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In this Nov. 8, 2017 photo, Steph Gaspar, a volunteer outreach worker with The Hand Up Project, an addiction and homeless advocacy group, cleans up needles used for drug injection that were found at a homeless encampment in Everett, Wash. The number of unsheltered chronically homeless – those who have been homeless for longer than a year while struggling with a serious mental illness, substance use disorder or physical disability – more than doubled in the Everett region since 2015. (AP Photo/Ted S. Warren)