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

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

It’s a New Year. Is your website accessible?

I often describe the conversation with my mom that occurred after the surgery that left me totally blind in which I asked her, “How can I do anything if I’m blind? How can I have a job or a family?” My mother’s response framed my future as she stated, “You can still do anything you wanted to do before; you’ll just have to do things differently now.”

My name is Kimberly Duff and I am a Licensed Professional Counselor and a Certified Rehabilitation Counselor (LPCCRC). These credentials mean that I am licensed to work as a counselor in Georgia and I have special education and certification in disability and chronic illness. Throughout my education and professional development I have paid particular attention to the advances in assistive technologies and also the changing laws and guidelines that have direct impact on my practice as a counselor and my life as a person with disabilities.

Did you know in 2020, 10,982 Title III ADA lawsuits were filed in federal courts. In 2019, a suit was filed by a visually impaired individual against Domino’s Pizza because he was unable to order a pizza through the company’s website in 2015. Domino’s was ordered to bring their website into compliance with industry standards for website accessibility and pay the plaintiff $4,000 in penalties.

Federal district courts have held that businesses are “places of public accommodation” and as such, must reasonably accommodate the disabled in accessing services. They violate ADA when they fail to make their websites and physical locations accessible for disabled customers.

Privately owned therapy offices are also considered “places of public accommodation” and are subject to Title III regulations as set forth in the ADA. This includes websites if the website provides the address or directions to the office, provides a phone number for the office, offers an online scheduling system for prospective clients, and provides a printable copy of an informed consent document or other intake paperwork.

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.

So, what should a counselor or practice manager like you do? Where should you start? Just like my mother told me, you can still do anything you want to do, you just need to do things differently now.

This newsletter will bring these issues to the forefront and offer clear guidance on how you can comply with current best practices and legal standards and also better serve your clients with disabilities. I hope to encourage dialogue to foster understanding and change within the counseling community. If you are ready to implement accessibility in your online course, counseling platform, or electronic forms, contact me so we can get started. To see if my accessibility services are the right fit for your practice, please fill out the contact form on my website here






Are you a clinician or medical professional interested in receiving regular updates on web site and online accessibility for the blind and visually impaired? Subscribe to Kimberly’s blog by going to https://www.counselingbykimberly.com/join-mailing-list/

Raindrops on Roses – 3 Ways to Control Your Thoughts and Foster Resilience

3 Ways to Foster Resilience

Raindrops​ on roses
And whiskers on kittens
Bright copper kettles and warm woolen mittens
Brown paper packages tied up with strings
These are a few of my favorite things

 Girls in white dresses with blue satin sashes
Snowflakes that stay on my nose and eyelashes
Silver-white winters that melt into springs
These are a few of my favorite things

​When the dog bites
When the bee stings
When I'm feeling sad
I simply remember my favorite things
And then I don't feel so bad

As a child with pediatric brain cancer, I recall listening to this song while in the hospital over and over to get through the many struggles I encountered. 

This song describes something  that psychologists and counselors study and try to impart during therapy… the impact of our thoughts on our feelings and overall mood. 

Here I examine  3 ways to foster this resilience and pattern of thinking including  developing an optimistic outlook through interventions such as cognitive behavioral therapy,meditating on scripture  and using imagery and mindfulness to foster psychological well-being.

Continue Reading

5 Simple Self-Care Practices to Help Improve Your Mental Health

Self-Care Practices for Mental Health

This is a guest post on 5 Simple Self-Care Practices by Brad Krause from SelfCaring.info. Brad is dedicated to helping people discover that we all have the potential to be the best versions of ourselves we can possibly be, but it comes down to prioritizing our own wellness through self-care.

When life gets busy, it can be hard to remember to take care of yourself. Many things can get in the way of putting yourself first, such as work commitments and time with friends and family. However, it’s important to practice self-care because if you don’t, your mental health can suffer. Here are some simple ways that you can improve your physical and mental health, so you can start living the best life possible.

Continue Reading