In most states, occupational therapy practitioners are restricted from advancing to formal school leadership positions. The absence of pathways to leadership may limit the ability to fulfill AOTA's Vision 2025 and Every Student Succeeds Act (ESSA). This study investigates how limited opportunities for career advancement affect school practice trends. We explore the perceptions of school practitioners in New York State concerning leadership, advocacy, and state policies. Seven hundred and fourteen current and former occupational therapy practitioners in New York schools completed a researcher-developed online survey. Notably, almost all respondents (94.7%) agreed that practitioners should be able to pursue educational administrative coursework. Most (94.6%) agreed that practitioners in New York should advocate for policies that would allow them to pursue such coursework. Many respondents reported that they would consider pursuing the coursework if available. This research emphasizes the misalignment between federal and state policies. Federal policy (ESSA) and Vision 2025 encourage greater involvement for occupational therapy practitioners, but state policy restricts their advancement. The findings demonstrate the pressing need for reform and the creation of pathways that enable occupational therapy practitioners to assume formal leadership positions in school settings, thus enhancing their contribution to the school community.