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<ns4:p>Background Although more commonly offered within services for children and their families, Family and Group Conferencing (FGC) is an option that is now also being offered within adult social care and mental health services. It provides a structured process whereby adults with potential support needs, together with members of their family and/or social networks, can devise their own plan for care and support . Based on a synthesis of evidence, this Paper develops an understanding of the programme theory that underpins current FGC practice for adults in Great Britain, outlining the range of potential outcomes that may be achieved and the contextual factors and mechanisms that may contribute towards successful outcomes. Methods Using a realist approach, evidence is synthesised from a review of the international literature, a national online survey, interviews with selected stakeholders (including people with lived experience) and a deliberative forum comprising a cross-section of informants from the field. Findings Potential relational, systemic and capability outcomes were identified over and above the FGC’s stated aim of creating a plan for care and support that builds on the preferences, aspirations and capabilities of the central person and their network. A number of contextual factors were seen as important, mostly relating to how the FGC service is set up and its ‘fit’ within a wider strengths-based practice ethos. Key processes and mechanisms of change are conceptualised, relating to inclusion, recognition, reconfiguration of power relations and restorative processes. Conclusions This elucidation of the programme theory that underpins FGC practice with adults has practical relevance for the development of existing and new FGC services, both in the UK and internationally.</ns4:p>