This report presents findings from the year-4 program evaluation of the City and County of Honolulu’s Housing First program. This mixed-methods evaluation assessed program implementation and client wellbeing outcomes using Photovoice methodology and latent class analysis & growth analysis of client survey data. Findings show that since year 1, 84% of clients have not returned to homelessness. Statistical analysis revealed that the program had differential impacts for some clients. Surveyed HF clients clustered into 4 “classes” based on different trajectories in changes to physical health over time in the program. Three of the 4 classes (73% of surveyed clients) experienced improvements in quality of life indicators, with one class (27%) experiencing substantial improvements. One class (27%) of surveyed clients experienced deterioration over time in the program. These clients tended to be homeless for longer prior to intake and had slightly higher VI-SPDAT scores than other classes and were more likely to report physical disability, domestic violence, and ongoing trauma. All four classes experienced a decrease in alcohol use, and all but one class saw a decrease in substance use. Despite overall improvement on most indicators, many clients have experienced increases in stress. Of a subsample, 50% or more clients said they had experienced primary & secondary trauma before the age of 18. Client-led research revealed that social support and community integration were integral to recovering from the trauma of homelessness but that stigma impeded access to social support and the community integration process. Clients indicated that having personal goals, hobbies, and projects also was essential to the recovery process by giving clients a sense of purpose, increasing self-esteem, and encouraging integration into the community. Recommendations included that the program continue to offer opportunities for clients to build social support and to reintegrate into the community; offer additional opportunities for volunteer work, advocacy, and/or peer support; continue community education efforts to reduce stigma with media, landlords, and neighbors; and directly addressing client stress during check-ins.