HlHllHtlllHll u THS | RETURNING MATERIALS: ; IV‘ESI_] P1ace in book drop to LJBR RJE remove this checkout from _£!!,;;,!,:L your record. FINES wi11 I be charged if book is ( returned after the date stamped be1ow. r "u I I ‘1‘ [)4 Hichioan State University SCHOOL OF SOCIAL WORK S.W. 899 A FOLLOW-UP STUDY: PRE-PAROLE GROUP PATIENTS RELEASED FROM THE IONIA STATE HOSPITAL Presented by Gerald Wilder Michigan State University East Lansing, Michigan J. W. Heffernan May 26, 1964 A551stant Professor ‘ * RETURNING MATEP' MSU P’“ce in book (5 LIBRARIES '° ””5 C‘ ‘ COP". Chapter TABLE OF CONTENTS I. STUDY PROBLEM, PURPOSE, AND BACKGROUND. II. III. IV. V. SUMMARY . . APPENDICES. o o o o BIBLIOGRAPHY. . . . RESULTS OF THE STUDY. ii COLLECTION AND ANALYSIS OF DATA DISCUSSION OF FINDINGS AND SPECULATION. Page 10 ll 13 l” 19 CHAPTER I STUDY PROBLEM, PURPOSE, AND BACKGROUND The purpose of this study was to determine the influence of a pre-parole group experience on patients released from the Ionia State HOSpital. Two groups of patients were compared in terms of their rate of return or readmission to the hospital. One of the groups experienced the pre—parole group sessions, the other did not. The pre-parole group involved a total of 25 patients who had experienced a minimum of four group sessions during the period from September 1962, when the program began, until sessions were terminated in mid-December 1962. Any male patient who had been recommended by the hospital medical staff for release on parole, or visit to his relatives, was selected to participate in the pre-parole groups that were supervised by this writer and one other institutional social worker. Four separate groups were formed consisting of seven to ten patients in each group who met for a two hour period each week. Group participants were occasionally released from the hospital being replaced by others having been recommended for release. The patients were assigned to groups without particular selection in terms of diagnosis, race, commitment type, or other classification. Host of the 2 patients experienced from 7 to 10 group sessions. The sessions were structured informally. Discussions emphasized expectations of community living including employment, interpersonal relation- ships with relatives and acquaintances, finances, leisure-time activities, alcoholic indulgence, and interpretations of laws, parole, and hOSpital visit regulations. A random sampling technique was utilized in selecting a control group for this study.1 This group consisted of 25 patients who were released from the hospital during the period from Sep- tember l, 1961 to October 1, 1962, and had not been subjected to the pre-parole group program. This period of time was selected as it was just prior to the initiation of the pre-parole groups, and therefore both groups would be taken from the near- est comparable point in time. It was hypothesized that those patients who experienced the pre-parole groups and were subsequently released, were less likely to return to the hospital than those patients who were not in the pre-parole group. The term "released" concerns those patients who were paroled from the hospital and were expected to serve approximately two or three years on parole status under the jurisdiction of the Michigan Department of Mental Health, and/or committing court. The term "return" refers to patients readmitted to the hospital as a result of parole violation and/or need for further hospitalization and treatment. This hypothesis was formulated on the idea that the pre—parole group sessions lEvery patient's name in the universe to be sampled will be numbered, and the numbers will be recorded on identical slips of paper. They will be folded identically, placed in a recep- tacle, mixed, and the required number for the sample will be drawn. would provide patients with an increased knowledge and awareness of problems they might encounter following release into the com- munity. This, in turn, would assist them to conduct themselves in a manner which would reduce the possibilities of their return- ing to the hOSpital. There are many studies in the literature based on the theory that the rehabilitated patient makes a better adjustment to expected social roles in the open community. A limited amount of study emphasis has been devoted to the relevance of pre-parole group success in rehabilitation. There are, however, reports available regarding the relevance of group psychotherapy, group work, and group therapy. It was also decided that other factors which may influence patients' return or not returning to the hospital could be con- sidered within the confines of this study. Therefore, it was necessary to review the literature in search of certain factors or characteristics that could be tested for significant associa- tions.3 2Curt Boenheim, "A Follow-up Study of Group Psychotherapy Patients," International Journal of Psychotherapy, 1959, pp. 9, ”BB-“7%. See by other authors: R. E. Olive, "Parole Viola- tion Among Michigan CSP's As Related to Group Therapy vs. Im- prisonment," (unpublished Master's thesis, Dept. of Psychology, Michigan State University), 1962. "Use of Groups in the Psy- chiatric Setting," N.A.S.W., 1960. Harleigh B. Trecher (ed.), Group Work in the Psychiatric Setting (New York: Whiteside Inc. andIWilliam'Norrow and Company,’I9SET, p. 53-60. 3Teresa P. Domanski, "The Elderly Patient Leaves the Mental Hospital," Smith College Study, XX (1949-50), p. 130. See by other authors. H. E. Freeman and O. G. Simmons, "dental Patients in the Community: Family Settings and Performance Levels," American Sociological Revue, XIII (April 1958), pp. 1u7-15u. Ruth Openshaw, "Some Factors Related to Adjustment of Schizo- phrenic Patients Five Years After Their First Parole From a Mental u Ten factors were selected for study which included the patients' age, race, type of commitment, length of hospitaliza- tion, marital status, occupation, income, living arrangement, size of community, and education. These factors selected are defined as follows: (1) Age referred to the number of years of age a patient was at the time of data collection in March 196%. Three age groupings were utilized for measurement. The first included those patients between the ages of 22 and 3n; the second group made up those between 36 and H8; and the third were those patients between 52 and 70. (2) Race was regarded as to whether the patient was white or negro. (3) Type of commitment was defined in terms of whether the patient had been originally committed to the hospital as mentally ill, or as a Criminal Sexual Hospital," Smith College Study, XII (lQHl-HZ), p. 192. H. E. Freeman and O. G. Simmons, "Wives, Mothers, and the Post—hospital Performance of Nental Patients," Social Forces, XXXVII (December 1958), pp. 153-159. H. B. Freeman and D. G. Simmons, The Mental Patient Comes Home (New York: John Wiley and Sons, 1963), p. 171- Igh. Jeanette Halper, "Factors Affecting the Adjustment of Patients Paroled From Family Care Homes," Smith College Study, XV (l95H-55), p. 14H. Betty Lou Haller, "Some Factors Related to the Adjustment of Psychopaths on Parole From a State Hospital," Smith College Study, XIII (19u2), pp. 193—199. Dinitz, Lefton, Angrist, and Pasamanick, "Psychiatric and Social Attributes as Predictors of Care Outcome in Mental Hospitalization," VIII (Sep— tember 1961, pp. 322-328. Robert E. Clark, "Size of Parole Com- munity As Related to Parole Outcome," American Journal of Sociology, 1951, pp. H3-H7. See by other authors. Milton Green- bIatt, R. H. York, and E. L. Brown, "Mental Hospitals," Russell Sage Foundation, 1955, pp. 2H3-2HH. C. H. Patterson, "Evaluation of the Rehabilitation Potential of the Hentally Ill Patient," Rehabilitation Literature, XXIII (1962), pp. l62-l72. Halper, loo. cit., Haller, loo. cit., Dinitz, Lefton, Angrist, and Pasa- mafiicRT—loc. cit. Edfiard_ziegler and Leslie Phillips, "Social CompetenEE—and—Uutcome in Psychiatric Disorder," Journal of Ab- normal Social Psychology, l961, pp. 269-271. 5 u (H) Length of hOSpitalization referred to the period Psychopath. of time the patient was in the hospital previous to his release on parole. The period of three years was used as an arbitrary dividing line. (5) Marital status was determined on the basis of whether or not the patient was married at the time of data collection. Those considered to be non-married included patients who were single, divorced, separated, or widowed. (6) Occupa- tion was regarded as the patients' employment situation at the time of data collection, or if returned to the hospital, his last gainful employment situation while on parole. (7) Income re- ferred to total weekly wages before deductions at the time of data collection. Division of patients was selected at the point where income was $50.00 or less, or more than $50.00 per week. (8) Living arrangement was determined on the basis of whether or not the patient was living alone in the community. Those con- sidered not to be living alone were living with their wife and family, parents, or other relatives. (9) Size of community re- ferred to the population density of areas where patients were residing on parole. In order to statistically measure this factor it was necessary to group the patients in terms of those living in areas of 18,000 population and less, and those living in areas of 53,000 or more. (10) Education referred to the academic grade completed by each patient. The dividing point used was whether patients had attained an eight grade education or more, or had L‘The term "Criminal Sexual PsychOpath" refers to patients committed to the Ionia State Hospital as sex offenders. These patients are not adjudicated as being mentally ill or insane, but hospitalization is deemed necessary in terms of their emo- tional disturbances resulting in their acting out in sexually abnormal manner. «flew II I 6 completed less than eight grades. The previously defined factors selected are by no means considered the only ones that could influence patients' return to the hospital. There may be others that are not included in this study which could be just as significant, if not more so. It was felt, however, that the factors chosen would be adequate in lieu of their significance indicated in prior research findings. CHAPTER II COLLECTION AND ANALYSIS OF DATA Data for this study was collected from case records, questionnaires, and interviews. The case records located at the Ionia State Hospital include social, psychological, and medical histories of each patient, and a sequential account of the patients' treatment, care, and progress is incorporated. The writer selected the data from the record fact sheets and progress notes which are considered acceptable because of legal recording requirements demanded of the hoSpital by the Michigan Department of Mental Health and the Circuit Courts of Michigan. Questionnaires were mailed to 28 patients which consti- tuted those individuals of both the pre-parole group and the control group who had not been returned to the hospital. All of these patients had been on parole for a period of at least eight months. Five patients who were on parole status were not sent questionnaires because of their whereabouts being unknown. This was a result of either the patient obsconding from parole, or because of tempor— ary delays in the hOSpital being notified of a patient's change in address. The primary purpose of the questionnaire was to deter- mine how the patients viewed the pre-parole group sessions in terms of their reactions and opinions of the program. Other factors 7 8 sought by the questionnaire included the respondents' marital status, living arrangement, occupation, income, further education, if any, and the most significant problem encountered in the com- munity. It was anticipated in conducting the questionnaire canvas that some of the respondents might tend to reSpond favorably to the pre-parole group exnerience because of their being previously involved in a treatment relationship with the writer. The formula- tion of the questionnaire attempted to manipulate the questions in a manner which would deal with the anticipated bias.5 There- fore, a multiple choice question was included containing five categories which were as follows: (1) Interviews with Physicians, (2) Group Therapy, (3) Occupational and Recreational Therapy, (H) Interviews with Social Workers, and (5) Pre-parole Group Meetings. There were three columns following each category en- titled "Very Helpful," "Helpful," and "Not Helpful." Respondents were asked to check how helpful each category had been to them since their release on parole, and to briefly explain their most favorable reSponses. The category, "Interviews with Social Workers," was expected to assist in the elimination of bias con- cerning favorable responses to the pre-parole group experience. Data was also collected through individual interviews with those patients of both groups that were returned, or re- admitted, to the hospital. The interviews were structured to extract the same factors sought by the questionnaires, except further emphasis was placed on the reasons why these patients 5See Appendix A on page 14. returned. The data collected from the case records, questionnaires and interviews was organized into nominal classifications. Checks on pre-coding and post-coding were made before and after pre- tests were ran on the questionnaires and interviews. Tabulations were made and 2 X 2 tables were constructed for the comparison of each variable or factor under observation. The statistical method of chi square was employed to test for significance of associations. This involved the comparison of the pre-parole and control groups in terms of their rate of return to the hospital. Both groups of patients were combined for the purpose of measuring the influence of other factors (age, race, marital status) on patient return. The factor of occupation was not tabulated as it was impossible to measure the numerous categories found in re- lationship to the limited amount of patients being studied. Questionnaire and interview responses were classified in terms of the most helpful programs indicated by the patients. Three categories were selected as being the primary groupings patients chose to be the most helpful to them following release from the hospital. These categories were the pre-parole group sessions, group therapy, and a combination of other treatment programs including interviews with physicians, occupational and recreational therapy, and interviews with social workers. The three categories were also tabulated for the purpose of measur— ing their association, if any, to patients returning to the hospital. CHAPTER III RESULTS OF THE STUDY Results of the statistical measurements showed that there was no significance to the proposition that those patients ex- periencing the pre-parole group sessions were less likely to return to the hospital than those who were not in the pre-parole group.6 The findings were not significant at the .01 level, nor even at the .05 level. This was also true of the other factors tested. This means that patients' age, race, type of commitment, length of hospitalization, marital status, income, living arrange- ment, size of community, education, or programs selected were not associated as to whether or not patients were returned.7 Questionnaire respondents, as well as the interviewees that had returned to the hospital, expressed various problems they experienced on parole, but there was not one, or even two, particular problems indicated as being significant among the re- porting group. 6See Table l on page 15. 7See Tables 2 through 11 on pages 15—18. 10 CHAPTER IV DISCUSSION OF FINDINGS AND SPECULATION The findings clearly show the lack of significance re- garding the pre-parole group sessions as well as other factors studied and their influence on the patients' return to the hOSpital. It is concluded that the initial hypothesis formulated in this study is rejected. The null hypothesis--those patients experienc- ing the pre-parole group sessions were just as likely to return to the hOSpital as those who were not in the pre-parole group, is accepted. It has been previously indicated by other writers that several of the factors measured in this study were significant variables influencing the rate of patient return to mental hos- pitals. Why they were not found to be significant in this study is not a simple question to answer. The Ionia State Hospital has been described as a unique institution in comparison to other mental hospitals in Michigan. This has been claimed mainly because of the criminal commitment aspect, and its being the only admitting hOSpital for sex offenders. Because of these differences there may be other variables working that would prove to be significant influences on patients' return- ing to the hospital following release onparole. A few of these 11 4'49. 12 variables might be the crime originally committed by the patient, diagnosis, or the amount of actual therapy received. The size of the universe and the sample drawn for this study were small because of the limited number of patients who experienced the pre-parole group sessions. There was also a limited number of sessions (a maximum of ten) in which patients were involved. The period of time used for selecting the sample control group was a year in which the hospital was highly en- couraged to parole many patients, which may indicate that the findings are not necessarily indicative of other periods of time. It is speculated that larger samples over a longer period of time, along with an increase in the number of pre—parole group sessions might produce different results in a study of this kind. CHAPTER V S UI’II-IARY It has been previously pointed out that the hypothesis stipulated in this study was rejected in View of the statistical results. The factors measured were also found not to be significant in terms of their relationship to whether or not patients returned to the hospital. Nevertheless, the writer sees the findings of this study as meaningful and useful material to be considered, along with the previously mentioned speculations, for future research endeavors in this area. 13 QUESFICNIEIIRE ."..-'-‘?ILI~ID IX A Please place an ”X” in the box following the word of_your choice. 8. I am presently: Single ( ) Married ( ) Divorced ( ) Separated ( ) I am now living with: ‘Wife ( ) Parents ( ) Other relatives ( ) Friends ( ) Employer ( ) Alone ( ) Where are you employed at the present time? Please specify briefly what your job is: What is your weekly pay before deductions? Less than $50 ( ) Between 350 & $75¢ Between 376 & $100 ( ) Between $101 & $130 ( ) Over $130 ( ) Do you receive any income such as a pension, welfare or social security benefits, or other? Yes ( ) No ( ) If you marked "yes", briefly explain what you receive, and the monthly amount. Have you attended any school courses since your release from the hospital? Yes ( ) No ( ) If you marked "yes", explain briefly just what course or courses you completed. *— Since your release from the hospital what has been the most difficult for you, or has caused you the mosttrouble? Family, children,_or marriage_problems ( ) E;n;ing or;§egping a job _ ( ) ._«_“___ 229 much spare time ___ ( )_ ngriendly_people ( _L Other -- please specify what _ Of the following programs at the hospital, please indicate how helpful you feel each one has been to you since your release on parole. VERY HELPFUL HELPFUL NOT HELPFUL Interviews with_physigians Group therapy Occupational & recreational therapy interviews with social wprkers - ———-——-—+- % Preeparole grou2_sessions .. ._ - .- _._ . ~L—o If you selected "very helpful" for any of the above, please tell briefly jrst why you chose that particular program, or if you marked ”helpful” without in- dicating any as ”very helpful”, please tell why you chose that one. .—. . —-—.—-.—-.—.—-.--.-- .—.—- .—-. —.. hag—H ‘mho - m .— .‘H-.—-—fi-o-o .—.- ’.—.— -—. - —— s—o -—-.-.. - -——. “fine-”p.-. 1H APPENDIX B Tables TABLE 1 Pre-Parole Group a l Returned to [ Control Group“ Hospital 9 Not returned [ 17 l 16 25 25 TABLE 2 Race White Negro Returned to [ . I MOSpital l2 5 Not Returned f 27 I 6 39 ll TABLE 3 Age Age 22 to 3” 736 to D8 » 52 to 70 Returned to I 1 | Hospital 6 7 u Not Returned [ '11 l 10 l 12 l7 17 16 15 17 33 50 17 33 50 17 33 50 16 TABLE Q Type of Commitment dentallv ill Criminal Sexual PsychOpath_ Returned to Hospital Not returneJ 7 10 I 17 f 9 2n | 33 15 3a 50 TABLE 5 H years or more Length of Hospitalization Less than u years_ Returned to Hospital Not returne< Returned to Hospital Not Returned 11 6 J 17 17 0 16 I 33 28 22 50 TABLE 6 Marital Status Non Married Married 13 u l 17 2a 9 l 33 37 13 50 17 TABLE 7 Income Less than $50 a Week $50 or more a week_ Returned to Hospital 9 9 18 Not Returned 11 18 I 29 20 27 97 TABLE 8 Living Arrangement Living Alone Living with wife and/or other relatives Returned to Hospital 7 10 17 Not Returne4’ 12 17 29 19 27 H6 TABLE 9 Size of Community Under 18000Apopulation 7 Over 53000 population, Returned to Hospital 5 12 17 Not Returned 6 i 23 J 29 ll 35 96 18 TABLE 10 Education 8th grade or more Less than 8th grade_ Returned } to Hospital 12 5 17 Hot Returned 21 12 I 33 33 17 50 TABLE 11 Most Helpful Programs _Pre-Parole Group iGroup Therapy Other Programs_ Returned to Hospital 9 H 2 10 Not ReturnedI 6 I 12 I 8 I 26 10 16 10 36 BIBLIOGRAPHY Books Freeman, H. E., and Simmons, 0. G. The Mental Patient Comes Home. New York: John Wiley and Sons, 1963. Payne, Stanley L. The Art of_Asking Questions. Princeton, New Jersey: Princeton UniVersity Press, 1951. Trecher, Harleigh B. (ed.) Group Work in the Psychiatric Setting. New York: Hhiteside Inc., and Hilliam Morrow and Co., 1956. Articles Boenheim, Curt. "A Follow-up Study of Group Psychotherapy Patients," International Journal of Psychotherapy, 9, 963-979, 1959. Clark, Robert E. "Size of Parole Community as Related to Parole Outcome," American Journal of Sociology, 43, 97-57, 1951. Dinitz, Lefton, Angrist, and Pasamanick. "Psychiatric and Social Attributes as Predictors of Case Outcome in Mental Hospitaliza- tion," Social Problems, 322-328, September 1961. Domanski, Teresa P. "The Elderly Patient Leaves the Mental Hos- pital," Smith College Study, 20:130, 1999-50. Freeman, H. E. and Simmons, 0. G. "Wives, Mothers, and the Post- hOSpital Performance of Mental Patients," Social Forces, 37: 153-59, 1958. Freeman, H. E. and Simmons, 0. G. "Mental Patients in the Com- munity: Family Settings and Performance Levels," American Sociological Revue, 23: 197-154, April 1958. Haller, Betty Lou. "Some Factors Related to the Adjustment of Psychopaths on Parole from a State Hospital," Smith College Study, 13: 193-H, 1942. Halper, Jeanette. 'Factors Affecting the Adjustment of Patients Paroled From Family Care Homes," Smith College Study, 15: 14H, 1959-55. 19 20 Openshaw, Ruth. "Some Factors Related to Adjustment of Schizo- phrenic Patients Five Years After Their First Parole From a Mental Hospital," Smith College Study, 12: 192, 1991-92. Patterson, C. H. "Evaluation of the Rehabilitation Potential of the Mentally 111 Patient," Rehabilitation Literature, 23: 162-172, 1962. Shoemaker, Louise. "Social Work With Groups, Use of Group Work Skills With Short Term Groups," N.A.S.H., 1960. Slocum, Empey, and Swanson. "Increasing Response to Question- naires and Structured Interviews," American Sociological Revue, 21: 221-5, April 1956. Smith, Donald S., and Hawthorne, Mary E. "Psychiatric Rehabilita- tion: A Follow-up Study of 200 Cases," Navy Medical Bulle- tin, ug: 655-669, 19u9. Wasser, E. "Caseworker as Research Interviewer in Follow-up Studies," Social Casework, 38: ”23-30, October 1957. York, R. H., Greenblatt, Hilton, and Brown, E. L. "Mental Hospi- tal," Russell Sage Foundation, 293-9, 1955. "Use of Groups in the Psychiatric Setting," N.A.S.H., 1960. Ziegler, Edward, and Phillips, Leslie. "Social Competence and Outcome in Psychiatric Disorder," Journal of Abnormal Social Psychology, 269-271, 1961. Unpublished Haterial Dailey, William. "Some Factors Associated With Release Adjustment of Mental Patients From Northville State Hospital." Unpublished study, School of Social Work, Michigan State University, 1963. Olive, R. E. "Parole Violation Among Michigan CSP's as Related to Group Therapy vs. Imprisonment," Unpublished Master's thesis, Michigan State University, 1962. d Wilder C U OUTLIWE FOP restaaca EFFORT I. Study Frooiem, Purpose, and Background. A. 6. Corrarison of :atient grours from the Tonia State Hosrit*l. i. T‘reoparOIe group, its description and ru wr 036. 3. ContrOI grout, its description, purpose, and sampling techn11ue employed. Hypothesis - Those patients who eXferienced the pre- parole group and were suosequrntly released, were less liyeiy to return to the hosrital than those patients who were not in the fire-parole group. 1. Pefinitior us of terr;s in the hypothesis. 8. The idea leading to the formulation of the Theoretical relevance and a :r0"riate literature. 1. 'he ith ilitated patient makes a setter adjust- rent to expected social roles in t.e co; ..... unity. 2. Other studies indicatung the relevance of group "sycnotnerafy, group work, and grou; therapy. 0 Other factors selected for reasurerent of their in- tiuence on ratio? t return to the hos;ital. 1. Literature review for selection of factors. 2. Factors selected and their deiir itions. (a). Age (a). Uace (c). Ty‘e of co:" 1trert (d). Le -gtn of hos iteiiza tion (a). :aritai status If). couration (g). Incoze (h). Living arrangeient (i 128 of cc*:unity (j fiducation Lir1its .tions concerning the footers seiec:ed. 1. These factors are not c;n61aered the only ones that could be relevant. 2. rnese factors were chosen oecause of their signi- ficance in previous researon studies. II. TIT. IV -2- Collection and Analysis of Fate. A. Sources of data collection and their description. 1. Case records, their location, and description. 8. Questionnaires, their gur ose, descri;tion, and data sought. (a). festondents (b). Factors sought kc). Problens and bias 5. Interviews, their :urnose, definition of inter— viewees, and data sought. r. ani irulation a: -d data anal 3rsis. l. “oding, classification and tabulations. 2 Statistical reasurenent of chi square to he used. (a). Ger arisen of the 3re-;arole and Control groujs in terns of their rate of return to he hosvitol. to). 602-31:at1:1 of both grou s to nee sure th ini'iuence of the other faoto s. (c). ”u sti:nnaire and interview res onses clas 1 ications for reasurexe ent cf r.ost helpful pregra s selected. Results of the Study. 5. Congarison of groups co: cerni ng those 3atients re— turned to the hosiit: l. 1. Significance of fir ding s. th signi:icant. P. Fther factors neasured. 1. significance of findings. ‘fot sigr -ificar nt. Fisoussion of Findings, an Sgecuiation. 5. Conclusion drawn from findings. 1. Original hypo hesis rejected, null hyjotiesis aooevted. F x lanatic n of linit atior s 0: fi- dings. The hospital as a unique institution. . 1‘cssibility of other variables working. (a). Crime counited by the patient. (b), Piagnosis. (c). Arount of there-y received. 3. Lirited size of sauMIe. 4. Li ited number of :re-rarOIe group sessior s. 5. reriod of tine used for selecting 3V ple control group. fireculation. 1. Larger sanfiles over a longer period of ti 7" Lo 2. Tnorease in the number of fire-garole wroup Q" °u vary fi. Statistical results. Usahility for further reacirch. 9. sessions. \ New. . .. .. wf \ makkt J . 1.» ,i n s .J a .\ "I71111111711111@1716