Social interventions, like medical ones, can produce negative as well as positive outcomes. It is important for policy and practice to learn what works, what doesn’t work, and what produces unintended effects, for whom and in what contexts. This is the task of realist evaluation. The formulation and evaluation of programs aiming to deal with problems in Australian Aboriginal and Torres Strait Islander communities face a number of practical, conceptual and methodological problems. Here, realist methods for the design and evaluation of promising programs from which transferable lessons can be derived are discussed in the context of an initiative aiming to reduce the prevalence and impacts of youth sexual violence and abuse. Tentative conclusions are drawn for what this might mean for programs targeting similar problems elsewhere.