The purpose of this qualitative study was to explore the context of service delivery decision-making in school-based occupational therapy practice. Participants included 14 occupational therapists. The primary source of data came from semi-structured, open-ended interviews. Open inductive coding was used for in-vivo data analysis. Themes in the data revealed that decision-making is impacted by therapists' professional identity and their conception of the role of occupational therapy in school settings. Therapists in this study relied mostly on traditional interventions that focused on skill development and was found to be the primary driver of decision-making about service delivery.