CHAPTER 5. DISCUSSION, RECOMMENDATIONS, AND CONCLUSIONS CHAPTER 1. INTRODUCTION Background of the Study The United States is becoming more ethnically and culturally diverse. 2008 U.S. Census Bureau statistics, as reported by Hansen and Beaver (2012) cite "nearly 37 percent of the U.S. population identified themselves as minority and greater than 55 million households have a first language other than English" (p. 166). Dass-Brailsford (2007) cite U.S. Department of Health and Human Services statistics (2005) "since 1975, the U.S. has resettled 2.4 million refugees. Since the enactment of the Refugee Act of 1980, the average number of refugees admitted annually is 98,000" (p. 226). Passel and Cohn (2008) indicate: The U.S. population is projected to grow by 117 million people between the years 2005-2050 due to the result of immigration. Of this increase, 67 million will be the product of direct immigration and 50 million will be their descendents (p. 1). Dass-Brailsford (2007) defines "refugee" according to the United Nations (U.N.) protocol "people outside their country of nationality who are unable or unwilling to return to their country because of persecution or a well-founded fear of persecution due to race, religion, nationality, or membership in a particular social or political group" (p. 226). Fairbairn and Jones-Vo (2010) define "immigrant" as "an individual who has permanently moved to a new country of their own accord" (p. 10). The magnitude of the changing demographics of the U.S. population is critically important to the healthcare industry from both a cost containment and a human respect perspective. "Cultural incompetence by healthcare providers can contribute to the additional difficulties endured by politically traumatized clients" (Dass-Brailsford, 2007, p. 230). In