This study examined the rates of a first presentation to the emergency department (ED) for suicide-related behaviour (SRB). Presentation rates of youth who were living permanently in the care of a child welfare organization were compared to their peers living with caregivers of origin. The sample is a population-based cohort of 12 to 17 year olds living in Ontario. To assess ED presentations for SRB, youth who were permanently living in out-of-home care (n=4,683) and their peers living with caregivers of origin (n=1,034,546) were individually linked to health care records. Findings of this retrospective study indicate that youth living under the care of a child welfare organization were five times more likely to present SRBs at the ED than youth living with their caregivers of origin. Authors suggest further research in the areas of prevention of child maltreatment, recurrence of child maltreatment, and the promotion of resilience after child maltreatment has been identified. Additionally, the need for collaboration between child welfare and mental health services provides an opportunity for intervention.