This article advocates for a conceptualization of occupational therapy service delivery and intervention for students with sensory integration and processing challenges which improves occupational participation and performance within the educational setting. By offering a full continuum of service delivery options through multi-tiered systems of support, the school-based practitioner can provide services at the appropriate level of programming. Additionally, sensory, regulatory, and relational processes are increasingly recognized as inextricably linked in development and necessary in the provision of services for students with differences in sensory integration and processing. Thus, services for this population must include a multi-tiered approach in offering a complete array of service delivery options, and intervention needs to be inclusive of strategies from three domains: sensory, regulation, and relationship.