This paper examines the long-term placement trajectories of youth aged 10 to 17 years at initial investigation, with attention to the comparative trajectories of youth served for sexual abuse gender differences, and the mediating effects of behavioral difficulties experienced post investigation. This analysis draws administrative data on all youth served (N = 77,579) by child protection agencies in Quebec for the first time in the last 12 years. Hazard results suggest that youth served for CSA do not enter out-of-home care as quickly as other youth and once in out-of-home care, it takes longer for these youths to reunify with their families. Behavioral problems drive the increased risk of placement for all served youth but play a more influential role for youth served for CSA. Understanding the effects of CSA on youth placed in out-of-home care can help practitioners and program implementers offer more comprehensive and targeted services to improve reunification timelines, and possibly avoid out-of-home placement and placement instability.