Building from recent studies on cognitive and meta-cognitive skills in experienced and early career Strength and Conditioning Coaches (SCCs), the current study employed a focus group methodology to compare and contrast these earlier findings. Focus groups (n = 8), reflecting the opinions of 29 participants, were conducted with purposefully recruited international groups of experienced high-performance SCCs. Participants considered two previously developed models, reflected on the associated themes, and these were then defined or combined. Within this process, the data also yielded new themes. Reflexive thematic analysis generated five themes surrounding the decision-making process of SCCs and the design of training programs: input from environmental lead, observe the athlete(s) with the head coach, connect with the athlete(s), integrate with others and consider logistics. Moreover, context, collaboration and communication were identified as providing depth and breadth to the perceived impact possible at each stage. With consideration of managing difficult situations within Strength and Conditioning domains, three themes were generated as being most impactful on SSCs' decision-making: situational awareness, improvisation and metacognition. We discuss the fit of these results with earlier studies, together with the implications for training and accreditation of SCCs.