Evidence Connection articles provide case examples of how practice decisions may be informed by findings of systematic reviews sponsored by the American Occupational Therapy Association Evidence-Based Practice Project. This Evidence Connection article is the second article in a two-part series. The first article described a case report of occupational therapy provided to a child with a diagnosis of autism spectrum disorder and challenges in sensory integration in a clinic setting (Parham et al., 2019). This article describes the same child's occupational therapy service delivery by the occupational therapist working in the school setting. A lejandro is a 6.5-yr-old boy who attends first grade and lives with both parents and a typically developing older sister. His prenatal and birth history was unremarkable. Developmental milestones were met until age 18 mo, when his parents began to notice unusual behavior, including limited eye contact, failure to respond to his name, and repetitive movements. He received a diagnosis of autism spectrum disorder (ASD) at the age of 2 yr, 4 mo, and was found eligible for home-based early intervention services. When Alejandro was age 35 mo, the early intervention team recommended that he transition to an early childhood special education preschool. Alejandro's parents declined this option and chose instead to enroll him at age 3.5 yr in the preschool that his sister had attended. Within 6 mo, he was expelled because of disruptive behaviors. At age 4 yr, Alejandro was placed in a home day care setting with one other child. Struggles with social interactions and behavior challenges with daily routines continued in this setting, but the home day care provider was able to calm him most days. At age 5 yr, Alejandro was enrolled in kindergarten at his neighborhood public elementary school. Alejandro succeeded academically, but difficulties with peer interactions and compliance with classroom routines continued. In first grade, his challenges with self-regulation of behavior, social engagement with peers, and difficulty following classroom routines increased, particularly when he was required to remain seated for desk work. His teacher made several attempts to assist Alejandro by changing his placement in the classroom, providing frequent verbal cues, and encouraging friendship with another peer, but change was minimal. The teacher contacted Alejandro's parents and suggested scheduling a meeting to discuss how best to support Alejandro. Multitiered Systems of Support Teaming for Alejandro The school's problem-solving team, including an occupational therapist, scheduled a meeting with Alejandro's parents and his teacher. The teacher reviewed her concerns and described the strategies she had tried in the classroom to assist Alejandro. The parents shared his past day care challenges and their current concerns in the home, namely Alejandro's refusing to eat a variety of foods, running away or having a tantrum when he became upset, and refusing to work on coloring or writing activities. The t...