School-based occupational therapy practitioners participate in multi-tiered systems of support (MTSS) for all students, including general education students who may be at risk for school failure. However, there is little information in the literature on how school-based therapists achieve this and the perceptions of teachers who engage with occupational therapy practitioners providing service within the MTSS framework. This study aimed to understand the experiences of elementary public-school teachers working with occupational therapy practitioners who provided services within an MTSS framework. A qualitative study with a quantitative component was employed to answer the research question. Teachers (n = 13) from four different regions of the United States participated. Data sources included verbatim transcribed interviews, surveys, and documents. Data analysis revealed several constructive themes, including teachers' learning from occupational therapists, frequent and efficient utilization, students' progress, and teachers' positive feelings toward occupational therapy practitioners participating in MTSS. Teachers understood occupational therapists' workloads, respected occupational therapy practitioners, and expressed a need for more occupational therapy services in MTSS. However, the teachers did not have documentation to verify the occupational therapists' service within the MTSS framework, which could be a stumbling block for future school-based occupational therapy practitioners' involvement in MTSS.