Nov. 20, 2015 was not the first time District crews had visited the encampment of homeless people off Virginia Avenue near the Kennedy Center to conduct a “cleanup.”

But this time, TV news cameras and reporters stood by while employees from the Department of Public Works collected items—mattresses, garbage, shopping carts, even tents, according to some advocates—and threw them into trash trucks. People in their tents could direct cleanup crews to pack select items into plastic containers that, according to city protocol, the Department of Human Services had to store for at least 30 days.

While DHS is primarily responsible for managing D.C.’s homelessness services, the Office of the Deputy Mayor for Health and Human Services, led by Brenda Donald, oversees and manages encampment protocol. If that office determines that an encampment on D.C.-government land “presents a security, health, or safety risk or becomes a significant community nuisance,” per a 2012 agreement signed by more than a dozen city agencies, it orders a cleanup and instructs the District Department of Transportation to post signs notifying camp residents of a sweep 14 days before it occurs.

“We have been working with everyone not only in the last few days but in the last few months to identify appropriate housing and other accommodations,” Donald told reporters. “For months, outreach teams from the Department of Behavioral Health and the Department of Human Services have been working with residents of the site to get them the services they need, such as housing services, food, and mental health services,” she wrote in an email to concerned advocates that day.

Outreach workers from DBH, DHS, nonprofit organizations, and churches serve on the frontlines of D.C.’s homelessness crisis, establishing relationships with people who have been homeless for months, years, and even decades. They offer everything from basics like socks and gloves on cold nights to big-picture assistance like housing and service assessments.

While outreach work has historically been underfunded in D.C., the city will be able to greatly expand its outreach services this year with a $9 million, three-year federal grant awarded to DBH. In addition, the D.C. Interagency Council on Homelessness—a collective of public and private agencies—has been working to establish a uniform outreach protocol and create a more formal working relationship between groups.

As the weather turns dangerous for people sleeping on the streets or in makeshift shelters, the work of these outreach teams becomes even more urgent. But as encampment cleanups for the first time ever continue into hypothermia season—when homeless citizens have a right to shelter—advocates worry that people unwilling or unable to go inside will be left without lifesaving protections.

It’s around 5 p.m. on a recent Monday, and the temperature outside is 34 degrees and dropping. Ron Esquivel is checking in with a man at the corner of Pennsylvania and North Carolina avenues SE. Esquivel offers him a new pair of gloves—he’s wearing a white tube sock on one of his hands—and asks where he plans to sleep that night. The man doesn’t want to go to a shelter, but says he’s willing to go to Banneker Recreation Center, which houses 50 beds for men on nights on which the city activates a hypothermia alert. Esquivel asks another member of the team to call the United Planning Organization to request a van pickup for the man, despite the man’s assertions that he can get there by city bus.

These two first met on a rainy day in November a block away, when the man was standing near a CitiBank branch next to a pile of boxes. The corner was recently the site of a city cleanup, but the man has remained in the area.

Esquivel is a member of the outreach team Community Connections created last year with a grant from DHS. On this night, the four-person group is doing targeted outreach, visiting areas where, based on their work since November, they expect to find people preparing to sleep outside. The temperature is expected to dip into the 20s, and the team has come prepared with free socks, long johns, gloves, hats, and Dunkin’ Donuts gift cards, as well as information about shelter options. Of the people they interact with that night—a woman with blankets in a chair near the L Street underpass in NoMa, a group of people in tents under a bridge on First Street near Union Station—nearly all seem prepared to sleep outside.

“People adapt. People learn to live outdoors, they learn to develop resources, anything really to survive in that environment,” Esquivel says. On the previous Monday, when D.C. called its first cold emergency of the season, he says most people they approached chose to stay outside, despite the frigid temperatures.

Determining whether or not a person is able to safely sleep outdoors is just one part of the outreach team’s job. The main objective is to establish a relationship and build trust. “A lot of the stories we hear are that, ‘What are you going to do that other people didn’t do?’” says Jamaal Crone, a member of the outreach team. “We have things like gloves or hats; those are things that especially in these winter months they’re more willing to just take advantage of and engage in conversation over.”

While the ultimate goal may be housing (1,425 people were housed as a result of street outreach in 2015, according to DHS), an outreach team’s job is to determine “what immediately can we do to support you,” Esquivel says.

If a person is willing to give his or her name, a team member can check it against a database to see if the person is connected to other service providers or has been assessed through the coordinate entry system. If not, they can offer to do a coordinated entry assessment, which helps determine which services and housing opportunities are available to the person. They also help clients obtain income, like Social Security, and basic identification documents.

“We’ve had to create identities for people who don’t know their own names,” says Pathways to Housing DC Executive Director Christy Respress. “Having the outreach team there to do the activities on the front end is crucial.”

Beyond outreach, Community Connections and Pathways to Housing offer a number of other services—from mental health care to housing—to homeless adults. But not all homeless adults are ready to accept help right away.

“If we’re, as a community, committed to ending homelessness for people with serious mental health issues and other chronic health conditions, sometimes that takes a lot of upfront work and getting to know people well enough so they accept the services in the first place,” Respress says. Of the 3,821 homeless single individuals identified during a January 2015 count, 14.9 percent reported chronic substance abuse, 13.3 percent reported severe mental illness, and 11.1 percent reported both.

Several public and private agencies play some role in homelessness outreach to adults, both formally and informally. The D.C. government has its own street outreach workers—DBH employs an eight-person team—while it also funds grants to community organizations. Pathways to Housing, for example, currently employs 12 people to conduct street outreach with funds from DHS, as well as from the Downtown BID and Golden Triangle BID.

While different outreach groups have communicated and shared information about their work for decades, a D.C. ICH committee has been working to make that relationship more formal by developing a uniform outreach protocol.

One of the first things the Outreach Policy Work Group did was map out existing coverage, says Kristy Greenwalt, executive director of the D.C. ICH. “We can’t afford to have our outreach workers working the same case without knowing it,” she says. In November, they conducted a census to get a sense of where people who need outreach services are during the day. (It wasn’t as “comprehensive” as the annual, late-night Point-in-Time count, Greenwalt notes, which will take place later this month.)

Greenwalt says the federal grant awarded to DBH will “double” the city’s outreach capacity. Ten new teams—run by Community Connections, Pathways to Housing, Green Door, and Miriam’s Kitchen—are expected to start work by February. Per the grant’s requirements, the teams will engage people with mental illness, substance abuse issues, or both, and will include a housing navigator and a certified peer specialist (a person who is or who has a family member recovering from a mental illness or substance abuse issue). The teams’ goal is to get this population of homeless veterans and people who are chronically homeless prepared for housing, so that when it’s available, they can take advantage of it as soon as possible.

“Every area of the city will have coverage,” Greenwalt says, adding that there will be a specific point of contact for different areas. “I really want to make sure that each outreach team has a specific caseload, that they’re working to help get their [clients’] documents ready and assist with benefits while we’re waiting for the housing opportunity to come up… It’s about having a more purposeful approach.”

What’s been exciting about the ICH’s work, Respress says, is “how we together as a community have created more protocols; that we’re sharing information, trading the protocols, and the procedures, and the processes to make this work consistent and sustainable over time.”

Privacy concerns have been and continue to be a challenge for outreach providers. The city is still working to find a balance between protecting a client’s personal information and allowing organizations to see needed data in the Homeless Management Information System.

But the progress already made will help keep homeless men and women on the streets from falling through the cracks. These street outreach changes are important parts of the Homeward DC plan, which, among other things, aims to end chronic homelessness by 2017.

“Sometimes it takes days, and other times it takes years,” Respress says. “If we don’t go to them, they will die on the streets. They will stay on the streets forever. And we see that all the time.”

“David Holt.” “Michelle Dancy.” “John Doe.”

In December, more than 100 people carried signs bearing the names of the 41 men and women who advocates say died in 2015 as a result of being homeless. The march, from Luther Place Memorial Church to Freedom Plaza, was held as part of the People for Fairness Coalition’s Overnight Homeless Vigil.

“Housing saves lives,” Albert Townsend of the coalition told those assembled at Luther Place. That sentiment turned into a demand when marchers shouted “What do we want? Housing. When do we want it? Now!” as they made their way down 14th Street NW.

For some homeless adults, the first step in what may be a long journey to housing is a connection with an outreach worker.

“I don’t know people who don’t want housing,” Respress says. “I know sometimes people are hesitant or scared or not ready to say ‘yes’ yet. And the outreach team’s job is to help them figure out what’s getting in the way. Maybe it’s the symptoms of their mental illness. Maybe they believe they’re not worthy for housing.”

In the interim, many people will choose not to accept shelter over safety fears, concerns about bedbugs and other pests, or because they want to stay with a partner or pet. (The 2015 Point-in-Time count identified 544 unsheltered single adults.) Some may chose to live in encampments, which can offer a sense of community or security.

The People for Fairness Coalition, an advocacy group made up of homeless and formerly homeless individuals, has called on the deputy mayor’s office to stop encampment cleanups during the cold weather months, but so far their efforts have failed.

“It’s not like we clean up the encampments and we’re in a house with our heater,” says Robert, a homeless member of the coalition. “It don’t come to mind that those people they clean out could be dead.”

Robert stays outside. Shelters can be chaotic places, he says, where fights break out over things as simple as a fan. Low-barrier shelters are only open from 7 p.m. to 7 a.m., and to get a spot, you may have to line up hours before the doors open, sometimes in the rain.

He attended a meeting in December with Donald and other city officials where advocates expressed concerns about the encampment sweeps. The city has refused to stop them. In an email, Donald told advocates “we will not put a moratorium on encampment clean ups but will continue to act responsibly and responsively to address the issues.”

An update to the encampment protocol is apparently in the works, and a spokesperson for the deputy mayor says “our team is working to incorporate feedback from the [ICH] outreach group into the [memorandum of understanding] now, so there will likely be some changes soon.”

Ann Marie Staudenmaier, a staff attorney at the Washington Legal Clinic for the Homeless, says she’s concerned that valuable belongings are being destroyed during the cleanups. And while some people are being housed, others “were just displaced.”

The encampment sweeps may also push people, many of whom are chronically homeless, into less visible areas or to a place where an outreach worker doesn’t know where to find them.

“They can see the direct effects of it with people being moved,” Staudenmaier says of the outreach workers she’s spoken to. “All of the work that the outreach worker puts in with connecting with somebody and building a rapport and getting them to trust them is going to be destroyed if that person suddenly comes back to where they were staying and everything’s gone… and then the person disappears. All that work goes out the window. If the city really wants people to be in a certain place to connect with outreach, to get into housing programs that we suddenly have money for, they can’t be moving people every two weeks to a new place.”

Respress says their outreach team “understand[s] why people would chose to live on the street rather than a shelter.”

“I don’t know that… things that have happened [with the encampments] have jeopardized our relationships with people, because it’s not our outreach workers who are making any decisions about encampments,” she says. “They are there to support people through any changes if they’re in encampments and… be a consistent presence in their life through whatever’s next. It’s a really challenging and difficult situation.”

Judy Williams describes her outreach team like a “wastebasket”—in a good way.

“When there are challenges with homeless people in the city, people are looking to throw things in our hands so we can take care of them,” says Williams, who leads DBH’s Homeless Outreach Program.

Williams’ team gets the call when someone is naked or wearing pants soaked with urine or exhibiting another behavior that raises concerns about a mental illness or substance abuse issue. The calls come from “everybody”: community members, DHS, out-of-state relatives looking for a missing son or daughter, MPD, nonprofit service providers.

They start with simple questions—what’s the person’s name? Age? What’s the behavior that you’re concerned about? One or two members of the team, depending on the situation, will meet the person on the street. They try to engage the person and, if they can, provide “brief case management that is solution-oriented,” she says. For the woman in the soiled pants, that could mean offering a shower, fresh clothes, or a trip to a doctor to see if there’s an underlying medical issue. “We troubleshoot for people.”

Williams works out of the Comprehensive Psychiatric Emergency Program building on the D.C. General campus. It’s where DBH provides emergency psychiatric services to people brought in by police or a member of its own mobile crisis services team. When a person who is homeless is brought to the facility, Williams and her team “help to close the [information] gap.” A person in distress who may not be willing to give her name to a police officer may engage with Williams or her team if they’ve already established a relationship.

“We don’t like to release people who are John and Jane Doe, because that doesn’t help them,” she says. “We want to relink them.”

Williams describes her team as the bridge, while the case managers from DBH or a community-based service provider are the road. “Never on the journey do you carry the bridge with you,” she says. “You go along the road. The bridge is just there to help you.”

She characterizes her team as care coordinators. They are people who can sit with a client in a hospital for hours or spend the day helping a person apply for benefits or accompany them to court. It’s an intense amount of work for a team that encounters thousands of people a year across the city. They only record interactions with people to whom they offer a service, but they keep an eye on all of them.

That work becomes even more important in winter. When the city activates a cold emergency—when the temperature with the wind chill dips to 15 degrees or below, or 20 degrees or below if there’s precipitation—Williams’ team goes into “nighttime operations.” By 7 p.m., they’re out in school buses from the Office of the State Superintendent and visiting places they know or believe homeless people will be.

The DBH team can use the city’s FD-12 form to take a person into custody for emergency hospitalization if he or she is unwilling to enter shelter or go to a warming site and is in danger. Williams says they sometimes have to “browbeat” people into accepting this help on extremely cold nights. “We have people who would rather die than go to shelter,” she says.

But they try to make accommodations that remove barriers, like a reluctance to leave bags and belongings. Her team uses the handicap lifts on the buses, for example, to transport shopping carts to the shelters or warming sites.

“When they see us now, we don’t have to do that much heavy lifting,” Williams says. “They know we’re really serious about their health.”

DBH is also responsible for part of the encampment cleanup process. Williams says the city has seen “an explosion of tents.”

“We had the tents pop up because of the presence of a provider,” she says, referring to the Walmarts that have opened in D.C., allowing both homeless people and well-meaning bystanders to buy cheap tents. “But those people were there all along. They were just invisible.”

There are “adversarial” moments in the work that Williams’ team does, like when they have to use an FD-12. The key is showing up at the hospital the next day and maintaining the relationship. “Once [a client is] safe,” she says, “we’re back in the relationship.”

But while everyone on Williams’ team can use an FD-12, only she and the team social worker attend encampment cleanups. “It’s hard for me to reconcile sending you out to care for somebody and then sending you out to stand by while DPW throws your stuff in the trash,” she says. “When [outreach workers] go out, the face of DBH is psychiatric care for ending your homelessness, for getting your benefits that you need.”

Trust is a word outreach workers use a lot. Trust that is often hard-earned and easily lost.

“It’s persistence. It is consistency,” Respress says. “You have to show up when you say you’re going to show up.”

In 2014, Williams says, the city housed two clients her team had been engaging with: Both had been homeless for 15 years. One of the people didn’t want to talk to anyone and insisted he was not mentally ill. “He kept sabotaging the [housing] process with DHS,” she said. Finally, a DHS worker told him there was an apartment he could look at that day. “‘Just go and we’ll bring you back,’” the DBH outreach worker told the man, Williams says.

The man saw an apartment at La Casa, a permanent supportive housing building in Columbia Heights, and decided he didn’t want to go back to the streets. He “didn’t want a single thing” from his previous life, Williams says.

“It took ten years of our team intermittently working with him,” Williams says. That doesn’t mean daily or weekly visits, but rather keeping up the connection. Engaging, Williams says, with conversations like “How are you doing? Hey, it’s your birthday! Hey man, you’re still here. I’m sorry to see you’re still here. Do you have some water? It’s really hot out today… What can we do differently? Can we get you some mental health services? How about you go see a doctor?”

Williams describes it as “like dropping in on family.”

“Ten years of that. And he finally said, ‘OK.’”