yielded a number of models tested and found to be effective in delivering these services and improving health. These models are described in Annex 4-1 at the end of this chapter and are listed in Table 4-1, which highlights components common to many or all of them: (1) identifying patients with psychosocial health needs that are likely to affect their ability to receive health care and manage their illness, and developing with patients appropriate plans for (2) linking patients to appropriate psychosocial health services, (3) supporting them in managing their illness, (4) coordinating psychosocial with biomedical health care, and (5) following up on care delivery to monitor the effectiveness of services and determine whether any changes are needed. Table 4-1 also includes practice guidelines, produced through systematic reviews of evidence, that identify approaches for the effective delivery of psychosocial health services, along with the consensus-based guidelines for Distress Management developed by the National Comprehensive Cancer Network (NCCN)—an alliance of 21 leading U.S. cancer centers. The various ways in which these programs carry out some of these functions also are listed in the table and elaborated on in the text that follows.

Evidence derived from the models listed in Table 4-1 (summarized in Annex 4-1) strongly suggests that a combination of activities rather than any single activity by itself (e.g., screening, case management, illness self-management) is needed to deliver appropriate psychosocial health care effectively to individuals with complex health conditions. This conclusion also is supported by the findings of several systematic reviews of psychosocial care. For example, not surprisingly, screening by itself is less effective than screening with follow-up. The U.S. Preventive Services Task Force, for instance, recommends screening for depression in adults in clinical practices only when practices have systems in place to ensure effective follow-up treatment and ongoing monitoring. This recommendation reflects research finding that only small benefits result from screening by itself, but larger benefits when screening is accompanied by effective follow-up (U.S. Preventive Services Task Force, 2002). Consistent with this finding, a review of studies of interventions to improve the management of depression in primary care settings found that those with the most multidimensional approaches (such as case management combined with clinician education and structured links to connect primary and specialty medical care) were most likely to achieve desired outcomes (Gilbody et al., 2003). Another systematic review of randomized controlled trials designed to improve the use of needed health and social services after hospital discharge found that interventions emphasizing follow-up on the results of a needs assessment showed more positive results than needs assessment alone (Richards and Coast, 2003).

In this chapter, the committee recommends a unifying model for plan-



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