The objective of this study was to contribute to the understanding of the child welfare organization by testing the hypothesis that the characteristics of organizations influence the decision to refer clients to additional services. Two aspects of organizational structure were examined: 1) role specialization, or the division of tasks intended to accomplish the mandate of the organization; and 2) service integration, or whether child welfare organizations and other services such as children's mental health are integrated. Other organizational factors proposed by the theoretical and empirical literature as salient to understanding child welfare decisions were included in the analyses (e.g., proportion of investigations of Indigenous children). Secondary data analysis of the Ontario Incidence Study of Reported Child Abuse and Neglect – 2013 was conducted. A subsample of 4949 investigations from 16 agencies was included in this study. Multi-level modeling was used to test the relative contribution of case and organizational factors to the referral decision. The results confirm the importance of clinical factors to child welfare decisions. Differences in organizational structure also influence the decision to refer clients to treatment and supportive services. Investigations conducted at agencies with a specialist structure were less likely to include a referral to other services, while investigations at multiservice agencies were more likely to include a referral. The proportion of investigations regarding Indigenous children influenced the decision to refer. The study contributes to the limited empirical evidence regarding the association between organizational structure and decisions.