Sexual violence (SV), which causes sexual harm, is a significant public health issue globally. In many nations, conventional legal remedies are the prevailing responses to SV. Restorative justice (RJ) shows promise as a potential alternative way to address sexual harm, given evidence that RJ better aligns with expressed needs and safety concerns of those directly impacted by SV. However, few empirical studies exist concerning best practices for and the effectiveness of using RJ for this purpose. This study helped address this research gap by conducting in-depth interviews to understand how organizations choose to use RJ to address sexual harm; how RJ is being operationalized to address sexual harm; how those involved in offering RJ to address sexual harm define success or positive outcomes; and factors that present challenges for or contribute to the success of RJ processes addressing sexual harm. We conducted 24 semi-structured key informant interviews with RJ practitioners and researchers in six countries. Interviews were transcribed verbatim and emergent themes were identified through a rigorous, iterative coding process. Informants discussed using formal RJ practices with a subset of sexual harm cases, typically instances of adult sexual assault or to resolve sexual harm adults experienced as children. These responses generally adhered to this sequence: referral, assessing appropriateness for participation, preparing participants, and conducting the process. Informants shared anecdotal examples of RJ benefits and measurable indicators of program success like participant satisfaction, increased coping skills, and signs that harm will not recur, although, most were not formally evaluating their programs. Challenges included limited resources, unsupportive RJ-related beliefs, and COVID-19. Factors that aid success include funding, partnerships, and positive RJ-related views. Study findings underscore the need for more research on using RJ to address sexual harm with exploration of best practices for delivering such services to diverse communities.