Scant evidence exists regarding occupational therapy in carceral settings. Exploring perspectives and experiences to understand current practices is needed. To explore how occupational therapy practitioners (OTPs) navigate evaluation, interventions, and role delineation. Qualitative study using phenomenological and hermeneutic approaches Data gathered through semistructured interviews with seven OTPs with average experience of 16 months, representing six states and four practice settings. Themes were identified by two independent coders who analyzed the data with consensus by third researcher. Four themes emerged: managing contextual challenges, interpersonal professional relationships, evidence-informed services, and client-focused care. Practitioners applied various frames of reference, utilized self-report and observation evaluation methods, and implemented holistic direct and indirect interventions. Understanding and supporting the value of therapeutic relationships, activity/occupational performance analysis, and foci of occupational therapy (OT) domains and processes that emphasize indirect roles can further define and highlight the distinctive nature of OT within carceral settings.