At-risk high school students face many challenges to occupational justice that lead to disconnection from school. They often are occupationally deprived and alienated, leading them to engage in risky behaviors such as gang involvement and substance abuse. They also tend to drop out of school, restricting employment opportunities and ability to maximize their occupational potential. High school students at risk for dropout may benefit from occupational therapy; however, they typically do not receive services or support without an educational diagnosis. Although often an overlooked role for school-based occupational therapists, program development may promote needed school connectedness sought by students at risk and prevent dropout.