A review was conducted on regional ecological assessments in the Appalachian region of the United States, focusing on quantifying forest-based ecosystem services, forest ecosystem processes, and their linkages. Various ecological assessment frameworks were discussed, including risk, vulnerability, resilience, and indicator-based approaches. Assessments often target ecosystem-level properties or specific ecosystem services or stressors. However, the quantification of how these properties or indicators related to ecosystem services was typically lacking. While individual ecosystem services were assessed for risk and vulnerability to external stressors, linkages to ecosystem processes and potential tradeoffs among ecosystem services were seldom quantified. The study suggested that integrated system-level assessment and ecosystem service assessment could enhance support for ecosystem management by improving our understanding of dependencies on modified ecosystem processes. Models assessing ecosystem services and underlying processes in a systems context were recommended as a way to achieve this goal.