The purpose of this study was to use a systems approach to examine informal communications, meaning those occurring outside of scheduled meetings, among stakeholders in a preschool early intervention program. This investigation expands the discussion of how occupational therapy treatment decisions are made in educational settings by using a systems model to map and understand informal interactions and connections. Eighteen participants shared their experiences, roles, and perspectives regarding the occupational therapy service decision-making process through surveys, interviews, and field notes. Participants were parents, administrators, occupational therapists, teachers, and other related service providers, with three or four members in each participant group. Data was analyzed through the use of descriptive statistics, concept mapping, and coding for themes revealed in detailed interviews and field notes. While the small sample size and single practice setting do not permit generalization of findings, the data suggest that informal communications affecting therapy decisions occurred but were unevenly distributed among stakeholders. Findings suggest the value of utilizing a systems approach to better understand informal interactions that exist apart from scheduled school meetings. Increased awareness of where imbalances exist among team communications can potentially improve practice. (Contains 3 figures.)