The Sheehan-Homicidality Tracking Scale (S-HTS): Structure and Clinical Use
Clinicians working with patients who express thoughts of harming others face a consistent challenge: how do you measure whether homicidal ideation is intensifying, stabilizing, or responding to treatment? The Sheehan-Homicidality Tracking Scale, or S-HTS, was developed to address exactly that need.
Structure of the S-HTS
The S-HTS is a short, structured scale for assessing and monitoring the core features of homicidality over time. The standard version contains 16 core questions covering the key phenomena associated with homicidal ideation and intent. Nine additional questions activate based on responses to those initial items, allowing the instrument to go deeper when the core responses indicate significant concern. This branching design keeps the scale efficient for most clinical encounters while preserving depth when it is needed.
The same version can be used as a clinician-rated instrument, as a patient self-report, or both at the same visit. That flexibility allows clinicians to compare self-report and clinician judgment within a single session, which can itself be clinically informative.
How It Is Used
The S-HTS was designed for two primary contexts. In clinical research, it functions as a safety monitoring measure, used to detect treatment-emergent homicidal ideation, meaning ideation that surfaces or intensifies during a study. This is a recognized safety concern in pharmaceutical trials, particularly for medications that may affect impulsivity or aggression. In clinical practice, it serves as a treatment outcome measure sensitive enough to detect change between appointments, giving clinicians a consistent vocabulary for tracking a patient's trajectory over time.
One notable feature of the S-HTS history: psychometric validation against another standardized homicidality tracking scale has not yet been completed. The reason is straightforward. No comparable validated instrument existed when the S-HTS was developed. The scale occupies a genuinely novel position in the clinical literature, structured enough to produce comparable scores across time points, but validated without a direct competitor to test against.
Pediatric Versions
Age-adapted versions of the S-HTS are available for children and adolescents: one for ages 6 to 8, one for ages 9 to 12, and one for ages 13 to 17. Each version is linguistically validated for its target age group. A Clinically Meaningful Change Measure variant, the S-HTS CMCM, extends the instrument for practitioners who need a more comprehensive primary outcome measure in research or a deeper homicidality profile in clinical settings.
Clinical Tracking and Behavioral Threat Assessment
The S-HTS is a clinical instrument. It belongs in direct therapeutic relationships, rated by licensed clinicians and the patients in their care. Organizations outside that context, including schools, workplaces, and faith communities, often need a different kind of structured assessment: one that evaluates behavioral warning signs, communication patterns, and contextual risk factors without requiring a clinical relationship.
Behavioral threat assessment was developed to meet that need. It does not replace clinical care but addresses a different question: not 'how severe is this patient's ideation this week' but 'does this person's pattern of behavior suggest they may be planning to act?' The two approaches are complementary. A clinician using the S-HTS in a treatment setting and a threat assessment team using a structured behavioral framework in an organization are often working with overlapping populations from different vantage points.
Where to Go from Here
Clinicians researching the S-HTS can find the standard version, the pediatric versions, and the CMCM variant at harmresearch.org. Organizations outside the clinical setting that need structured threat assessment capacity can explore the research base and assessment resources at Homicide Zero to find tools and frameworks built for that context.