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They are the most visible sign of New York’s homelessness crisis: A man covered in dirt sits outside a subway station in Jamaica, Queens. Another man, cross-legged and ragged on a Midtown sidewalk, begs for money. A dozen people form an encampment in Central Park.

While the overwhelming majority — about 95 percent — of the more than 78,000 people who qualify as homeless in New York actually have temporary shelter, others live on the streets, for a host of reasons. They represent a persistent challenge. Since an annual count began more than a decade ago, that population has never fallen below about 2,300, and it hit near-record levels under Mayor Bill de Blasio.

But there has been some recent cause for cautious optimism. For the second year in a row, the number of people known as chronically homeless, or “unsheltered," has fallen.

The decline, while modest, may be traced to more intense outreach efforts and an expansion of so-called safe havens. These specialized shelters have fewer restrictions and a streamlined application process to try to quickly place people into permanent housing. “We’re using every tool that we can develop to try to help people rebuild their lives,” said Steven Banks, the city commissioner of social services.

There are still thousands of people living in the open overnight. An annual count conducted in late January estimated 3,588 people fell into that category.

They are often grappling with a constellation of problems, so helping them means not only providing shelter but perhaps finding a drug rehabilitation program, a psychiatrist, a medical doctor or even guidance in a getting birth certificate or Social Security card.

That differs greatly from the kind of assistance the city gives to families with children, who often simply need shelter and a voucher to find an apartment.

Some of the homeless on the street struggle with a constellation of problems, which may include mental illness and a drug or alcohol addiction. Others prefer the independence of living in the street and balk at having to comply with the rules of the city’s shelter system, such as curfews or sobriety.

The number of chronically homeless people climbed to almost 4,000 after Mr. de Blasio took office, when he abruptly stopped opening shelters, including safe havens, in response to complaints from elected officials and residents who said the city was opening shelters without adequate community input. Other factors contributed to the increase, from high rents to a jump in both the number of patients discharged from mental health facilities and inmates released from jail and prison.

The city changed course, and the number of beds in safe haven shelters has tripled to 1,800, with plans to add hundreds more, Mr. Banks said.

“A lot of us were saying, ‘We need beds, and we need these kinds of beds,’” said Muzzy Rosenblatt, the chief executive of the Bowery Residents’ Committee, a nonprofit that first started the safe haven model. “Better late than never.”

Safe havens are an alternative to the city’s more traditional dormitory-style shelters for single adults, which some people avoid because they have a reputation as unsafe and drug-ridden.

Hylema Aiken, who used to be part of a clutch of people who set up camp each night in Central Park near 110th Street, said she used to prefer to take her chances on the street. She said she once went to a job interview with two black eyes after being attacked in a shelter.

The park restroom was available for bathing, and she could time her meals around nearby soup kitchens. But Ms. Aiken said she finally got tired and found her way to a safe haven in the East Village operated by Bowery Residents’ Committee.

“I’m almost 60 years old. I can’t keep going here, there, sliding, dipping. I have children. I have grandchildren I want to see,” she said.

There is no available data to compare the success of safe haven shelters with traditional ones. Supporters of the safe haven model argue the approach can mean the difference between continuing to sleep outside, risking injury and death, and achieving some stability.

But the process of skipping the traditional shelter system to enter a safe haven — and eventually, subsidized housing — is arduous.

The United States Department of Housing and Urban Development, which pays for the housing, requires entrants to have a disability, which could include addiction or mental illness, and live under certain conditions for at least 12 months.

In addition, outreach workers have to confirm that a person is living on the street before that person can move into a safe haven, which often means spotting someone at least three times. Some advocates said the process can be confusing: Different outreach workers can give different information, and some people are spotted more than three times before they are allowed to move.

Outreach groups said they also need cooperation from people on the street; workers can spend months cajoling someone even to share his or her name.

Bonnie Coover, director of street medicine for the Center for Urban Community Services, has been searching for people who need help in parks, on sidewalks and beneath railroad tracks since 2016. “To me, it feels like being an old-time country doctor,” said Ms. Coover, a nurse practitioner.

Ms. Coover had spent nearly three years on foot with a backpack, but in early April, the center began operating a medical van. Ms. Coover can now store blood samples in a cool place and perform electrocardiograms to check for heart disease.

The van also offers privacy. Inside, it looks like a small doctor’s office, with a padded blood-drawing chair and an examining table. A client, Tarsha, propped herself up on the table one recent day in Harlem.

Tarsha, 50, who asked that her full name not be used, began sharing her troubles. She said she had been in a psychiatric ward and visited an emergency room, and she had spent much of the winter helping residents of a nearby apartment building carry groceries and clean sidewalks.

Ms. Coover handed Tarsha a coffee and then began her examination.

Tarsha said she had lived on and off the streets, mostly on, for more than 30 years. She used to play basketball. She used to be a bus driver. “When stuff falls apart, I fall apart. Not right away, but I do,” Tarsha said.

Her immediate worry was losing what she called “my little hole,” a living space tucked near stairs outside the apartment building, where staffers took trash to the curb for pickup. “Now, they got new management, and they treat me like a wet food stamp,” she said.

Back at the safe haven in the East Village, Ms. Aiken recalled the times she could not feel her toes. Now, she was staying in a room that looked like a college dorm room, with two twin beds and a dresser where she displayed a picture frame still holding a stock photo.

Ms. Aiken said she did not yet have her own photo to put in the frame. “That’s all going to change,” she said.

Nikita Stewart covers social services with a focus on New York City Hall. She has previously worked at The Washington Post, The Star-Ledger in New Jersey, The Journal News in Westchester County and The Courier-Journal in Louisville, Ky. @kitastew

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