH (937) Child Health Center - West 2166 North Gettysburg Avenue Dayton, OH (937) Public Health - Dayton & Montgomery County 17

20 HIV/AIDS Prevention The HIV/AIDS Prevention Program concentrates on the prevention of HIV/AIDS transmission in Montgomery County through evidenced-based educational interventions, counseling, testing, outreach, and community planning. The program reaches out to injection drug users and individuals involved in high-risk behaviors, and offers free testing throughout the community. Clients are offered anonymous and confidential HIV testing using the OraQuick HCV rapid test that provides results in 20 minutes. Services are provided at three locations. HIV Intervention Services Dr. Charles R. Drew Health Center 1323 West Third Street, Dayton, OH Public Health Clinic lower level, Monday - Friday: 8 am - 11:30 am and 12:30 pm - 4:30 pm Public Health Mobile Unit HIV testing and counseling services closer to you! To schedule the Mobile Unit, call Immunization Action Program The Immunization Action Program is aimed at reducing or eliminating vaccine-preventable diseases in Montgomery County by evaluating and improving immunization rates in infants under the age of three. Services for providers include continuing education programs, monthly newsletters, a quality assurance program, and other educational materials. Providers or parents interested in more information or wanting to schedule a program should call Monday - Friday: 7:30 am - 4 pm Immunization Clinic The Immunization Clinic reduces the spread of vaccine-preventable diseases by providing immunization education and vaccination services. We provide routine immunizations to children from birth to 18 years of age through the publicly funded Vaccines For Children (VFC) program. These vaccines are available at our clinic and outreach locations around the county. The current outreach schedule is available online at under Quick Links: Immunization Clinic. The clinic also provides vaccines for adults, international travelers, refugees, those with occupational risk, medical indications, and for postexposure disease control efforts. For information about vaccines required for international travel, call lower level, Monday - Thursday: 8 am - 11 am and 12:30 pm - 3:30 pm Friday: 9 am - 11 am and 12:30 pm - 3:30 pm 18 Public Health - Dayton & Montgomery County

21 Sexually Transmitted Disease (STD) Clinic Public Health s Sexually Transmitted Disease (STD) Clinic provides patient evaluation, laboratory testing and treatment of sexually transmitted diseases. HIV testing, including rapid testing, is also available. The Public Health STD Lab supports the clinic by providing quick testing results. Since STDs are preventable and many can be easily treated or cured, Public Health provides educational materials about STD transmission, prevention, and treatment to all Montgomery County residents. - lower level Monday - Friday: 8 am - 11:30 am and 12:30 pm - 4:30 pm Tuberculosis (TB) The Tuberculosis Program controls the spread of tuberculosis (TB) in Montgomery County. We ensure all persons with active TB are completely treated. We work with community partners to screen individuals who are at high risk, including contacts to active TB cases, substance abusers, homeless persons, those who test positive for HIV, those in correctional facilities, and people who come from countries with a high incidence of TB. To schedule an appointment for an evaluation of a positive result, contact the TB clinic at during normal business hours. lower level Monday - Friday: 8 am - 11:30 am and 12:30 pm - 4:30 pm TB skin tests are provided on a walk-in basis on Monday, Tuesday afternoon, Wednesday and Friday. All other tests are by appointment only. Public Health - Dayton & Montgomery County 19

22 Women s Health The Women s Health Services Program provides quality medical and nutritional care to women who are uninsured or under-insured. Protective health services include: comprehensive physical exams, pap smears, breast exams, birth control methods and preconception planning. When a chronic health problem such as diabetes or hypertension is detected, a referral to a primary care provider is made. Dr. Charles R. Drew Health Center 1323 West Third Street Dayton, Ohio Monday, Tuesday and Friday: 8 am - 4:30 pm 2nd and 4th Thursday: 8 am - 4:30 pm Southview Children and Family Services 25 Thorpe Drive Dayton, Ohio West Carrollton Center 113 Central Avenue West Carrollton, Ohio Public Health - Dayton & Montgomery County

23 Women, Infants, and Children (WIC) The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a nutrition education program. WIC services include distribution of coupons to purchase specific foods at local grocery stores or farmers markets that are contracted to accept WIC coupons. WIC foods are high in vitamins and nutrients frequently lacking in the diets of the program s target population (families up to 185% of the Department of Health and Human Services poverty income guidelines). WIC participants receive nutrition education and are monitored with regards to nutritional needs and intake. Services also include breastfeeding education and breastfeeding peer assistance. Hours apply to all locations Monday: 10 am - 2 pm and 3 pm - 6:30 pm Tuesday - Friday: 8 am - 12 noon and 1 pm - 4:30 pm Sunrise Center 1320 East Fifth Street Dayton, Ohio Women, Infants, and Children 113 Central Avenue West Carrollton, Ohio Women, Infants, and Children 4500 Salem Avenue Dayton, Ohio Dr. Charles R. Drew Health Center 1323 West Third Street Dayton, Ohio Public Health - Dayton & Montgomery County 21

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