Happy April! Topic – Service Animals

As we enter the second week of April, spring is in full swing. I hope everyone approaches their work with a renewed sense of life and vigor as you see all the beauty of nature in full bloom.

In this month’s issue, I want to focus on providing education about emotional support animals vs. service animals.

When my husband and I were first married, he relied on a Seeing Eye dog to travel, and I gained firsthand experience in the importance of educating the public to facilitate the guide dog user’s travel success.

For example, I remember often needing to tell others about the importance of not petting the dog or sneaking food if the dog is to work effectively.

In this month’s issue, I want to help therapists understand the importance of our role in providing letters for ESA letters to clients.

As a therapist, you may be asked by your clients to write a letter supporting their request to obtain an emotional support animal. While this concept may be unfamiliar to some mental health professionals, it is important to understand the differences between emotional support and service animals and the federal laws in the United States that pertain to these animals in the areas of housing, travel, and public accommodation.

Service Animals

Service animals are animals that have received special training to help a person with a physical, sensory, cognitive, or psychiatric disability. These animals are protected by Title II and Title III of the Americans with Disabilities Act (ADA), and their work must be directly related to the person’s disability.

Emotional Support Animals

On the other hand, emotional support animals, sometimes known as comfort animals, may help provide support to an individual by helping mitigate symptoms of depression, relieving loneliness, and/or providing companionship.

However, these animals are not trained to provide a service to a person with a disability and are not covered by the ADA.

As a mental health professional, it is essential to consult laws in your specific jurisdiction regarding emotional support animals since they vary from place to place. Emotional support animals do not have specialized training, and these animals are not protected by the ADA.

Under the ADA, the owner of a housing facility is required to allow a service animal on the premises, and the owner is not allowed to charge a fee or deposit for the service animal.

Additionally, owners of the housing may be required to allow emotional support animals for persons with psychiatric or other disabilities. Landlords may require proof of disability and verification that the animal is an emotional support animal.

Under the ADA, service animals must be allowed to travel with the person with a disability. The transportation provider may not charge a fee for the animal, and the person with a disability is not required to provide prior notice.

Individuals wishing to travel with an emotional support animal on an airplane may be required to provide documentation from a licensed mental health professional stating the person’s mental health diagnosis.

Verified service animals are covered by the ADA and must be permitted in public spaces such as restaurants and shopping centers. Emotional support and therapy animals are not protected by the ADA and should not be allowed in public places unless the establishment permits pets or other animals.

When faced with a request to write a letter for a client related to emotional support and/or service animals, it is important to verify the client’s psychiatric disability and the need for the animal in the client’s treatment.

Professionals should also understand that the illegitimate use of emotional support animals confuses the public and may ultimately jeopardize the effective working relationship of the person who uses a service animal to mitigate the effects of their disability.

If the therapist determines the ESA letter is necessary for the patient’s proper functioning, the letter of verification should include the professional’s license, state or jurisdiction of the license, the date(s) of the license, the individual’s clinical diagnosis, a statement that the individual is under the care of this professional, and that the animal is necessary for the individual’s functioning/treatment.


If you would like more information, check out some of the additional resources below:

I hope this information is useful to you. If you have any questions or concerns, please do not hesitate to contact me about this topic or other accessibility concerns.

If you are interested in wellness coaching or therapy and are looking for help for a disability or chronic illness, are in the military or a military family member, or are seeking Christian-centered services, please contact me through my website: https://www.counselingbykimberly.com/

Best regards,

Kimberly R. Duff MS, LPC, CRC

Owner and Therapist, Overcomers Counseling, LLC

Hello, all of my friends!

Thank you for your support of my personal and professional goals. Being a therapist with a disability isn’t easy, but having wonderful clients and colleagues makes all the effort so rewarding.

Spring is an exciting time of growth as we see trees and flowers explode with beauty. Yet, it may be hard to find beauty or purpose after receiving a new diagnosis or acquiring a new physical disability.

I encourage others to look at this time of year as a way to reflect on their personal health and wellness goals. Is this a good time to start a walking routine, or do you or someone you know need help organizing the many therapy and doctor appointments that come with a new disability or chronic condition?

I am excited to announce the newest service for those with a disability at Overcomers Counseling, LLC:

Christian wellness coaching for persons with a newly acquired disability or newly received chronic illness diagnosis. This service is perfect for those who:

  • Are looking for resources for an employee with a newly diagnosed disability.
  • Need a friend who personally experienced a devastating diagnosis and a complex rehabilitation process.
  • Are looking for an expert on the medical and psychological aspects of disabilities.
  • Live out of the state of Georgia Need help navigating decisions related to their new diagnosis.
  • Need help understanding all of the new medical jargon.
  • Are looking for help making decisions about their future career and personal goals.
  • Need help navigating the confusing world of vocational rehabilitation.

Keep in mind that coaching does not take the place of mental health counseling.

Contact Overcomers Counseling for a free 15-minute consultation on therapy versus coaching and to see if you are a good fit for this service. To contact me, go to https://www.counselingbykimberly.com/contact/.

Virtual therapy continues to be available for persons throughout the state of Georgia.

Navigating the Web with Visual Impairments: A Look at JAWS and Zoom Text

Greetings to my February 2023 audience!

I hope this finds everyone happy and feeling loved! As someone who has been married for 17 years, I vaguely remember my single years in college and watching “anti-Valentine” movies with my single girlfriends. I guess whether it’s a happy or crappy time all depends on your stage of life!

This month, I am bringing a further demonstration of how people who are blind and visually impaired access the internet using assistive technology. First, let me explain the range of levels of blindness. A person may be blind or visually impaired. A person who is entirely blind can be diagnosed with or without light perception (Lp or nlp()). These individuals typically use a screen reader such as JAWS. The program uses keyboard commands to access the content on the screen.

As I write today’s newsletter, I am using JAWS to edit the file. For a real-life demo of the process of using JAWS to access a web page, check out this video: https://www.youtube.com/watch?v=hmkQUpJgDjU.

Visual impairment and legal impairment are declared when the individual meets the following criteria with best correction: 20/200 in the better eye or a field of vision that is less than 20 degrees. Persons who are visually impaired typically use screen magnification technology. One commonly used program is Zoom Text.

Check out a demonstration of a person using screen magnification to access a web page by visiting https://www.youtube.com/watch?v=ojtiVj78QPw.

In conclusion, Overcomers Counseling, LLC stands ready to help you reach compliance in your online practice or website. Individuals with disabilities or chronic illnesses, military and their family members, and those seeking Christian counseling can book a counseling appointment by visiting https://www.kimberlyduff.com.

Great New Service from Overcomers Counseling!

Hello and happy new year to all of my buddies! I hope everyone had a terrific holiday and is looking ahead to a prosperous year full of growth and opportunity. In this month’s issue of the newsletter I want to introduce my newest service offering. This service will help you avoid lawsuits and become compliant in your online counseling practice and product offerings.

If you have read my previous newsletters you understand online accessibility provides important independence and access to counseling services in an ethical manner.

Furthermore, you also understand that having ADA compliant web sites will help you avoid costly lawsuits.

Lawsuits are on the rise

With the rise of online commerce and virtual service offerings, we see a corresponding rise in law suits targeting those who conduct business virtually. A study of lawsuits pertaining to accessibility in 2021 found that accessibility lawsuits are filed at the rate of 10 per day, with an increase of 15% in 2021 . The highest rates of these suits are found in those with ecommerce web sites.

Additionally, data on these lawsuits excludes the practice of demand letters, which occurs when the individual or company demands money to stop a lawsuit. Consensus exists that the practice of demand letters occurs much more frequently than the filing of lawsuits.

What about online healthcare and counseling practices? In the past 3 years, there has been a 300% increase in lawsuits targeting online accessibility for healthcare practices with 1 in 5 lawsuits relating to these medical companies.


Thus, online compliance continues to be an important way to avoid costly lawsuits for the healthcare practice.

I know that many of you are confused about how to implement a compliant solution in your practice. That’s why I am excited to help you with my newest offering of website auditing. Website auditing includes reporting to give you the actionable steps you need to take to make your online content accessible. If you are interested in this service please contact me for a quote.

My passion continues to be helping persons with mental health issues through therapy and counseling. Additionally, I currently have openings for those seeking therapy. If interested fill out the contact form at my web site at www.kimberlyduff.com I specialize in disability and chronic illness, military and their family members and Christian counseling.



Happy holidays from Overcomers Counseling, LLC!

Happy holidays from Overcomers Counseling, LLC!

I’m writing this month to spread a little holiday cheer. And also, to give you a quick explanation of the online shopping experience for persons who are blind and use a screen reader.

First, I want to say that I know the holidays can be a stressful time. From both a practical as well as family standpoint. Remember to practice your self-care routine by taking a few deep breaths. Or, taking a break with a nice cup of warm tea or hot cocoa. This really does help you relax and reset so you are ready to face the holiday hustle and bustle.

Of course, many of us are shopping in person or online as we buy gifts for friends and family. As a person who uses a screen reader, I realize the process for online shopping is different for those of us who are blind. Today I will use the example of the Amazon shopping experience.

As I stated in my previous newsletter, screen readers automatically read the page top to bottom and left to right. So, when I go to the Amazon site, it is somewhat of an auditory party in my ears as I listen to all the content on the page. So, the first thing I need to do is to zero in on what I’m shopping for.

Let’s say I want to find a women’s hoodie sweatshirt. I start by using the “c” key to find the category combo box. Next, I use alt and the right arrow key to open the category choices and arrow down to ”women or women’s clothing’”. After this category is selected, I press enter. Next, I tab over to the search field and type in the text such as ”women’s hoodie”. I then press enter to run the search.

Afterwards, the search results will come up and I can read down the page. I can also use the “tab” or “h” key to move through links or headings. Of course, product descriptions may or may not be enough for me to make the best choice when shopping. In these cases I have my sighted family members offer their opinion before adding items to my cart.

Once the choice is made, I use arrow keys and combo boxes to choose my color and quantity. I then hit the “b” for the add to cart followed by the “proceed to checkout” button. As you can see, it isn’t easy to shop online with a screen reader!

In conclusion, I hope everyone has a blessed holiday season filled with God’s goodness and blessings. As always, feel free to contact me if I can do anything to help. Go to https://www.kimberlyduff.com and fill out my contact form.

Take a holiday time out by taking a moment to listen to this song by Amy Grant. In it she describes Mary’s search for peace in the middle of her Christmas turmoil.

October 2022 Accessibility Newsletter

Overcomers Counseling

I recall the first time I met someone who was blind; the event occurred following the brain surgery in which I awoke totally blind myself. I became increasingly amazed by this individual. He seemed to have almost superhuman skills that enabled him to navigate independently using a cane and tell time using a talking watch.

I also recall the first time I attempted to use a computer with a speech synthesizer. It was so difficult to understand anything it said. I needed the speed to be slowed down to a snail’s speed in order to recognize the words spoken.

I assume many of my readers are like me. In the early days of blindness, you may have never met anyone without sight. Perhaps, just recently introduced to the terms “accessible web site” or “screen reader.” Thus, I thought it helpful to devote the current newsletter to describing the experience of using a screen reader to my accessibility audience.

Screen Readers

First, screen readers are used by individuals who are totally blind or those without enough vision to read the text on the screen. The 2 main screen readers that are used by the blind in the US are NVDA and JAWS. Another screen reader that won’t be further mentioned is called Window Eyes. I personally use JAWS. This application was first introduced to me back in the days of DOS and floppy disks. It has been used throughout my transition to Windows, Office, and the internet. NVDA is a free program that stands for Non-Visual Desktop Access. It is highly recommended by users but unfamiliar to the author.

So, what happens when the individual with a screen reader visits a webpage?

The screen reader begins to read the page from left to right, line by line. The screen reader user is able to use keyboard commands to explore the site. Moving up and down, word by word depending on the information needed. Keyboard commands can also be used to move by headings, elements, combo boxes, check boxes or to find text fields or buttons. Additionally, the user can use a command to get a list of links on the page. As well as find the desired link and press enter to navigate to the link location. So, I think this explanation illustrates the process adequately without getting into too much detail.

To prevent boring my audience with more details, information on online shopping will be explained further in next month’s newsletter. Yet, I can reassure everyone that this procedure occurs quickly and automatically to the experienced screen reader user.


In conclusion, accessibility consultation is available through Overcomers Counseling, LLC. Current openings for counseling during the holiday season can be booked by filling out the contact form located at https://www.counselingbykimberly.com/contact/.

September 2022 Accessibility Newsletter

Accessible Communication for Online Counseling Services

This year marks the 32nd anniversary of the Americans with Disabilities Act. Here, I plan to highlight the application of accessibility to online products and services and the importance of an accessibility statement on your company web site.

In a 1996 response to a memo requesting clarification about the topic of online accessibility the DOJ offered the following guidance: “Covered entities under the ADA are required to provide effective communication, regardless of whether they generally communicate through print media, audio media, or computerized media such as the Internet. Covered entities that use the Internet for communications regarding their programs, goods, or services must be prepared to offer those communications through accessible means as well.”

One way professionals can start to promote this cause is by providing an accessibility statement on their web site. This statement explains the company’s commitment to making their content accessible to everyone and should contain a phone number an individual can call if he or she encounters a barrier while on the site. The statement should also contain information about the company’s accessibility policy as well as any ADA compliant products offered. Check out the following page for help in the accessibility statement process:


Kimberly also stands ready to offer consultation for those who need help in implementing accessibility in their health practice. Feel free to reach out with your needs and concerns. Clinicians and medical providers can join Kimberly’s accessibility email list by going to: https://www.counselingbykimberly.com/join-mailing-list/

Overcomers Counseling, LLC has current openings for counseling in the areas of Christian counseling, disability and chronic illness, and military and their family members. Please visit the following web site to contact Kimberly with any questions or referral information: https://www.counselingbykimberly.com




Welcome to the summer newsletter for Overcomers Counseling!

I hope everyone is staying cool during these hot months. I’m trying to find the perfect balance between my love of coffee and my need to feel chill. Today, I’m writing to share important updates that include the ability to accept new insurance plans and an exciting feature story that highlights my personal story and the mission of Overcomers Counseling.

So, let’s cut to the chase with all my news. First, I joined a company called Headway which will allow me to accept Aetna, Anthem/Blue Cross/Blue Shield of Georgia, Cigna, Oxford, Oscar Health and United Healthcare Insurances. I continue to accept Humana, Tricare and private pay as well. I’m using Headway to manage my billing and admin work, so that I can focus my energy on our time together. Headway manages everything related to payments and insurance, and clients have found that they make it really easy. They’ll send you an email directly, prompting you to create an account and provide your insurance information and a credit card for your copay or deductible. Headway will use your existing insurance benefits, which will determine your cost per session. When you’re ready to get started in the process, visit my personal headway link at https://headway.co/providers/kimberly-duff.

Next, I’m very excited to share a feature on my personal history and business by the writers at Canvas Rebel. Be sure to check it out by going to https://canvasrebel.com/meet-kimberly-duff/

In closing, I’m a phone call or email away if you or someone you know wants to explore the counseling process or schedule an appointment. I want to be there for anyone struggling with mental health, physical health or family issues. As a counselor with over 15 years of experience, I specialize in Christian counseling, disability and chronic illness, and military and their family members. Visit me online at https://www.kimberlyduff.com or send a secure email to [email protected] for more information.

Accessible Communication for Online Counseling Services

Accessible Communication for Online Counseling Services

As we consider online counseling for persons who are blind or visually impaired, we must first ask: Shall we consider online mental health counseling a business service or a medical service? Since mental health counseling coverage typically falls under the individual’s health policy, I maintain that mental health counseling can be considered a medical service and will most likely be governed by future policies that pertain to health and medical practices.

Here, I examine the current status of the law as it pertains to communication with persons with disabilities and medical services. The ADA requires that Title II entities (State and local governments) and Title III entities (businesses and nonprofit organizations that serve the public) communicate effectively with people who have communication disabilities. The goal is to ensure that communication with people with these disabilities is equally as effective as communication with people without disabilities.

In implementing communication solutions, the business or public accommodation should first consider the person’s preferred method of communication. Such as speech electronic text or large print.

• For people who are blind, have vision loss, or are deaf-blind, this includes providing a qualified reader; information in large print, Braille, or electronically for use with a computer screen-reading program.

• The key provision of the communication rules is that the person with the disability should be able to fully communicate to the covered entity and to fully understand the information conveyed by the covered entity resulting in a free exchange of information with both parties.

What do the courts require with regard to access to medical care? Under the Barrier Free Healthcare Initiative, the courts have recently targeted the enforcement of the law for communication with persons who are deaf or have hearing loss, physical barriers for persons with mobility impairments and discrimination towards persons with HIV/AIDS. The most recent rulings on these matters can be found at https://www.ada.gov/usao-agreements.htm

Here we see the courts repeatedly find in favor of the plaintiffs who were denied communication and physical access to medical care. Examples include Brookside Rehabilitation and Nursing Center Settlement agreement which is a case where the medical facility was required to provide an interpreter for the person who was deaf or hearing impaired. The North Ft. Mitchell Settlement agreement required the defendant to provide proper auxiliary aids and services to the person with a sensory disability. Additionally, there are many legal cases that found that physical barriers must be eliminated for persons with physical disabilities. Thus, the courts currently are focusing on accessibility for these populations. Accessibility for the blind and visually impaired, such as online mental health and virtual medical treatments, has not yet been addressed. However, one can assume that the courts will eventually find that accessibility online is equally important to make certain persons who are blind and visually impaired have equal access to online mental health and medical care especially considering the difficulty that exists for these individuals getting out of the house and accessing medical offices .

Are you looking for accessibility guidance? Kimberly can be contacted for networking, conversation and consultation on the topic of accessibility. To contact Kimberly go to: https://www.counselingbykimberly.com/contact/

Clinicians and medical providers can join Kimberly’s accessibility email list by going to: https://www.counselingbykimberly.com/join-mailing-list/

Overcomers Counseling, LLC has current openings for target populations of Christian counseling, disability and chronic illness, and military and their family members. Visit the following web site to contact Kimberly with any questions or referral information: https://www.counselingbykimberly.com

Welcome to my February 2022 accessibility newsletter.

This month I want to highlight why making your private practice web site or online platform accessible is simply the right thing to do even if you haven’t been given a legal challenge at this point. I want to give credit to disability rights attorney Lainie Feingold. Much of this current content comes from her webinar from 12/10/2021. You can learn more about her practice and the current state of the law with regard to accessibility by going to her web site at www.lfl-egal.com.

How should we view the concept of access and accessibility? First, therapists should recognize that accessibility is a civil right of the person with a disability. Digital accessibility means that the person who is blind or visually impaired can utilize the digital information independently without asking for help. This right of the individual grants them privacy, independence, and security. A web site that cannot be accessed independently creates a barrier for the person, thereby breaking the person’s right to privacy, independence, and security. Privacy is broken when I need to ask a sighted person to assist me with completing a task. Of course, this means I am not able to be independent when I must ask for this assistance. Security is broken because I must typically give the person access to user names or passwords in this process.

We know that the law solidifies these civil rights through Title II and Title III of the ADA. Title II mandates that federal, state, and local governments make their web sites accessible to the public. Private practices that accept federal funds through Medicaid, Medicare, or other federal or state programs are expected to make their online services accessible to the public.

Title III applies to the business that offers a service or a product to the public. Last month we highlighted how this act easily applies to the brick and mortar business and any architectural barriers. We recognized that the guidelines for the online business or practice may not be as clear-cut as technology and the law are rapidly evolving.

I agree with accessibility attorney Lainey Feingold who states that it’s better to be proactive rather than reactive in these circumstances. Therapists who practice online or who have a web site should make a good faith effort to promote accessibility to avoid future legal conflicts and to promote the dignity and civil rights of persons with disabilities. Therapists should recognize that accessibility is about people and about promoting an individual’s dignity and sense of independence. As therapists, we are bound by an ethical code that requires that we promote the ethical concepts of autonomy, beneficence, and non-malfeasance. Providing information in an accessible manner promotes these concepts as it enables the person who is blind to be independent and to be empowered to accomplish a task.

Are you looking for accessibility guidance? Kimberly can be contacted for networking, conversation and consultation on the topic of accessibility. To contact Kimberly go to: https://www.counselingbykimberly.com/contact/