Inside Our Clinical Excellence Meetings and Why It Matters

Behind the scenes at SMART Spot, our team comes together fortnightly for Clinical Excellence meetings. These are deep-dive sessions where we share knowledge and reflect on what helps children thrive.

Recently, we explored the Learning Hierarchy

At SMART Spot, we’re often guided by the Learning Hierarchy, a framework that reminds us that children’s communication doesn’t develop in isolation. To support meaningful, lasting change, we need to look below the surface and consider what’s underneath.

This means going bottom-up.

Instead of jumping straight to speech drills or academic tasks, we begin by asking:

Does this child feel safe, regulated, and connected enough to learn?

Here’s what a bottom-up lens might explore:

• Emotional safety – Does the child feel calm, understood, and supported?

• Sensory processing – Is their nervous system able to take in, sort, and respond to the world around them?

• Sleep and diet – Are foundational needs like rest and nourishment being met?

• Screen time – Is there space for real-world connection, interaction, and play?

• Hearing and attention – Can the child access what’s being said or shared?

• Play and social connection – Are there rich, joyful interactions building the foundation for communication?

• Speech and language – Once the nervous system is regulated, this is where skill-building can truly flourish.

When we approach therapy this way, it’s not about doing less, it’s about doing what matters most, in the right order.

Because a child who is dysregulated, exhausted, or overwhelmed won’t be able to access higher-level learning, no matter how skilled the therapy session is.