There is no research available describing how school Occupational Therapy practitioners (OTPs) in Western New York (WNY) provide services. The purpose of this study was to determine OTP practice patterns in WNY schools, with a focus on delivery of contextual services and the contributing factors, consistent with American Occupational Therapy Association (AOTA) and special education guidelines. Forty school-based OTPs in WNY completed a 27-question online survey in an exploratory study that examined their practice patterns by type of setting (urban, suburban, rural). OTPs were asked to describe the type of services provided and the location of service provision To analyze our hypotheses we used a Kruskal-Wallis one-way ANOVA and chi-square analyses. All statistical analyses used SPSS 26.0. More students (77.0%) received services through special education then general education. There was no difference in setting type (urban, suburban, or rural). A higher number of students received out-of-context services (83.5%) with no difference by setting type. However, OTPs hired by the districts reported a higher percentage of in-context services than those not hired by the district. Most participants (90.0%) reported satisfaction with current service delivery models with no difference in setting type. WNY practices and special education laws and AOTA guidelines suggest that OTPs provide services to all students and they learn best in-context. Our study examined the factors that may influence this finding including type of setting, type of employer, years of experience, and type of practitioner. Our study found that although practitioners report preferring in-context services, the majority continue to use out-of-context services through special education. The factors that contributed to a preference for contextual service provision included type of employer and years of experience.