This paper examines the extent to which regional variations in poverty and health and social services spending impact the risk of placement, after controlling for individual-level risk factors and regional latent differences in delivery of child protection services. Clinical administrative child protection data were merged with income and health and social services spending data for the province of Quebec; the final data set included all children (N = 122,466) investigated for maltreatment for the first time between April 1, 2002 and March 31, 2010, of which 22.6% (N = 27,710) were placed in out-of-home care. Multilevel hazard results indicate that poverty, controlling for health and social services spending, contributes to the increased risk of placement. Specifically, poverty and health and social services spending account for 57.1% of the variation in regional placement for younger children < 5 years of age and 38.1% for children age 5 to 11 years.