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Calls for a contextual approach to abuse prevention highlight a need to better understand how contextual frameworks may be operationalized. Using a dual-case study design, this research compares two contrasting pilot projects underpinned by contextual theories of abuse prevention. One was implemented in a small remote Indigenous community in Australia and aimed to reduce the extent of youth-perpetrated sexual abuse. The other occurred in a densely populated urban area in London (UK) and involved the co-creation and testing of a contextual child protection response to peer-to-peer abuse. Despite their divergent approaches to developing contextual practice, a comparison of the two projects identified shared features of implementation. Both involved context-specific community buy-in and ownership of a response to peer-to-peer abuse; solutions that were co-created between professionals and communities; and the enhancement of community guardianship, pro-social use of space, and changes to the physical design of areas to increase safety. Consequentially, both projects demanded a radical transformation in the way health and social care professionals viewed the target of their interventions—the what—and the approach to achieving change—the how. Comparing these two case studies provides a unique opportunity to extend knowledge on the practical application of contextual theoretical approaches to abuse prevention.