Objective. This study investigated one aspect of the role of school-based occupational therapists working with students with complex health care needs during the school day.

Method. One hundred seventy-two occupational therapists working in school systems were surveyed with regard to their involvement with children with complex health care needs, particularly specific complex health care procedures performed, knowledge of policies, training in the administration of health-related procedures, and perceived levels of competency.

Results. Sixty-eight (61%) of the therapists reported having children with complex health care needs on their caseload; of these, 65% reported involvement in seizure monitoring and 24% reported performing gastrostomy feedings. Most respondents reported an awareness of policies regarding administration of medication, gastrostomy feeding, and seizure monitoring in their school system. Respondents’ main role with this population included activities in positioning, environmental modification, and staff instruction.

Conclusion. The major role of occupational therapists working in school systems involved providing direct intervention with the student and not conducting or instructing others in health-related procedures. Therapists also served as a resource on health-related issues for school personnel.