Use this concise record with the IEMT Treatment Plans workflow and Roy-informed governing principles. It is a proposed planning aid, not a validated assessment scale or diagnostic instrument. It does not establish that IEMT is suitable for a particular person.
Copy the prompts into your practice records or use the printable sheet. Add detail where the work requires it. Keep completed records in your secure practice system; do not enter client information on this public wiki.
| Field | Complete with the client |
|---|---|
| Record details | Client reference; practitioner; date; review date. |
| 1. Chosen life outcome | What would the client like to become possible? Why does it matter? |
| 2. Starting point | What happens now, in which situation, and how often? Record the client's account separately from observation. Agree a baseline indicator and any rating anchors. |
| 3. Demands and resources | Focal stimulus: what is most immediate? Contextual factors: what contributes? Residual influences: what remains uncertain? Note strengths, practical constraints and available support. |
| 4. Four-mode review | Physiological: rest, comfort and activity. Self-concept: meanings and values. Role function: responsibilities and limits. Interdependence: support and relationships. Record relevant strengths and difficulties. |
| 5. Working explanation | How might these factors relate? What supports this account? What is an alternative explanation? What is not yet known? |
| 6. Agreed action and consent | IEMT target if appropriate; rationale, options and uncertainties discussed; practical or support actions; who will do what; referral or coordination needs. How will the client pause or stop? |
| 7. Review and next decision | Compare the agreed indicators with baseline. Record the client's view, unchanged or unwanted effects, and other changes that could explain the result. Continue, revise, conclude, pause or refer: why, and when next? |
The two worked examples show how to use the same record for a possible IEMT target and for circumstances where practical support takes priority. They are fictional and do not report treatment outcomes.
The categories and mode names come from the Roy Adaptation Association's account of the model. The prompts and their application to IEMT are proposals developed for this wiki, rather than a worksheet authored or validated by Roy.